Medicine and Health Sciences Commons^™

Cervical Spine Angles, Craniocervical Posture, Neck Length, And Oropharyngeal Airway Analyses Of Sleep Apnea Patients In Both Supine And Upright Positions: A Retrospective 3-D Imaging Study, Brian Tuan Luong

Theses & Dissertations

Obstructive sleep apnea (OSA) is one of the most common respiratory disorders. Previous airway studies of OSA subjects have largely relied on 2-D radiographs.

The purpose of this study is to use 3-D imaging to the analyze the relationships among cervical spine angles, craniocervical posture, cervical spine length and the oropharyngeal airway volume in OSA patients in both the supine and upright positions.

Twenty-eight OSA subjects with 3-D imaging were included. Airway, craniocervical posture, spine angles, and spine length were assessed using Dolphin 11.8. Correlation analyses were utilized to detect associations among the recorded and measured variables. Mean differences were …

Identification And Intervention For Action Planning Deficits In Children With Hemiplegic Cerebral Palsy, Swati M. Surkar

Theses & Dissertations

The primary purpose of this investigation was to describe and quantify action-planning deficits during goal-directed movements in children with hemiplegic cerebral palsy (HCP). Three specific topics were addressed: brain activation, kinematics, and the use of visual input. First, we assessed prefrontal cortex (PFC) activation during complex goal-directed actions in children with HCP. The outcome suggested that children with HCP have higher PFC activation than age matched typically developing (TD) children during action planning, potentially due to the difficulty in allocating attentional resources for simultaneously processing the cognitive (i.e., attention, memory, information processing) and motor demands of the goal-directed task. Reduced …

Barriers To Pediatric Triage Guideline Compliance: A Survey Of Nebraska Emergency Departments, Jonathon J. Gruba

Theses & Dissertations

Nebraska emergency departments may be underprepared for a mass casualty event involving a large number of children, as indicated by the results from the 2013 Emergency Medical Services for Children’s (EMSC) Pediatric Readiness Project (PRP) report. This was primarily evident by the lack of existence of a pediatric triage policy among Nebraska emergency departments. Utilizing a survey, this study attempted to identify the emergency departments in Nebraska that followed the EMSC guideline of having a pediatric triage policy, as well as to identify possible barriers to guideline adherence among those that did not have the policy.

It was found that …

Behavioral Care For Children In Urban And Rural Integrated Primary Care, David I. Taylor

Theses & Dissertations

Mental, emotional, and behavioral issues in children are a significant concern for the children, their families, and society. Despite the existence of evidence-based treatments, the success of behavioral healthcare to meet the needs of these families will require high quality communication and relationships across a wide range of stakeholders. Integration of care represents a patient-centered strategy to unify these stakeholders into a single cohesive care team. The purpose of this dissertation is to define the behavioral healthcare team in integrated primary care for children in terms of the functional roles involved and to evaluate the quality of relationships and communications …

The Effect Of Agricultural Exposures And Genetics On Respiratory Phenotypes, Lisa W. Boyd

Theses & Dissertations

Agricultural workers are at risk for respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis, due to exposures and inflammatory agents found in their work environment. While previous studies have been conducted to examine agricultural effects of chronic respiratory diseases more closely, there are still several significant gaps in the existing literature.

This dissertation explores the relationship between agricultural exposures and respiratory diseases. Utilizing two populations, the Keokuk Country Rural Health Study and the AgLung Study, this research: 1) used principal factor analysis (PFA) to distill exposure data into essential variables characterizing long-term agricultural exposures in order …

The Use Of Electroacupuncture For Cervical Ripening In Pregnant Women, Becky A. Nauta

Theses & Dissertations

The purpose of this study was to compare cervical ripening outcomes, based on Bishop scoring methodology, of pregnant women receiving usual care treatment (UC) with those receiving electroacupuncture plus UC. A sample of 36 pregnant women completing their 39^th week of gestation was randomized into one of the two groups. The women in the UC group continued to meet with their provider on a weekly basis until delivery. The women in the electroacupuncture plus usual care group met with their provider on a weekly basis and also received electroacupuncture treatments: three in the 39th gestational week and two in …

Adoption Of Medication Management Technologies By U.S. Acute Care Hospitals After The Hitech Act, Aastha Chandak

