Medicine and Health Sciences Commons^™

Comparative Study Of Coronary Heart Disease Incidence In Smokers Vs. Non Smokers: A Longitudinal Cohort Analysis From The Framingham Heart Study, Mona Melvin Periera

Capstone Experience: Master of Public Health

Objective: To evaluate the association between smoking and coronary heart disease (CHD) incidence while adjusting for potential confounding factors, including age, education level, systolic blood pressure, BMI, serum cholesterol, and diabetes, using data from the Framingham Heart Study.

Methods: A cohort of 4,434 participants aged 32–70 years, free of CHD at baseline, was analyzed. Smoking status (current vs. non-current smokers) was the primary exposure, and CHD incidence was the outcome. Adjustments were made for confounders using multivariable logistic regression models. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: CHD was diagnosed in 27.96% of …

The Role Of Serum Total Cholesterol In Coronary Heart Disease: A Prospective Cohort Analysis From The Framingham Heart Study, Sanish Maharjan

Capstone Experience: Master of Public Health

Objective: To investigate the association between serum total cholesterol and coronary heart disease (CHD), accounting for key risk factors in adults aged 32–70 years.

Methods: We analyzed data from 4,382 participants of the Framingham Heart Study, a prospective cohort study with 24 years of follow-up. Multivariable logistic regression was used to assess the relationship between serum cholesterol and CHD, adjusting for age, sex, smoking status, systolic blood pressure, BMI, diabetes, and heart rate.

Results: Individuals with high (aOR = 1.87; 95% CI = 1.52 - 2.32; p<.0001) and borderline high (aOR = 1.40; 95% CI = 1.13 - 1.75; p = 0.0024) cholesterol levels have significantly higher odds of developing CHD than those with normal cholesterol. Older (aOR=1.03; 95% CI=1.03–1.05), male (aOR=2.16; 95% CI=1.86–2.51), current smokers (aOR=1.20; 95% CI=1.03–1.39), hypertensive (aOR=1.88; 95% CI=1.55–2.26), obese (aOR=3.03; 95% CI=1.24–7.43), and diabetic individuals (aOR=2.41; 95% CI=1.63–3.56), had significantly higher CHD risk.

Conclusions: Elevated serum cholesterol significantly increases CHD risk, emphasizing …

55-Word Stories: Insight Into Healthcare, Nancy E. Krusen

Translational Science in Occupation

Narrative medicine and health humanities focus on arts, ethics, and clinical practice. Many health education programs incorporate creative activities to facilitate learner self-awareness and insight. We include them to address programmatic themes of professional growth and translational science.

Effectiveness Of Interventions In The Scope Of Occupational Therapy For Mental Health In Children And Adolescents: A Systematized Review, Shawn Macdonald, Jaden Siegle, Cheyney Loper, Simone Regnier, Danielle Westmark, Stacy Smallfield, Molly Whitlow

Student Systematized Reviews: Occupational Therapy

Importance: 1 in 5 children in the US have a mental health disorder (Larson et al., 2017) which affects health across the lifespan, including engagement in school and play (Rizvi et al., 2024).

Objective: This systemized review explored literature about the effectiveness of mental health interventions for children and adolescents within the occupational therapy (OT) scope of practice.

Data Sources: A medical librarian searched articles from 2019-2024 that were retrieved from PubMed, CINAHL, and PsycINFO.

Study Selection and Data Collection: Studies were included if the outcome measures addressed mental health, interventions were within the scope of OT, participants were children …

The Hunger Vital Sign Alone Misses Patients Who Are Not Food Secure, Avry Logeman, Susan Evans, Jenenne Geske

Posters and Presentations: Family Medicine

No abstract provided.

