Medicine and Health Sciences Commons^™

Design And Synthesis Of Small Molecule Drugs For Cns Disorders, Kirsten T. Tolentino

Theses & Dissertations

Dopamine (DA) is an important neurotransmitter for the regulation and long-term function of the central nervous system (CNS). DA binds to Dopamine Receptors (DR) to stimulate or inhibit adenyl cyclase production to further elicit a pharmacological response. DRs were cloned, and it was determined that there are two families separated by their function and five total subtypes distinguished by their amino acid structure. The Dopamine 4 receptor (D4R) is the second least studied subtype but has high expression in the frontal cortex, amygdala, hippocampus, hypothalamus, globus pallidus, substantia nigra pars reticula, and thalamus. Dopamine signaling and transmission, especially in the …

Improving Peripheral Nerve Regeneration Through Rehabilitation And Biomaterial-Based Drug Delivery Strategies, Yunfan Kong

Theses & Dissertations

Peripheral nerve injury (PNI) is a common problem worldwide, with trauma being a common cause. PNI can lead to loss of sensory and motor functions, chronic neuropathic pain, and mental health issues, significantly impacting patients' family life, work, and social situation. Recent studies revealed that beyond the topical injury site at peripheral nerves, PNIs can also induce dysfunctions in the central nervous system (CNS) by causing maladaptive plasticity, which will result in exaggeration and exacerbation of the pathological condition caused by primary injuries. The common therapy strategies for PNI treatment are using sutures, nerve autografts or conduits in cases requiring …

Evaluating The Impact Of Culturally Informed Interventions On Nebraska's Refugees: A Pilot Study With Healthcare Workers, Falah Nayif Rashoka

Capstone Experience

Background: Refugees in the US are at increased risk of poor health outcomes, spanning mental health and general well-being, compared with American-born individuals. With the rapid growth of the refugee population in Nebraska, the need to train healthcare providers to provide culturally competent care has never been greater. A common point of access to healthcare for the refugee population after resettlement is via local health departments and the primary healthcare network. Recent estimates show close to five thousand Yazidi refugees living in Nebraska, most of whom moved after 2009 based on federal legislation admitting those who served in the …

The Risk Factors Associated With Personal Protective Equipment Usage Rates In The Central States By Generalized Multilevel Models, Carter E. Vogel

Capstone Experience

Background: Agriculture producers in the United States face some of the highest rates of fatal and non-fatal injuries among all occupations. This includes a high risk of respiratory damage when working in dusty environments, chemical and health hazards when working with pesticides or other dangerous chemicals, and hearing damage when working in noisy environments. These risks can be reduced using personal protective equipment (PPE). While some workplaces are required by the Occupational Safety and Health Administration (OSHA) to provide necessary PPE and monitoring according to the risks of a job, many small farms are not required by OSHA to provide …

Effects Of Hospital Interventions On Maternal Mortality Rates Of African American Women: A Literature Review, Oluwatosin A. Soyege

Capstone Experience

Maternal mortality is a serious health concern and harms society’s economic, physical, and psychological well-being. It is tragic for the woman’s family and community when a woman passes away during pregnancy, at delivery, or shortly after delivery. Hospital interventions are needed to mitigate the social impact of maternal mortality. In the U.S., several initiatives have been enacted to reduce maternal mortality. Fighting racism would also help African American women’s rates of maternal mortality as they are subject to stigma in everyday contexts, during pregnancy and obtaining healthcare, and when obtaining resources and services during pregnancy. This paper reviews the literature …

A Literature Review Of The Psychosocial Impacts On Livestock Producers And Veterinary Responders Involved With Depopulation During And After An Animal Health Emergency, Beth Galles

Capstone Experience

A vital aspect of an animal health emergency in the United States is removing and disposing of diseased and healthy animals through depopulation. It is frequently required to prevent the spread of diseases that affect human health or economic stability. Production animals are eventually slaughtered, but this does not negate the human-animal bond felt between these animals and their caretakers. There is increasing recognition that participation in depopulation may be a traumatic event requiring care for the individuals involved, including livestock producers and veterinarians. Despite this, limited resources are available for these individuals when an animal health emergency occurs. This …

Evaluating Nebraska’S State Health Assessment (Sha) And State Health Improvement Plan (Ship) Methodology To Inform The Redesign Evaluation Plan, Austin J. Osborn