Theses & Dissertations

Medication errors and adverse drug events (ADEs) are a significant public health concern in the United States as they pose a threat to patient safety. The medication management process is a complicated process in U.S. acute care hospitals, consisting of a series of steps such as ordering, transcribing, dispensing and administration and each step is prone to medication errors.The use of technology is considered to be an important intervention in improving the medication management process and thereby reducing medication errors and ADEs and further improve patient safety. The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in …

The Effects Of A Preceptor Coaching Intervention On Use Of Clinical Judgment By New Graduate Nurses, Sue A. Schuelke

Theses & Dissertations

This work attempts to evaluate a preceptor intervention on the development of critical thinking/clinical judgment from the new graduate’s point of view as well as from the preceptor’s point of view. Manuscript 1 is a systematic review of the literature related to preceptor’s interventions and its effect on clinical judgment. Manuscript 2 describes the results of focus group interviews of preceptors and the viewpoint on clinical judgment and related concepts. Results of a pilot study: The effects of a preceptors coaching on new graduates clinical judgement, is reported in Manuscript 3. Each section includes an overview of each manuscript, a …

The Impact Of Electronic Health Records On Healthcare Service Delivery, Patient Safety, And Quality, Kate Elizabeth Trout

Theses & Dissertations

The HITECH Act has provided over $30 billion of support through the Meaningful Use program to implement Electronic Health Records (EHRs) with aims to improve healthcare service delivery, efficiency, quality, and patient safety. New healthcare models, such as pay-for-performance and value-based purchasing, were envisioned to aligning quality with reimbursement mediated with the use of EHRs. It is unclear of how EHRs and Meaningful Use have impacted health service delivery, patient safety, and quality of care. Thus, making it difficult to determine if the specific set of objectives for Meaningful Use have had a positive impact on outcomes, which ultimately is …

Raising The Minimum Legal Sales Age For Tobacco Products In Nebraska, Fernando A. Wilson, Nizar K. Wehbi, Kavita Mosalpuria, Li-Wu Chen

Reports: Center for Health Policy

No abstract provided.

Increased Mitochondrial Superoxide In The Brain, But Not Periphery, Sensitizes Mice To Angiotensin Ii-Mediated Hypertension., Adam J. Case, Jun Tian, Matthew C. Zimmerman

Journal Articles: Cellular & Integrative Physiology

Angiotensin II (AngII) elicits the production of superoxide (O2(•-)) from mitochondria in numerous cell types within peripheral organs and in the brain suggesting a role for mitochondrial-produced O2(•-) in the pathogenesis of hypertension. However, it remains unclear if mitochondrial O2(•-) is causal in the development of AngII-induced hypertension, or if mitochondrial O2(•-) in the absence of elevated AngII is sufficient to increase blood pressure. Further, the tissue specific (i.e. central versus peripheral) redox regulation of AngII hypertension remains elusive. Herein, we hypothesized that increased mitochondrial O2(•-) in the absence of pro-hypertensive stimuli, such as AngII, elevates baseline systemic mean arterial …

Membrane-Active Epithelial Keratin 6a Fragments (Kamps) Are Unique Human Antimicrobial Peptides With A Non-Αβ Structure., Judy T.Y. Lee, Guangshun Wang, Yu Tong Tam, Connie Tam

Journal Articles: Pathology and Microbiology

Antibiotic resistance is a pressing global health problem that threatens millions of lives each year. Natural antimicrobial peptides and their synthetic derivatives, including peptoids and peptidomimetics, are promising candidates as novel antibiotics. Recently, the C-terminal glycine-rich fragments of human epithelial keratin 6A were found to have bactericidal and cytoprotective activities. Here, we used an improved 2-dimensional NMR method coupled with a new protocol for structural refinement by low temperature simulated annealing to characterize the solution structure of these kerain-derived antimicrobial peptides (KAMPs). Two specific KAMPs in complex with membrane mimicking sodium dodecyl sulfate (SDS) micelles displayed amphipathic conformations with only …

Treatment Of A Chemoresistant Neuroblastoma Cell Line With The Antimalarial Ozonide Oz513., Don W. Coulter, Timothy R. Mcguire, J. Graham Sharp, Erin M. Mcintyre, Yuxiang Dong, Xiaofang Wang, Shawn Gray, Gracey R. Alexander, Nagendra K. Chatuverdi, Shantaram Joshi, Xiaoyu Chen, Jonathan L. Vennerstrom

Journal Articles: Pharmacy Practice

BACKGROUND: Evaluate the anti-tumor activity of ozonide antimalarials using a chemoresistant neuroblastoma cell line, BE (2)-c.

