Medicine and Health Sciences Commons^™

Next Generation Of Translational Long-Acting Cabotegravir, Tian Zhou

Theses & Dissertations

Recent development of long-acting antiretroviral therapeutic regimens has opened a new chapter for HIV/AIDS management. Cabotegravir (CAB), as one of the very first long-acting antiretroviral regimens, has drawn tremendous attention. However, the remaining challenges include suboptimal dosing intervals, large injection volume, injection site reactions, lack of tissue penetration, etc. As one of the pioneers in this field, our lab was successful in harnessing mononuclear phagocytes as “Trojan horses” for antiretroviral drug delivery and transportation to viral reservoirs. We proposed this targeted delivery strategy could address the limitations of current CAB formulation. To this end, we developed folic acid decorated CAB …

Validation Of A Revised Food Frequency Questionnaire In A Population Of Elderly Men And Women With Fragility Fractures And Correlation With Bone Mineral Density And Biochemical Markers, Laura Graeff-Armas

Theses & Dissertations

Assessing food intake is important to estimate nutrient intake and counsel patients regarding their diet patterns and supplement use. The purpose of this study was to revise a validated Block Calcium/Vitamin D Screener to include protein for use in elderly patients with a history of fragility fracture. The Block Calcium/Vitamin D Screener food list was refined by adding protein foods and culling the calcium and vitamin D food items based on 2003-2006 NHANES survey. A nutrient database for the revised FFQ was developed from the United States Department of Agriculture Agricultural Research Service National Nutrient Database. Validation of the revised …

Use Of The Simplified Diet Method To Improve Metabolic Control Among Teens And Adults With Phenylketonuria: A Mixed Methods Approach, Jill Skrabal

Theses & Dissertations

Phenylalanine hydroxylase (PAH) deficiency, commonly known as phenylketonuria (PKU), is an inborn error of metabolism that causes the accumulation of phenylalanine and results in intellectual disability if left untreated. The primary treatment for PKU is a lifelong diet that selectively restricts phenylalanine intake and is aimed at keeping blood phenylalanine in the therapeutic range of 120-360 μmol/L. Qualitative research in PKU is limited, but research has stressed the challenges individuals face in following a diet so different than their peers Previous attempts in Europe and Australia have been successful in allowing free use of certain fruits and vegetables, as well …

Effects Of Two High-Frequency Physical Therapy Programs On Balance, Gait, Fatigue, And Quality Of Life In People With Multiple Sclerosis, Min Liu

Theses & Dissertations

Multiple sclerosis (MS) is an inflammatory disease involving the inflammation and demyelination in both brain and spinal cord. MS typically affects people in early adulthood in the range of 20-40 years old, and most patients with MS experience symptoms on a daily basis, such as walking difficulties, balance impairment, and fatigue, which can be disabling and impact the Quality of Life (QOL).

The main purpose of this investigation is to determine if our novel, adaptive, high-frequency physical therapy protocol, compared with the conventional therapeutic exercise protocol, has the potential to improve participants’ dynamic balance, gait, fatigue, and overall QOL based …

Selective Generation Of Dopaminergic Precursors From Human Fibroblasts By Direct Lineage Conversion, Miao He

Theses & Dissertations

Transplantation of dopaminergic precursors (DPs) is a promising therapeutic strategy of Parkinson’s disease (PD). However, limited cell source for dopaminergic precursors has become a major obstacle for transplantation therapy. In the first part of the study, we demonstrated that Foxa2 is superior to Lmx1a in inducing dopaminergic neuronal differentiation from induced neural progenitor cells (iNPCs). Based on the results above and some other published results, our group demonstrated that mouse fibroblasts can be reprogrammed into induced dopaminergic precursors (iDPs) through ectopic expression of transcription factors Brn2, Sox2 and Foxa2(1). In the current study, we hypothesized that similar strategy …

The Impact Of Rural-Urban Residency On Colorectal Cancer Screening, Stage At Diagnosis And Treatment In The Privately Insured Population, Mesnad Alyabsi

Theses & Dissertations

Colorectal Cancer (CRC) is the third most common and leading cause of cancer death in the United States. Although CRC screening can prevent and detect CRC at an early stage, about 35% of Americans are not screened. Despite the recent increase in screening, people with lower SES and those who live in rural areas have lowest screening. In rural areas, a common obstacle for screening is the long trips for health services which is associated with advanced CRC.

