Medicine and Health Sciences Commons^™

Development Of A Patient Educational Resource On Carrier Screening, Katelyn Watkin, Kristen Fishler Malone, Sara Fisher

Capstones: Genetic Counseling

Objective: Previous studies suggest carrier screening is not consistently offered to all patients meeting national guidelines. Introducing basic carrier screening options prior to an appointment could potentially decrease the time providers spend discussing this screening, while increasing patient awareness. Our goal was to create an educational handout that was a source of baseline knowledge on carrier screening, accessible, and non-directive.

Methodology: We developed this educational handout in four phases: preliminary research, resource development, stakeholder feedback, and revision. Preliminary research involved compiling existing guidelines published by professional organizations such as the American College of Obstetricians and Gynecologists, the American …

Contextual Factors And Sti/Hiv Sexual Risk Behaviors Among Hispanic Youths Aged 13 To 24 Years, Mariam Taiwo

Theses & Dissertations

Despite the growing population of Hispanics and several efforts to combat the high STI/HIV rates among Hispanic youths aged 13 to 24 years in the United States, this population continues to experience stark disparities in STI/HIV and is underrepresented in STI/HIV research relative to their White peers. This dissertation consists of three distinct studies designed to identify and understand the contextual factors of STI/HIV sexual risk behaviors across the social-ecological model that are pertinent to Hispanic youths.

Results from the first study showed that STI/HIV sexual risk behavior varied by Hispanic youths’ acculturation types and moderated by gender. We found …

Ethical Sensitivity Of Padis Care Among Critical Care Nurses: A Mixed Methods Study, Denise Waterfield

Theses & Dissertations

Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. To better understand the complexities of PADIS care, two reviews of the literature were completed. The first is an integrative review of the use of PADIS assessment tools by critical care nurses. The second is a qualitative systematic review of the literature on the integration of care ethics and nursing workload. Ethical sensitivity of everyday …

Characterization Of 1,1-Diarylethylene Foxm1 Inhibitors Against High-Grade Serous Ovarian Carcinoma Cells, Cassie Liu

Theses & Dissertations

Forkhead box M1 (FOXM1) is a member of the conserved forkhead box (FOX) transcription factor family. Over the last two decades, FOXM1 has emerged as a multifunctional oncoprotein and a robust biomarker of poor prognosis in many human malignancies. FOXM1 and its associated oncogenic transcriptional signature are enriched in >85% of ovarian cancer cases, and FOXM1 expression and activity can be enhanced by a plethora of genomic, transcriptional, post-transcriptional, and post-translational mechanisms. As a master transcriptional regulator, FOXM1 promotes critical oncogenic phenotypes in ovarian cancer, including: (1) cell proliferation, (2) invasion and metastasis, (3) chemotherapy resistance, (4) cancer stem cell …

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

MD Honors Theses

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level Deprivation …

Evaluating Medical Student Confidence And Competency Related To Dermatologic Morphology And The Effect Of An Educational Module And Summary Document, Grant Starkey

MD Honors Theses

Abstract

Background: Non-dermatologist physicians perform ~60% of visits related to the primary diagnosis of a dermatological condition, yet dermatology education and training are extremely limited within medical school making up 0.23-0.3% of the curricula. This data points to the possible need for further educational resources for medical students regarding dermatology. In 2007, the American Academy of Dermatology (AAD) created a curriculum for medical students to use while on a dermatology clerkship to supplement their medical school curriculum. The goal of this study is to evaluate current University of Nebraska Medical Center (UNMC) medical student’s confidence and ability in describing skin …

Modulation Of Immune Homeostasis In Neurodegenerative Diseases, Pravin Yeapuri

Theses & Dissertations

Modulating the immune system via. transformation of CD4+ T cell effector to regulatory (Teff to Treg) or promoting microglial clearance of abnormal disease proteins are attractive therapeutic strategies to restore immunological balance in neurodegenerative diseases like Parkinson’s disease (PD) and Alzheimer’s disease (AD). In the past decade, we defined a safe and effective pathway for Treg induction through the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF was developed in PD animal models and early phase I human studies demonstrating proof-of-concept efficacy for ameliorating disease signs and symptoms. Despite the recorded efficacy, the medicine’s short half-life, limited bioavailability, and injection site reactions …