METHODS: The activity of 12 ozonides, artemisinin, and two semisynthetic artemisinins were tested for activity against two neuroblastoma cell-lines (BE (2)-c and IMR-32) and the Ewing's Sarcoma cell line A673 in an MTT viability assay. Time course data indicated that peak effect was seen 18 h after the start of treatment thus 18 h pre-treatment was used for all subsequent experiments. The most active ozonide (OZ513) was assessed in a propidium iodide cell cycle flow cytometry analysis which measured cell cycle transit and apoptosis. …

Il-10 Plays An Important Role In The Control Of Inflammation But Not In The Bacterial Burden In S. Epidermidis Cns Catheter Infection., Yenis M. Gutierrez-Murgas, Gwenn Skar, Danielle Ramirez, Matthew Beaver, Jessica N. Snowden

Journal Articles: Pathology and Microbiology

BACKGROUND: Shunt infection is a frequent and serious complication in the surgical treatment in hydrocephalus. Previous studies have shown an attenuated immune response to these biofilm-mediated infections. We proposed that IL-10 reduces the inflammatory response to Staphylococcus epidermidis (S. epidermidis) CNS catheter infection.

METHODS: In this study, a murine model of catheter-associated S. epidermidis biofilm infection in the CNS was generated based on a well-established similar model for S. aureus. The catheters were pre-coated with a clinically derived biofilm-forming strain of S. epidermidis (strain 1457) which were then stereotactically implanted into the lateral left ventricle of 8-week-old C57BL/6 and IL-10 …

Mitochondrial Superoxide Signaling Contributes To Norepinephrine-Mediated T-Lymphocyte Cytokine Profiles., Adam J. Case, Colton T. Roessner, Jun Tian, Matthew C. Zimmerman

Journal Articles: Cellular & Integrative Physiology

Norepinephrine (NE) produces multifaceted regulatory patterns in T-lymphocytes. Recently, we have shown that NE utilizes redox signaling as evidenced by increased superoxide (O2●-) causally linked to the observed changes in these cells; however, the source of this reactive oxygen species (ROS) remains elusive. Herein, we hypothesized that the source of increased O2●- in NE-stimulated T-lymphocytes is due to disruption of mitochondrial bioenergetics. To address this hypothesis, we utilized purified mouse splenic CD4+ and CD8+ T-lymphocytes stimulated with NE and assessed O2●- levels, mitochondrial metabolism, cellular proliferation, and cytokine profiles. We demonstrate that the increase in O2●- levels in response to …

Near Infrared Fluorescent Nanoparticles Derived From Hyaluronic Acid Improve Tumor Contrast For Image-Guided Surgery., Tanner K. Hill, Sneha S. Kelkar, Nicholas E. Wojtynek, Joshua J. Souchek, William M. Payne, Kristina Stumpf, Frank C. Marini, Aaron M. Mohs

Journal Articles: Pharmaceutical Sciences

Tumor tissue that remains undetected at the primary surgical site can cause tumor recurrence, repeat surgery, and treatment strategy alterations that impose a significant patient and healthcare burden. Intraoperative near infrared fluorescence (NIRF) imaging is one potential method to identify remaining tumor by visualization of NIR fluorophores that are preferentially localized to the tumor. This requires development of fluorophores that consistently identify tumor tissue in different patients and tumor types. In this study we examined a panel of NIRF contrast agents consisting of polymeric nanoparticle (NP) formulations derived from hyaluronic acid (HA), with either physically entrapped indocyanine green (ICG) or …

An Overview Of State Criteria For Declaring A Public Health Emergency, Fernando A. Wilson, Nizar K. Wehbi, Kavita Mosalpuria

Reports: Center for Health Policy

No abstract provided.

Click Here! E-Learning Modules For Innovative Instruction And Learning, Nicole M. Sleddens, Betsy J. Becker, Sara E. Bills

Posters and Presentations: Physical Therapy

Purpose: Re-designing all or portions of a course with a fresh perspective can re-energize faculty and make the content more engaging for the learner. Teaching the millennial generation is also prompting faculty to revisit educational strategies. The use of electronic learning platforms, such as eLearning modules, is an innovative learning strategy with several reported benefits including flexibility and convenience for usage, ability for learners to study at their own pace and adaptability to different learning styles. Using technology that is free or already available to faculty, even the novice designer can begin development of these useful study tools. The key …

Redefining Our Territory: Reaching Pre-Matriculation Students With Case-Based, Online Instruction, Cynthia M. Schmidt, Teresa Hartman