Capstone Experience

The Division of Public Health (DPH) within the Nebraska Department of Health and Human Services (DHHS) is redesigning its State Health Assessment (SHA) and State Health Improvement Plan (SHIP) procedures. This study aimed to support the Nebraska DPH SHA/SHIP redesign evaluation plan by determining the local health department (LHD) health priority determination processes, Tribal and LHDs’ (T/LHD) CHA/CHIP methodology, and if any differences exist between rural & urban and small, medium, and large jurisdictional size health departments in Nebraska. The results show that most health departments utilize the MAPP process to conduct their CHA/CHIP, one tribal entity utilizes a different …

The Impact Of Doulas On Breastfeeding In Black Women: A Literature Review, Delaney C. Holland

Capstone Experience

This literature review was conducted to explore the impacts doulas have on breastfeeding initiation and continuation in the Black population. Black women’s breastfeeding and continuation is exceptionally low compared to white women and other races and ethnicities. Six journal articles were used to examine the relationships that doulas have on breastfeeding initiation and continuation in black communities. There was an array of study designs found throughout the articles to help support the doula and breastfeeding relationship in Black women. The results of this literature review were preliminarily positive, but more evidence is required to firmly establish the positive impact of …

Housing Is Safety: An Evaluation Of A Transitional Housing (Th), Rapid-Rehousing (Rrh), And Joint Th/Rrh Program For Survivors Of Interpersonal Violence, Bridget L. Claborn

Capstone Experience

In this capstone project, I created a program evaluation plan and conducted preliminary analysis for the Mar􏰀 Parrish Center􏰁s (MPC) transitional housing (TH), rapid-rehousing (RRH), and joint TH/RRH programs for survivors of interpersonal violence and their families. The intent of the project is: (1) to better understand the impact of MPC housing programs; (2) to inform strategies for continuous improvement in client outcomes, access, and satisfaction; (3) to further evaluation capacity for the organization; and (4) to generate practice-based evidence to inform the field at large. As a practitioner in the field of interpersonal violence and former MPC staff member, …

Understanding Gendered Risks For Severe Covid-19 Through Surveying The Gender Diverse Community, Arden Kimme

Capstone Experience

Early on in the pandemic, the medical community began noticing that men were more likely to be hospitalized, require admission to the ICU, and die of COVID-19 than women but few studies of COVID-19 make mention of gender diverse people, an often-overlooked population who may have vastly different experiences than non-gender diverse men or women. Their variations in gender and sex characteristics may also help provide further insight into which traits are protective or risk factors for this disease. This project used Poisson regression in order to analyze self-reported survey data. The major associations of interest will be between disease …

Occupational Exposures Associated With Thyroid Cancer In The Thyroid Tumor And Cancer Collaborative Registry In The Integrated Cancer Center Repository For Cancer Research, James Buckley

Capstone Experience

Thyroid cancer is one of the fastest growing cancers in the United States, with the rate of new cases increasing from 5.2 per 100,000 in 1985 to 13.8 per 100,000 in 2019, with a peak of 14.5 per 100,000 in 2015. Increased thyroid cancer incidence is associated with certain occupations, including healthcare and agriculture. Most existing literature on occupational exposures and thyroid cancer evaluate their association in terms of occupation type and thyroid cancer, rather than specific occupational exposures and thyroid cancer. This study sought to utilize the wide range of occupational exposure data in the Integrated Cancer Center Repository …

Operation Wasatch: Scenario Based Planning To Assess The Cold Weather Preparedness Of The National Disaster Medical System, Alison Matthews

Capstone Experience

Background: The National Disaster Medical System has little experience with sustained mission operations under anything other than temperate environmental conditions. Extreme weather events increase the complexity of disaster response by presenting significant logistic, operational, and safety challenges. Identifying gaps and vulnerabilities in response capabilities can promote improved Disaster Medical Assistance Team preparedness.

Methods: This discussion based exercise utilized a scenario involving a 7.0 magnitude earthquake along the Wasatch Fault in winter. This exercise was conducted with members of the Wisconsin-1 Disaster Medical Assistance Team. Team members provided oral and written feedback in response to exercise objectives and prompts. This feedback …

The Relationship Between Congenital Heart Disease And Infant Mortality In Low- And Middle-Income Countries: A Comprehensive Literature Review, Helen Nneoma Odo

Capstone Experience

Congenital heart diseases (CHD) are conditions that are present at birth and can affect the structure of an infant’s heart and the way it works. Millions of children are born each year with congenital heart disease yet screening for CHD is not practiced in Low- and Middle-income countries (LMICs). Studies on access to healthcare for infants with congenital heart disease have not kept pace. This literature review centers on the role of congenital heart disease in infant mortality, its burden, incidence and prevalence in LMICs. The databases of PubMed, Google Scholar and Embase were searched and the selected articles for …

