Medicine and Health Sciences Commons^™

Association Between Adverse Events In Childhood And Bmi Among People With Schizophrenia And Bipolar Disorder, Nicholas Guenzel

Theses & Dissertations

Background: People with schizophrenia and bipolar disorder die significantly earlier than members of the general public (16-18 years and 12-13 years, respectively). Diseases associated with obesity such as diabetes, heart disease, and stroke account for much of this discrepancy. People with mental illness often have difficulty losing weight despite intensive interventions. As a result, nurses caring for patients with mental illness need to monitor their weight diligently and implement individualized interventions to promote achieving or maintaining a healthy weight. Because intensive interventions come with some risk and expense, programs must target individuals with the most potential to develop obesity. In …

Ccr5 And The Blood Brain Barrier During Hiv-1 Infection And Cell-Cell Communications, Shawna M. Woollard

Theses & Dissertations

Human Immunodeficiency Virus (HIV-1) infection often results in blood-brain barrier (BBB) dysfunction and central nervous system (CNS) impairment. Since most viral strains that cross the BBB and enter the CNS are macrophage-tropic and use the C-C chemokine receptor type-5 (CCR5) to enter and infect target cells, we hypothesized that CCR5 plays a major role in monocytes-endothelial interactions and HIV-induced BBB dysfunction. Because the cytoskeleton is responsible for cellular morphology and motility, we further hypothesized that HIV-induced monocyte-endothelial interactions and transendothelial migration involve cytoskeletal changes and that CCR5 blockers would also affect these changes. To this end we used two small …

Targeted Magnetite Tissue Delivery For Antiretroviral Pharmacokinetics, Tianyuzi Li

Theses & Dissertations

Pharmacokinetics and pharmacodynamics studies are required for bench to bedside translation of any new drug, formulation or device. Multifunctional magnetite nanocarriers enable magnetic resonance imaging tracking of nanomaterial encased antiretroviral drugs serving to improve the effectiveness of formulation developments. Targeting ligands used to deliver nanoparticles to HIV harboring cells can be tested using multifunctional magnetite nanocarriers. To this end, two types of magnetite nanocarriers were developed. These included small magnetite antiretroviral therapy particles. The second were ALN-PEG coated magnetite particles for testing macrophages targeting ligands. Overall, these works should serve to speed the development of long acting nanoformulated ART to …

Role Of Macrophages In Muscle Transfection With Pdna/Pluronic Formulation, Vivek Mahajan

Theses & Dissertations

Non-ionic amphiphilic block copolymers of poly(ethylene oxide) (PEO) and poly(propylene oxide) (PPO), Pluronics, arranged in a tri-block structure PEO-PPO-PEO, have raised a considerable interest in skeletal muscle Gene Therapy. Previous studies have demonstrated that co-administration of Pluronics with naked plasmid DNA (pDNA) by direct i.m. injection enhanced transgene expression not only in muscle but also in distal lymphoid organs (spleen and lymph nodes) and this response was strain-dependent; not observed in athymic (BALB/c nu/nu) mouse; suggesting a role of immune cells in gene transfer to skeletal muscles. Therefore, we first evaluated the role of inflammation and inflammatory cells, on muscle …

Roles Of Serum Lycopene In The Prevalence And Mortality Of Metabolic Syndrome In The Adult Population, Guang-Ming Han

Theses & Dissertations

Metabolic syndrome (MetS) is a cluster of metabolic disorders, including increased fasting glucose, blood pressure, plasma triglyceride, reduced high-density lipoprotein cholesterol and abdominal obesity. It leads to an increased risk of cardiovascular disease and diabetes. The growing prevalence of MetS is strongly related to the increasing prevalence of overweight/obesity. As an antioxidant, lycopene can reduce the risk of MetS. However, it is unclear whether lycopene has similar effects among overweight/obese individuals and whether lycopene can reduce the risk of mortality among individuals with MetS. The purpose of this study was to explore the roles of lycopene in the prevalence and …

Investigation Of Behavioral And Cellular Changes In The Maternal Immune Activation Model Of Autism Spectrum Disorders, Shreya Roy

Theses & Dissertations

Maternal infection during pregnancy, which leads to maternal immune activation (MIA), is an environmental risk factor for autism spectrum disorders (ASD). MIA can be induced in mice and their offspring exhibit behaviors that model the core symptoms of ASD. One of the core behavioral symptoms in ASD patients is presence of increased repetitive behavior, which is modeled by an increase in marble burying in MIA mice. It has been shown that the deficits seen in MIA mice are associated with the dysregulation of cytokine levels in the developing brain, specifically an increase in pro-inflammatory cytokines. In this thesis, I tested …