Interventions To Improve Or Maintain Activity Of Daily Living Performance In Adults With Dementia: A Systematized Review, Abbey J. Seevers, Tristen F. Toelle, Tate M. Pfeifer, Jake D. Cera, Danielle Westmark, Stacy Smallfield, Molly Whitlow

Student Systematized Reviews: Occupational Therapy

Importance: Dementia is a progressive cognitive disorder that leads to the degradation of one’s abilities until they are dependent for all activities of daily living (ADLs) (Andersen et al., 2004). There’s an increasing importance to search for effective ways to preserve independence in ADLs and quality of life for adults with dementia (Weng et al., 2019).

Objective: To identify effective occupational therapy (OT) interventions for maintaining or improving ADL performance among adults with dementia.

Data Sources: PubMed, CINAHL, PsycINFO. This search was conducted by a medical librarian.

Design: Inclusion criteria encompassed interventions within the scope of OT, at least one …

Synthesis And Characterization Of Zoledronic Acid Prodrugs: A Potential Therapeutic For Enhanced Drug Delivery And Targeted Treatment, Shweta Wani

Theses & Dissertations

Bisphosphonates, particularly zoledronic acid (ZA), are crucial in managing bone resorption and treating skeletal disorders like multiple myeloma (MM). While ZA has demonstrated significant anti-myeloma activity in-vitro, its clinical use is limited by poor systemic exposure and potential off-target effects. This thesis investigates two strategies to conjugate polyethylene glycol (PEG) and hyaluronic acid (HA) to ZA to overcome these limitations. The first strategy, targeting the tertiary alcohol group of ZA, faced significant challenges due to the difficulty in conjugation. The second strategy, focusing on the hydroxyl group of the phosphonate moiety in ZA, successfully yielded a ZA-PEG conjugate, enhancing …

A Nursing Education Intervention For Delirium Prevention, Sarah Eckles

Doctor of Nursing Practice Projects: College of Nursing

Background

At a large, tertiary care hospital in the Midwest, it had been anecdotally noted that delirium or acute encephalopathy cases were increasing. Specifically, inpatient neurology consultations for delirium were on the rise. This data had been confirmed by hospital administration. Delirium has been identified as a well-known problem in elderly, hospitalized adults—most notably in elderly, postoperative adults. It can cause a cascade of additional complications for elderly patients. Delirium prevention is known to be the best method to combat delirium incidence. Prevention has been proven to occur by way of non-pharmacologic, early interventions by nursing. Bedside nursing staff must …

Understanding The Role Of Malondialdehyde-Acetaldehyde Adducts (Maa) In Inflammatory Bowel Disease, Megan L. Otte

Theses & Dissertations

Inflammatory Bowel Disease (IBD) comprises autoimmune diseases of the gastrointestinal tract that greatly reduce the quality of life of patients and currently afflict up to 200 individuals per 100,000 Americans. Ulcerative colitis (UC) and Crohn’s Disease (CD), the two principal diseases comprising IBD, share symptoms and risk factors, however, precise etiology remains unclear. The diagnostics and clinical management of IBD have progressed greatly in recent years especially due to immune modulating therapies and biologics, however, IBD and its specific forms are still difficult to diagnose and cannot be cured with current treatments. The overarching mechanisms of IBD pathogenesis are known …

Central Nervous System Antiviral Pharmacology, Sean N. Avedissian

Theses & Dissertations

Soon after viral infection, viruses like Human Immunodeficiency Virus (HIV) and SARS-CoV-2 can disseminate throughout the body and establish reservoirs in the central nervous system (CNS). The persistence of viruses in cells of these reservoirs is a major obstacle to virus eradication. This is due to the abundance of cells/receptors that these viruses utilize to gain entry into cells found at these various reservoir sites. Consequently, these same anatomical sites also may be pharmacologic sanctuaries, as evidenced by concentrations of antiretroviral drugs (ARVs) and antivirals (AVs) that are lower in reservoirs than those in peripheral blood; in some cases, these …

Ct Scan Identified Sarcopenia And The Relationship With The Mst And And/Aspen Malnutrition Guidelines In Gastrointestinal Cancer Patients, Samantha Dieckmann

