Medicine and Health Sciences Commons^™

Perioperative Outcomes And Mortality In Liver Transplant Patients 65 And Older, Nathaniel S. Pester, Trevor J. Wilke, V K. Shostrom, Cale A. Kassel

Graduate Medical Education Research Journal

Background: The number of patients over the age of 65 awaiting liver transplantation (LT) continues to grow and an increasing number of patients will undergo liver transplantation. While age is not an absolute contraindication to liver transplantation, understanding the risks to older patients remains essential to ensure good outcomes with the limited number of grafts available.

Methods: This retrospective study included patients undergoing LT at the University of Nebraska Medical Center. A total of 421 patients were enrolled and stratified to patients under 65 years old (351 patients) and patients over 65 (70 patients). Geriatric patients were defined as aged …

Prosthetic Valve Endocarditis With Cardiobacterium Hominis: A Case Report, Kaci Griffin, Timothy Jang, Rees Adomako, Jasmine R. Marcelin, Jonathan H. Ryder

Graduate Medical Education Research Journal

Background: Cardiobacterium hominis (C. hominis) is an uncommon cause of infective endocarditis and often presents sub-acutely with fevers, cardiac murmurs, or embolic phenomena. We present a rare case of C. hominis infective prosthetic valve endocarditis that presented with new-onset atrial flutter and systemic emboli.

Case: A 38-year-old male presented to the emergency department with palpitations, shortness of breath, and chest tightness and was found to be in atrial flutter. He underwent a transesophageal echocardiogram-guided cardioversion and was incidentally found to have a one-centimeter echodensity on the ventricular side of his prosthetic aortic valve. (Figure 1.) He …

Effective Strategies In Improving Internal Medicine In-Training Exam Performance - A Systematic Review, Derek Clar, Ryan Juneau, Valentina Mcneal, Dhara Patel, Prutha Patel, Amro Ilaiwy

Graduate Medical Education Research Journal

Background: The IM-ITE is administered annually to provide residents and program leadership with a measure of the residents' knowledge compared with that of their peers nationwide. Several approaches have been used to improve IM-ITE scores as a means of achieving higher first-time board examination pass rates. While these interventions helped improve outcomes in target programs, it remains unclear whether one approach was superior to another and how different program demographics may have played a role in the outcome of the intervention. Objective: To identify the most effective methods used to improve IM-ITE scores in the literature. Methods: We searched MEDLINE …

Daddy Goggles, Mason J. Rohr

Graduate Medical Education Research Journal

N/A

Promoting Confidence And Evidence-Based Practices For Attention-Deficit/Hyperactivity Disorder Among Integrated Primary Care Providers: A Qualitive Improvement Education Initiative, Omar Samateh, Margaret Emerson, Kayla Meisinger, Taylor Wilson, Leeza Struwe

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Primary Care Providers (PCPs) are seeing growing number of patients presenting for adult attention-deficit/hyperactivity disorder (ADHD) evaluations as a result of social media influences highlighting ADHD. Yet, PCPs report lacking confidence and education with adult ADHD. The purpose of this quality improvement study was to develop educational materials to promote confidence, competence, and adherence to ADHD evidence-based recommendations among integrated care PCPs. Methods: A literature review and retrospective chart review of 19 patients were used to create 1) Baseline ADHD Provider Education (PE) tool, 2) Standardized ADHD Diagnosis (SAD) referral process, 3) ADHD Assessment, Treatment, and Monitoring …

Minimizing Infant Injury Risk By Utilizing Parental Education In A Primary Care Setting, Courtney Munroe, Erin Kuehl, Rachel Mahlberg

Doctor of Nursing Practice Projects: College of Nursing

Introduction

Accidental injury and death to infants has been correlated to lack of proper education to parents of infants in the primary pediatric care setting. Sudden infant death syndrome (SIDS) and unintentional injuries were the second and third leading causes of post neonatal death during this period of time (Centers for Disease Control and Prevention [CDC], 2016). Studies have found that motor vehicle accidents are a leading cause of child injury and death for infants under 12 months of age. The CDC found that drowning, suffocation, and poisoning were other leading causes that contributed to child injury and death rates …

Design And Investigation Of Small Molecule Drugs For Potential Treatment Of Cns Disorders, Flaviviral Infections, And Cancers, Viktoriya Mashinson