Risk Factors For Agricultural Injury: An Evaluation Using Systematic Review And Injury Surveillance, Rohan Mahadeo Jadhav

Theses & Dissertations

Purpose- Agriculture is the most hazardous industry in the United States. The effectiveness of intervention programs for injury prevention can be improved by acquiring knowledge of risk factors for occupational injury in agricultural operators. The landscape of agriculture is changing in the U.S. Agricultural populations, environments and risk factors are changing as well with the changes in the structure of farms and ranches. The objective of this study was to identify significant risk factors for agricultural injury based on the literature and three years of injury surveillance data covering seven U.S. states. Methods- We conducted a systematic review of reported …

Effect Of Chemical Pocket Disinfection As An Adjunct To Non-Surgical Maintenance Therapy Of Inflamed Periodontal Pockets, Chad Riggs

Theses & Dissertations

Purpose: Scaling and root planing with adjunctive chemical pocket disinfection (SRP+C) utilizing sodium hypochlorite solution has been used to treat inflamed pockets of periodontal maintenance patients for many years, without evidence of its benefits. The primary objective was to determine if SRP+C is more effective than scaling and root planing alone (SRP) in improving clinical outcomes. The secondary objective was to compare the effect of SRP+C and SRP on pro-inflammatory IL-1β, anti-inflammatory IL-1ra, and anti-inflammatory index (IL-1ra/IL-1β ratio) found in gingival crevicular fluid (GCF).

Materials and Methods: Pockets (≥ 5 mm and BOP) of 31 maintenance patients were included. Test …

Use Of Smartphones To Capture Measures Of Functional Status In Frail And Non-Frail Community Dwelling Older Adults, Cassia R. Hanton

Theses & Dissertations

Numerous important health outcomes directly relate to one's ability to maintain normal gait speed. The purpose of this study is to employ ubiquitous smartphone technology, using algorithms developed and validated by our lab in a controlled setting, to continuously and noninvasively measure aspects of subject health status, including step counts, gait speed, and activity level, in a naturalistic community setting. A total of 33 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 22 healthy control and 11 frail individuals. Clinical performance measurements of frailty (4MW, TUG, F8W) and validated survey responses (LLFDI, SAFFE, PROMIS) were compared to …

The Role Of Glutaminase 1 In Hiv-1 Associated Neurocognitive Disorders And In Brain Development, Yi Wang

Theses & Dissertations

Glutaminase is the enzyme that converts glutamine into glutamate, which serves as a key excitatory neurotransmitter and one of the energy providers for cellular metabolism. Glutamate is essential for proper brain functioning but at excess levels, it is neurotoxic and has a key role in the pathogenesis of various neurodegenerative diseases, including HIV-1 associated neurocognitive disorders (HAND). However, the detailed mechanism of glutamate-mediated neurotoxicity remains unclear. In part I, we identified the regulation of glutaminase 1 (GLS1) in the central nervous system (CNS) of HAND animal models including HIV-Tat transgenic (Tg) mouse and HIVE-SCID mouse, since GLS1 is the dominant …

Role Of Redox-Sensitive Calcium/Calmodulin-Dependent Protein Kinase Lla In Angiotensin Ii Intra-Neuronal Signaling And Angiotensin Ll-Mediated Hypertension, Urmi Basu

Theses & Dissertations

Activation of renin-angiotensin system and elevated levels of circulating and brain angiotensin II (AngII) has been implicated in the pathogenesis of neuro-cardiovascular diseases, such as hypertension and heart failure. In central neurons AngII increases generation of reactive oxygen species (ROS), which in turn regulates neuronal ion channels. Previous studies have demonstrated that ion channels can also be regulated by protein kinases, such as calcium /calmodulin-dependent protein kinase II (CaMKII) as a downstream mediator of AngII signaling. In the heart, CaMKIIδ undergoes oxidation upon AngII stimulation and increased pro-oxidant conditions. However, the exact mechanism by which AngII and ROS regulate CaMKIIα, …

Improving Antibiotic Resistant Infection Transmission Situational Awareness In Enclosed Facilities With A Novel Graphical User Interface For Tactical Biosurveillance, Valeriya V. Kettelhut

Theses & Dissertations

Serious challenges associated with antibiotic resistant infections (ABRIs) force healthcare practitioners (HCP) to seek innovative approaches that will slow the emergence of new ABRIs and prevent their spread. It was realized that traditional approaches to infection prevention based on education, retrospective reports, and biosurveillance often fail to ensure reliable compliance with infection prevention guidelines and real-time problem solving. The objective of this original research was to develop and test the conceptual design of a situational awareness (SA)-oriented information system for coping with healthcare-associated infection transmission.

