Medicine and Health Sciences Commons^™

Surgical Outcomes And Decision Making For Bicuspid Aortic Valve, Adam Larsen

Graduate Medical Education Research Journal

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Langerhans Cell Histiocytosis Masquerading As Refractory Intertriginous Rash, Nicole Wozny

Graduate Medical Education Research Journal

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Survey Of Current Clinical And Imaging Practices Amongst Regional Obstetric Providers In Nebraska: A Discussion Of Future Application Of Artificial Intelligence In Fetal Echocardiography, Farhath Sulthana

Graduate Medical Education Research Journal

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An Educational Interventional Study To Compare The Effectiveness Of Small Group Discussion Versus Role Play As A Teaching Learning Method In The Subject Of Pharmacology, Akanksha B. Prajapati, Alay Patel, Rupal Shah, Vipul Chaudhari

Graduate Medical Education Research Journal

BACKGROUND: Teaching-learning methods include lectures, discussions, and small group activities. Small group discussions and role-plays enhance adult learning by promoting participation, reflection, communication, and teamwork. These methods improve knowledge retention and prepare students for real-life scenarios and professional challenges through experiential, interactive learning. Aim of the study was to compare the effectiveness of Small Group Discussion (SGD) vs Role play as a teaching learning (T/L) method among Phase II medical students.

METHODS. Out of 140 Phase II MBBS students, 88 participated in the pharmacology schedule and were included in the study. After randomization, 42 students (Group A) underwent SGD, and …

Immune Thrombocytopenic Purpura Association With Epstein-Barr Virus, Amer Aldamouk, Bachr Masri, Ali Khan, Pulkita Uppal

Graduate Medical Education Research Journal

Immune thrombocytopenia (ITP), also referred to as idiopathic thrombocytopenic purpura, is an acquired form of thrombocytopenia caused by antibodies directed against platelet glycoproteins, particularly anti-GpIIb/IIIa antibodies. Epstein-Barr virus (EBV), a herpes virus infecting a large majority of the population before adulthood, has been implicated in various immune-mediated disorders, including ITP. In this report, we present a case of a young adult female with a history of thrombocytopenia who was found to have severe thrombocytopenia attributed to chronic EBV infection. Despite initial treatment with corticosteroids and intravenous immunoglobulin (IVIG), the patient's condition necessitated second-line therapies, including rituximab and thrombopoietin receptor agonists. …

A Rare Delayed Neuropsychiatric Encephalopathy After Hyperbaric Oxygen Treatment For Carbon Monoxide Poisoning: A Couple’S Case Report, Sabrina Kasha, William J. Naber Ii, Michael Reimer

Graduate Medical Education Research Journal

Background: Carbon monoxide (CO) poisoning is caused when carbon monoxide builds up in the blood, most specifically due to its high binding affinity for the heme structure in hemoglobin. This can lead to serious tissue damage and even be fatal. CO poisoning is primarily the result of incomplete combustion of fuels, with common sources domestically and internationally including furnaces, gas heaters, generators, and motor vehicles.2 Symptoms tend to present as neuropsychiatric symptoms, such as dementia, psychosis, parkinsonism, and incontinence. There are few well-researched CO poisoning specific treatments, which suggest supplemental oxygen and hyperbaric oxygen are most effective. We present a …

Characteristics And Educational Background Of Current Deans Of Medicine, Joseph T. Mcgrath, Calla M. Sullivan, Divya Sharma, Evelyn Fagan, Erin X. Wei

Graduate Medical Education Research Journal

Background. Medical school leadership demographics have been examined previously, but there has not been a study investigating the educational background of the current Deans of Medicine (DOMs). The purpose of this report is to examine the demographics, as well as the educational and training background, of the current DOMs to determine how medical school leadership can continue to be diversified across various attributes, such as gender and specialty type.