Posters and Presentations: Leon S. McGoogan Health Sciences Library

Online educational tools have made it possible for our library to claim some educational territory that was previously unavailable to us, the pre-matriculation period. During the summer of 2015 we were able to add a two-part, case-based, online tutorial to our incoming medical students’ pre-matriculation materials. We created the story of Sarah Pilger, a hypothetical, obese, pregnant teenager whose pregnancy is complicated by a fetal toxoplasmosis. The case introduces the incoming students to almost all the resources they might want to use while enrolled at UNMC and also introduces students to the roles of the many healthcare professionals who are …

Race Inclusion Diversity & Equity: The Ride Report, Renaisa S. Anthony, Todd A. Wyatt, Chad Abresch, Maria Teel, Kandy Do, Olubadero Yerokun-Houessou, Talia Mcgill, Angela Benton

Reports: Center for Reducing Health Disparities

The Race, Inclusion, Diversity & Equity (RIDE) Report is presented as a resource to augment, strengthen and support existing and future diversity, inclusion & equity efforts at the University of Nebraska Medical Center (UNMC). It is organized into 7 sections and highlights the voices, perspectives and ideas of over 150 UNMC administrators, students, faculty, staff and community partners (key stakeholders).

Evaluating Isolation Behaviors By Nurses Using Mobile Computer Workstations At The Bedside., Elizabeth L. Beam, Shawn G. Gibbs, Angela L. Hewlett, Peter C. Iwen, Suzanne L. Nuss, Philip W. Smith

Journal Articles: College of Nursing

This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an …

Antiretroviral Therapy For The Prevention Of Hiv-1 Transmission., Myron S. Cohen, Ying Q. Chen, Marybeth Mccauley, Theresa Gamble, Mina C. Hosseinipour, Nagalingeswaran Kumarasamy, James G. Hakim, Johnstone Kumwenda, Beatriz Grinsztejn, Jose H.S. Pilotto, Sheela V. Godbole, Suwat Chariyalertsak, Breno R. Santos, Kenneth H. Mayer, Irving F. Hoffman, Susan H. Eshleman, Estelle Piwowar-Manning, Leslie Cottle, Xinyi C. Zhang, Joseph Makhema, Lisa A. Mills, Ravindre Panchia, Sharlaa Faesen, Joseph Eron, Joel Gallant, Diane Havlir, Susan Swindells, Vanessa Elharrar, David Burns, Taha E. Taha, Karin Nielsen-Saines, David D. Celentano, Max Essex, Sarah E. Hudelson, Andrew D. Redd, Thomas R. Fleming

Journal Articles: Internal Medicine

BACKGROUND: An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission.

METHODS: We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 …

Nox2-Derived Oxidative Stress Results In Inefficacy Of Antibiotics Against Post-Influenza S. Aureus Pneumonia., Keer Sun, Vijaya Kumar Yajjala, Christopher Bauer, G. Talmon, Karl J. Fischer, Tammy Kielian, Dennis W. Metzger

Journal Articles: Pathology and Microbiology

Clinical post-influenza Staphylococcus aureus pneumonia is characterized by extensive lung inflammation associated with severe morbidity and mortality even after appropriate antibiotic treatment. In this study, we show that antibiotics rescue nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (Nox2)-deficient mice but fail to fully protect WT animals from influenza and S. aureus coinfection. Further experiments indicate that the inefficacy of antibiotics against coinfection is attributable to oxidative stress-associated inflammatory lung injury. However, Nox2-induced lung damage during coinfection was not associated with aggravated inflammatory cytokine response or cell infiltration but rather caused by reduced survival of myeloid cells. Specifically, oxidative stress increased …

Local Minocycline To Reduce Future Inflammation And Bone Loss In Periodontal Maintenance Patients, Jeffery S. Jensen

Theses & Dissertations

The objectives of this study were to compare the effect of SRP+MM versus SRP alone on inflammatory cytokines, interleukin (IL)-1β and IL-1 receptor antagonist (ra), found in gingival crevicular fluid (GCF) and saliva, and correlate IL-1 values with clinical outcomes over a 2-year period of PMT. Fifty-five patients with an initial posterior pocket ≥5 mm and history of bleeding on probing (BOP) were randomized to test (SRP+MM, n=27) and control (SRP, n=28) groups. Clinical measurements and GCF samples were done at baseline and 24 months. SRP+MM or SRP were provided at 6-month intervals. IL-1β and IL-1ra were measured in GCF …

