Medicine and Health Sciences Commons^™

Mucin And Splice Variant Profiles Of Pancreatic Adenocarcinoma Predict Patient Survival And Subtyping, Christopher M. Thompson

Theses & Dissertations

PDAC is a pancreatic epithelial malignancy and demonstrates aggressive progression and bleak patient prognosis. Despite decades of research, the evolution of novel diagnostics and intervention modalities for PDAC is stagnant. This dissertation explores the characteristic aberrant and elevated expression of mucins in PDAC. Beginning with the hypothesis that mucins are associated with disease aggressiveness, analysis of PDAC patient survival in TCGA revealed no associations between single mucin expression and patient survival. This led to the underlying issue of PDAC tumor cellularity since this disease demonstrates variability in the proportion of cancer cells within the tumor. Tumor purity assessed with the …

Neurocognitive Impairment In People Living With Human Immunodeficiency Virus (Hiv): Risk Factors And Mortality, Zaeema Naveed

Theses & Dissertations

Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH) with clinical and public health implications. Studies have generated inconsistent results regarding etiological factors for NCI in PLWH and a brief user-friendly predictive tool is desirable in clinical practice to assess the probability of having NCI in PLWH. Furthermore, factors associated with clinically meaningful decline in neurocognitive status and survival disadvantage for patients with NCI are understudied in the post-cART era. The goal of this dissertation was to investigate factors associated with baseline NCI and neurocognitive decline and the association …

Clinical Consequences And Determinants Of False Positive Blood Cultures In Adult Hospitalized Patients, Sidra Liaquat

Theses & Dissertations

Blood cultures are the gold standard for detecting blood stream infections. However, in the US, 0.6-6% of all blood cultures get contaminated leading to adverse clinical outcomes such as unnecessarily prolonged hospital stay and antibiotic therapy. Using electronic medical records, we explored the clinical outcomes and patient-specific risk factors of contaminated blood cultures in an era where rapid blood culture testing was being utilized to provide blood culture results within hours. Rapid blood culture test results can help clinicians in early and more effective management of patients with contaminated blood cultures, thus improving clinical outcomes. We also studied the impact …

Examination Of Access, Utilization, And Barriers To Care Among Special Populations In The United States, Jed R. Hansen

Theses & Dissertations

Utilizing healthcare services is a complex phenomenon in the United States. While system-level barriers and facilitators of care, along with individual consumer choices, are known to affect access and subsequent use of services, the interaction among the factors that lead to utilization remains unknown. Examining access and utilization of healthcare services using a consumer framework incorporating both access barriers and facilitators and consumer-level dimensions that affect choice in seeking care may inform access and utilization research. The purposes of this dissertation were 1) to explore the presence of facilitators and barriers to care in ambulatory healthcare locations for non-emergent care …

Fire Service Covid-19 Infection Prevention And Control Policy Comparison, Saaddedine Dichari

Theses & Dissertations

To date, there have been over 2.7 million deaths and more than 126 million cases attributed to the COVID-19 pandemic (JHU, 2021). This pandemic has affected nearly every aspect of daily life. Among those impacted are U.S. firefighters, as they provide many services beyond simply extinguishing structure fires and are frequently dual certified as emergency medical technicians. Many of the victims of this pandemic have relied on first responders to provide them with emergency medical care and hospital transport. When caring for these infected patients, firefighters have an increased risk of exposure and must be provided with adequate …

Characterization Of Di-Aryl Urea Compounds Against Acute And Chronic Toxoplasma Gondii, Austin Sanford

Theses & Dissertations

Toxoplasma gondii is an obligate intracellular parasite that has infected nearly 60 million individuals in the United States alone. Acute infection causes ill effects to the fetus in utero when mothers are primarily infected, and to immunocompromised individuals. Chronic infection consists of quiescent tissue cysts located primarily in brain tissue and is capable of reverting back to the acute stage causing severe toxoplasma encephalitis in immunocompromised individuals. Current treatments for acute infection are lacking while there are no approved treatments for the clearance of chronic infection. The aim of this research was to evaluate a family of di-aryl urea compounds …