Theses & Dissertations

Sarcopenia is a debilitating muscle loss disorder caused by aging or chronic conditions. It decreases quality of life and increases morbidity and mortality. Gastrointestinal cancer patients are at a high risk for the condition given the impact of the disease and its treatments. There is limited consensus on how to identify and screen for sarcopenia. Previous research is limited on the use of clinically available tools currently used for malnutrition and their ability to screen for sarcopenia. This study aimed to investigate the Malnutrition Screening Tool (MST) and the Academy of Nutrition and Dietetics, and the American Society for Parenteral …

Association Between Agrichemical Mixtures And Pediatric Health Outcomes: Evidence From A Nebraska Population-Based Surveillance, Jabeen Taiba

Theses & Dissertations

Human exposure to environmental contaminants is associated with various pediatric health outcomes. Agrichemicals are a significant environmental risk factor for childhood cancers and congenital anomalies, and reduced exposure could improve pediatric health outcomes. Previous studies in Nebraska have explored the association between single pollutants and pediatric cancers and birth defects. However, it is important to estimate the overall effect of the agrichemical mixture on these pediatric health outcomes. In addition to environmental risk factors, several social vulnerability factors also contribute to increased agrichemical exposure and show disparities in pediatric cancers and birth defects. The objectives of this dissertation are to …

Synthesis And Characterization Of An Activity-Based Probe To Isolate And Quantify Adduct Formation In Ntsr1 Trt., Aadarsh Khairnar

Theses & Dissertations

Targeted radionuclide therapy (TRT) has emerged as a promising cancer treatment by offering precise delivery of radioisotopes to cancer cells via molecular targets. Recent advancements in the small molecule TRTs offer efficient targeting and rapid clearance, reducing off-target toxicity. The Neurotensin receptor 1 (NTSR1) targeted small molecule antagonist 3BP-227 when labeled with [¹⁷⁷Lu], has demonstrated effective tumor targeting but suffers from rapid washout from the target cancer cell, limiting its therapeutic potential.

To enhance tumor retention and therapeutic efficacy of the NTSR1-targeted TRT, the Garrison laboratory has developed a novel approach utilizing cysteine cathepsins (CCs) and the E64 …

Long-Term Neurodevelopmental Outcomes Post-Chronic Midazolam Exposure During Early Life, Nghi M. Nguyen

Theses & Dissertations

In recent decades, the rising number of neonates born in the Neonatal Intensive Care Unit (NICU) due to prematurity has raised concerns about their overall well-being and development. Premature neonates are at higher risk of health complications and often require invasive procedures. These invasive procedures often induce stress and agitation, prompting physicians and healthcare providers to provide sedation or general anesthesia to manage discomfort. Epidemiological studies of human patients have revealed a correlation between childhood exposure to general anesthetic and sedative agents and subsequent cognitive deficits. This association is also supported in animal models, which shows that exposure to anesthetics …

Rheumatoid Arthritis Disease Activity Is Associated With Frailty In Veterans, Courtney N. Loecker

Theses & Dissertations

Frailty, a physiologic vulnerability to everyday stressors, affects approximately 30% of the 1.3 million Americans with rheumatoid arthritis (RA) and is associated with increased risk for adverse health outcomes. Active RA manifests as inflammation, pain, and joint damage leading to functional impairments and morbidity which cumulatively influences frailty. However, the relationship between RA disease activity and frailty is incompletely understood.

