Medicine and Health Sciences Commons^™

Accuracy Of Interproximal Reduction In Commonly Used Operator Positions Using An Intraoral Scanner, Behnoush Bakhtiari

Theses & Dissertations

Introduction: The aim of this study was to determine operator’s best position when doing interproximal reduction. Also, to determine if these positions are ergonomically recommended.

Materials and methods: 54 sets of upper and lower models were scanned and 3D-printed. Air-rotor stripping was performed at different provider positions. Vertical and horizontal deviations were measured, and errors were recorded.

Results: In LA, there was no statistically significant difference between vertical deviations in P7 and 11, however, they were both superior to P9. In LL, P11 leads to significantly lower vertical deviation than P7 and 9. In LR, P9 and 11 were superior …

Intramuscular Administration Of The Host-Derived Immunostimulant Cpdi-02 Increases Protection Of Outbred Mice And Piglets Against Dermal Mrsa Infection In A Curative Setting And Is Well Tolerated After Repeated Administration, Jason P. Stewart

Theses & Dissertations

Staphylococcus aureus is the most common cause of bacterial skin and soft tissue infections (SSTIs) and the leading cause of hospital-associated infections in the United States. The abundance of S. aureus infections is due, in part, to its virulence factors that suppress host immune system and the development of antibiotic resistance strains such as methicillin-resistant S. aureus (MRSA). In contrast to antibiotics, Host-Directed Therapeutics (HDTs), avoid the pitfalls of antibiotics by targeting the host for immune system rather than targeting the pathogen. This mechanism of action avoids selective evolutionary pressure, which leads to antibiotic resistance and helps the host immune …

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 …

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.

Targeted Therapies For Improving The Treatment Of Sonic Hedgehog And Myc Driven Medulloblastoma, Bharti Sethi

Theses & Dissertations

The aim of this thesis to develop a novel potent dual inhibitor to target BDR4/PI3K and MDM2/ XIAP pathways to treat medulloblastoma. A series of new analogs were synthesized, characterized, and evaluated in vitro and in vivo using xenograft and orthotopic mouse models.

In Chapter 1 an overview of Blood brain barrier such as their components, physiology, current drug delivery system and nanomedicines to treat medulloblastoma.

Chapter 2 includes synthesis of new molecule MDP5, targeting both BRD4 and PI3K pathways. We used X-ray crystal structures and molecular modeling approach to confirm the interactions between MDP5 with BD domains from both …

Center Based Cardiac Rehabilitation Outcomes Associated With Covid-19 Pandemic: A Retrospective Comparative Cohort Study, Haley Williams, Kayla Woodworth

Doctor of Nursing Practice Projects: College of Nursing

Background: Traditional cardiac rehabilitation (CR) is a multidisciplinary, multifaceted program for cardiac patients. Throughout the Covid-19 pandemic, health care, including center-based CR (CBCR) programs, were closed to in-person sessions. Even with the return to CBCR participation, patient outcomes may have been affected by this disruption in care. The goal of this study was to determine if CR participation outcomes differed before and after CBCR program closure due to Covid-19.

Methods: A retrospective comparative cohort design was used to examine CR participant outcome data before and after the Covid-19 pandemic. Convenience sampling of CR participants at a large, urban …

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 …

Creation Of Tatde Rlnps For The Excision Of Integrated Hiv-1 Proviral Dna, Mahmudul Hasan

Theses & Dissertations

The persistence of integrated human immunodeficiency virus type 1 (HIV-1) proviral DNA despite combination antiretroviral therapy (ART) is the principal challenge to eliminating HIV-1 infection. This is made ever more complex based on the high viral mutation rates, diversity and resistance profiles. Taken together, these factors present principal obstacles towards any means to eliminate the virus from its infective human host. To address these factors, we have developed and validated a TatDE rLNP RNA delivery system. The system utilizes Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR) guide RNAs (gRNAs) to target multiple exons of an integrated proviral HIV-1 (tat_{1-2 …}