Constantly changing patterns in spatial distribution of patients, prevalence of infectious cases, clustering of contacts, …

Determinants Of Patient Activation In Hospitalized Multimorbid Patients, Myra S. Schmaderer

Theses & Dissertations

Post-hospitalization care transition is a vulnerable time for multimorbid patients. Self-management challenges happen due to acute symptoms and complex new treatment plans. Literature suggests higher activated patients have better outcomes; however, there is little research that identifies determinants that predict patient activation in the multimorbid hospitalized patient. Understanding predictive factors will facilitate planning interventions that promote self-management of multimorbid conditions. The purpose of this dissertation was to identify determinants that predict patient activation in patients with multimorbidity at discharge from the hospital.

A descriptive, predictive research study was conducted with 200 hospitalized multimorbid patients discharged to home. Their mean age …

Diagnostic Utility Of Who Defined Sepsis Syndromic Criteria With Procalcitonin In Identification Of Sepsis In Children With Suspected Infections, Samuel Owuor Akech

Theses & Dissertations

Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections

Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health …

Mental Health Clinical Managers And Their Multicultural Leadership Practices, Christie Marie Melonson

Theses & Dissertations

There is a general recognition that the United States has historically failed to provide adequate mental health services to ethnic minorities. The American Counseling Association has mandated multicultural competence of counseling professionals in today’s context of dramatic demographic change. Despite numerous studies on practitioners, organizations, models, and interventions geared toward minorities, disparities in access, usage, and outcomes in still exist. Simultaneously, counseling fields have emphasized leadership development as a key factor in improving services, yet training or research on leadership remains scarce. In response to these conditions, this basic interpretive qualitative study focused on exploring clinical managers’ perceptions of their …

Caregivers’ Knowledge, Perceptions And Home Management Practices Of Fever In Children Under The Age Of Five Years Presenting With Acute Febrile Illnesses, Katherine Oyieke

Theses & Dissertations

Background: Fever in children is one of the most common clinical symptoms and a frequent cause of caregiver concern. It is a normal body response to a variety of conditions, the most common of which is infection. Many childhood illnesses are accompanied by fever, which is often treated at home prior to presentation at a health facility. Nearly every child will develop a febrile episode at some point in life. The challenge for caregivers is to know when to be concerned and how to manage such episodes appropriately when they occur. Caregiver knowledge and perceptions regarding fever are an important …

Respiratory Function Amongst Asymptomatic Hiv Positive And Hiv Negative Clients At Aga Khan University Hospital, Nairobi, Noah Kipkemei Murbiy

Theses & Dissertations

Background: Spirometry is used to asses respiratory function abnormalities. This is usually in reference to a validated normal range unique to a particular gender, race, age, weight and height. Majority of persons are usually asymptomatic until the expected FEV1 has decreased by 50%. Early intervention on the abnormalities even in this asymptomatic group has been shown to retard the rate of pulmonary deterioration. An unpublished audit at the Aga Khan University Hospital, Nairobi, revealed that majority of newly diagnosed HIV positive persons were admitted at the Critical Care Units with a pulmonary cause which later resulted in poor outcomes. This …

A Grounded Theory Study Of How Parents Made The Decision About Residential Group Home Placement For Their Adult Child With Intellectual/Developmental Disabilities, Laura A. Sardinia-Prager

Theses & Dissertations

Background: The parent caregivers of a child with an Intellectual Disability/Developmental Disability (ID/DD) face lifelong challenges that may at some point involve the decision about residential group home placement of the adult child. In the course of the child’s lifetime, the parents who have provided care may need to consider a safe alternative. The decision about residential group home placement of the adult child can be the result of numerous factors. Objective: The purpose of this qualitative inquiry was to investigate the phenomenon of how the parent caregivers made the decision for residential group home placement for their adult child …

Development Of A Guide By Postgraduate Residents On Receiving Feedback From Faculty In The Operating Theatre At Aga Khan University Hospital, David Karuri Maina

Theses & Dissertations

Background: Direct observation of residents in clinical encounters by faculty and assessment for learning has now become a key component of postgraduate training programs. DOPS, a workplace-based assessment form, was designed to provide formative assessment and feedback about a trainee’s procedural skills. Interactions between residents and faculty are central to this learning process and are influenced by multiple factors both at faculty and resident levels as well as contextual factors. The feedback may be used by the receiver to contemplate behaviour change. The receptivity of the resident to the feedback is a key determinant as to whether the process to …