Long-Acting Antiretroviral Nanoformulation Development And Subcellular Trafficking, Dongwei Guo

Theses & Dissertations

The introduction of nanoformulated antiretroviral therapeutic regimens is a promising alternative to standard once a day oral treatment of HIV infection. Our lab has pioneered this effort and was successful in harnessing mononuclear phagocytes (monocytes, dendritic cells and macrophages) as nanoformulated drug carriers. The approach was developed as Trojan horses for drug transport, delivery and distribution to sites of viral replication in order to facilitate microbial elimination in HIV sanctuaries. However, the remaining challenges for current antiretroviral nanoformulations include to formulate a broad range of hydrophilic short-acting drugs, and to elucidate the mechanism of sequestered nanoparticles in macrophages at the …

Antioxidant And Anti-Inflammatory Nutrients On Lung Function In Chronic Obstructive Pulmonary Disease, Jessica M. Hinds

Theses & Dissertations

Introduction Veterans are three times more likely to develop chronic obstructive pulmonary disease (COPD) than the general population. This is likely due to increased use of tobacco and exposure to environmental risk factors. Nutritional intake has been linked to COPD, and veterans report unique barriers to improving their eating habits.

Purpose The primary outcome of this study was to examine the relationship between antioxidant and anti-inflammatory nutrient intake and lung function in veterans with COPD. It was hypothesized that a higher intake of lutein + zeaxanthin, ß-cryptoxanthin, lycopene, retinol, ɑ-carotene, ß-carotene, vitamin C, vitamin D, ɑ-tocopherol, omega-3, zinc and selenium …

Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt

Theses & Dissertations

Left ventricular diastolic dysfunction (LVDD) of the heart is a condition where the heart does not relax properly. This condition is important during times of stress, as LVDD is associated with significant morbidity of elderly surgical patients. LVDD is often asymptomatic and unrecognized as many of these patients have normal ejection fractions. However, LVDD may lead to heart failure in patients with preserved systolic function, with the incidence being as high as 50% in hospitalized elderly patients. The diagnosis of LVDD is an independent risk factor for postoperative major adverse cardiac events (MACE) and negatively impacts post-surgery readmission rates. Anesthesiologists …

Stability And Kinetics Of Dna Pseudoknots: Formation Of T∗A•T Base-Triplets And Their Targeting Reactions, Calliste Steffensmeier

Theses & Dissertations

Pseudoknots have been found to play important roles in the biology of RNA. These stem-loop motifs are considered to be very compact and the targeting of their loops with complementary strands is accompanied with lower favorable free energy terms. We used a combination of spectroscopic (UV, CD and fluorescence), calorimetric (DSC, PPC and ITC) and kinetic (SPR) techniques to investigate: 1) Local base-triplet formation in pseudoknots; 2) energetic contributions for the association of pseudoknots with their complementary strands; and 3) the kinetic rates as a function of targeting strand length.

We investigated a set of DNA pseudoknots with sequence: d(TCTCT …

The Use Of Platelet Rich Fibrin In Pulpal And Periodontal Regeneration, Elisabeth L. Easley

Theses & Dissertations

Purpose: Platelet rich fibrin (PRF) has been postulated to aid in regeneration. Therefore, the purpose of this study is to evaluate the inflammatory response of PRF in vitro, and analyze clinically and histologically the effectiveness of PRF on pulpal regeneration after reimplantation.

Materials and Methods: The in vivo experiment included 18 patients (69 teeth). Teeth were extracted and apicoectomy performed. The tooth was reimplanted and splinted after PRF was condensed into the apex. Control teeth received the same treatment with the exception of the PRF. After 3-11 months, vitality was checked, teeth were extracted and analyzed histologically. For the in …

Identifying Characteristics Associated With Ileus Development Post Coronary Artery Bypass Graft Surgery, Kara C. Hannon

Theses & Dissertations

Background: Postoperative ileus (POI) is the period of intestinal paralysis following any surgical procedure. POI is manifested by nausea, vomiting, abdominal distention, delayed tolerance of oral diet and delayed time to flatus and stool. Little is known about POI following coronary artery bypass grafting (CABG) as no other study has focused specifically on the incidence of POI following CABG.

Purpose: The primary objective of this study is to determine the incidence of POI post CABG. The secondary aim is to evaluate baseline characteristics associated with POI following CABG.

Methods: This was a retrospective cohort study of 100 patients who underwent …