Theses & Dissertations

Chapter 1 discusses the development of antagonists against the dopamine 4 receptor (D4R) that is expressed in the motor, associative, and limbic subdivisions of the basal ganglia network and is involved in Parkinson’s disease (PD). Levodopa is the firstline drug for the management of PD symptoms but its long-term use often leads to development of levodopa-induced dyskinesia (LID). D4R antagonists have been shown to decrease the abnormal involuntary movement scores in mouse models of LID. Chapter 1 outlines the development and optimization of selective D4R antagonists for potential treatment of LID. During the investigation of our D4R antagonists we discovered …

Priorities To Care Within The Military Health System: A Mixed Methods Study On Military Spouse Access To Care During Covid-19 On Okinawa, Elayne L. Wilson

Theses & Dissertations

Military spouses in Okinawa experienced denial of care at military treatment facilities and off base Japanese healthcare facilities during the COVID-19 pandemic. Over two years of travel restrictions further contributed to difficulties accessing healthcare while stationed on the island with their active-duty spouse. This study examined the implications of a priority-based access system through the TRICARE program implemented due to limited resources during COVID-19 and its impact on military spouses in a scarce medical resource environment. This concurrent mixed-methods research used a survey tool developed by Community First Hawaii to quantify access to healthcare and in-depth interviews to further explore …

Sparkled: Social Programming In Kids Affects Risk Of Latent Endothelial Disease, Rebecca Drakowski

Theses & Dissertations

Background: Social Health Programming (SHP) is a holistic intervention that can empower communities to address modifiable risk factors for poor cardiovascular health, including suboptimal nutrition or psychosocial stressors. SHP participation has been shown to increase dietary intake of fruits and vegetables, decrease perceived stress, and improve cardiovascular endurance. However, it is unknown how SHP participation during adolescence affects carotenoid serum levels, hair cortisol concentrations (biological marker of chronic stress), or vascular reactivity index (VRI; measure of subclinical cardiovascular health).

Methods: Adolescent girls and young adult women (12–29-year-old) were enrolled in this observational cohort study. Serum, hair, and saliva samples were …

A Comprehensive Usability And Economic Analysis Of Heat-Related Wearable Technologies: Applications To Occupational Health, Ryan T. Cannady

Theses & Dissertations

The purpose of this research was to analyze the usability and economic considerations of real-time wearable technologies that are implemented in occupational settings to assess risk of heat stress and heat strain. The study population included current agriculture workers and Department of Energy (DOE), Environmental Management (EM) contractors. We employed a mixed-methods approach to comprehensively analyze the usability and economic considerations of heat-related technologies. Specifically, our approach assessed three distinct aspects the applications of these technologies in occupational settings to comprehensively address our research objective: (1) worker perceptions of heat-related wearable technologies, (2) field-based assessment of these heat-related wearable technologies, …

Development Of A Streptococcus Mutans Biofilm Model On A Typodont Platform To Investigate Its Dynamics In Orthodontics, Hibah Chughtai

Theses & Dissertations

Introduction: Biofilm formation plays a significant role in dental health, resulting in plaque accumulation, which can lead to caries and oral diseases. Streptococcus mutans (S. mutans) is a key bacterium involved in this process. The goal of this study was to establish a protocol for the development of an S. mutans biofilm on dental typodont teeth to analyze the effects of orthodontic brackets on biofilm formation. Understanding these dynamics is critical for developing strategies to mitigate biofilm accumulation during orthodontic treatment. Methods: S. mutans biofilms were cultivated under three conditions: 96-well tissue culture plates, S. mutans inoculated non-bracketed …

Ccr5-Ligand Decorated Rilpivirine Lipid-Based Nanoparticles For Sustained Antiretroviral Responses, Milankumar Patel

Theses & Dissertations

Antiretroviral therapy (ART) is the standard remedy to improve the health-related quality of life of people living with human immunodeficiency virus (HIV). However, limited access to the viral reservoir has significantly hindered its effectiveness in fully eradicating HIV. Therefore, to improve HIV therapy, here we propose a C-C chemokine receptor type 5 (CCR5)-targeted theranostic lipid Based Nanoparticles (LBNPs) to noninvasively track and specifically deliver the antiretroviral drugs (ARVs) to the viral reservoir. A multi-modular radioactive nanoprobe was synthesized and co-encapsulated with rilpivirine (RPV, an ARV) into the LBNP to achieve a theranostic LBNP that can be tracked by positron emission …

Biobehavioral Correlates Of Multidimensional Fatigue In Men With Prostate Cancer, Kristin Dickinson

Theses & Dissertations

The purpose of this thesis project was to 1) examine trajectories of multidimensional cancer-related fatigue (CRF) in men with prostate cancer during and after radiation treatment completion, and 2) identify biobehavioral correlates (demographic, clinical, co-occurring symptoms, and biologic [inflammatory cytokines]) for the different CRF dimensions.