Modulating Cardiac Remodeling After Myocardial Infarction, Upendra Chalise

Theses & Dissertations

Cardiac remodeling after myocardial infarction (MI) is indicated by infarct wall thinning, reduced ejection fraction, and dilation of the left ventricle (LV). Inflammation presides in the early days of MI as a key event in cardiac wound healing. Infiltration of inflammatory cells, predominantly neutrophils and macrophages, is stimulated by ischemic cardiomyocytes that secrete inflammatory cues. This dissertation focused on identifying factors that influence cardiac remodeling after MI. S100A9 is a neutrophil-derived factor identified that exacerbated infarct wall thinning and cardiac dilation by increasing neutrophil and macrophage infiltration. Similarly, murinoglobulin 1 (Mug1) and galectin (Lgals)3 were macrophage-derived factors identified that regulate …

Psychological Trauma Alters T-Lymphocyte Inflammation And Redox Through Sympathetic Mechanisms, Safwan K. Elkhatib

Theses & Dissertations

Posttraumatic stress disorder (PTSD) is a devastating psychiatric disorder characterized by distinctive symptom clusters, including intrusive memories (i.e., flashbacks), avoidance of related stimuli, affective changes, and hyperarousal. Strikingly, patients with PTSD face a significantly increased risk for a number of inflammation-driven pathologies, ranging from cardiovascular to autoimmune disease. Yet, the exact etiology of this increased risk remains unknown. The immune system is known to be strongly influenced by the sympathetic nervous system, and sympathetic overactivity is a hallmark of PTSD. Lymphoid organs, such as the spleen, are richly innervated by sympathetic nerve fibers which terminate near adaptive immune …

Maternal Distress In The Neonatal Intensive Care Unit, Morgan A. Staver

Theses & Dissertations

Maternal distress in the NICU is a common and potentially harmful phenomenon for mothers with a sick infant. The overall purpose of this dissertation was to describe maternal distress and to examine maternal distress among mothers who have infants greater than or equal to 34 weeks of gestation at birth in the NICU. This was accomplished by first conducting a concept analysis of maternal distress in the NICU. Next, an integrative review of the literature was done to assess maternal distress and associated variables in response to infant hospitalization in the NICU. Finally, a mixed methods study was done to …

Investigation Of Cumulative Genetic Risk And Cc16 In Adult Asthma And Copd Populations, Kelli C. Gribben

Theses & Dissertations

INVESTIGATION OF CUMULATIVE GENETIC RISK AND CC16 IN ADULT ASTHMA AND COPD POPULATIONS

Kelli C. Gribben, Ph.D.

University of Nebraska Medical Center, 2022

Supervisors: Paraskevi A. Farazi and Tricia D. LeVan, Ph.D.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) have complex etiologies and lack biological predictors that can be used for primary prevention, early detection, progression, or monitoring. Genetic risk scores (GRS) aggregate genetic effects from GWAS-identified susceptibility variants associated with a trait. GRS may provide opportunities to improve disease prediction to inform public health and clinical interventions. Asthma GRS studies utilizing multi-ethnic populations are scarce and there is a …

Evaluation Of Awareness, Knowledge, And Preventive Intervention Of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults, Yi Du

Theses & Dissertations

The prevalence of nonalcoholic fatty liver disease (NAFLD) among Chinese young adults (CYA) aged 18-25 years ranges from 4.7% to 15.1% and has kept increasing in recent years. Previous studies reported limited awareness and knowledge of NALFD among middle-aged and older Chinese populations, however, they have not investigated awareness in CYA, for which there is no well-validated questionnaire. There is currently no efficacious educational intervention on NAFLD for CYA.