Methods. The current DOMs at 159 Doctor of Medicine (MD) and 41 Doctor of Osteopathic (DO) programs were identified using medical school websites. Information about the DOM’s background, including pronouns used …

Enhancing Learning Through Role-Play In A Low-Fidelity Disaster Simulation, Susan S. Braithwaite, Susan J. Barcinas, Colleen A. Hayes

Innovations in Health Sciences Education Journal

ABSTRACT

Background: This report shares a best practice approach to low-fidelity simulation as a pedagogical method in disaster triage training for undergraduate nursing students.

Methods: This study utilized multi-year quantitative data such as student age, gender, GPA, prior simulation experience, and self-reported confidence in the START Triage application. It also utilized a secondary qualitative analysis of the debriefing process.

Results: Students who participated in a simulation event playing the role of a disaster victim scored significantly higher on subsequent performance as TRIAGE practitioners than students without roleplay experience. Perhaps even more compelling, these learning outcomes were demonstrated 18 months after …

Mucin4 (Muc4) Antibody Labeled With An Nir Dye Brightly Targets Pancreatic Cancer Liver Metastases And Peritoneal Carcinomatosis, Sunidhi Jaiswal, Siamak Amirfakhri, Javier Bravo, Keita Kobayashi, Abhijit Aithal, Sumbal Talib, Kavita Mallya, Maneesh Jain, Aaron M. Mohs, Robert M. Hoffman, Surinder K. Batra, Michael Bouvet

Journal Articles: Biochemistry & Molecular Biology

BACKGROUND/OBJECTIVES: Pancreatic cancer is the fourth leading cause of deaths related to cancer. It is a highly aggressive malignancy and often metastasizes quickly to other parts of the body and organs. The most effective cure is surgical resection, which also is limited by tumor identification and clear tumor margin visualization. Previously, we used MUC4 antibodies labeled with IRDye800CW (anti-MUC4-IR800) to target primary human pancreatic cancer in orthotopic cell line mouse models.

METHODS: In the present study, we established a pancreatic cancer liver metastasis mouse model by implanting a tumor fragment in the liver and a peritoneal carcinomatosis mouse model by …

Knowledge Discovery In Databases Of Proteomics By Systems Modeling In Translational Research On Pancreatic Cancer, Mathilde Resell, Elisabeth Pimpisa Graarud, Hanne-Line Rabben, Animesh Sharma, Lars Hagen, Linh Hoang, Nan T. Skogaker, Anne Aarvik, Magnus K. Svensson, Manoj Amrutkar, Caroline S. Verbeke, Surinder K. Batra, Gunnar Qvigstad, Timothy C. Wang, Anil Rustgi, Duan Chen, Chun-Mei Zhao

Journal Articles: Biochemistry & Molecular Biology

BACKGROUND: Knowledge discovery in databases (KDD) can contribute to translational research, also known as translational medicine, by bridging the gap between

METHODS: This framework includes the data collection of a composition model (various research models), processing model (proteomics) and analytical model (bioinformatics, artificial intelligence/machine leaning and pattern evaluation), knowledge presentation, and feedback loops for hypothesis generation and validation. We applied this workflow to study pancreatic ductal adenocarcinoma (PDAC).

RESULTS: We identified the common proteins between human PDAC and various research models

CONCLUSIONS: This systems modeling workflow can be a valuable method for KDD, facilitating knowledge discovery in translational targets in …

St6galnac-I Regulates Tumor Cell Sialylation Via Nectin2/Muc5ac-Mediated Immunosuppression And Angiogenesis In Non-Small Cell Lung Cancer, Muthamil Iniyan Appadurai, Sanjib Chaudhary, Ashu Shah, Gopalakrishnan Natarajan, Zahraa W. Alsafwani, Parvez Khan, Dhananjay D. Shinde, Subodh M. Lele, Lynette M. Smith, Mohd W. Nasser, Surinder K. Batra, Apar Kishor Ganti, Imayavaramban Lakshmanan