Comparison Of Cardiovascular Risk Profiles Amongst Newly Diagnosed Cancer Patients And Non-Cancer Patients At The Aga Khan University Hospital Nairobi, Majid Lingani-Ncube Sikosana

Theses & Dissertations

Background: Non-Communicable Diseases (NCDs) are fast becoming the leading causes of morbidity and mortality in Low and Middle-income countries (LMIC) with cancers and cardiovascular diseases (CVDs) becoming the most prominent. CVD can be prevented if appropriate measures of screening and treatment of modifiable risk factors are addressed. This may translate to reduced risk of CVDs and some cancers in the long term. Increasing evidence exhibits common risk factors for both CVDs and cancer and that CVDs and their risk factors when present in cancer patients may worsen the overall outcome.

Objectives: The primary objective was to determine and compare …

Ultrasound Evaluation Of Umbilical Coiling Index In Second Trimester Of Gestation And Its Association With Small For Gestational Age Status At Birth, Josephine Mwikali Ndolo

Theses & Dissertations

Introduction: The degree of coiling of the umbilical cord, referred to as umbilical coiling index, has been shown to have an effect on perinatal adverse outcomes such as small for gestational age neonates, interventional delivery, meconium staining, low fetal pH and low Apgar score. This study proposes that the antenatal umbilical coiling index performed in the second trimester of pregnancy has a correlation with the gestation-specific birth weight and can therefore be used as a marker to predict small for gestational age neonates.

Objective: To determine the association between antenatal umbilical coiling index (aUCI) in the second trimester and small …

Comparison Of Quantitative Analysis To Qualitative Analysis For Interpretation Of Lower Limb Lymphoscintigraphy, Edward Chege Nganga

Theses & Dissertations

Background: Lymphoscintigraphy is now the primary imaging modality used in determining a diagnosis in patients with suspected extremity lymphedema. However, analysis is mainly by visual qualitative analysis which is subjective and has a wide inter-observer variability. Subtle differences in ilioinguinal uptake between normal and abnormal limbs may be missed with visual qualitative analysis. This study seeks to compare quantitative analysis to qualitative analysis by computing percentage ilioinguinal nodes uptake at 1.5 hours.

Objectives: To compare quantitative analysis to qualitative analysis of lower limb lymphoscintigraphy in the diagnosis of lymphedema.

To determine the diagnostic accuracy of quantitative lymphoscintigraphy analysis.

Methodology: 52 …

Prevalence Of Suspicious Ultrasound Findings In Patients With Mammographic Focal Asymmetry At Aga Khan University Hospital, Nairobi, Jacqueline Ndunge Mavuti

Theses & Dissertations

Background: Breast cancer has become the leading cancer in women in both economically developed and developing countries, accounting for 25% of all cancers diagnosed worldwide in 2012. The cornerstone of breast cancer control remains early detection in order to improve outcomes and survival. Thus far the only breast cancer screening method that has proved to be effective is mammography. Although mammography is the mainstay of early detection, a fundamental limitation is its low inherent contrast difference between the soft tissue structures in the breast. Mammographic specificity relies on the ability to distinguish benign from malignant breast lesions based on their …

Fall Prevention Among Older Adults Living In The Community, Clarissa Silva Lopez

Theses & Dissertations

Older adults are within the fastest population growth rate in the United States, and as the population ages, the potential for falls increases (DHHS, 2011). This was a mixed-method explanatory study that investigated the perceptions of older adults regarding the usefulness, adequacy, and positive experience of fall information among older adults living in the community when received from healthcare professionals during physician’s office visits. The research questions were: 1. What is the relationship among perceptions of usefulness, adequacy, and positive experience of fall information among older adults? 2. Is there a difference in the perceptions of usefulness and adequacy among …

An Assessment Of The Relationship Between The Hospital Chief Executive Officer’S Leadership Behaviors And Hospital Success, Newton J. Courtney

Theses & Dissertations

The health care delivery system in the United States has received increased attention over the last 2 decades. Concerns of access, choice, cost, and quality have been in the forefront. This study was conducted to assess the leadership behaviors of hospitals’ chief executive officers and how they impact the performance of hospitals. Two instruments were used to collect the data for the study: the Multifactor Leadership Questionnaire (MLQ-5X; Avolio & Bass, 2004) and a demographics questionnaire. A correlational research design was used to measure the degree of association between variables related to hospital CEOs, the hospitals they represented and hospital …

Prevalence Of Vitamin D Deficiency In Exclusively Breastfed Infants At The Aga Khan University Hospital, Nairobi, Nusrat. A. Said

Theses & Dissertations

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk …