Medicine and Health Sciences Commons^™

Determinants Of Facilitated Health Insurance Enrollment For Patients With Hiv Disease, And Impact Of Insurance Enrollment On Targeted Health Outcomes., Renae Furl, Shinobu Watanabe-Galloway, Elizabeth Lyden, Susan Swindells

Journal Articles: Infectious Diseases

BACKGROUND: The introduction of the Affordable Care Act (ACA) has provided unprecedented opportunities for uninsured people with HIV infection to access health insurance, and to examine the impact of this change in access. AIDS Drug Assistance Programs (ADAPs) have been directed to pursue uninsured individuals to enroll in the ACA as both a cost-saving strategy and to increase patient access to care. We evaluated the impact of ADAP-facilitated health insurance enrollment on health outcomes, and demographic and clinical factors that influenced whether or not eligible patients enrolled.

METHODS: During the inaugural open enrollment period for the ACA, 284 Nebraska ADAP …

Midwest Pharmacists' Familiarity, Experience, And Willingness To Provide Pre-Exposure Prophylaxis (Prep) For Hiv, Jordan M. Broekhuis, Kimberly K. Scarsi, Harlan R. Sayles, Donald G. Klepser, Joshua P. Havens, Susan Swindells, Sara H. Bares

Journal Articles: Internal Medicine

INTRODUCTION: Pharmacist provision of pre-exposure prophylaxis (PrEP) through collaborative practice agreements with physicians could expand access to people at risk for HIV. We characterized pharmacists' familiarity with and willingness to provide PrEP services in Nebraska and Iowa.

METHODS: An invitation to complete an 18-question survey was emailed to 1,140 pharmacists in Nebraska and Iowa in June and July of 2016. Descriptive analyses and Pearson chi-square tests were used to determine to what extent demographics, familiarity and experience were associated with respondent willingness to provide PrEP. Wilcoxon rank-sum tests compared ages and years of experience between groups of respondents.

RESULTS: One …

Common Diagnoses Among Refugee Populations: Linked Results With Statewide Hospital Discharge Database, Kerui Xu, Shinobu Watanabe-Galloway, Ming Qu, Brandon Grimm, Jungyoon Kim

Journal Articles: Epidemiology

BACKGROUND: According to the U.S. State Department's Refugee Processing Center and the U.S. Census Bureau, in the fiscal year 2016, among all states in the United States, Nebraska resettled the highest number of refugees per capita.

OBJECTIVES: The objectives of this study were to determine the most common reasons for refugees utilizing hospital services in Nebraska between January 2011 and September 2015, and to examine whether refugee patients had increased risks for adverse health conditions compared to non-refugee patients.

METHODS: Statewide linkage was performed between Nebraska Medicaid Program's immigration data, and 2011-2015 Nebraska hospital discharge data inpatient and outpatient files. …

A Needs Assessment For Simulation-Based Training Of Emergency Medical Providers In Nebraska, Usa, Nizar K. Wehbi, Rajvi Wani, Yangyuna Yang, Fernando A. Wilson, Sharon J. Medcalf, Brian Monaghan, Jennifer Adams, Paul Paulman

Journal Articles: Epidemiology

Background: Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program.

Methods: The needs assessment used a three-step process: (1) four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants' perceived training gaps; (2) based on the findings from the focus group, a …

Atrioventricular Junctional Tachycardia With Exit Block In An Adolescent, Nicholas M. Cundiff, Jeffrey A. Robinson, Bryan C. Cannon, Christopher S. Snyder

Journal Articles: Pediatrics

No abstract provided.

Depressed Left And Right Ventricular Cardiac Output In Fetuses Of Diabetic Mothers, Jennifer Winter, Aparna Kulkarni, Mary Craft, Ling Li, Lisa K. Hornberger, David A. Danford, Shelby Kutty

Journal Articles: Pediatrics

INTRODUCTION: We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) to a large normal cohort.

METHODS: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters: semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD), stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO calculated. These were normalized using nonlinear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z-scores and 95% confidence limits (CL) were calculated, and compared to zero.

RESULTS: LVCO, RVCO, and parameters they were calculated from, …

Selective Infarct Zone Imaging With Intravenous Acoustically Activated Droplets, Songita A. Choudhury, Feng Xie, Shelby Kutty, John Lof, Elizabeth Stolze, Thomas R. Porter

Journal Articles: Pediatrics

BACKGROUND: Microbubbles (MB) can be compressed to nanometer-sized droplets and reactivated with diagnostic ultrasound; these reactivated MB possess unique imaging characteristics.

OBJECTIVE: We hypothesized that droplets formed from compressing Definity MB may be used for infarct-enhancement imaging.

METHODS: Fourteen rats underwent ligation of their left anterior descending (LAD) artery, and five pigs underwent 90 minute balloon occlusions of their mid LAD. At 48 hours in rats, transthoracic ultrasound was performed at two and four minutes following 200 μL intravenous injections (IVI) of Definity droplets (DD), at which point the MI was increased from 0.5 to 1.5 to assess for a …

Atrioventricular Junctional Tachycardia With Exit Block In An Adolescent, Nicholas M. Cundiff, Jeffrey A. Robinson, Bryan C. Cannon, Christopher S. Snyder

Journal Articles: Pediatrics

No abstract provided.

Ecg Findings In Pediatric Patients Under The Influence Of Marijuana, Jeffrey A. Robinson, Sahana Somasegar, Jill K. Shivapour, Christopher S. Snyder

Journal Articles: Pediatrics

Background: The effects of marijuana on the cardiac conduction system are ill defined. The purpose of this study is to describe the association between electrocardiogram (ECG) findings and positive urine drug screening (+UDS) for marijuana in the pediatric population. Methods: A retrospective review was conducted through the electronic medical record from Emergency Department (ED) visits dated 10/13- 11/14 of patients ≤ 18 years of age who tested positive for marijuana exposure by +UDS in the ED. Inclusion criteria included: 1) +UDS for marijuana performed in the ED and 2) electrocardiogram (ECG) performed on same day as +UDS. Each ECG was …

A Pharmacist-Led Medication Switch Protocol In An Academic Hiv Clinic: Patient Knowledge And Satisfaction, Sarah S. Lee, Joshua P. Havens, Harlan R. Sayles, Jennifer L. O'Neill, Anthony T. Podany, Susan Swindells, Kimberly K. Scarsi, Sara H. Bares

Journal Articles: Infectious Diseases

BACKGROUND: Tenofovir alafenamide (TAF) is associated with less renal and bone toxicity compared with tenofovir disoproxil (TDF). TAF's recent FDA approval has spurred HIV providers to consider switching antiretroviral therapy (ART) regimens containing TDF to TAF to minimize long term risks. Patient views on the process of such medication switches have not been explored.

METHODS: Patients taking elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF) following the Food and Drug Administration's (FDA) approval of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) received medication education from an HIV pharmacist prior to switching to the tenofovir alafenamide (TAF) formulation. Patients were asked to complete a cross-sectional survey assessing satisfaction with …

Mir-133a Mimic Alleviates T1dm-Induced Systolic Dysfunction In Akita: An Mri-Based Study, Shyam S. Nandi, Hamid R. Shahshahan, Quanliang Shang, Shelby Kutty, Michael D. Boska, Paras K. Mishra

Journal Articles: Pediatrics

Diabetic cardiomyopathy is a leading cause of heart failure. Developing a novel therapeutic strategy for diabetic cardiomyopathy and characterizing animal models used for diabetes mellitus (DM) are important. Insulin 2 mutant (Ins2^+/-) Akita is a spontaneous, genetic, mouse model for T1DM, which is relevant to humans. There are contrasting reports on systolic dysfunction and pathological remodeling (hypertrophy and fibrosis) in Akita heart. Here, we used magnetic resonance imaging (MRI) approach, a gold standard reference for evaluating cardiac function, to measure ejection fraction (indicator of systolic dysfunction) in Akita. Moreover, we performed Wheat Germ Agglutinin (WGA) and hematoxylin and …