From Pipeline To Health Equity: A Case Study Of Health Profession Pipeline Students, Sonja F. Tutsch

Theses & Dissertations

Health equity arises from the social determinants of health. Access to culturally and linguistically competent health services is a major determinant of health. Despite health profession pipeline intervention efforts spanning more than 50 years, diversity in the health professions has not been achieved, and disparities in health among members of minority groups remain prevalent. Health profession pipeline programs came into existence to help grow minority representation among health professionals serving in underserved, disadvantaged, communities, where disparities in health are most prevalent. One underlying assumption was that minority students from underserved communities understand the needs of these communities best and are …

Early Systolic Dysfunction And Impact Of Gene Mutation Severity In Marfan Syndrome, Aaron Clem, Lois J. Starr, David Danford, Mary Craft, Ling Li, Jason Christensen, Anji Yetman

Child Health Research Institute Pediatric Research Forum

Background

Marfan syndrome is caused by a mutation in the fibrillin-1 gene that manifests with a variety of features including aortic root dilation. Recent research has identified a primary cardiomyopathy in patients with Marfan syndrome, hypothesized to be due to the presence of abnormal fibrillin-1 in the myocardium. Controversy over the nature and significance of this cardiomyopathy remains. Echocardiographic measurement of the first-phase of ejection (defined as the beginning of systole to peak aortic valve flow) may be more sensitive to systolic dysfunction and provide useful clinical information. The purpose of this study is to:

1. Assess systolic dysfunction in patients …

Femoral And Tibial Indications For Initial And Reoperation Surgeries With Fassier-Duval Intramedullary Rods For Children With Osteogenesis Imperfecta, Adriano Dellapolla, Kaeli Samson, Tinotenda Sekeramayi, Arianna Dalamaggas, Megan Gillespie, Vincent Eaton, Elizabeth Strudthoff, Maegen Wallace

Child Health Research Institute Pediatric Research Forum

Background: Osteogenesis imperfecta (OI) is a genetic connective tissue disorder affecting quantity and integrity of collagen type I, which is integral for the strength of osseus tissue. OI has a heterogenous molecular inheritance pattern – divided into four major subgroups (I-IV). Defects in collagen protein products lead to poor development of skeletal structures and increased fracture rates. Children with OI suffer from multiple fractures and bone deformities often requiring surgical intervention with osteotomies and intramedullary telescoping rods, most often with Fassier-Duval (FD) rods. Our study–updated cohort from 2018 paper Azzam et al.–looked at the relationship between initial and reoperation indications …

Evaluation Of Pseudomonas Aeruginosa Eradication Protocol In Pediatric Patients With Cystic Fibrosis: A Retrospective Medical Chart Review, Adam Devries, Heather Thomas, Diane Acquazzino

Child Health Research Institute Pediatric Research Forum

Background

Pseudomonas aeruginosa (Pa) is a leading cause of lung infection in patients with cystic fibrosis (CF), increasing morbidity and mortality. Despite this, there is no standardized treatment among the medical community for Pa eradication in patients with CF. The Nebraska Regional Cystic Fibrosis Center at Children’s Hospital and Medical Center (CHMC) in Omaha, Nebraska has a Pa eradication protocol. This study aims to increase Pa eradication for children with CF by investigating the effectiveness and adherence to the current Pa eradication protocol.

