Medicine and Health Sciences Commons^™

Rural Or Underserved Practice Interest Among Doctor Of Physical Therapy Students. Do Clinical Education Experiences Change Opinions?, Brandon Godin, Trenton Poulson, Mac Neil Moresca, Tyler Satoshige

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: People living in rural and underserved areas are poorly served by our country's healthcare system. The Federal Office of Rural Health Policy reports that approximately 18% of people in the United States live in rural areas. Within the physician and nursing literature the largest reported predictor of rural practice is having a rural background. Mandated rural medical rotations during training have been shown to positively alter interest in rural practice and employment. While nursing and medical students have been thus studied, limited evidence exists for physical therapists. The objective of this study was to determine how rural …

The Moderation Effect Of Bdnf Genotype And Self-Reported Lifetime Physical Activity Habits On Postural Instability In Parkinson’S Disease, Samantha Johnson, Tyler Ormsby

UNLV Theses, Dissertations, Professional Papers, and Capstones

Brain-derived neurotrophic factor (BDNF) levels play an important role in neuroplasticity in normal and neurologically compromised individuals. Studies suggest that BDNF levels increase in response to physical activity and are also affected by genotype. In individuals with Parkinson’s Disease (PD), it is not known if physical activity habits and BDNF genotype modulate this neuroprotective response. The purpose of this study was to determine if BDNF genotype interacts with lifetime self-reported physical activity levels to affect age of disease onset and severity of PD symptoms, specifically gait, balance, and motor dysfunction

Patellar Tendon Morphology In Trans-Tibial Amputees Utilizing A Prosthesis With A Patellar-Tendon-Bearing Feature, Jessica Kellogg, Kelly Teter, Michelle Evers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: A patellar-tendon-bearing (PTB) bar is a common prosthetic design feature used in individuals with trans-tibial amputations. As the patellar tendon in the knee of residual limb is subjected to the perpendicular compressive force not commonly seen in normal tendon loading, it is possible for tendon remodeling and degeneration to occur over time; however, there is limited data to support this idea. The primary purpose of this study was to use ultrasound imaging to compare the morphological differences between tendons of the residual and intact limb in unilateral trans-tibial amputees who utilize a prosthesis with a PTB feature. We hypothesized …

Intra- And Inter-Rater Reliability Of A Ballet-Based Dance Technique Screening Instrument, Jessie Lesar, Zachary Shaver, Ivetta Lassey

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: To execute the aesthetic demands of dance while utilizing proper biomechanical body position, a dancer needs the ability to maintain lumbopelvic stability, external rotation of the femur, and alignment of the knee, foot, and ankle. The ability to identify technique deficits can guide preventative programs that may reduce injury risk and frequency. Purpose: The purpose of this study was to investigate intra- and inter-rater reliability of the ballet-based Dance Technique Screening Instrument by physical therapists (PTs) and student PTs (SPTs) with prior dance medicine or dance experience. Subjects: Twenty-eight adult subjects served as raters which included licensed PTs and …

Neurodynamics Under Different Walking Speeds In Individuals With Chronic Post-Stroke Hemiparesis, Corey Ackley, Kiley Aki, Joshua Arias, Jassie Trinh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Stroke is the leading cause of long-term disability in adults worldwide. The ability to return to walking is often a main goal of rehabilitation in individuals with chronic post-stroke hemiparesis. To increase walking speed, non-neurologically impaired individuals produce greater ankle propulsion force at push-off with greater ankle dorsiflexion angles in swing phase with no change in ankle muscle co-contraction index in the swing phase. It remains unclear if individuals post-stroke would adopt similar neuromuscular strategies. Therefore, our aim was to examine the effect of altered walking speeds on propulsion force at push-off, ankle dorsiflexion angle during swing, …

Physiotherapy Is Associated With Improvements In Gait And Balance In Individuals With Cognitive Impairment: A Retrospective Analysis, Steven Jackson, Elbert Chen, Jason Phan

UNLV Theses, Dissertations, Professional Papers, and Capstones

BACKGROUND: Evidence suggests that individuals with cognitive impairment (CI) exhibit significant motor impairments; however, these motor impairments receive little treatment attention compared to more prominent CI. Moreover, there is a lack of evidence about physiotherapy (PT) in individuals with CI. OBJECTIVE: The purpose of this study was to determine if PT was effective at improving gait and balance in individuals with Alzheimer disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI). METHODS: Retrospective data of 173 individuals with CI conditions and an initial evaluation for PT were extracted from electronic records from January 2016 …