Chest Wall Injury Pain With Movement, Lindsey Cavlovic

Theses & Dissertations

Rib fractures are the most common injury in patients who sustain trauma to the chest wall. These patients often report exacerbated pain severity with deep breathing, coughing, and performing movements of the upper body. Clinical experience in treating these patients shows that patients usually avoid movement due to increased pain severity. Most pain scores from patients with chest wall injuries are assessed while the patient lies comfortably in bed. Although pain is the primary complaint of patients with chest wall injury, the assessment of this pain is likely under-represented, given that these patients remain inactive due to the pain that …

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 …

'The Very Structure Of Opportunities Has Collapsed': How Taxation Policies Enhance, Decay, And Otherwise Affect The Distribution Of Health & Health Services In The United States, Valerie Pacino

Theses & Dissertations

Taxation is a function of government that patterns our lives socially, economically, and politically, but it remains understudied in public health. This dissertation examines three different elements of tax policy in the United States. First, a systematic review assesses the effects of in-work tax credits on child health outcomes and suggests they improve some infant and child health outcomes, particularly overall health, low birthweight, gestational age, and abuse and neglect. It concludes with suggestions to improve both the study of and structure of tax credits. Next, an interrupted time series analysis tracks ten years of community benefits spending by nonprofit …

Oxidative Damage Together With Post-Occlusive Re-Oxygenation Kinetics, In Calf Muscle, Implicate Microvessels In The Myopathy Of Peripheral Artery Disease, Molly Schieber

Theses & Dissertations

Background:Peripheral Artery Disease (PAD) is characterized by calf muscle fibrosis and myofiber oxidative damage (OxD). Our laboratory has demonstrated architectural changes of calf-muscle microvessels (

Methods:Gastrocnemius biopsies were collected from controls, patients with Stage II PAD, and Stage IV patients with limb-threatening ischemia. Carbonyl adducts (CA; oxidative damage), and Heme Oxygenase-1 (HO-1; anti-OxD in microvessels) were quantified in microvessels (

Results: Post-occlusive re-oxygenation of calf muscle was slowed in Stage II patients versus controls. Kinetic parameters correlated poorly with Ankle-Brachial Index. Microvessel CA was increased in pre- and post-exercise Stage II patients and in Stage IV patients versus …

Development Of Combination Therapy Strategies To Treat Cancer Using Dihydroorotate Dehydrogenase Inhibitors, Nicholas Mullen

Theses & Dissertations

Cancer cells require supraphysiologic levels of nucleotide triphosphates to fuel their malignant behaviors, including uncontrolled proliferation, immune evasion, metastasis, and therapy resistance. This requirement is met by hyperactive flux through the de novo pyrimidine and de novo purine pathways. Dihydroorotate dehydrogenase (DHODH) is an essential enzyme in the de novo pyrimidine pathway that can be targeted by FDA approved and experimental drug compounds. A robust body of preclinical evidence, encompassing hundreds of independent studies over several decades, demonstrates impressive activity of DHODH inhibitors in animal models of cancer. Paradoxically, however, all clinical trials to date have failed to demonstrate efficacy …

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 …

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. …

Translating A Pediatric Weight Management Intervention Into Medically Underserved Areas, Caitlin Golden

Theses & Dissertations

Despite substantial prevention and treatment efforts, childhood obesity remains a pressing public health concern. Disparities persist in obesity prevalence among children of lower socioeconomic status, racial and ethnic minority groups, and those residing in rural areas. The vast majority of efficacious pediatric weight management interventions (PWMIs) have been based in larger cities and urban areas delivered through inter-disciplinary teams in a hospital or medical center, and the degree to which these or other efficacious PWMIs have been translated to, and are feasible in, typical rural or micropolitan areas is unclear. This dissertation describes a dissemination strategy and a systematic approach …

Targeting The Cxcr1/2 Axis In Pancreatic Ductal Adenocarcinoma, Caitlin Molczyk

Theses & Dissertations

Pancreatic ductal adenocarcinoma (PDAC) is notoriously challenging to diagnose and treat. This tumor has an aggressive phenotype and benign clinical features until severe disease dissemination, which makes it too late to eradicate. Although it is only the 10th most common cancer in the United States, it is the fourth leading cause of cancer-related deaths. The treatment options are complicated further due to tumor heterogeneity, meaning not all tumor cells are in the same state phenotypically or epigenetically. They also express cytokines, chemokines, and receptors differently. Here we explore the usage of CXCR1 and CXCR2 and their ligands in PDAC tumor …