Methods

This study is a retrospective medical chart review of 1–21-year-olds with CF receiving care …

Power Training Improves The Sensorimotor Cortical Oscillations In Youth With Cerebral Palsy, Morgan Busboom, Anna Reelfs, Mike Trevarrow, Brad Corr, Heidi Reelfs, Sarah Baker, Hannah Bergwell, Tony W. Wilson, Max J. Kurz

Child Health Research Institute Pediatric Research Forum

Background: Our magnetoencephalographic (MEG) brain imaging studies have shown that youth with cerebral palsy (CP) demonstrate altered sensorimotor beta (18-24Hz) cortical oscillations when controlling their leg motor actions and these anomalous cortical oscillations are linked with the extent of their mobility impairments. Current therapeutic trends for improving mobility have shifted from strength training to high-velocity power training, which has shown improvements in isokinetic strength, power production and mobility of youth with CP. However, no studies have assessed whether these clinically relevant improvements are linked with changes in the sensorimotor cortical oscillations. The objective of this study was to utilize MEG …

Novel Mouse Model For Analysis Of Macrophage Function In Neuroblastoma, Gabrielle L. Brumfield, Shelby M. Knoche, Alaina C. Larson, Brittany Poelaert, Benjamin T. Goetz, Poomy Pandey, Don W. Coulter, Joyce C. Solheim

Child Health Research Institute Pediatric Research Forum

Background: Neuroblastoma is the third most common childhood cancer and accounts for 12% of cancer-associated deaths in children under the age of 15. Patients with high risk neuroblastoma have a poor 5-year survival rate of less than 50%. Neuroblastoma tumors treated with the histone deacetylase inhibitor (HDACi) vorinostat have increased infiltration of macrophages with upregulated immune cell-surface receptors. Neuroblastoma cells release VEGF and M-CSF, which may alter intratumoral macrophage populations. VEGF has also been implicated in alteration of amyloid precursor protein family processing. Our lab demonstrated that amyloid precursor protein 2 (APLP2), a member of the amyloid precursor protein …

Evaluation Of Brain Cholesterol Metabolism After Neonatal Hypoxic-Ischemic Brain Injury, Amanda Dave, Luke Allen, Zeljka Korade, Eric Peeples

Child Health Research Institute Pediatric Research Forum

Introduction

Neonatal hypoxic-ischemic brain injury (HIBI), resulting from impaired cerebral blood flow and oxygen delivery to the brain, affects at least 1.5 per 1,000 live births each year in the United States. Altered levels of cholesterol and cholesterol metabolites have been identified in brain tissue and in serum after adult brain injury such as traumatic brain injury and stroke. We hypothesized that there would be temporal and brain region-specific alterations in cholesterol and sterol precursors after neonatal HIBI.

Methods

Postnatal day 9 CD1 mouse pups were anesthetized with isoflurane and randomized to HIBI induced by carotid artery ligation or controls …

Direct Hyperbilirubinemia In Infants With Trisomy 13 And 18, Jeffrey Kepple, Eric Peeples

Child Health Research Institute Pediatric Research Forum

Background: Survival in trisomy 13 (T13) and 18 (T18) has increased in recent years, but little is known about the prevalence and management of the non-lethal complications in these populations.

Significance of Problem: A subjectively high rate of direct hyperbilirubinemia (DH) was noted at Children’s Hospital & Medical Center compared to the general population. Defining the prevalence, timing, and risk factors for DH will allow for the development of screening and management guidelines.

Hypothesis, Problem or Question: We hypothesized that infants with T13 and T18 would have high rates of DH, with no significant difference in prevalence between …

Profound Neonatal Anemia Due To A Fetal To Maternal Hemorrhage: A Case Study, Margaret Hogan Smoot, Terrance Zach

Child Health Research Institute Pediatric Research Forum

A female infant was born by cesarean section at 36 weeks of gestation after the mother presented with perceived decreased fetal movement, blood-tinged mucous vaginal discharge, and a non-reactive non-stress test. Upon delivery, the infant appeared extremely pale and in mild respiratory distress. A complete blood count upon admission showed profound neonatal anemia, and a Kleihaur-Betke test confirmed fetomaternal hemorrhage as the cause. Transfusions corrected the infant’s hematocrit levels, and she was discharged on day 8 following a normal brain MRI. Fetal to maternal hemorrhage is a known cause of neonatal anemia, however the presentation is nonspecific leading to underdiagnosis …