Impact Of Clinician Experience And Positive Language On Subject Expectation Of Cervical Spine Manipulation Effects, Joshua Wood, Jonah Mawae, Stephen Elmer

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Acute neck pain is a worldwide epidemic that physical therapists treat with cervical spine manipulation (CSM). While the mechanical and neurological effects of CSM are important, it is possible that the patient’s perception of the therapist’s skill level may also play a role in patient outcomes. Along with the patient’s perception of the practitioner, evidence suggests that patient expectation for intervention efficacy may also alter patient outcomes. The implication is that special consideration must be taken when practitioners choose their words when describing both themselves and their interventions. The purpose of this study is to examine if …

The Environmental Impact And Formation Of Meals From The Pilot Year Of A Las Vegas Convention Food Rescue Program, Samantha To, Courtney Coughenour, Jennifer Pharr

Environmental & Global Health Faculty Research

Annually, millions of tonnes of leftover edible foods are sent to landfill. Not only does this harm the environment by increasing the release of greenhouse gases which contribute to climate change, but it poses a question of ethics given that nearly 16 million households are food insecure in the US, and hundreds of millions of people around the globe. The purpose of this study was to document the amount of food diverted from landfill in the pilot year of a convention food rescue program and to determine the amount of greenhouse gas (GHG) emissions avoided by the diversion of such …

Permanent Junctional Reciprocating Tachycardia In Infants And Children, Ranjit I. Kylat Md, Ricardo A. Samson

School of Medicine Faculty Research

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate …

Health Care-Associated Infection Prevention Outcomes: Evaluating The Link Between Infection Prevention Practices In Healthcare Facilities And Their Health Care-Associated Infection Rates, Chidinma Veronica Njoku

UNLV Theses, Dissertations, Professional Papers, and Capstones

Healthcare-associated infections (HAI) are a pressing problem affecting vulnerable individuals who come to the hospital to receive care for one condition only to find that they have contracted another during their stay. Studies point to the importance of training and educating staff in order to implement and comply with recommended infection control and prevention control and prevention practices as lack of training and knowledge about infection control and prevention has been perceived to bring about a limited ability for direct care staff to adhere to recommended processes and activities. Although there are prior studies on the effects of assessments, infection …

Hot Snare Vs. Cold Snare Polypectomy For Endoscopic Removal Of 4-10mm Colorectal Polyps During Colonoscopy: A Systematic Review And Meta-Analysis Of Randomized Controlled Studies, Mahendran Jayaraj

School of Medicine Faculty Research

Introduction In recent years, cold snare polypectomy (CSP) has increasingly been used over hot snare polypectomy (HSP) for the removal of colorectal polyps (4 – 10 mm in size). However, the optimal technique (CSP vs. HSP), in terms of complete polyp resection and complications, is uncertain. Our aim was to compare incomplete resection rate (IRR) of polyps and complications using CSP vs. HSP. Methods Randomized controlled studies (RCTs) comparing CSP and HSP for removal of 4 – 10 mm colorectal polyps were considered. Studies were included in the analysis if they obtained biopsy specimens from the resection margin to confirm …

Medical Student Mistreatment: Understanding 'Public Humiliation', Jesse D. Markman, Thomas M. Soeprono, Heidi L. Combs, Ellen M. Cosgrove

School of Medicine Faculty Research

Introduction: Mistreatment in medical school is an enduring problem in medical education. Little is known about the concept of ‘public humiliation,’ one of the most common forms of mistreatment as identified on the AAMC Graduation Questionnaire. The objective of this study was to further investigate ‘public humiliation’ and to understand the underpinnings and realities of ‘public humiliation’ in medical education. Method: Focus groups of medical students on clinical rotation at the University of Washington School of Medicine were conducted over one and a half years. Qualitative analysis of responses identified emergent themes. Results: Study results included responses from 28 third …

Gigantic Stomach: A Rare Manifestation Of Duchenne Muscular Dystrophy, Amaninder Dhaliwal, Sarvani Madiraju, Banreet S. Dhindsa, Getaw W. Hassen, Fedja A. Rochling

School of Medicine Faculty Research

Duchenne muscular dystrophy (DMD) is characterized by degeneration and atrophy of skeletal, cardiac, and smooth muscles after a latent period of apparently normal development and function. The gastrointestinal manifestations start in the second decade of life and are mainly due to atrophy of smooth muscle layers. Refractory gastroparesis and chronic constipation can lead to severe gastric and small bowel dilatation, which can be life threatening. Here, we present a case of a 21-year-old male with a gigantic stomach secondary to DMD resolved with conservative management and no surgical intervention.