Pancreatic Cancer Associated With Obesity And Diabetes: An Alternative Approach For Its Targeting, Ramesh Pothuraju, Satyanarayana Rachagani, Wade M. Junker, Sanjib Chaudhary, Saraswathi Viswanathan, Sukhwinder Kaur, Surinder K. Batra

Journal Articles: Biochemistry & Molecular Biology

BACKGROUND: Pancreatic cancer (PC) is among foremost causes of cancer related deaths worldwide due to generic symptoms, lack of effective screening strategies and resistance to chemo- and radiotherapies. The risk factors associated with PC include several metabolic disorders such as obesity, insulin resistance and type 2 diabetes mellitus (T2DM). Studies have shown that obesity and T2DM are associated with PC pathogenesis; however, their role in PC initiation and development remains obscure.

MAIN BODY: Several biochemical and physiological factors associated with obesity and/or T2DM including adipokines, inflammatory mediators, and altered microbiome are involved in PC progression and metastasis albeit by different …

Implementation And Evaluation Of Guillain-Barré Syndrome Surveillance In Puerto Rico During The 2016 Zika Virus Epidemic, Chelsea G. Major, Emilio Dirlikov, Nicole A. Medina, Roberta Lugo-Robles, Desiree Matos, Jorge Muñoz-Jordán, Candimar Colón-Sánchez, Myriam García-Negrón, Marangely Olivero-Segarra, Graciela Malavé-González, Dana L. Thomas, Carlos A. Luciano, Stephen H. Waterman, James Sejvar, Tyler M. Sharp, Brenda Rivera-García

Journal Articles: Epidemiology

OBJECTIVE: Guillain-Barré syndrome (GBS) is an uncommon autoimmune disorder that follows infection or vaccination, and increased incidence has been reported during Zika virus (ZIKV) transmission. During the 2016 ZIKV epidemic, the Puerto Rico Department of Health (PRDH) implemented the Enhanced GBS Surveillance System (EGBSSS). Here, we describe EGBSSS implementation and evaluate completeness, validity, and timeliness.

METHODS: GBS cases were identified using passive surveillance and discharge diagnostic code for GBS. Completeness was evaluated by capture-recapture methods. Sensitivity and positive predictive value (PPV) for confirmed GBS cases were calculated for both case identification methods. Median time to completion of key time steps …

Schistosoma Mansoni And Other Intestinal Parasitic Infections In Schoolchildren And Vervet Monkeys In Lake Ziway Area, Ethiopia, Dejene Teklemariam, Mengistu Legesse, Abraham Degarege, Song Liang, Berhanu Erko

Journal Articles: Epidemiology

OBJECTIVE: To assess Schistosoma mansoni and other intestinal parasitic infections in schoolchildren and vervet monkeys (Chlorocebus aethiops) in Bochessa Village, Ziway, Ethiopia.

RESULTS: Fecal specimens from selected schoolchildren and droppings of the vervet monkeys were collected and microscopically examined for intestinal parasites using the Kato-Katz thick smear and formol-ether concentration techniques. The prevalences of S. mansoni, Trichuris trichiura, Ascaris lumbricoides, Enterobius vermicularis, hookworms, Hymenolepis nana and Taenia species among the children were 35.7, 26.9, 24.1, 2.1, 2.1, 1.07 and 2.1%, respectively (by Kato-Katz) and 39.3, 36.1, 35.6, 2.9, 10.0, 4.3, and 2.9%, respectively (by formol-ether concentration). Prevalence of S. mansoni …

The Role Of Yes-Associated Protein 1 In Ovarian Physiology And Pathology, Xiangmin Lv