Mir-1253 Potentiates Cisplatin Response In Pediatric Medulloblastoma By Regulating Ferroptosis, Ranjana K. Kanchan, Naveenkumar Perumal, Pranita Atri, Ramakanth C. Venkata, Ishwor Thapa, Mohd W. Nasser, Surinder K. Batra, Sidharth Mahapatra

Child Health Research Institute Pediatric Research Forum

Introduction Among CNS tumors, medulloblastoma (MB) is the most common malignant pediatric brain tumor. Of the four subgroups, group 3 (G3MB) tumors fare the worst. Haploinsufficiency of 17p13.3 is a hallmark of these high-risk tumors; included within this locus is miR-1253, which has tumor suppressive properties in medulloblastoma. Therapeutic strategies capitalizing on the anti-neoplastic properties of miRNAs can provide promising adjuncts that can improve efficacy while mitigating toxicity of current chemotherapeutic drugs.

Objective In this study, we explored the potentiation of miR-1253 on cisplatin cytotoxicity in group 3 MB.

Methods We used RNA Sequencing to isolate a putative target for …

Fit For Life: Educating About A Healthy Lifestyle In Omaha Elementary Schools, Emilee Greager, Mary Conklin, Jordan Nustad, Tyler Bendrick, Haley Bremer, Tavishi Chopra, Jane Driano, Connor Eggleston, Lily Foley, Jeffrey Kepple, Ryan Leuty, Taylor Mattice, Alison Mause, Elizabeth Mause, Molly Olsen, Breanne Parets, Heerali Patel, Thomas Pennington, Miranda Prints, Eva Schaible, Christopher Toivonen, Grace Vitek, Claire Willman, Allen Zheng, Kody Moffatt

Child Health Research Institute Pediatric Research Forum

Background: The prevalence of childhood obesity is increasing across the country. Health education at a young age is critical for children to establish healthy habits. The Fit for Life program is put together by Creighton medical students to inspire elementary students to lead a healthy lifestyle. The curriculum integrates physical exercise, real organ demonstrations, emotional wellness exercises, and nutritious meal building to model and encourage healthy habits.

Methods: Over four weeks, medical students taught the 4^th and 5^th graders of two Omaha schools over live video while they followed along with hands-on activities. Before and after the program, …

Do I Add Value? A Mixed Methods Study Comparing Medical Students’ Experiences With Patient Documentation, Shannon Haines, Kari Nelson, Kaeli Samson, Nathan Gollehon

Child Health Research Institute Pediatric Research Forum

Background

Clinical documentation is an essential skill for practicing physicians, yet many medical students are not prepared for the documentation demands required during residency.^1,2 Recent CMS rule changes now allow medical students’ notes to be used for billing.³ Previous studies have shown positive perceptions of medical students whose notes were used in an outpatient setting.⁴ We utilized Constructivist Learning Theory to frame our work, where students construct their knowledge as faculty and residents facilitate the process.⁵

Objectives

To explore if using student documentation for billing impacts student perceptions and experiences during the pediatric clerkship.

Methods

Pediatric …

Klinefelter’S Syndrome: A Fortuitously Diagnosed By Non-Invasive Prenatal Testing, Steven V. Yackley, Terence L. Zach

Child Health Research Institute Pediatric Research Forum

Case Report: A male infant born at 37 weeks gestation. His mother was a 29-year-old, gravida 4 para 3 woman. During her pregnancy she was curious as to the gender of the fetus and requested a non-invasive prenatal test (NIPT) rather than fetal ultrasound. The NIPT returned with a karyotype of XXY. The male infant was born vaginally with a birth weight of 2670 grams. Apgar scores were 8 and 9 at one and five minutes respectively. He was admitted to the newborn intensive care unit secondary to respiratory distress. He had no obvious dysmorphic features. He had normal appearing …