Asymmetric Crying Facies Syndrome, Kai-Yu Ho Pt, Phd, Jing Nong Liang Pt, Phd

Physical Therapy Faculty Research

A female infant, born vaginally at 40 weeks of gestation with a birthweight of 3260 g had an Apgar score of 10 at 1 and 5 minutes. She presented with an asymmetric facial expression when crying, with the right side of her mouth deviating inferior-laterally (Figure, A and Video[available at www.jpeds.com]). At rest, her facial expression was symmetric and a thinner left lower lip was noted (Figure, B). A pediatricneurologist noted intact motor, reflex, and cranial nerve functions, and she was diagnosed with asymmetric crying facies, likely because of hypoplasia of the left depressor angularis oris muscle. Asymmetric crying facies …

Cardio-Metabolic Disease Risk Factors Among South Asian Labour Migrants To The Middle East: A Scoping Review And Policy Analysis, Shiva Raj Mishra, Saruna Ghimire, Chandni Joshi, Bishal Gyawali, Archana Shrestha, Dinesh Neupane, Sudesh Raj Sharma, Yashashwi Pokharel, Salim S. Virani

School of Public Health Faculty Research

This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) risk factors among South Asian labor migrants to the Middle East. We conducted a qualitative synthesis of literature using PubMed/Medline and grey literature searches, supplemented by a policy review of policies from the South Asian countries. We found a high burden of cardio-metabolic risk factors among the migrants as well as among the populations in the home and the host countries. For example, two studies reported the prevalence of diabetes mellitus (DM) ranging between 9 and 17% among South Asian migrants. Overweight and obesity were highly …

Differential Microrna Expression Of Mir-21 And Mir-155 With Oral Cancer Extracellular Vesicles In Response To Melationin, Matthew Hunsaker, Greta Barba, Karl Kingsley, Katherine M. Howard

Dental Medicine Faculty Research

Objective: Extracellular vesicles derived from oral cancer cells, which include Exosomes and Oncosomes, are membranous vesicles secreted into the surrounding extracellular environment. These extracellular vesicles can regulate and modulate oral squamous cell carcinoma (OSCC) progression through the horizontal transfer of bioactive molecules including proteins, lipids and microRNA (miRNA). The primary objective of this study was to examine the potential to isolate and evaluate extracellular vesicles (including exosomes) from various oral cancer cell lines and to explore potential differences in miRNA content. Methods: The OSCC cell lines SCC9, SCC25 and CAL27 were cultured in DMEM containing 10% exosome-free fetal bovine serum. …

Evidence-Based Practice Guide And Workflows: Improving Hospital Throughput And Reducing Emergency Department Overcrowding, Maulah Halley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospitals in the United States are experiencing disruptions to patient throughput. These disruptions create barriers to patients who seek emergent care in the Emergency Department (ED) and who must be moved to hospital inpatient beds after the decision to admit has been made. As a result, patients requiring hospital admission via the ED may have long wait times, which, in turn, contribute to ED crowding and overcrowding. The root causes of ED overcrowding are inefficiencies within the system and the inability of hospitals to meet demand. Although bed capacity on any given unit may not be altered, ED patient’s arrival …

Prevalence And Use Of High-Fidelity Simulation In Family Nurse Practitioner Programs, Christina Rosa Pendrak Pepin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family nurse practitioner (FNP) programs represent almost 60% of all accredited primary-care NP programs in the U.S. in 2015. Increased enrollments and creation of new NP programs has led to a shortage of appropriate clinical sites and the increased competition for quality clinical sites. FNP programs have turned towards utilizing innovative ways to address this shortage including the use of high-fidelity simulation. However, a lack of literature supports substituting traditional clinical hours with high-fidelity simulation. Only 45 articles were found over a 35-year period describing the use of high-fidelity simulation in an FNP program and of those published since 2014, …

An Analysis Of Postmastectomy Breast Reconstruction Due To Breast Cancer In Nevada And The United States From 2008-2013, Jenna Webb

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: In the United States, female breast cancer was the leading cause of new cancer cases from 2011-2015. Since the Women’s Health and Cancer Act of 1998 (WHCRA), the federal government mandates employee and private health insurance providers to cover breast reconstruction if they cover mastectomies. Postmastectomy breast reconstruction (PBR) rates increased after the WHCRA, but these rates have remained relatively low throughout recent years. Objective: The objective of this study was to determine factors associated with women having PBR due to breast cancer in Nevada and the United States from 2008 to 2013. Methods: Using two HCUP database, NIS …