Association Of Socioeconomic Status And Mental Health Characteristics And Participant Attrition In A Cohort Study, Mathews Thampi

Capstone Experience

The cohort study is an essential design for investigating associations between a variety of risk factors or exposures and a plethora of health outcomes. However, one of their biggest weaknesses is participant attrition, which can introduce bias and impact validity. Understanding whether this attrition is related to exposure and outcome is a critical aspect of assessing the potential for selection bias. The Women and Their Children's Health (WaTCH) study is a prospective cohort study designed initially to examine the health impacts of exposure to the Deepwater Horizon oil spill. The study has undergone two waves of data collection and is …

Assessing The Role Of Distance To Level I Trauma Units On Atv Rollovers, Tractor Rollovers, And Machinery Entanglement Outcomes, Andrew K. Schissel

Capstone Experience

All-Terrain Vehicle (ATV) rollovers, tractor rollovers, and machinery entanglements cause traumatic injuries to agricultural workers. Response time of first responders combined with travel to trauma units can take a significant amount of time in rural areas, potentially leading to an increased risk of fatal outcomes for those involved in these incidents. The aim of this study is to determine if distance to a level I trauma unit is a factor in the outcomes of these incidents. ATV rollovers, tractor rollovers, and machinery entanglement injuries and fatalities, collected from a 7-state Midwestern region were entered into a GIS system along with …

Early Childhood Nutrition Education Implementation Evaluation And Planning: Learn, Grow, Eat & Go!, Alyssa L. Wessling

Capstone Experience

The obesity rate among American children aged two to five years old is 12.7% (Centers for Disease Control, 2022), indicating a need for health interventions at this critical life stage. Nebraska Extension’s Nutrition Education Program has identified a need for direct education materials to reach Nebraskans in early childhood. Learn, Grow, Eat & Go! Early Childhood was identified as an appropriate curriculum to be tested in an early childhood intervention pilot. Learn, Grow, Eat & Go! Early Childhood is a newly developed program built upon the foundation of teaching children about healthful foods and physical activity through gardening. An early …

The Role Of Psychological Safety On Employee Satisfaction And Retention In Healthcare Delivery Settings: A Systematic Literature Review, Jamey Paul

Capstone Experience

The healthcare industry typically has a high rate of employee turnover due to higher job stresses and burnout, lower job satisfaction, and insufficient organizational support and work culture. This turnover has worsened since the onset of the COVID-19 pandemic. Psychological safety, a shared belief by organizational members that the team/unit is safe for interpersonal risk-taking, can be one of the many ingredients that contribute to employee satisfaction and reduce turnover. This systematic literature review explored the role of psychological safety on job satisfaction and retention of healthcare workers in delivery settings by synthesizing the known antecedents and outcomes of psychological …

Effect Of Computerized Cognitive Training In Persons With Multiple Sclerosis, Sam Jack

Theses & Dissertations

Between one million and 1.75 million persons with multiple sclerosis (PwMS) worldwide are estimated to suffer from cognitive impairment. Unfortunately, there is currently no consensus on the best treatment for cognitive impairment in PwMS. Finding non-pharmacological interventions to mitigate cognitive decline is essential to ensure that quality of life for PwMS matches our ability to treat and mitigate their physical symptoms of MS. Computerized cognitive training has emerged as a potential option for PwMS suffering from cognitive impairment. The objective of this study was to determine the effectiveness of computerized cognitive training with BrainHQ on changes in cognitive impairment for …

Evaluating The Impact Of Routine Enteral Iron Fortification On Gastrointestinal Dysbiosis In Premature Infants, Matthew Van Ormer

Theses & Dissertations

The gastrointestinal microbiome in preterm infants bears significant influence on optimal outcomes – dysbiosis is shown to substantially increase the risk of the life-threatening necrotizing enterocolitis, whereas optimal microbiome composition improves nutrient digestion and immune function. Iron is a vital nutrient especially during the perinatal window of rapid hemoglobin production, tissue growth, and foundational neurological development. However, excess colonic iron exhibits potent oxidation capacity and alters the competitive environment of microbes – potentially facilitating the proliferation of pathological bacterial strains in the gut. Of note, breastfed preterm infants routinely receive iron fortification starting at 14 days of life and are …

Variations In Source And Pattern Of Arterial Supply To The Trigeminal Ganglion With Clinical Relevance, William S. Srinivasan