Severe Colitis And Malnutrition In Association With Neonatal Hemophagocytic Lymphohistiocytosis, Laura Tarantino

Child Health Research Institute Pediatric Research Forum

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of overwhelming immune activation causing multiorgan dysfunction that may be genetic and/or acquired. Patients with familial HLH often present by one year of age, though most are asymptomatic in the first month of life. We present the case of a neonate with diarrhea and malnutrition who developed signs and symptoms consistent with a clinical diagnosis of HLH.

Case: A neonate born at 35 5/7 weeks was transferred to a Level IV neonatal intensive care unit at 39 4/7 weeks for failure to thrive. Though feeding adequately and non-dysmorphic, he had …

Comparison Of Third Year Medical Student Wellness Before And During The Sars-Cov2 Pandemic, Jenna Scholl, Oladapo Akinmoladun, Amissabah Kanley, Nathan Gollehon, Jason Burrows

Child Health Research Institute Pediatric Research Forum

Introduction

Depression and suicidal ideation have a higher prevalence in medical students when compared to other age-matched populations.^1,2 The SARS-CoV2 pandemic has further threatened medical trainee well-being with increased stress and risk of mental illness.^3,4

Objective

To compare medical student well-being at a single institution before and during the SARS-CoV2 pandemic.

Methods

Third year medical students at a single institution voluntarily completed a survey during pediatric clerkship orientation as part of an ongoing, non-pandemic longitudinal wellness study. The survey instrument includes basic demographic information, the validated World Health Organization (WHO) (FIVE) Well-Being Index (WHO-5), and questions about physical …

Expanding The Phenotype Of Hnrnpu-Related Disorders To Include Brief, Resolved, Unexplained Events (Brue), Jonah Scheffler, Kristen P. Fishler, Lois J. Starr

Child Health Research Institute Pediatric Research Forum

hnRNP-U deficiency is caused by pathogenic variants in HNRNPU, which encodes the heterogeneous nuclear ribonucleoprotein U (HNRNPU), a highly conserved protein responsible for assisting spliceosomes in mediating transcription and alternative splicing activity. HnRNPs are responsible for the regulation of translation at the presynaptic sites as well as the transportation of stabilized mRNAs along the axonal cytoskeleton. Here, we report a 2-year-old-male with a HNRNPU variant with a new presentation of apparent recurrent apneic spells with an underlying epileptic origin. These were described as apnea followed by desaturation and tachycardia in the 180's-200 range prior to resolution of symptoms. He also …

Relationship Between Mir-335 And Sterol Levels After In Vitro Hypoxia-Ischemia Of Primary Brain Cells, Namood-E Sahar, Zeljka Korade, Eric Peeples

Child Health Research Institute Pediatric Research Forum

Background/Purpose: Cholesterol homeostasis is vital for synaptogenesis and myelination during fetal and neonatal brain development. Both brain and plasma sterol levels have been shown to be associated with outcomes in adult stroke, and animal studies have suggested brain and plasma sterol changes in neonatal hypoxic-ischemic brain injury. MicroRNA-335 (miR-335) has been associated with brain sterol metabolism and our preliminary data showed that sterol metabolism is dysregulated in the brain after hypoxic-ischemic injury in a mouse model. This study sought to describe the effect of oxygen-glucose deprivation in vitro on individual brain cell populations and to validate the associations between sterol …

Postnatal Diagnosis Of Dandy Walker Malformation With Encephalocele, Heerali Patel