Journal Articles: Biochemistry & Molecular Biology

Glycosylation controls immune evasion, tumor progression, and metastasis. However, how tumor cell sialylation regulates immune evasion remains poorly characterized. ST6GalNAc-I, a sialyltransferase that conjugates sialic acid to the glycans in glycoproteins, was overexpressed in an aggressive-type KPA (KrasG12D/+ Trp53R172H/+ Ad-Cre) lung adenocarcinoma (LUAD) model and patient samples. Proteomic and biochemical analysis indicated that ST6GalNAc-I mediated NECTIN2 sialylation in LUAD cells. ST6GalNAc-I-deficient tumor cells cocultured with T cells were more susceptible to T cell-mediated tumor cell killing, indicating a key role for NECTIN2 in T cell dysfunction. Mice injected with St6galnac-I-knockdown syngeneic cells showed reduced lung tumor incidence and Nectin2/Tigit-associated immunosuppression. …

Online Multimedia Education Effect On Breast Health Knowledge And Self-Efficacy, Brooke D. Hancock, Elizabeth Frankle, Jennifer Cera, Leeza Struwe, Mackenzie Koch

Doctor of Nursing Practice Projects: College of Nursing

Objective: To evaluate comprehension and retention of breast health and BSE by providing evidence-based education via a website. The researchers aimed to measure knowledge of breast health, self-efficacy of performing breast health promotion, and usability of the interventional website.

Design: A single group efficacy trial was used.

Setting: The study was conducted in two outpatient clinics in Nebraska that provided well women health care.

Participants: A convenience sample of 100 women were enrolled

Methods: Breast health knowledge was assessed with the Breast Health Assessment (BHA) and consisted of 3 subscales. The Champions Health Belief Model Scale (CHBM) assessed BSE self-efficacy …

Implementation Of An Adolescent Women’S Health And Wellness Education Program, Lauren Acker, Laynee Conner, Jennifer Cera

Doctor of Nursing Practice Projects: College of Nursing

Objectives: The goal of this research study was to provide scientific evidence supporting the importance and effectiveness of implementing a women’s health and wellness education course and its effect on (1) adolescent knowledge of sexual health and hygiene, (2) self-efficacy in menstrual management, and (3) self-empowerment in managing their own reproductive health.

Design: This was a mixed methods pilot study utilizing a pre/post-test single intervention efficacy trial. Quantitative and qualitative data were obtained.

Setting: The setting included two different sites including one outpatient ambulatory obstetrics/gynecology clinic and one community outreach center. Both sites were located within a midwestern metropolitan …

Evaluation Of An External Urinary Device Protocol And Practices In Hospitalized Female Patients: A Quality Improvement Project At A Rural Midwestern Hospital, Melissa Leibnitz, Ashley Causa, Susana Lopez

Doctor of Nursing Practice Projects: College of Nursing

Aims and Objectives- 1: Describe and measure current implementation and management practices of the PureWick™. 2: Describe and measure current outcomes in the use of the PureWick™ device including mobility scores, skin breakdown, Braden scores, moisture-associated dermatitis, CAUTIs, PAUTIs, hospital LOS, HAIs and HPIs. 3: Measure the survey results from staff regarding the current PureWick™ practices. 4: Propose recommendations for an improved EB protocol for the PureWick^TM.

Background: Currently, the PureWick^TM device has been utilized by facilities as an alternative to indwelling urinary catheters in an effort to reduce the incidence of CAUTI. Since the introduction …

Universal Adolescent Depression Screening And Implications For Identification Of Adolescent Depression And Mental Health Referrals, Cherry Cooper, Juan Zhou Powell

Doctor of Nursing Practice Projects: College of Nursing

Background: Throughout the United States, mental health concerns have been steadily increasing, which has created a significant impact for caregivers, overburdened healthcare facilities, and patients. In fact, a large number of those experiencing mental health issues are unidentified and thus more likely to experience mental health crises, suicidal ideation, or suicide attempts. Rural adolescents are significantly more vulnerable than their urban counterparts related to disparities in both mental health services and preventative screening. Coordination with a critical access hospital (CAH) emergency department revealed that there was no universal adolescent depression screening in place, and patients were potentially going undiagnosed and …