This study evaluated the relationship of RA disease activity and frailty at baseline and over up to five years in Veterans. A cohort study was performed using data from the Veterans Affairs Rheumatoid Arthritis registry. RA disease activity was measured …

Pharmacokinetics And Tissue Distribution Of A Lipid-Based Extended-Release Nano-Formulation Of Mo-Oh-Nap Tropolone To Enhance Pulmonary Delivery For The Treatment Of Pulmonary Metastatic Osteosarcoma, Wafaa N. Aldhafiri

Theses & Dissertations

Osteosarcoma is the most common primary bone tumor in children and adolescents. Metastasis is prevalent in 25% of patients, at diagnosis, with the lungs being the most common metastatic site. Pulmonary metastatic osteosarcoma is a significant therapeutic challenge with a 5-year survival rate of ≤30%. Patients with pulmonary metastatic disease at diagnosis receive the same standard of care as patients with local disease, which hasn’t changed over the past 30 years. The treatment and prevention of pulmonary metastatic osteosarcoma represents a significant critical and unmet need.

MO-OH-Nap tropolone is a novel small molecule with cytotoxic activity across multiple human osteosarcoma …

Understanding The Role Of Mastl In Colon Homeostasis And Colitis-Associated Cancer Development, Kristina Pravoverov

Theses & Dissertations

Colitis-associated cancer (CAC) is the most devastating complication of longstanding inflammatory bowel disease (IBD). Understanding the mechanisms underlying the switch from damage-repair to dysplasia in IBD is critical for identifying novel therapies to facilitate mucosal healing while mitigating CAC risk. Microtubule-associated serine-threonine kinase-like (MASTL), though crucial in cell growth and repair, is upregulated in sporadic colorectal cancer and CAC. This study sought to delineate the role of MASTL in colitis and CAC development.

First, we examined whether MASTL is associated with colitis and recovery. Review of publicly available data found significant elevation of MASTL and interleukin (IL)-22 in biopsies from …

Novel Mechanisms For The Neural Control Of Breathing In Acute Lung Injury, Kajal Kamra

Theses & Dissertations

Acute lung injury (ALI) triggers inflammation that disrupts the normal alveolar-capillary endothelial barrier, impairing gas exchange and causing hypoxemia, which reflexively increases respiration. An elevated respiratory rate (fR) usually develops within hours to days following ALI. This acute respiratory failure disorder affects approximately 200,000 new cases annually in the US and accounts for 10% of ICU admissions, with high morbidity and mortality. The neural mechanisms underlying respiratory dysfunction post-ALI are not fully understood. My doctoral dissertation aimed to investigate the mediators of abnormal ventilation during ALI. Systemic hypoxia stimulates the carotid body (CB) chemoreflex, a crucial protective reflex that maintains …

Characterization Of Population Pharmacokinetics And Associated Interindividual Variability Of Drugs Used In Mass Drug Administration Against Lymphatic Filariasis, Abdullah Alshehri

Theses & Dissertations

Lymphatic filariasis (LF) is a mosquito-borne filarial infection that affects the lymphatic system. The progression of the disease is associated with severe comorbidities and social stigma among patients. The World Health Organization has categorized the disease as a public health problem, and it has been targeted by mass drug administration (MDA) campaigns over the past two decades. Several preventive chemotherapies have been used in MDA campaigns against LF, including a combination of three anti-filarial drugs (IDA therapy): albendazole (ALB), diethylcarbamazine (DEC), and ivermectin (IVM). Other antiparasitic drugs, such as moxidectin (MOX), are still under investigation for their activity against LF. …

A Third Generation Long-Acting Dimeric Dolutegravir Prodrug Nanoformulation, Bhoomika Suresh Gowda

Theses & Dissertations

Dolutegravir (DTG) is an integrase strand transfer inhibitor (INSTI) widely used as a part of first-line combination antiretroviral therapy. DTG has a high barrier to resistance However, one therapeutic challenge centers on its life-long daily use. Sub-optimal adherence to daily oral pills underscore the need for long-acting formulations. To these ends, our research activities have focused on the development and translation of ultra-long-acting ART. Monomeric ester prodrugs provided initial success in extending the apparent half-life of DTG and other INSTIs. One is the DTG prodrug formulation called NM2DTG. NM2DTG’s significantly extended the parent drug’s apparent half-life [Nature Communications, 3226 (2022)]. …