Data for this secondary analysis were obtained from a descriptive, longitudinal IRB-approved study investigating men with non-metastatic prostate cancer receiving radiation therapy (RT). Data were obtained from 68 participant medical records, self-report questionnaires, and blood samples. Data were collected at: baseline (T1), completion of RT (T2), 6 months (T3) and 2 years (T4) after completion …

Prospective, Crossover, Comparative Study Of Two Methods Of Chlorhexidine Bathing, Richard J. Hankins

Theses & Dissertations

Bathing intensive care unit (ICU) patients with chlorhexidine gluconate (CHG) decreases hospital acquired infections (HAIs). The optimal method of CHG bathing remains undefined. Prospective cluster crossover study comparing CHG daily bathing with 2% CHG impregnated cloths versus 4% CHG solution. In phase 1, from January 2020 through March 2020, one ICU utilized 2% cloths, while the other ICU utilized 4% solution. After an interruption caused by the COVID-19 pandemic, in phase 2, from July 2020 through September 2020, the unit CHG bathing assignments were reversed. Swabs were performed three times per week from patients’ arms and legs to measure skin …

Specifically Targeting Muc16 For Fluorescence-Guided Surgery Of Pancreatic Ductal Adenocarcinoma, Kathryn M. Muilenburg

Theses & Dissertations

Pancreatic cancer is a lethal disease with a low 5-year survival rate and a high rate of resection recurrence. However, surgery remains the only treatment with curative potential for pancreatic cancer. Many factors such as high desmoplasia, a lack of intraoperative imaging, and micrometastatic disease contribute to the high rate of incomplete resections in pancreatic cancer. Fluorescence-guided surgery (FGS) is a potential intraoperative tool for application in surgical resection. FGS works through passive or active targeting of a free dye or dye-containing moiety (e.g. antibody, peptide, and nanoparticles) to specifically fluoresce the tumor compared to the surrounding normal, fibrotic, and …

Formulation And Characterization Of Biologics – From Sirna To Monoclonal Antibodies, Chinmay M. Jogdeo

Theses & Dissertations

Biologics are a rapidly growing class of therapeutics, encompassing a wide range of modalities, with gene therapy products and monoclonal antibodies (mAbs) constituting the majority. Proper formulation and characterization of these complex therapeutics is crucial to ensure their safety and therapeutic efficacy.

This dissertation focuses on two main areas: the development of a novel renal-targeted siRNA delivery system and the assessment of structural and conformational stability of mAbs in a simulated subcutaneous (SC) environment.

The first part of this dissertation presents the synthesis and characterization of a novel renal-targeted polymer for selective siRNA delivery to injured kidneys. Inulin was modified …

Bio-Preparedness In A Global Context: Multi-Site International Study Investigating Global Health Security Challenges In Egypt, Oman, And The United States, Rima M. Al Balushi

Theses & Dissertations

The COVID-19 pandemic exposed myriad vulnerabilities globally within public health systems, from inadequate bio-risk management in laboratories to overwhelming utilization of hospital resources and disparities in vaccine access and uptake. The Global Health Security Index (GHSI), which critically evaluates health security domains including health systems and risk environments, reports serious weaknesses in global health security. This dissertation aims to investigate critical aspects of global health security domains by examining factors impacting biosafety and biosecurity capacities in laboratories in Egypt, healthcare resource utilization in hospitals in Oman relating to acute respiratory infections (ARI), and COVID-19 vaccine uptake in the United States. …

Examining Change In Burnout And Empathy Among Physician Assistant Students During The Clinical And Didactic Years, Jannelle Reynolds, Kimberly Gomes, Nicole M. Sleddens, Jana L. Wardian Phd

Innovations in Health Sciences Education Journal

Few studies investigate how burnout affects physician assistant's student empathy. This study aimed to determine the degree of burnout and empathy in didactic PA students as compared to burnout and empathy in their clinical year.

Methods: One cohort of PA students at a Midwestern university were surveyed twice during their education. Once during didactic and once during the clinical year. Two surveys were used to assess burnout and empathy.