Program Evaluation Of The Behavioral Interventions Monitoring Assessment System-2 For High School Students In Rural Nebraska, Laura Burnett, Lakin Braman

Doctor of Nursing Practice Projects: College of Nursing

Behavioral and mental health issues among adolescents in rural areas often go unrecognized due to limited access to screening and intervention. This study evaluated the efficacy of the BIMAS- 2 tool in identifying at-risk high school students in a rural Nebraska high school. Methods: A retrospective cohort program evaluation was conducted over two years with 263 students in grades 9-12. The BIMAS-2 assessment was administered electronically each semester, followed by in-person mental health interviews. Descriptive statistics and Pearson chi-square tests assessed the tool’s sensitivity, specificity, and predictive value. Results: The BIMAS-2 demonstrated high sensitivity (100%) and specificity (96.15%), with a …

Enhancing Nurse Confidence In Labor Pain Management And Respectful Maternity Care Through Implementation Of The Coping With Labor Algorithm, Diane Johnson, Amy Murlowski

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to implement the Coping with Labor Algorithm in the labor and delivery setting and study its impact on nurse self-efficacy and on birthing persons’ experiences.

Design: A quasi-experimental pre- and post-design was used for this project.

Setting: The project was conducted in a maternity unit with six labor beds located in the Midwest.

Methods: This project was conducted over twelve weeks. Twenty-five registered nurses were provided in-person education, access to educational materials, and training on how to use the Coping with Labor Algorithm. A pre-test was administered before the unit implementation of the …

Relationship Between Maternal Plasma Retinol And Provitamin A Carotenoids With Fetal And Infant Kidney Development, Anum Akbar

Theses & Dissertations

Vitamin A plays a critical role in fetal organ development. Studies suggest that maternal vitamin A deficiency affects fetal nephron numbers, potentially leading to smaller kidney sizes and an increased risk of chronic kidney disease later in life. However, human studies exploring maternal vitamin A's impact on fetal kidney development lack longitudinal data and within-cohort comparisons. Furthermore, the influence of provitamin A carotenoids (α-carotene, β-carotene, β-cryptoxanthin) on kidney size remains unexplored. This dissertation addresses these gaps by analyzing relationships between maternal and cord plasma retinol and provitamin A carotenoid concentrations with fetal and infant kidney sizes. Our prospective cohort …

Coordinating Connections: A Mixed-Methods Exploration Of Relational Coordination And Interprofessional Team Development With Health Professions Students And Survivors Of Stroke, Teresa Marie Cochran

Theses & Dissertations

The need for effective healthcare teams is widely recognized, yet strategies for team education and evaluation remain areas of ongoing investigation. This study presents a longitudinal, interprofessional tele-team learning initiative designed to enhance health professions students’ collaborative skills through Salas’ “Big Five” of Teamwork and Gittell’s Relational Coordination Theory. Additionally, the project aimed to mitigate social isolation among stroke survivors by forming nine interprofessional tele-teams composed of students from medical nutrition therapy, nursing, occupational therapy, physical therapy, and speech-language pathology. Over six virtual meetings, these teams engaged with stroke survivors, assisting them in progressing toward self-selected goals.