The objectives were 1) to develop and validate a questionnaire which can be used to assess the awareness and knowledge of NAFLD among CYA; 2) to assess the awareness and knowledge …

Leukocyte Subsets In The Peripheral Blood And Spleen Of Gastrointestinal Cancer Patients, Kathryn E. Cole

Theses & Dissertations

In 2022, an estimated 62,210 people will be diagnosed with pancreatic ductal adenocarcinoma (PDAC) and approximately 49,830 will die from the disease. Current treatment strategies for gastrointestinal (GI) cancer patients, such as PDAC, have shown limited benefit, suggesting the need to develop novel, multimodality therapeutic approaches. Adoptive cellular therapy (ACT) using autologous tumor infiltrating lymphocytes (TILs) has shown efficacy in patients with melanoma; however, this approach is costly and requires extensive cell culture for sufficient numbers of T-cells for infusion. GI cancer patients with borderline resectable disease, whose primary tumor is adjacent to the splenic vasculature, can sometimes undergo a …

1-Check Unmc Mobile App Usage: A Quantitative Analysis Of The Data, Molly Pofahl

Theses & Dissertations

As COVID-19 cases continued to rise in Nebraska, universities and colleges were faced with unique challenges in the effort to continue providing quality education for students. The University of Nebraska Medical Center (UNMC) took on especially difficult challenges due to its status as an academic medical center. By the Fall of 2021, students, faculty, and staff were beginning to return to campus. The 1-Check UNMC app was created to help keep sick people from coming to campus. The UNMC community was expected to screen themselves for COVID-19 using this app each day before coming to campus. This thesis is an …

Erα As A Modulator Of The Sle1b Lupus Susceptibility Locus And B Cell Receptor Signaling, Jared H. Graham

Theses & Dissertations

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by loss of immune tolerance and the production of anti-nuclear autoantibodies. 90% of lupus patients are women, and this sex bias is due to the actions of estrogens, which promote lupus pathogenesis. Our lab has shown that estrogen receptor alpha (ERα) mediates the effect of estrogens in lupus and that ERa acts in a B cell intrinsic manner to promote the development of autoantibodies and SLE. Genetic factors also contribute to lupus. One major lupus susceptibility locus, Sle1, controls loss of tolerance and autoantibody development as well as immune cell …

Frailty And Neurocognition In Prostate Cancer, Lindsey Hanson

Theses & Dissertations

Prostate cancer (PCa) treatment often leads to distressing side effects ranging from muscle loss, physical inactivity, and fatigue to cancer associated cognitive decline (CACD). Evidence suggests that men treated with androgen deprivation therapy (ADT) may have a specifically high risk of CACD, partially due to increased frailty. However, the current literature on cognitive effects of ADT is equivocal. Therefore, the primary objectives of this study were to (1) compare cognitive function, physical activity (PA), and fitness in men receiving ADT, men scheduled to receive radiation, and men under active surveillance for PCa; (2) examine changes in cognitive performance and PA …

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone: Master of Health Administration

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected …

Reflective Journaling Intervention To Impact Self-Awareness, Professional Health, And Overall Well-Being In Nurses, Brittany M. Langan, Katherine Keppen

Doctor of Nursing Practice Projects: College of Nursing

Background. Burnout among nurses has been on the rise and was exacerbated with the pandemic. Reflective journaling after work may be a strategy to decrease feelings of burnout. Reflective journaling, as an intervention, has been shown to improve self-awareness, compassion fatigue, and burnout among nurses. The purpose of this study was to pilot a 4-week reflective journaling intervention in hospital-based nurses and describe participant professional quality of life, self-awareness, and overall well-being.