Telehealth For Healthy Aging: A Multi-Level, Multi-Methods Approach, Vaibhavi Mone

Theses & Dissertations

Telehealth, rapidly adopted during the pandemic, has shown its usefulness and limitations, yet was not designed with older adults in mind. This dissertation encompasses three interconnected studies exploring telehealth utilization for Medicare Annual Wellness Visits (AWVs) among older adults, provider perspectives on telehealth AWVs, and the impact of teleconferencing on primary care providers' knowledge and confidence in geriatric care. The objectives are to determine patient characteristics using telehealth AWV (study 1), understand provider perspectives on telehealth AWV (study 2), and evaluate the effectiveness of geriatrics education through telehealth (study 3). Study 1 investigates the changes in AWV utilization among 18,405 …

The Dissemination And Implementation Of N95 Fit Testing Capacities For Nebraska Long-Term Care Facilities: A Mixed-Methods Analysis Using The Re-Aim Framework, Anthony Blake

Theses & Dissertations

Background: Ensuring the proper fit of N95 respirators used by healthcare workers in long-term care facilities (LTCF) is essential for their safety. The Nebraska Department of Health and Human Services launched a LTCF strike team project (STP) in the summer of 2022, focused on increasing the number of staff trained in infection control and building internal capacity for LTCFs to fit test their employees. This study describes the N95 fit-testing initiative for Nebraska LTCFs.

Methods: Staff from all 19 local health departments (LHD) received “train-the-trainer” training to prepare LTCF staff to perform qualitative fit testing. LTCF administrators were requested to …

Immediate Vs Delayed Feedback In A Progressive Musculoskeletal E-Module Case For Clinical Reasoning Development, Megan Frazee, Krista Gipson, Elizabeth Lyden, Stephanie Langel

Innovations in Health Sciences Education Journal

Introduction: Clinical reasoning (CR) skills are essential when preparing healthcare students to transition to clinical practice. The purpose of this study was to evaluate the effects of feedback timing within a case-based learning (CBL) e-module. The secondary aim was to examine the longitudinal impact on student performance within a standardized patient (SP) simulation and their overall course grade at the end of the semester.

Review of Literature: Feedback is a powerful teaching method to improve student learning. However, there are highly conflicting results regarding the best frequency and timing of feedback. This may be influenced by the level of the …

Unmc Quick Checks: An “Opt-Out” Model For Health Profession Student Appointments With Mental Health Counseling Services, Hannah K. Tandon Md, Taylor J. Kratochvil Md, Ms, Katherine L. Keiser Ms, Limhp, Nicole J. Kent Bs, Kaitlyn E. Schultis Bs, Jeffrey W. Knapp Msw, Jeffrey P. Gold

Innovations in Health Sciences Education Journal

Background: Health professions trainees experience high rates of anxiety and depression but are often reluctant to seek help. Institutional outreach during pre-clinical training may identify vulnerable students, improve resource awareness, and destigmatize psychological counseling. The University of Nebraska Medical Center (UNMC) Quick Check program is a novel opt-out program connecting health professions students to mental health counselors.

Objective: The purpose of this study was to evaluate student perceptions and utilization of mental health resources after participation in the UNMC Quick Check program.

Methods: For this limited pilot study, second-year pharmacy students were assigned to UNMC Quick Check appointments with UNMC …

Not Ready: The Need For A Training Standard In Healthcare Emergency Preparedness, Patrina White

Dissertations: Doctor of Public Health

Background: Disasters, both natural and human-induced, are increasing. Disasters impact public health and safety in many ways including disruption of healthcare. Emergency preparedness mitigates disaster impacts. Training improves preparedness however no training standard exists. Purpose: This study aimed to explore the current state of U.S. healthcare preparedness and the impact of training on preparedness; determine the best strategies to improve healthcare emergency preparedness training; propose a standard for training in healthcare emergency preparedness; and identify barriers to adopting a standard for training in healthcare emergency preparedness including strategies to overcome identified barriers. Methods: A comprehensive literature review, …