Theses & Dissertations

Ovarian granulosa cells are the major somatic components of the ovarian follicle. Proper proliferation and differentiation of ovarian granulosa cells are essential for successful follicle development. Accumulating evidence indicates that the Hippo-YAP signaling pathway plays critical roles in both development and tumorigenesis of several organs. The present study aims to investigate the role of Yes-associated protein 1 (YAP) in ovarian granulosa cell proliferation, differentiation, and malignant transformation. At first, we found that nuclear YAP (active) was highly expressed in proliferative granulosa cells, whereas cytoplasmic YAP (inactive) was detected mainly in terminally-differentiated luteal cells. Further studies suggested that endogenous YAP activity …

Novel Therapeutic Approaches For Juvenile Neuronal Ceroid Lipofuscinosis (Cln3), Megan Elizabeth Bosch

Theses & Dissertations

Juvenile Neuronal Ceroid Lipofuscinosis (JNCL) is a lysosomal storage disease caused by autosomal recessive mutations in CLN3. Neuronal loss is thought to occur via glutamate excitotoxicity; however, little is known about neuron-astrocyte glutamate regulation in JNCL. We discovered that Cln3^Δex7/8 astrocytes have significantly lower basal spontaneous Ca²⁺ oscillations and decreased responses to glutamate, indicating a disrupted signaling network. Cln3^Δex7/8 astrocytes also displayed significantly lower basal mitochondrial respiration and ATP production, suggesting impaired metabolic functions. Concurrent with diminished astrocyte metabolism and Ca²⁺ signaling, Cln3^Δex7/8 neurons were hyper-responsive to glutamate stimulation. These studies suggest that CLN3 …

Evaluation Of Immune-Modulating Therapies For Parkinson's Disease, Katherine E. Olson

Theses & Dissertations

Parkinson’s disease (PD) is the second most common neurodegenerative

disorder, second only to Alzheimer’s disease (AD). It is characterized by a

progressive loss of dopaminergic neurons along the nigrostriatal axis and the

formation of proteinaceous inclusions of alpha-synuclein (α-syn). Secondary to

the loss of dopaminergic neurons is a progression in motor and non-motor

symptoms. Motor symptoms are characterized by slowness in movement,

stiffness and tremor. Non-motor symptoms include depression, constipation,

sleep abnormalities and loss of sense of smell. The cause of disease remains

incompletely understood. However, age, genetics, environment, viral infection,

and interplay between the innate and adaptive immune system …

Risk Of Post-Ercp Pancreatitis In Liver Transplant Patients: Single Center Experience, Shailender Singh

Theses & Dissertations

Introduction: Acute pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The exact cause of post-ERCP pancreatitis (PEP) is unclear. Regardless of the mechanism that initiates PEP, the pathways of inflammation are similar to other forms of acute pancreatitis and include the activation of various inflammatory cytokines, released from the acinar cells and subsequently from helper T lymphocytes and macrophages. Liver transplants (LTx) patients on immunosuppressive medications have impaired T-cell response and hence decreased ability to generate these cytokines. The aim of this study was to review incidence rates and risk factors of PEP in this …

The Effect Of Mechanical Vibration On Pain And Rate Of Tooth Movement During Initial Orthodontic Alignment, Leslie Ellingson

Theses & Dissertations

Purpose: The purpose of this investigation was to evaluate the effect of mechanical vibration on pain experienced and rate of tooth movement (OTM) during the initial alignment phase of orthodontic treatment.