Moreover, surgery is a substantial part of CRC treatment since stages I-III and some metastatic CRC (mCRC) patients are treated with surgery. …

The Effect Of Dust Mite Extract On Esophageal Tight Junctions In Eosinophilic Esophagitis, Kyle Hinz

Theses & Dissertations

Eosinophilic Esophagitis (EE) is a chronic inflammatory disease that effects individuals of all ages. EE is mediated by an allergen response, causing the release of thymic stromal lymphopoietin (TSLP), and subsequent inflammation and eosinophil migration and infiltration of the esophagus through the activation of the JAK/STAT pathway and CD4+ T-cells. EE has typically been associated with food allergies, but studies have shown that aeroallergens can cause EE as well. Current treatments of EE have primarily focused on nonspecific methods, though anti-TSLP is beginning to be tested as a possible treatment for EE. The aim of this study was to see …

The Survival And Treatment Refusal Of Lung Cancer Patients: Analyses Of National Cancer Registries, Poppy Deviany

Theses & Dissertations

Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer mortality of both genders in the United States. A recent report suggests that the relative five-year survival rate of lung cancer is only 18%. Studies indicate many factors are associated with the survival of lung cancer patients, including age at diagnosis. It is widely known as a disease of older people, but the literature shows a substantial number of young people have been diagnosed with lung cancer. The literature also indicates that the refusal of recommended treatment contributes to cancer-related death and poorer survival. The …

Functional Signature Ontology-Based Identification And Validation Of Novel Therapeutic Targets And Natural Products For The Treatment Of Cancer, Beth Neilsen

Theses & Dissertations

Multiple studies have revealed that Ras-driven tumors acquire vulnerabilities by adapting cellular mechanisms that promote uncontrolled proliferation and suppress apoptosis. Kinase Suppressor of Ras 1 (KSR1) modulates ERK activation downstream of oncogenic Ras, and knockdown of KSR1 selectively kills malignant, Ras-driven cancer cells, but does not kill immortalized, non-transformed human colon epithelial cells (HCECs). KSR1^-/- mice are fertile and phenotypically normal, but resistant to Ras-driven tumor formation suggesting KSR1 represents a vulnerability in cancer cells.

To identify additional vulnerabilities in cancer, a screening approach termed Functional Signature Ontology (FUSION) was used to screen 14,355 genes and 1,200 natural product …

Elucidation Of The Functions Of Neuropilin 2 In Osteoclasts In Promoting Prostate Cancer Bone Metastasis., Navatha S. Polavaram

Theses & Dissertations

Bone metastasis is one of the major clinical concerns that causes skeletal related malignancies and increased mortality. Bone is one of the preferred sites for metastatic prostate cancer. The metastatic prostate cancer cells interact with bone cells (osteoblasts and osteoclasts) resulting in an imbalance in the bone homeostasis leading to increased activation of osteoblasts over osteoclasts. Our preliminary data indicated a non-tyrosine kinase receptor Neuropilin 2 (NRP2) is expressed in osteoclasts induced by metastatic prostate cancer cells and acts as a negative regulator of osteoclast differentiation and function. We hypothesize that prostate cancer -induced NRP2 expression in osteoclasts is necessary …

Pandemic Planning: Estimating Disease Burden Of Pandemic Influenza To Guide Preparedness Planning Decisions For Nebraska Medicine, Angelia Wimberly

Theses & Dissertations

This year marks the 100^th anniversary of the 1918 “Spanish Flu” outbreak that killed 50-100 million people worldwide. If a pandemic of this proportion happened today, the federal pandemic influenza plan predicts that 30 percent of the population could become infected with up to 50 percent seeking outpatient care. With Nebraska Medicine currently operating at nearly full capacity (95-97%), surge capacity for hospital space, staff, and supplies would be in severe demand and would quickly overwhelm the organization. To assess the impact of pandemic influenza in Douglas County Nebraska and Nebraska Medicine, pandemic modeling tool FluAid and FluSurge 2.0 …