Effect Of Insufficient Sleep On Activity Limitation: Results From The Brfss 2022 Survey, Jonathan Meyer

Capstone Experience: Master of Public Health

Objective: To determine whether insufficient sleep (less than 7 hours per night) is associated with activity limitation (14 days or more of poor mental or physical health interfering with everyday activities) in Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2022. Methods: BRFSS is a nationally representative cross-sectional survey of non-incarcerated US adults. The exposure of interest was insufficient sleep, and the outcome of interest was activity limitation. Other demographic variables used in a final weighted adjusted analysis include age >65 years, race/ethnicity, gender, marital status, income, and total physical inactivity. Results: The weighted prevalence of insufficient sleep for …

Ensuring Safe Mri Examinations And Earlier Detection Of Recurrent Cancer: A Scoping Review To Identify Breast Tissue Expanders That Are Safe For High-Risk Breast Cancer Survivors, Kristin E. Westmore

Capstone Experience: Master of Public Health

Purpose

This capstone project aims to conduct a scoping review to identify breast tissue expanders that are safe for high-risk breast cancer survivors, ensuring safe magnetic resonance (MR) examinations. The goal is safe MR examinations for early detection of recurrent cancer, post-operative evaluation, monitoring, and reducing preventable morbidity and mortality.

Background

The MR safety of manufacturers' tissue expanders is defined according to the United States Food and Drug Administration (FDA) guidelines and regulations as MR Conditional or MR Unsafe. Before 2023, there was a safety concern about using tissue expanders containing a magnetic port during the first stage of breast …

Exploration Of Canine T. Cruzi Seroprevalence As A Trigger For Enhanced Human Chagas Surveillance, Brittany N. Hocking

Capstone Experience: Master of Public Health

Background: Chagas disease, caused by the parasite Trypanosoma cruzi, is endemic in many Latin American countries and now the southern United States. An increasing number of Chagas cases in the U.S. have occurred because of autochthonous transmission and enzootic cycles involving infected wildlife and domestic animals, like canines.

Objective: This study aimed to explore canine seroprevalence as a trigger for enhanced human Chagas surveillance by describing detected U.S. T. cruzi from human and canine testing data, creating maps to explore geographic areas with potential high yield for T. cruzi surveillance via animal testing, and developing a SWOT analysis for …

Reducing Greenhouse Gases Through Food Waste Reduction: A Literature Review Of Programs And Behavior Change, Schafer Flowerday

Capstone Experience: Master of Public Health

Anthropogenic greenhouse gas (GHG) emissions significantly contribute to climate change. Methane is a potent GHG emitted in landfills as organic material breaks down. Food waste is the single most common item disposed of in Lincoln’s Bluff Road Landfill (LTU, 2022). As such, food waste disposal in the landfill is a preventable issue that could dramatically reduce GHG emissions in Lincoln. This project seeks to determine what barriers and motivations exist for reducing food waste at a consumer level. A literature review was conducted to find what behavior change campaigns and interventions have taken place nationwide to encourage residential food waste …

A Process Evaluation Plan For The Nebraska Fetal Infant Mortality Review (Fimr) Program, Mamello Makhele

Capstone Experience: Master of Public Health

The United States (U.S.) has made substantial progress in reducing fetal and infant mortality, but high rates of infant mortality persist, particularly within minority populations. In Douglas County, Nebraska, racial disparities in infant mortality rates remain a significant issue. In 2019, the infant mortality rate among African American mothers was 14.2 infant deaths per 1,000 live births, compared to 5.7 infant deaths per 1,000 live births among Caucasian mothers.

To reduce fetal and infant mortality in the U.S., the Centers for Disease Control and Prevention along with the Human Resources and Services Administration, fund the Fetal and Infant Mortality Review …