Theses & Dissertations

The trigeminal ganglion (TG) is known to receive its arterial supply from branches of the internal carotid artery (ICA), middle meningeal artery (MMA), accessory meningeal artery (AMA), or superior cerebellar artery (SCA). Existing information about the prevalence and patterns of blood supply to the TG is limited despite their high clinical relevance to basicranial surgeries. The objective of this study is to investigate the source and pattern of arterial supply to TG and discuss their clinical relevance. Left and right TG were examined on 75 embalmed human cadavers from an ethically approved anatomical donor program. A literature review was conducted, …

Cystic Duct Morphology And Heister Valves: A Cadaveric Study, Cierra R. Goerish

Theses & Dissertations

Continued occurrence of cholelithiasis, gallstones, commonly results in cholecystectomy, removal of the gallbladder. Having a comprehensive anatomical, histological, and physiological knowledge of the biliary apparatus is imperative in clinical medicine today. Additionally, the functionality of cystic duct (CD) Heister valves (HV) has been speculatory since being reported in 1732. This study summarizes the morphology, orientation, and variability of the gross biliary system and provides data to help justify HV functionality.

Cadaveric dissection was utilized for gross observation and analysis of the biliary system. The angulation of the CD was found primarily as an acute angle; however, obtuse angulation could be …

Use Of Pre-Transplant Cmi To Predict Infection And Mortality Post-Cardiac Transplantmortality Post-Cardiac Transplant, Chetaj A. Mahabir

Theses & Dissertations

This paper discusses a study investigating the relationship between the cell-mediated immunity (CMI) level before cardiac transplant and the incidence of infection and mortality after the transplant. CMI is an important measure of a person's immune system. The study included 126 patients who underwent cardiac transplants between September 2011 and January 2020. Out of these, 21 patients had a low CMI level (<225), and 105 had a high CMI level (≥ 225) before transplant. The mean CMI level in the low CMI group was 175.3, while in the high CMI group, it was 479.9. The two groups were similar except for the lower white cell count and cardiac output in the CMI< 225 groups and the higher Caucasian demographic in the CMI≥ 225 groups. The study concludes that patients with lower CMI levels before cardiac transplant have a higher risk of infection (p=0.052) and mortality (p=0.005) one year after the transplant. The risk of dying for patients with CMI <225 is 12.9 times the risk of dying for patients with CMI ≥ 225 after adjusting for the other covariates in the model. However, this study has some limitations including its retrospective nature, small sample size, and single-center design. Further studies are needed to replicate these findings and investigate the optimal immunosuppressive regimens based on baseline CMI levels.

Mechanisms Of Mutated Myosin Vb Mediated Cholestasis In Microvillus Inclusion Disease, Melissa S. Holzapfel

Theses & Dissertations

Microvillus inclusion disease (MVID) is a constitutive intestinal epithelial disease which causes definitive intestinal failure and cholestatic liver disease primarily caused by mutations in the Myosin Vb gene. Genotype-clinical phenotype associations suggest that the progression of liver disease can be predicted through a correlation between myosin Vb residual function and variable retention of bile salt transport machinery in intestinal enterocytes and liver hepatocytes. We proposed that aberrant distribution of bile salt transport proteins disrupts enterohepatic regulation of bile acids and contributes to the progression of cholestatic liver disease. To investigate the genotype-phenotype correlation, samples from MVID patients were evaluated for …

Evaluation Of The Effectiveness Of The Ihi Joy In Work Framework Among Nurses, Jezlynn M. Vonnahme

Doctor of Nursing Practice Projects: College of Nursing

Background: Registered nurses are leaving the bedside at alarming numbers with many of them suffering from burnout, a decrease in compassion satisfaction, a lack of joy in work, and/or lack of work-life balance. It is critical these issues within nursing are identified and mitigated in order to reduce the number of nurses planning on leaving the bedside as 33% of nurses are currently considering leaving their role or reducing their hours. This statistic does not help with the current nursing shortage and its prediction to continue to grow with employment needs for nurses expected to increase 9% more than any …

Pediatric Diabetic Ketoacidosis Fluid Composition And Rate In Care Of Type 1 Diabetic Patients, Gabriel Hansen, Janae Langner, Michaela Tarpley

Doctor of Nursing Practice Projects: College of Nursing

Objective

Complications of diabetic ketoacidosis (DKA) include iatrogenic hyperchloremia and acute kidney injury (AKI). The objective of this study was to evaluate the association of decreasing sodium chloride (NaCl) composition in standard DKA fluid resuscitation and the rates/severity of hyperchloremia and AKI in pediatric patients.