The Beta-Catenin/Muc1.Ct Interaction In Pancreatic Cancer, Edwin Wiest

Theses & Dissertations

MUC1 is overexpressed in over 90% of pancreatic cancer cases, and its interaction with beta-catenin promotes progression of the disease. Various in vitro and in vivo methods show that beta-catenin and MUC1 interact by way of the cytoplasmic tail of MUC1 (MUC1.CT). This interaction occurs in the membrane of pancreatic cancer cells but is found to a smaller extent in the nucleus as well. Biophysical methods suggest that MUC1 interacts with beta-catenin through a sequence of amino acids in the tail of MUC1 that sit very near the transmembrane domain of MUC1. In pancreatic ductal adenocarcinoma cells, it appears that …

Healthcare Utilization For Behavioral Health Disorders: Policy Implications On Nationwide Readmissions, And Outcomes In The States Of Nebraska And New York, Rajvi J. Wani

Theses & Dissertations

The main goal of this dissertation was to estimate national-level inpatient readmissions and state-level hospital-based emergency department (ED) visits with behavioral health (BH) conditions in the states of Nebraska and New York. The dissertation aims to assess the impact of the policy mandates under the Patient Protection and Affordable Care Act on these state and national estimates. The Nationwide Readmissions Database and the State Emergency Department databases maintained by the Healthcare Cost and Utilization Project were used for this dissertation. US Adult population with high-risk of readmissions in the inpatient departments for alcohol-related disorders (ARD) and of visiting ED for …

Alcohol Drives Oxidation-Dependent Desensitization Of Airway Cilia Motility Responsiveness, Michael Price

Theses & Dissertations

Alcohol abuse, which can impair clearance of pathogens and debris from the airway, is associated with an increase in complications and a higher mortality rate during the progression of pneumonia. With prolonged alcohol exposure, mucociliary clearance (MCC), which depends on the coordinated beating of cilia, is dysfunctional. Effective MCC relies on cAMP-dependent protein kinase (PKA) activation of ciliary beat frequency (CBF). PKA activation and stimulation of CBF are blunted with chronic exposure to alcohol. This phenomenon is known as alcohol-induced ciliary dysfunction (AICD). Previous studies have shown that concomitant feeding of mice with alcohol and antioxidants prevents AICD, suggesting a …

A Study Of Acoustically Activated Nanodroplets, Songita Choudhury

Theses & Dissertations

Current treatment of acute myocardial infarction (AMI), which is the main pathophysiological event leading to death in the United States, has advanced considerably with the introduction of emergent percutaneous interventions, but there remains an urgent need for novel techniques to rapidly and accurately detect infarcted or ischemic tissue that results from AMI. Ultrasound contrast agents, also known as microbubbles (MB), have become commonplace in echocardiography. However, MBs are purely intravascular tracers and unable to cross endothelial barriers due to size. The limitations of MBs, namely size and short circulation times within the human body, led to the development of phase-change …

The Effect Of Treatment Delay, Non-Adherence To Treatment Guidelines, And Never-Smoking Status On The Survival Of Lung Cancer Patients, Trisari Anggondowati

Theses & Dissertations

Despite many significant medical advances, lung cancer continues to cause more deaths than any of the other cancers in the United States (US), and worldwide. Timeliness of care and evidence-based guidelines are among the components of quality of care that are expected to improve patient outcomes. However, evidence on the effect of timeliness of care and adoption of evidence-based guidelines on patient survival remains lacking. In addition, there has been increasing concern on the fact that smokers are not the only group that suffers from lung cancer. Never-smokers comprise at least 10% of lung cancer patients in the US, or …

Microrna Expression And Disease Correlation In A Hispanic Lupus Cohort, Thandiwe Jere

Theses & Dissertations

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with varying clinical presentation and severity in different ethnicities/races. Micro-RNAs (miRNAs) modulate the immune system, and there is a growing interest in their role in SLE pathogenesis and disease presentation. Studies on miRNAs expression in SLE have been done in Caucasians and Asians but no comprehensive profiling has been done in Hispanics. This cross-sectional study of a Hispanic cohort of SLE patients (n =185) and healthy controls (HC) (n =185) from the Dominican Republic determined the expression of 10 selected miRNAs and their correlation to inflammatory markers and auto-antibody production in …

Muc4 Based Immunotherapy For Pancreatic Cancer, Kasturi Banerjee

Theses & Dissertations

Pancreatic Cancer (PC) is a lethal disease claiming approximately 45000 lives in the US in 2018, and it establishes an elaborate immunosuppressive tumor microenvironment that aids in disease pathogenesis. Immunotherapy has emerged as a strategy to target tumor cells by reprogramming patient’s immune system. Challenges present in PC immunotherapy are: i) identifying a tumor-associated antigen that could be targeted, ii) identifying adjuvants that could efficiently deliver antigens, iii) eliciting robust anti-tumor responses and iv) overcoming peripheral tolerance and immunosuppression elicited by the tumor.