Theoretical Framework. The Theory of Reasoned Action (TRA) was chosen as the theoretical framework because it identifies the belief that performing a particular behavior will lead to a …

The Impact Of Simulation-Based Mastery Learning For Central Venous Catheter Dressing Changes With Staff Nurses At A Nebraska Critical Access Hospital, Paige Pavlik, Michaela Haddock

Doctor of Nursing Practice Projects: College of Nursing

Abstract

Purpose

The purpose of this pilot feasibility study was to assess if a simulation-based mastery learning (SBML) intervention on central venous catheter (CVC) dressing changes by staff nurses at Nemaha County Hospital could further develop staff nurses’ central line care skills by increasing their knowledge of a central line dressing change, improving their comfort level and learning self-efficacy with central line care, determining if there is a relationship between knowledge, learning self-efficacy and comfort in the clinical area, and assessing nurses’ satisfaction on the SBML intervention. The clinical research questions being explored are, “Will nurses in a Nebraska critical …

Development Of Bioactive Polymers For Anticancer Sirna Therapy, Siyuan Tang

Theses & Dissertations

Pancreatic ductal adenocarcinoma is a deadly disease with limited treatment options due to late diagnosis and resistance to conventional chemotherapy. Moreover, with the decreased survival rate in the past several years, pancreatic cancer may become the second leading cause of cancer-related death by surpassing breast cancer in 2030. CXCR4/CXCL12 pathway is crucial in tumor-supporting microenvironment, tumor progression, angiogenesis, metastasis and chemotherapy resistance. Small interfering RNA (siRNA) is one of the interfering RNA (RNAi), which targets mRNA specifically then knockdowns the overexpressed oncogene. Thus, siRNA has been widely used as a therapeutic strategy for various diseases including PDAC. In the research …

Fortuitous Diagnosis Of Total Anomalous Pulmonary Venous Return In A Newborn With Hypoglycemia, Joseph Maes, Terence Zach

Child Health Research Institute Pediatric Research Forum

No abstract provided.

Misinformation And Vaccine Hesitancy Determinants: The Significance Of Framed Public Health Messaging, Alexandra I. Todd

Capstone Experience: Master of Public Health

In 2020, the SARS-CoV-2 (COVID19) outbreak effectively disrupted worldwide operation for months, leading to tremendous economic loss and adverse health outcomes. While countries grappled to control the virus and scientists worked around the clock to deliver a vaccine in record time, a pubic health communication crisis emerged. The spread of false and misleading information, also known as misinformation, has proved to be a barrier in the fight against COVID19 and its vaccination effort. Many factors including the rise of social media, distrust of government, polarization of news sources, and fragmented media have created an environment susceptible to misinformation. Utilized correctly, …

Financial Analysis Of New Medicare And Medicaid Guidelines, Reimbursement Rates, And Increased Enrollment On Four Nebraska Clinics, Jamilah J. Abdul-Hakim

Capstone Experience: Master of Public Health

Government health insurance plans such as Medicaid and Medicare were created with the intention of providing elderly, low-income, or disabled citizens with affordable and quality health insurance through government-contracted providers (Baicker et al., 2013). Medicare is a government health insurance program that provides healthcare to United States citizens 65 years and older, regardless of their income or past medical history. Medicaid was implemented as an assistance program to provide health insurance for low-income Americans and their families. Medicaid is administered by each state independently, which creates variation in reimbursement rates, services, and structure. (Grabowski, 2007).

Providers accepting Medicare and Medicaid …

A Survey And Analysis Of Educational Materials Addressing The Health Consequences Of Drinking Nitrate Contaminated Water In Medical Clinics Located In The Most At-Risk Areas Of Nebraska: Are Healthcare Providers Equipped To Protect And Educate Their Patients?, Laura Nagengast

Capstone Experience: Master of Public Health

Background: Eighty five percent of Nebraskans rely heavily on groundwater sources, including private wells, as their primary source of drinking water. Nitrate is one of the most common chemicals found in private well water. Numerous studies demonstrated the serious human health consequences from prolonged nitrate exposure. Therefore, due to the potential health risks, this project aimed to identify and evaluate the existing knowledge and awareness among healthcare providers as well as the educational materials in medical clinics in Nebraska related to health effects of drinking nitrate contaminated water.