Using an explanatory …

Identification And Preclinical Assessment Of Novel Therapeutic Modalities In Environmental Exposure-Induced Lung Disease, Aaron D. Schwab

Theses & Dissertations

Environmental lung diseases are preventable respiratory conditions either caused or made worse by inhaled environmental exposures. Contemporarily, environmental lung diseases are most associated with workplace exposures given specific occupational processes aerosolize inflammatory agents that can be inhaled at high concentrations. Although a considerable amount is known regarding immunoglobulin (Ig)E-mediated responses to environmental exposures, little is known about non-IgE mediated respiratory conditions resulting from lipopolysaccharide (LPS)-enriched organic dust exposure(s). Chronic respiratory diseases such as asthma, hypersensitivity pneumonitis, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis have all been identified as environmental lung diseases caused or exacerbated by such environmental dusts. Therapeutic …

Neurodegenerative Disease Mechanisms: Mitochondrial Impairment, Tau Aggregation, And Neuroinflammation As Central Drivers Of Disease Progression, Luis D. Estrella

Theses & Dissertations

The study of the intricate molecular mechanisms behind the pathology of neurodegenerative diseases has become a primary research area in the past decades. The major branches of these studies involve both disease progression and disease pathogenesis, in which neuroscientists have studied, and continue to study, the role that mitochondrial dysfunction, aberrant protein aggregation (like Tau), and immune cell reactions have on these. However, more recent studies have shined light to the fact that these three pathological features are not independent from one another and that their synchronous contributions may be the ultimate driver of neurodegeneration. This dissertation encompasses four different …

Revenue Cycle Management: Audit Of A Primary Care Clinic, Strategy, & Future Improvements, Izaak Colgrove

Capstone: Master of Health Administration

Healthcare practices that offer primary care, an essential service, are dependent upon financial liquidity for survival. This project evaluated the financial wellbeing of a local primary care clinic through the process of revenue cycle evaluation. The clinic has transitioned from the startup phase into a period of growth and as the clinic scales up, it faces new challenges related to revenue cycle management (RCM) and overall operational efficiency.

For any practice, the process of evaluating the revenue cycle, formally known as Revenue Cycle Management (RCM), is critical to help ensure financial stability. Central to managing the revenue cycle is the …

Evaluation Of The Usage And Effectiveness Of The Gross Anatomy Osteology E-Learning Module, Conor Young

Theses & Dissertations

Supplementary online learning modalities have reached near ubiquity in graduate health sciences education, yet evidence about their effectiveness remains mixed. The Department of Genetics, Cell Biology, and Anatomy at UNMC recently introduced their own bespoke electronic study platform called the Osteology e-Learning Module to aid gross anatomy students in the study of osteology. To assess its effectiveness, osteology and whole gross lab practical exam scores were compared in four different content units across three school year cohorts of graduate students in the same gross anatomy class. A survey was also distributed to one cohort to capture subjective information about the …

From Vector To Consequence: Integrating Vector Surveillance, Environmental Drivers, And Public Health Impact Into Lyme Disease Risk Management, Kathleen E. Angell

Theses & Dissertations

Lyme disease is the most common vector-borne disease in North America. This dissertation examines (1) how crowd-sourced compares to active vector surveillance and whether they are associated with Lyme disease, (2) how ecological factors relate to tick abundance and whether they can predict high disease years, and (3) estimated health and economic burden of Lyme disease and savings when interventions are applied. Tick abundance data from active and passive surveillance were compared and tested for association with Lyme disease in the first aim. We found differences in tick life-stage, species, and seasonality. Tick observations were positively correlated with Lyme disease. …

Cholestasis And Fluid Flow Are Biomechanic Regulators Of Cholangiocarcinoma Progression, Andrew Oleksijew

Theses & Dissertations

Cholestasis, altered or absent bile flow, is associated with poor survival in patients with cholangiocarcinoma, an aggressive cancer of the biliary epithelium. Changes in bile flow often result in stricture or obstruction. Experimental cholestasis promoted tumor growth and progression. However, studies are needed that directly assess the mechanical interaction between bile flow, or bile shear stress, and cholangiocarcinoma signaling. We hypothesized that cholestasis and absent bile shear stress activated cancer signaling and increased aggressive cellular behaviors such as proliferation and migration. Fluid shear stress approximating bile flow was applied by orbital culture plate method and compared to identical static culture …

Validating The Ability Of Iag933 To Block The Interaction Of Yap1 And Tead In Ovarian Cancer Cells, Alex Sage

Theses & Dissertations

Ovarian cancer is the most common and deadliest gynecologic malignancy. Approximately 40% of ovarian cancer patients exhibit chemoresistance after receiving initial treatment in the form of neoadjuvant chemotherapy or interval debulking surgery, of which YAP1 (Yes-associated protein 1) has been implicated in enhancing the resistance of ovarian cancer to Cisplatin and Taxol.^1,2. This highlights the need to develop new therapeutic strategies that target the Hippo pathway to overcome resistance to traditional therapies.