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 …

Self-Managment Of Urinary Incontinence In Women, Abbey Klein

Theses & Dissertations

Urinary incontinence is experienced by approximately 60% of adult women in the United States and negatively impacts many aspects of physical and psychological health. Many women do not seek care for urinary incontinence due to social stigma. However, those who do seek care do not often receive treatment options that align with clinical guidelines. Urinary incontinence self-management has been used interchangeably in the literature with other terms, like self-care and coping, but no conceptual definition has been delineated. The overall purpose of this dissertation was to describe urinary incontinence self-management in women. To accomplish this, a concept analysis was conducted …

Investigating Host Cell Transcriptional Heterogeneity And Metabolism In Staphylococcus Aureus Biofilm Infections, Christopher M. Horn

Theses & Dissertations

Staphylococcus aureus (S. aureus) is a leading cause of prosthetic joint infection (PJI). These infections are often intractable due to biofilm formation, which are complex bacterial communities that adhere to biotic and abiotic surfaces. Within a biofilm, there is considerable heterogeneity in bacterial metabolism and gene expression that contributes to the establishment an anti-inflammatory milieu at the site of infection, which favors bacterial persistence even in the context of an immunocompetent host. This is due, in part, to the preferential recruitment of granulocytic myeloid-derived suppressor cells (G-MDSCs), which are a population of pathologically activated immature leukocytes that develop …

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, …

Nitrous Oxide Exposure In The Workplace: A Study Of Pediatric Dental Clinics In Saudi Arabia, Badr Alhemayyed

Theses & Dissertations

Nitrous oxide (N2O) is frequently used in dental offices and is regarded as safe for patients getting dental work done. However, nitrous oxide exposure at work has been linked to harmful health outcomes like infertility and diseases of the liver, kidneys, and nervous system. Unfortunately, Saudi Arabia lacks an occupational safety and health regulatory body, which may influence dental professionals' safety. This is a serious problem because it puts dental professionals at risk of nitrous oxide exposure at work.

Exposure to nitrous oxide at work can have serious health consequences. Therefore, it is critical to evaluate dental professionals' occupational exposure …

Primary Care Providers’ Practices And Attitudes Towards Brca Genetic Testing For Unaffected 19- To 24-Year-Old Patients., Madison C. Groene, Terri Blase Ms, Cgc, Jessica Maxwell Md, Frcsc

Capstones: Genetic Counseling

Prior literature has described unique psychosocial considerations for emerging adults (18- to 25-year-olds) considering predictive BRCA genetic testing. Due to these unique concerns, the Society of Gynecologic Oncology (SGO) recommends waiting until individuals are older than 21 before offering testing. While primary care providers (PCPs) are important stakeholders in increasing access to hereditary cancer genetic testing, their approach for emerging adults has not been previously described. We surveyed PCPs in Nebraska regarding their pre- and post-test clinical practices as well as attitudes towards BRCA genetic testing for unaffected 19- to 24-year-olds. Pre-test clinical practice questions and attitudes questions were asked …

A Twin Study Of Genetic Heritage And Environmental Influences On Tobacco Susceptibility And Initiation On Early Age, Yadi Liu

Capstone Experience: Master of Public Health

Purpose: Tobacco product susceptibility is defined as the interest a person has to start smoking. Tobacco product initiation refers to whether a person has ever used tobacco products. We aim to understand and explain how genetic and environmental factors affect tobacco products' susceptibility and initiation in children. Methods: The classical twin model estimates three sources of variance: additive genetic (A), shared environmental (C), and unique environments (E). Each source of variance is latent and is calculated from the similarity in the correlations of twin pairs on a phenotype. The magnitude of difference in the correlation of a particular …

Utilization Of Routine And Recommended Preventive Care Among Individuals With Disabilities In Nebraska, Snehal Jadhav

Capstone Experience: Master of Public Health

Background: Healthcare access disparities exist among individuals with and without disabilities (IWD, IWoD). There is a scarcity of studies focused on Nebraskans living with disabilities.