Firstly, we detected circulating autoantibodies to MUC4 present in PC patients and observed that IgM autoantibodies to …

Transvaginal Cervical Length Surveillance Frequency And The Management Of Spontaneous Preterm Delivery In Twin Gestations, Ashley Janssen

Capstone Experience: Master of Public Health

Strategies to prevent preterm birth in multifetal gestation remain a high-priority in the United States. In women with a history of spontaneous preterm birth (sPTB) and singleton gestation, transvaginal cervical length (TVCL) surveillance and subsequent treatment is associated with a reduction in spontaneous preterm birth, however, there is limited data on the role of TVCL surveillance in twin gestation. The goal of this study is to determine if an association exists between TVCL and spontaneous preterm birth in twin gestations. Additionally, our research will assess whether TVCL surveillance impacts the timing of antenatal corticosteroids (ACS), magnesium sulfate administration, and maternal …

Massage Therapy Intervention For Pediatric Palliative Care Patients And Their Families, Taelyr Weekly

Capstone Experience: Master of Public Health

This study examined the feasibility and acceptability of a massage therapy intervention for pediatric palliative care patients and their adult caregivers to reduce their symptom impact at an urban pediatric hospital in Omaha, NE. Potential symptoms to be impacted by massage included stress for caregivers and pain, nausea, dyspnea, and anxiety for children. One hundred and thirty five massages were delivered to patients and caregivers in the PICU, NICU, and the inpatient hospital floor during the course of this non-randomized, pre-post study. Validated instruments were used to collect objective data from patients and caregivers, while observations were used to record …

A Strategic Approach To Employee Retention At Nebraska Families Collaborative, Rachel Walters

Capstone Experience: Master of Public Health

Nebraska Families Collaborative (NFC) is a nonprofit organization that supports children and families who are at risk, in eastern Nebraska. They offer a variety of services with the goal of moving children toward safety, permanency and well-being. Organizations such as NFC rely heavily on the commitment of the employees to carry out their mission, as do many other non-profit social service agencies across the country. The overall goal of the project was to identify reasons for high turnover and to identify potential solutions to reduce turnover and increase retention in the workplace at NFC. The main objectives were to analyze …

Quality Improvement: Assessing The Gaps In Education And Training Among Staff At Health, Education, And Law Project Hospital Sites In Nebraska, Michael Sauter

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project. The goal of this quality improvement study was to enhance the effectiveness of future Health, Education, and Law Project (HELP) training sessions for staff members of HELP sites in Nebraska. Through the use of an online survey tool, we received staff members’ input on the current training program, assessed their knowledge on relevant topics, and gave respondents an opportunity to include any appropriate suggestions. By means of this study, we were able to conclude that although staff members seemed to appreciate the training sessions overall, …

Macra Legislation (Medicare Access And Chip Reauthorization Act) And The Quality Provider Payment Program: Policy Analysis And Educational Program Evaluation, Katie Joseph-Johnson

Capstone Experience: Master of Public Health

ABSTRACT

Goal: The goal of this Service Learning/Capstone Experience is to provide an in-depth policy analysis and interpretation of the 2018 proposed changes in the Quality Payment Plan (QPP) as part of the 2015 MACRA legislation for the purpose of developing organizational training material.

Objectives: The key objectives of this project are 1) to complete a policy review of the current and proposed Quality Payment Program legislation from the Centers for Medicare and Medicaid Services (CMS), including June 2017 proposed updates and the November 2017 final rule updates; 2) to gain physician and hospital administrator’s perspective on realized …

Examining The Benefits And Client Satisfaction Of The Open Arms Of Minnesota Meal Service Program, Carlie Rhinehart

Capstone Experience: Master of Public Health

Chronic disease can leave individuals incapable of caring for themselves, leading to a low quality of life. Public health researchers have proven how crucial medically tailored meals are to those fighting such chronic diseases. Open Arms is a local nonprofit that started in 1986. They make and deliver meals, free of charge, to people with life-threatening illnesses.