YAP1 is a protein that acts as a transcription coregulator, promoting the transcription of genes involved in cellular proliferation and suppressing apoptotic genes. It is a …

Knowledge, Skills, And Barriers To Palliative Care Referrals By Oncology Providers, Audra Meador, Bailey Waldron

Doctor of Nursing Practice Projects: College of Nursing

Palliative Care is an evidence based and integrative aspect of cancer care that has demonstrated improved quality of life and diminished symptomology, however, barriers to referrals exist. With the growing interest in and demand for specialized healthcare services, more research on integration and referral practices surrounding palliative care is necessary. This study aimed to explore the knowledge, attitudes, perceptions, and barriers to referring cancer patients to outpatient palliative care at a teaching and research hospital. In one cancer center, 50 physicians, Advance Practice Providers, and nurse case managers responded to an electronic survey regarding interest and support for palliative care …

Multilevel Considerations For Youth Attention-Deficit/Hyperactivity Disorder Prognosis And Management: Examining The Relationship Between Health Care Factors And Familial Factors In Families Of Children And Adolescents With Adhd, Carey A. Wheelhouse

Theses & Dissertations

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder impacting up to 10% of U.S. youth, and is associated with several negative social, health, and academic or occupational outcomes. Risk and prognostic factors for ADHD are multifactorial, and the management of youth ADHD is multimodal. Familial environments are one prognostic factor for ADHD, with family resilience being positively associated with youth ADHD prognosis. Researchers exploring multilevel interventions for the management of youth ADHD have proposed health care systems as a setting for interventions targeting family resilience, however little research examines the relationship between health care system factors and family factors in families …

Schistosoma Haematobium Infection In Ethiopian Children: Evaluating Praziquantel Efficacy, Nutritional Effects, And Diagnosis Using Flukecatcher, Louis Fok

Theses & Dissertations

Urogenital schistosomiasis continues to impact the wellbeing of hundreds of millions of people worldwide and remains a significant public health challenge across Ethiopia. Despite existing knowledge on the disease, there remain significant unanswered questions with regard to its treatment and diagnosis. This dissertation evaluated the efficacy of praziquantel at treating urogenital schistosomiasis, improving nutritional parameters among children and the performance of FlukeCatcher at detecting and determining the intensity of infection. In effecting this, a total of 977 children aged 5 through 15 from the Afar and Gambella regions of Ethiopia were screened for S. haematobium infection using urine filtration microscopy …

Navigating Lipid Nanoparticle Design: From Microfluidic Optimization For Rna Delivery In Pancreatic Cancer To Extended-Release Formulations For Hiv-1 Therapy., Farhana Islam

Theses & Dissertations

Lipid nanoparticles (LNPs) have emerged as a powerful platform for the delivery of RNA and small-molecule therapeutics, enabling improved drug stability, biodistribution, and cellular uptake. This study explores the formulation and optimization of LNPs for two distinct therapeutic applications: (1) mRNA-based therapy for pancreatic cancer (PC) and (2) extended-action fostemsavir (FTR) delivery for HIV-1 treatment. For PC therapy, a library of 48 mRNA-LNP formulations was developed for intraperitoneal (IP) administration in an orthotopic pancreatic tumor mouse model. Using microfluidic assembly, LNPs were engineered with varying lipid compositions and characterized based on size, zeta potential, and cytotoxicity. Biodistribution and mRNA expression …