Methods: An 8 multiple choice question survey was developed using Microsoft Forms. …

Evaluating First Responder Personal Preparedness In Douglas County, Nebraska's Volunteer Fire And Emergency Medicine Service, Kylie Johnson

Capstone Experience: Master of Public Health

In disaster response, it is essential for first responders to focus on their disaster role. Lack of personal preparedness at home could hinder a responder’s ability to focus their attention on their response role (13). Personal conflict, such as that caused between family duties and response duties, in a disaster can be mitigated through several means. One mitigation tactic is preparedness education and support offered by the responder’s organization. While the importance of responder personal preparedness cannot be understated, there is a lack of baseline data on the topic related to Nebraska responders.

To assess the state of first responder …

Assessing Meat Processing Workers’ Attitudes And Concerns Regarding Covid-19 Vaccination, Karen Schmeits

Capstone Experience: Master of Public Health

The COVID-19 pandemic has impacted industries across the globe. Specifically, for meat processing (meatpacking) facilities, the pandemic has changed the way facilities operate, how the workers perform tasks, and how workers perceive their health. The development of an FDA approved COVID-19 vaccine brought hope to meat processing employers and workers. However, little research has been conducted to know how meat processing workers feel about vaccines generally and how they perceive the COVID-19 vaccine. The purpose of this cross-sectional study was to investigate preventive vaccine determinants and attitudes and concerns specifically regarding the COVID-19 vaccine. Surveys were conducted with 128 meat …

Weight Gain Trajectory Over Five Years For Adult Primary Care Patients In Nebraska, Elizabeth M. Morris

Capstone Experience: Master of Public Health

INTRODUCTION: The continued rise in the prevalence of adult obesity in the United States is a public health concern. Several studies have identified the increasing rates of obesity, its impacts, and the factors leading to obesity. Some researchers have made obesity prevalence projections at the national and state levels. This study aims to fill the critical gap in real-time weight data trends among primary care adult patients in Nebraska. The main goal of this study is to determine and analyze the weight trajectory of adults in Nebraska over the past five years and determine if the trends vary among age …

Assessing Facilitators And Barriers To Enrolling In Cardiac Rehab, Michaela R. Geiser

Capstone Experience: Master of Public Health

Abstract: Heart disease has been a leading cause of death since the early 1900s (Heron & Anderson, 2016). Americans are at higher risk for heart disease if they have high blood pressure, high cholesterol, are overweight, inactive, and smoke, among other risk factors (CDC, 2019). If a person already has heart disease or has had a cardiac intervention (such as a stent), they may be referred to a local cardiac rehab program. Bryan Health in Lincoln, NE, currently offers two methods of delivering cardiac rehab: in-person or home-based. Research has not yet been done to assess enrollment facilitators and barriers …

The Perception Of Technology On Continuous Health And Environmental Monitoring For Professional Drivers, Troy Suwondo

Capstone Experience: Master of Public Health

Due to the sedentary nature of professional truck driving (among other high-risk behaviors and hazardous exposures) many suffer from acute and chronic health conditions. There are many potential hazards in the professional driving profession. Many of these hazards come from those that transport hazardous materials. Figuring out what health and environmental indicators are important to measure can be a way to minimize hazards. Continuous health monitoring technology may be an option to detect disease and alert professional drivers when vital signs indicate impending health crises. Before this can be implemented, it will be important to evaluate the perception of wearable …

Systematic Literature Review: Culturally Appropriate Approach To Advance Care Planning For Ponca Tribe Elders, Priscila Soto Prado

Capstone Experience: Master of Public Health

Advance Care Planning is understudied in Native American and Alaskan Natives communities. There is a strong need for further research on culturally adapting advance care planning (ACP) for indigenous communities. Specifically, for the Ponca Tribe, culturally adapting the ACP used would ideally increase the acceptance of ACP in that community. This systematic literature resulted in identifying four themes other tribes have utilized to culturally adapt their ACP, advance directive, palliative and/or end-of-life processes in an effort to increase completion rates. The four themes were involving the elders with the adaptation process, increasing education efforts and awareness of ACP and ADs, …