Materials and Methods: Participants were randomly allocated to control, low frequency or high frequency. An electric toothbrush was modified to provide high frequency vibration. A low frequency vibration device was acquired from a commercial vendor. Experimental groups applied vibration to the dentition for 20 minutes daily. All participants completed questionnaires using visual analog scales at five time points. Pain experience was measured in millimeters (mm) with the scale measuring …

Cpap-Mad Combination Therapy For Cpap Intolerant Patients With Moderate To Severe Osa, Jacob Stadiem

Theses & Dissertations

The treatment of obstructive sleep apnea (OSA) allows for a multidisciplinary approach between dentistry and medicine. Continuous positive airway pressure (CPAP) is the gold standard for OSA treatment, but the non-adherence rates are high. The mandibular advancement device (MAD) has a higher acceptance rate than the CPAP, however the efficacy is much lower in cases of moderate to severe OSA. This thesis attempted to evaluate if there was a change in compliance when a MAD was added as a combination therapy to moderate to severe OSA subjects that were currently non-compliant with their CPAP. In addition, the change in air …

Public Health Perspectives On Sexual Health And Family Planning, Molly Mccarthy

Theses & Dissertations

Large bodies of evidence document the importance of sexual and reproductive health (SRH) in the lives of individuals and among populations. Of particular interest are sexually transmitted diseases (STDs), due to their potential for long-term health consequences, and unintended pregnancy because of its association with social and economic outcomes for women and families.

This dissertation addressed three distinct but related areas of reproductive health and family planning: counseling for condom use following an STD test, counseling for contraception following a pregnancy test in a clinical setting, and the effect of abortion on having and achieving long-term plans. These topics are …

Exploring Perceptions And Experiences With Resources Among Rural Alzheimer's Dementia Family Caregivers In The Midwest, Rita M. Million

Theses & Dissertations

Exploring PERCEPTIONS AND EXPERIENCES WITH RESOURCES AMONG RURAL Alzheimer’s Dementia Family Caregivers in the Midwest

Rita M. Million

University of Nebraska, 2017

Supervisor: Karen Schumacher, Ph.D., RN

Background. Despite vast amounts of research on informal caregiving in the Alzheimer’s dementia (AD) population, research on the experience and perceptions of rural caregivers is limited. A better understanding of rural caregivers’ knowledge, use, and nonuse of resources is essential to offset the impact of caregiving. Purpose. This study explored Alzheimer’s dementia family caregivers’ experiences and perceptions with resources in rural Midwest communities. Design. A descriptive qualitative approach with one-time semi-structured interviews was …

Self-Efficacy For Symptom Management In Adult Hematopoietic Stem Cell Transplant Patients, Lynn White

Theses & Dissertations

Hematopoietic stem cell transplant (HSCT) is a treatment for hematologic cancers and other hematologic conditions that causes severe treatment-related symptoms. The first 30 days after HSCT, or the acute phase, is when symptoms are most intense. During this time, the ability of patients to manage their symptoms, in collaboration with their health care providers, is crucial to reduce the distress caused by the symptoms. Self-efficacy is the person’s confidence in their ability to perform a behavior, such as symptom management. This body of work describes the concept of self-efficacy for symptom management (SESM), presents an integrated literature review on self-efficacy …

Novel Therapeutic Strategies For Treatment Of Castration-Resistant Prostate Cancer, Matthew A. Ingersoll

Theses & Dissertations

Prostate cancer (PCa) remains the most commonly diagnosed solid tumor and is the third leading cause of cancer-related death in United States men. While androgen deprivation therapy is the current standard-of-care treatment for metastatic PCa, most patients eventually relapse and develop castration-resistant (CR) tumors, for which there is currently no effective treatment. Therefore, synthesis of novel therapeutic agents and identification of alternative target proteins are necessary to improve treatment. Herein, I investigate the efficacy of novel imidazopyridine and statin derivatives as alternative therapeutic compounds. These molecules not only inhibit androgen receptor signaling, but also block activation of the AKT axis, …

Relationships Between Complex Pediatric Health Conditions And The Built, Physical And Social Environments, Brittany Corley

Theses & Dissertations

The relationship between human health and the environment is complex and overall poorly understood. The environment has a lasting impact on health, and the processes appear to start at conception. Thus, this dissertation examines the potential relationship between pediatric health and the environment.