The goal of this study is to examine the benefits of the meal services provided by Open Arms of Minnesota to clients who are chronically ill. To learn about the benefits, analysis was conducted on the client satisfaction survey data collected. The anonymous …

Hipaa Compliant Patient-Provider Communication: Student-Clinician Perceptions, Rachel Wenzl

Capstone Experience: Master of Public Health

Purpose: To evaluate the service learning clinical training facility’s HIPAA training by assessing student-clinician knowledge of the clinic’s HIPAA Compliance Plan and the impact of its training on student-clinician perceptions toward HIPAA-compliant patient-provider communication (PPC). For example, do student-clinicians feel it is important to be HIPAA-compliant and are they confident in discussing health-related activities and programs with patients or caregivers? The purpose of this project is not, at this time, to measure student-clinician intention to perform the behavior.

Methods: This project employed a mixed-methods, non-experimental cross-sectional study design using a retrospective post-test survey and group interview. The survey …

Mental Health Provider Perceptions On The Implementation Of Behavioral Health Interventions To Increase Access To Mental Health Care Services In Rural Nebraska, Grant Brueggemann

Capstone Experience: Master of Public Health

Abstract

Rural Nebraska communities are influenced by socioeconomic conditions and lack health care resources which contributes to the prevalence of mental health. As such, there is a need to implement effective intervention programs and evaluate current programs to reduce morbidity and mortality associated with mental health.

Goals: To assess the perceptions of mental health practitioners regarding public health programs and support services. This project also intends to gauge the effectiveness and viability of specific programs as potential solutions for increasing access and use of rural mental health care services. Furthermore, this project aims to inquire perceptions about the role …

Winnebago County Dryhootch Outreach Program, Greg Brittnacher

Capstone Experience: Master of Public Health

Abstract

Winnebago County Veterans Dryhootch Outreach Program

Aims: The Dryhootch Outreach Program focused on increasing behavioral activation through social interaction in a population of military veterans with Post Traumatic Stress Disorder (PTSD). The goals of the intervention were to reduce the prevalence of anxiety, depression, and PTSD symptoms. Additionally, the project aims to assist veterans to develop and maintain healthy relationships, assimilate with the “civilian” community, and effectively contribute to society.

Methods: Twenty-seven veterans with PTSD attended the twelve-week Dryhootch Outreach program provided by the Winnebago County Veterans Service office and partnering organizations. A pre-post interventional study format was utilized …

Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff

Capstone Experience: Master of Public Health

The goal of this Capstone Project is to better define and geographically locate the potential distribution of individuals who fall within the current Medicaid Coverage Gap and those populations who would be eligible for Medicaid under the expansion of Medicaid within the state of Nebraska. Using data from multiple United States Census Bureau sources, along with available data from the Health Resources and Services Administration (HRSA), this project looks to also locate populations of these individuals that may live within established Medically Underserved Areas (MUA's) or Health Professional Shortage Areas (HPSA's) within the state. American Community Survey 5-year Public Use …

Piloting An Observation Tool For The Garden To Table Program To Assess Education Of Underserved Youth In Omaha, Nebraska, Anthony Gargano

Capstone Experience: Master of Public Health

The Big Garden is a private 501-c3 organization, which utilizes multiple programs to grow healthy food, healthy kids, and healthy communities. The “Garden to Table” program helps students learn how to grow vegetables and herbs in their school garden as well as how to properly harvest, cook, and preserve these crops through various methods. This program specifically highlights STEAM education through plant science and organic gardening techniques, nutrition, and healthy lifestyles. In 2017, the “Garden to Table” program was taught after school at 5 middle schools in Omaha Public Schools: Marrs, McMillan, Monroe, Lewis and Clark, and King Science Center. …

Nebraska Wic Client Survey & Study Of Preterm Birth, Caleb Unekwu Adejoh

Capstone Experience: Master of Public Health

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides supplemental foods, health care referrals, and nutrition education to low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children. Preterm birth remains the second leading cause of infant mortality following birth defects but there is a dearth of research on characteristics of WIC clients who are at risk of preterm birth. Objectives: The objective of the service learning was to design paper and online client satisfaction survey forms in English and Spanish for use by the Nebraska WIC program. The objective of …