Child Health Research Institute Pediatric Research Forum

Encephalocele is a defect of the neural tube. Dandy Walker malformation (DWM) is a defect involving agenesis or hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and enlargement of the posterior fossa. This is a case of a female preterm infant born at 36 weeks’ gestation who presented with DWM and an encapsulated occipital encephalocele at birth. The pregnancy was complicated by poorly controlled maternal diabetes. Prenatal ultrasound indicated a central nervous system anomaly. Amniocentesis did not show chromosomal abnormality. The infant also presented with polydactyly of the right thumb. MRI showed evidence of soft tissue within …

3d Printed Adjustable Glasses: A New Model Of Corrective Lens Delivery For Pediatric Refractive Error In Underserved Communities, Nathan Ostlie, Mari Ogino, Donny Suh, Gabe Linke, James Hermsen

Child Health Research Institute Pediatric Research Forum

Purpose:

Uncorrected refractive error (URE) remains a major cause of preventable vision impairment in the pediatric population with large inequities in disease burden. The present study aims to elucidate the global burden of pediatric URE and explore the current lens delivery systems which address this problem. Within this framework, we introduce a new model of corrective lens delivery that may improve upon existing models.

Methods:

The present study involved an extensive literature review of epidemiological data to determine the global prevalence of URE. Prevalence data was then compared against WHO data on refractionist coverage gaps divided by region. …

Food Protein Induced Enterocolitis Syndrome Triggers At Children’S Hospital, Rachel Nelson, Russell Hopp

Child Health Research Institute Pediatric Research Forum

Background

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food disease characterized by delayed vomiting and diarrhea, often at the first ingestion of the food. The clinical phenotype of FPIES, including trigger food and disease course, varies by region. A literature review of the most common FPIES foods in children in the United States and worldwide includes cow’s milk, soy, oats, rice, and egg.

Objective:

We sought to survey the most common FPIES foods seen at Children’s hospital in the past five years.

Methods:

A data search of the EPIC electronic medical record using FPIES codes ICD-10 (K52.21) and ICD-9 …

Perceptions Of Pediatricians On The Sars-Cov2 Vaccine, Karl Khandalavala, Kari Simonsen, Jeffrey A. Robinson

Child Health Research Institute Pediatric Research Forum

Introduction: The novel SARs-CoV2 coronavirus has infected approximately 30,000,000 people in the USA. To date, approximately 146 million doses of SARs-CoV2 vaccines have been administered. Perceptions of rapid vaccine development have resulted in reported vaccine hesitancy and refusal. Though not currently FDA approved for use in pediatric populations, but pediatric vaccination may contribute to herd immunity. Previous study demonstrates that physician recommendations significantly impact perceptions of routine pediatric immunizations among parents. Given this historical data, this study aimed to describe the strength of recommendation by pediatricians for the SARs-CoV2 vaccine for pediatric patients and their parents.

Methods: A …

To Addend Or Not To Addend? Exploring Pediatric Residents' Perceptions Of Using Medical Students’ Notes For Documentation, A Mixed Methods Approach, Shannon Haines, Kari Nelson, Kaeli Samson, Nathan Gollehon

Child Health Research Institute Pediatric Research Forum

Background

Clinical documentation is an essential skill for practicing physicians, yet many medical students are not prepared for documentation required during residency.^1,2 CMS rule changes now allow medical students’ notes to be used for billing.³ Residents are often the primary authors of notes and provide medical student supervision and instruction. However, little is known about how the use of medical student notes in patient documentation would impact residents. We utilized Constructivist Learning Theory to frame our work, where students construct their knowledge as residents and subsequently faculty facilitate the process.⁴

Objectives

To evaluate how utilizing clerkship medical …

Unsolicited Advice, Kara Arnold

Child Health Research Institute Pediatric Research Forum

This piece was written with the phrases that have been said to me or to other female colleagues throughout my year of clinical rotations. Although women in medicine have come a long way, I want this to illustrate the pain that is still inflicted towards female professionals through words like these.

Life As Medical Student On Rotation, Amanda Goodwin

Child Health Research Institute Pediatric Research Forum

A reflection of the stress and wonder surrounding M3 year