The first relationship examined was between the built environment and comorbid Attention Deficient Hyperactivity Disorder and Autism Spectrum Disorder. Many publications have reported the relationship between socioeconomic disadvantage, Attention Deficient Hyperactivity Disorder, and Autism Spectrum Disorder. However, the link between the built environment and Attention Deficient Hyperactivity Disorder and Autism Spectrum Disorder symptom severity is poorly understood. …

Identifying The Role Of Janus Kinase 1 In Mammary Gland Development And Breast Cancer, Barbara Swenson

Theses & Dissertations

The development of the postnatal mammary gland is tightly controlled by peptide hormones and cytokines. The signaling of these extracellular ligands through their corresponding receptors rely on Janus Kinases (JAKs) that activate downstream Signal Transducers and Activators of Transcription (STATs). The JAK/STAT signaling pathway is crucial for processes such as growth, proliferation, and cell survival of the epithelial tissue, but also for the breakdown and remodeling of the mammary gland via IL-6 class inflammatory cytokines (e.g. LIF and OSM). JAK1 and JAK2, which are expressed in the mammary gland, are thought to have redundant functions. However, our previous studies demonstrated …

Maternal Life Course Adversity: The Intersection Of Psychosocial And Biobehavioral Adaptive Response In Pregnancy, Crystal Modde Epstein

Theses & Dissertations

The link between life course adversity and adverse health outcomes is well established, particularly early life adversity (ELA). There is also evidence that the physiologic adaptations associated with stress, depression and ELA can be transmitted intergenerationally via long-term set-point changes within the maternal hypothalamic-pituitary-adrenal axis (HPA). It is unknown how the type and timing of maternal stress and adversity influences HPA regulation during pregnancy and whether maternal coping attenuates this relationship. Manuscript 1 was an integrative review of studies examining the association between maternal ELA and HPA regulation during pregnancy. In manuscripts 2 and 3 the findings of the dissertation …

The Current Burden Of Chlamydia And Gonorrhea Infections In The Three Rivers Health District, Donna Jordan

Capstone Experience: Master of Public Health

Background: The proportion of Chlamydia and Gonorrhea in Douglas County, Nebraska is significantly higher than Nebraska and the U.S. Consequently, the Douglas County Health Department has initiated numerous programs to combat STIs. However, the prevalence of Chlamydia and Gonorrhea has sharply increased in recent years. Adjacent to Douglas County is the Three Rivers Health District, including Dodge, Saunders, and Washington Counties. Few studies have assessed the burden of Chlamydia and Gonorrhea in the Three Rivers Health District.

Objectives: The objectives of the study were to 1) Compare Chlamydia and Gonorrhea by age, gender, and ethnicity for Dodge, Saunders, and Washington …

Analysis Of Food Security, Snap Benefit Duration, Income Level And The Relationship With Depression In Households With Children In Omaha., Tatiana Tchouankam

Capstone Experience: Master of Public Health

Food insecurity is defined as a lack of access to “sufficient, safe, and nutritious food that meets individuals’ dietary needs and preferences for an active and healthy life.” From 2015 to 2016, the number of people undernourished increased from 777 million to 815 million worldwide. Food insecurity affected 12.3 % of Nebraskans and 13.8% of the residents in Douglas County during the same year. There is evidence of associations between food insecurity, income level, and several adverse health outcomes, specifically with regards to mental health. The objective of this study was to examine food security, SNAP benefit duration (i.e., how …

Hpv Vaccination Of Children Among Motherse Of Mexican Origin, Bibiana M. Carvajal-Suarez

Capstone Experience: Master of Public Health

Background. The Human Papillomavirus (HPV) is a causative agent for the development of cancer which is a public health concern worldwide. In the United States (US), the highest incidence of cervical cancer is among Hispanics/Latinos. Although Hispanics/Latinos show the highest utilization rate of HPV vaccine, in general, the vaccination rates are still behind the Healthy People 2020 goal of 80%. The knowledge about this virus has been found low or nonexistent among most populations in the US, especially among minorities and populations with lower education and socioeconomic status. The knowledge and beliefs of Hispanic/Latin mothers about HPV and HPV …