Results: Our findings showed moderate to high levels of emotional exhaustion and depersonalization at the end of the didactic phase and significant improvement in lack of personal achievement and emotional exhaustion …

A Replication Study — Suicidal Thoughts And Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2021, Mallory Hays

Capstone Experience: Master of Public Health

Suicidal thoughts and behaviors among adolescents are critical public health concerns in the United States, with suicide being the third leading cause of death among high school-aged youths (14-18 years). This study replicates and extends the findings of the 2021 Youth Risk Behavior Survey (YRBS) conducted by Gaylor et al., which analyzed data from 13,677 students in 2019 and 17,232 students in 2021. The original study revealed alarming increases in suicidal ideation and behaviors, particularly among female students, and highlighted disparities across demographic groups. Using raw YRBS datasets, this replication involved a pure replication of the original findings, followed by …

Promoting Adolescent Mental And Physical Health: Initiatives Focused On Connecting Public Health And Social Services To The Health Sector In Nebraska, Theresa Nguyen

Capstone Experience: Master of Public Health

This capstone focuses on the second recommendation of improving access to comprehensive, coordinated health services from the National Academies of Sciences, Engineering, and Medicine report The Promise of Adolescence: Realizing Opportunity for All Youth (2019). This proposal uses secondary data from the research project, Moving Evidence-Based Recommendations to Practice to Strengthen the Health Care System in Nebraska. Key stakeholders (n=28) were interviewed from the health care, public health, social services, and policy sectors. Each subject was asked to participate in a semi-structured interview by a trained interviewer. The interview was 1 hour long and conducted via phone call or Zoom. …

The Association Between Systolic Blood Pressure And Coronary Heart Disease In The Framingham Heart Study: A Long-Term Prospective Cohort Study, Alexandrea M. Welch

Capstone Experience: Master of Public Health

Coronary heart disease (CHD) is a leading cause of morbidity and mortality worldwide, with systolic blood pressure (SBP) as a critical risk factor. This study utilized data from the Framingham Heart Study to assess the association between SBP and CHD among participants. Univariate, bivariate, and multivariable logistic regression was used to explore this association as well as the association with other key covariates. We found a significant positive association between elevated SBP and the risk of CHD (adjusted OR: 1.69, 95% CI: 1.41-2.01, p < 0.0001). Age, sex, current blood pressure medication use, and body mass index (BMI) were significantly associated with CHD. Our findings support the need for blood pressure management to prevent cardiac events and reduce CHD burden.

Closing Gaps To Address Lifespan Health: Considerations For Developing A Preconception Healthcare Training For Community Health Workers, Jaclyn R. Vancamp

Capstone Experience: Master of Public Health

Community health workers (CHWs) are frontline public health workers who are embedded in their own communities and as linkages to care, decreasing health disparities for underserved individuals. The goal of this capstone project was to identify Michigan CHWs' knowledge gaps in the area of preconception healthcare. Through administering a training needs assessment to a sample of community health workers, the goal was to characterize knowledge gaps and make recommendations about what type of training would be most useful to them. The results of this needs assessment showed that the general state of self-reported knowledge about preconcept health among Michigan community …

Dietary And Physical Activity Behaviors In 2021 And Changes From 2019 To 2021 Among High School Students: A Replication Study, Jamila Nasir

Capstone Experience: Master of Public Health

Shannon L. Michael et al. conducted the study “Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students” to compare the prevalences of specific dietary and exercise behaviors among high-school students between 2019 and 2021, in order to examine how the COVID-19 pandemic affected these behaviors and to identify disparities in these effects.

This replication of the study focuses on exercise behaviors. The study data, drawn from the CDC’s YRBS in 2019 and 2021, had been selected using a three-stage cluster sampling method in which the clusters in the third stage were selected …

Association Between Cigarette Smoking And Angina Pectoris Among Middle-Aged Adults: Findings From The Framingham Cohort Study, Lauren M. Hron

Capstone Experience: Master of Public Health

Objectives: This study investigates the relationship between current cigarette smoking at baseline and the occurrence of angina pectoris during follow-up among middle-aged adults (30-70 years), adjusting for age, sex, BMI, diabetes status, education, and number of cigarettes smoked per day.

Methods: Using the Framingham Heart Study cohort (N=4,434), logistic regression analyses were performed. A backward selection approach identified confounders and explored effect modification.