Methods: Access to Care Nebraska surveyed adults (age 19+) in Oct 2020-Mar 2021. We used Andersen’s model of healthcare utilization to group risk factors for non-compliance with routine care and recommended cancer screening. A multivariate log-binomial regression compared the non-compliance between IWD and IWoD to compute adjusted prevalence ratios (aPR) for risk factors.

Results: Of the 1101 participants,96(8.7%) were IWD. IWD had a higher proportion of non-compliance to routine preventive care (61.7% vs 54.1%) and …

A Systematic Literature Review On Long-Term Care Quality Improvement Initiatives In The United States, Daisy D. Pang

Capstone Experience: Master of Public Health

As the number of people 65 and older increases due to the baby boomer population, there will be a greater demand for long-term care (LTC) services. Quality improvement in LTC is essential to ensure positive health outcomes, patient satisfaction, and reduction in healthcare costs. The purpose of this systematic literature review is to identify the current quality initiatives for LTC in the United States and evaluate the outcomes, effects, and values of each quality initiative identified to support the claim that current the quality initiatives have a limited effect on quality improvement in LTC settings. The Preferred Reporting Items for …

Cultivating A Robust Safety Culture Through Identifying And Overcoming Barriers Within Organizations, Morgan Shradar

Capstone Experience: Master of Public Health

The hierarchical power structure within healthcare and response teams may impede communication about safety risks and violations. In developing or enhancing the safety culture within the emergency response to infectious disease events in healthcare organizations, the hierarchy of controls can be utilized to evaluate successful transmission prevention or further harm to responding teams. Within the tool, administrative controls focus on policies, procedures, and practices that minimize the risk of exposure/transmission. The idea of a safe culture emerged following the Chernobyl Disaster, in which a combination of human and system failures led to this emergency. Safety culture has been integrated into …

Reducing Burnout Using Emergency Planning: A Literature Review, Taylor Vaughn

Capstone Experience: Master of Public Health

Objective

The objective of this capstone is to gain knowledge on what burnout is, what causes it, what can be done to prevent it, and what can be added to public health emergency plans to reduce burnout in local emergency preparedness workforces.

Methodology

A literature review was completed through peer-reviewed articles, and documents from professional and governmental organizations. The results were used to search current plans to determine whether burnout-related recommendations were present.

Results

Burnout prevention at the personal level includes a good diet, routine exercise, and mindfulness activities. At the organizational level it should include providing emotional support, emphasizing …

Comprehensive Literature Review: Assessing The Impact Of Covid-19 Policies, School Closures And Social Distancing, On The Mental Health Of School Age Children, Fatuma A. Hassan

Capstone Experience: Master of Public Health

Mental health is vital to the well-being of all individuals, especially children. COVID-19 unveiled a significant public health issue with poor mental health during the pandemic. There is limited literature about the mental health implications of COVID-19 policies for children and adolescents and preventive strategies for future pandemics. This comprehensive literature review seeks to further investigate the mental health impacts of school shutdowns and social distancing, which were nonpharmaceutical strategies, on school-aged children, 5-18 years old, and propose recommendations for public health officials to mitigate the mental health impacts for future pandemics. Additionally, the review aims to highlight the potential …

Exploring How Social Determinants Of Health Affects Rates Of Chronic Obstructive Pulmonary Disease (Copd) In The Des Moines Metro, Kyla Winkelman

Capstone Experience: Master of Public Health

Chronic Obstructive Pulmonary Disease (COPD) is consistently in the top ten leading causes of death and most recently ranked fourth in the United States (Heron, 2021). Research on health disparities and SDOH has increased recently as investigators learn their importance in diagnosing chronic conditions. Several studies show that a person’s life and environment can determine their risk of exposure, susceptibility, course, and disease outcome. UnityPoint Health (UPH) clinics were utilized for this project to explore how the social determinants of health and health disparities affect COPD rates in Des Moines, Iowa. Initial data was obtained surrounding COPD statistics in the …