Methods

In December 2020, Children’s Hospital and Medical Center (CH&MC) changed the standard base composition of DKA fluids from 0.9% to 0.675% sodium chloride (NaCl) and increased the fluid resuscitation rate for patients over 30kg as a quality improvement project. A retrospective chart review analyzed patients admitted with DKA from January 2019-December 2021, excluding patients …

Implementation Of Chronic Obstructive Pulmonary Disease Action Plan On The Step Down Critical Care Unit: A Pilot Study, Peter Chambers, Kaelee Dameron, Carolyn Kiefer

Doctor of Nursing Practice Projects: College of Nursing

Background: Hospital readmissions due to chronic obstructive pulmonary disease (COPD) exacerbations are a significant economic and resource burden on the United States healthcare system. Current professional guidelines for the prevention of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) include providing patient-focused education with a written action plan such as a COPD Action Plan.

Aims: The primary purpose of this project was to determine if providing an educational intervention to patients admitted for AECOPD would reduce hospital readmission rates for COPD and improve patient outcomes. Method: We performed a quasi-experimental pilot study of 10 participants admitted with a COPD exacerbation …

Infrared Thermography (It) And Subepidermal Moisture Scanning (Sem) To Identify Early Tissue Injury And Reduce Hospital Acquired Pressure Injuries In Patients Undergoing Procedures Greater Than Four Hours In Duration, Irish Mills Parker, Makaela Waddell, Alexa Johnson

Doctor of Nursing Practice Projects: College of Nursing

Objective: The purpose of this pilot feasibility study was to more effectively prevent hospital-acquired pressure injuries in high-risk patients by using infrared thermography and subepidermal moisture scanning to identify early signs of tissue injury from pressure. Methods: Data was collected in the Cardio-Vascular Intensive Care Unit (CVICU) and cardiac medical-surgical care floors at Nebraska Medicine. Inclusion criteria are adults, scheduled for a surgery or procedure(s) predicted to last four or more hours, and planned admission to the ICU afterward. Participants were scanned with FDA-approved infrared thermography (IT) and subepidermal moisture (SEM) scanners before their procedure, two hours post-procedure, and then …

Implementation Of A Nurse-Led Clinical Algorithm For Pressure Injury Prevention Associated With Non-Invasive Ventilation Medical Device Use, Capri Steinkuhler, Kaitlin Rogge

Doctor of Nursing Practice Projects: College of Nursing

Purpose and Aims

Medical device related pressure injuries (PI) account for as much as 61-81% of all hospital reported wound incidents (Gefen et al., 2020) and are frequently caused by respiratory devices such as non-invasive ventilation (NIV). Use of NIV in critically ill patients dramatically increased during the pandemic. PI are one of the leading causes of injury to hospitalized patients and lengthens hospital stays (National Pressure Injury Advisory Panel [NPIAP], 2019). The NPIAP recommends routine skin assessment under devices, proper mask fit, protective barrier, moisture reduction, and interdisciplinary collaboration to prevent PIs from NIV masks. This feasibility study’s purpose …

Evaluating Nurse Use And Satisfaction With Video-Based Discharge Education For Adults With Heart Failure, Krystyna Simon Rn, Bsn, Molly Hendrickson Rn, Bsn, Windy Alonso Phd, Rn, Fhfsa

Doctor of Nursing Practice Projects: College of Nursing

Background

Heart failure (HF) readmission rates are high and influenced by self-care practices and self-efficacy for managing chronic disease. Using digital education via tablet can help improve the discharge education process and may increase self-care knowledge.

Objective

The purpose of the study is to assess the current discharge processes implemented for HF patients in cardiovascular units at a Midwestern academic medical center.

Methods

Participants for this two-phase study were recruited from two inpatient cardiovascular units within a 700-bed, Midwestern academic medical center. Phase one used a pre-post quasiexperimental design to evaluate a discharge educational intervention using the teach-back method in …

Increasing Communication Of Patient Daily Goals During Interdisciplinary Rounds In An Inpatient Pediatric Cardiac Unit, Sage Bailey

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Ineffective communication between interdisciplinary team members in a pediatric inpatient setting results in poor documentation compliance and decreased staff satisfaction of daily goals. The use of a standardized patient daily goal sheet improves effective communication among interdisciplinary team members. The primary aims of this study were to improve RN satisfaction and knowledge regarding interdisciplinary communication, improve verbalization of patient daily goals in daily rounds, increase the number of daily goals verbally discussed and improve the quality of documentation in the electronic medical record (EMR). Methods: Data were collected on a pediatric academic 30-bed cardiac care unit involving 100 nurses. …