Results: Angina prevalence was 16.4%, with higher odds observed in males, older individuals, and those with obesity or diabetes. Smoking status showed a non-significant association with angina in multivariable models (aOR:0.86, 95% CI: 0.73-1.01). However, age and …

Cybersecurity Vulnerabilities And Considerations In U.S. Healthcare Facilities: A Scoping Review, Rebecca J. Campbell

Capstone Experience: Master of Public Health

Robust cybersecurity measures are essential for business continuity of U.S. healthcare institutions which is to maintain care standards for all patients. Hackers seek to disrupt healthcare delivery for financial and political means, to disrupt services in retaliation, or simply for malicious intent (Wasserman & Wasserman, 2022). The COVID-19 pandemic further accelerated innovation and digitization in healthcare, including wearable and implanted medical devices, telehealth care delivery options, artificial intelligence, and cloud-based data management (Kioskli, Fotis, & Mouratidis, 2021). This progress in innovation continues today but also brings new vulnerabilities and challenges to stay ahead of cybersecurity threats.

Given that cyberattacks have …

Knowledge, Attitudes, And Behaviors Regarding Water Quality, Nitrate Contamination, And Related Health Issues Among Nebraska Healthcare Professionals, Jessenia Hincapie

Capstone Experience: Master of Public Health

Background: Nitrate contamination in drinking water is a public health concern, particularly in agricultural regions. Healthcare professionals often address water quality issues but may lack sufficient knowledge regarding the health effects of nitrate contamination. This study evaluates whether Nebraska healthcare professionals' knowledge and attitudes about nitrate contamination predict their behaviors in addressing this issue.

Methods: A survey was administered to healthcare professionals across Nebraska to assess their knowledge, attitudes, and behaviors regarding nitrate contamination in drinking water. A total of 462 respondents participated. Generalized linear regression analysis was employed to assess the impact of knowledge and attitudes regarding nitrate contamination …

Understanding And Mitigating The Potential Effects Of Postpartum Depression On Fathers And Male Support Persons, Rachel Norton-Turk

Capstone Experience: Master of Public Health

Background. During the postpartum period, best practices dictate that medical professionals screen new mothers or birthing persons for anxiety and depression and direct them to the appropriate resources and services they may need. This qualitative study explored the steps being taken to identify depression and anxiety concerns in male support partners during the postpartum period and to understand what resources are being brought to their attention if depression and anxiety are identified. Methods. A convenience sample of male support persons participated in semi-structured, one-on-one interviews either in-person or over Zoom between September and October 2024. Interviews were recorded, transcribed, …

Investigating The Association Of Total Cholesterol Level And Odds Of Angina In Women Over 40: A Cohort Study Using Data From The Framingham Heart Study, Katelyn Mitchell

Capstone Experience: Master of Public Health

Objective To investigate the association between total cholesterol level and the odds of experiencing angina in women over the age of 40.

Methods This retrospective cohort study was conducted using a subset of the cohort from the Framingham Heart Study to create a multivariable logistic regression model for analysis. Out of the 4,434 participants in the Framingham cohort, 2,148 participants were women over the age of 40 and included in this study.

Results Of the participants who experienced angina (n=308) in this study, 62% had high cholesterol at the baseline. After controlling for age, women with high cholesterol had 2.03 …

A Cohort Study Examining The Risk Of Smoking On The Likelihood Of Developing Angina Among Women Under Age 65, Sarah Ward

Capstone Experience: Master of Public Health

Objective:

To determine if current smoking status is a risk factor for angina among women under the age of 65.

Methods:

A subset of participants from the Framingham Heart Studywere used to complete a cohort study. The analyses evaluated population means and characteristics, followed by bivariate and multivariable logistic regression, to determine the association of smoking and other key factors with angina.

Results:

Smoking status had a significant association to angina(OR 0.67, 95% CI: 0.52, 0.86, p-value= 0.0015). Age as a categorical variable had a significant relationship with angina (OR 0.97, 95% CI: 0.617, 1.520, p-value=

Conclusions:

Smoking had a …

Beryllium Work Area And Tank Waste, Angelica Zarate

Capstone Experience: Master of Public Health

My capstone was conducted at the Hanford site in Richland, Washington. It was once a location that produced weapons-grade plutonium, but now its mission is to clean up the radioactive waste that was left behind. My project focused on beryllium and how much is present in the 56 million gallons of waste that needs to be disposed of. I evaluated the OSHA regulations for beryllium work areas, medical surveillance, and beryllium exposure's environmental and health implications. The purpose was to determine if the concentrations present meet the requirements to continue to be considered a beryllium work area.