Determinants Of Disparities In The Colorectal Cancer Burden, Karen Elizabeth Callahan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Colorectal cancer (CRC) is the third leading cause of cancer incidence and mortality in the United States, with an estimated 140,000 new cases and 51,000 deaths expected in 2018. Like most cancers, the burden of CRC is unequally distributed among population groups. The current dissertation included two studies filling gaps in knowledge about CRC disparities. Study 1 characterized the relationship between educational attainment and CRC mortality by race/ethnicity. Six years of CRC mortality data (2012-2017) from the diverse state of California, with 30,180 deaths were analyzed. Sex-specific mortality rate ratios (MRR) stratified by race/ethnicity as well as by educational level …

Implementation Of An Asthma Action Plan In A Pediatric Outpatient Clinic, Noelle Cerdan

UNLV Theses, Dissertations, Professional Papers, and Capstones

A combination of asthma evidence-based education by nurse practitioners and other healthcare providers as well as self-management by patients with asthma and their caregivers are necessary to provide effective asthma care. According to the National Asthma Education and Prevention Program (NAEPP) guidelines from the National Institute of Health (NIH), effective asthma care includes a detailed Asthma Action Plan (AAP). However, despite this evidence-based recommendation for all patients with asthma, studies suggest many healthcare providers do not routinely utilize an AAP.

The purpose of this Doctor of Nursing Practice (DNP) project was to develop and evaluate a process for the integration …

Assessing The Long-Term Effects Of A Cultural Immersion Experience On Nursing Practice, Karen H. De La Cruz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Cultural immersion has been identified as a preferred method of teaching cultural competence in undergraduate nursing education. Multiple qualitative and quantitative studies have shown that baccalaureate nursing students enjoy international learning experiences and, based on self-efficacy evaluations, feel they have increased cultural competency following immersion experiences. However, there is little evidence to indicate concepts learned during undergraduate cultural competency course work is retained or integrated into nursing practice after leaving the milieu of academia.

To inform future cultural competency educational efforts, I conducted a qualitative phenomenological study to provide a baseline of evidence regarding the impact of a cultural immersion …

Public Exposure To Outdoor Bioaerosols In Particulate Matter In Las Vegas: Daily And Seasonal Variations, Karey Renee Fortier

UNLV Theses, Dissertations, Professional Papers, and Capstones

Bioaerosols are airborne particles of biological origin including viruses, bacteria, pollen, fungi, and fragments of their metabolic products. Bioaerosol exposure may represent a health risk, in particular for risk groups such as immunosuppressed persons, and those suffering from allergies or respiratory diseases. Bioaerosols of sizes

This study seeks to assess outdoor bioaerosol number concentrations and size distributions in Las Vegas, NV, as the first step in understanding their health risks. PM2.5 and PM10 were collected on black polycarbonate filters for 24-hour duration using MiniVol air samplers on UNLV campus in the spring and fall of 2017. Bioaerosols in these samples …

Telomeres, Nutrition And Mortality: Risk Factors For The Rate Of Telomere Length Decline And The Associations Between Telomere Length, Nutrition And Mortality, Saruna Ghimire

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Telomeres are nucleoprotein structures located at the ends of eukaryotic chromosomes, thought to protect the DNA from damage. As a person experiences stressors, harmful exposures, and other diseases throughout their life, telomeres are thought to become damaged and their length shortened, decreasing their ability to protect the DNA. Nutrition is an important aspect of healthy aging. Preservation of telomere length (TL) is thought to be one of the mechanisms by which good nutrition can delay or prevent the development of chronic disease and death. Recent evidence of preservation of TL with good nutrition is promising. Thus, the aim of …

Health Disparities Among Sexual And Gender Minorities, Jennifer Keeley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Decades of research has shown that sexual and gender minorities (SGMs) experience adverse health and mental health outcomes to a greater extent than their heterosexual peers. The need to better understand and eliminate health disparities in the SGM population was recognized by the National Institute on Minority Health and Health Disparities (NIMHD) at NIH. The Secretary of Health at the Department of Health and Human Services approved the designation of the SGM population as a health disparities population in 2016 and called for SGM studies to examine the health needs of the SGM population across SGM subgroups via large representative …

Prevalence Of Aggregatibacter Actinomycetemcomitans And Fusobacterium Nucleatum Among Clinical Orthodontic Saliva Samples, Jason Robert Klingler

UNLV Theses, Dissertations, Professional Papers, and Capstones

Changes to the oral microflora occur when there are shifts in the levels of the numerous bacterial species. Changes in bacterial load occur in health, disease, and dental treatments such as orthodontics and can be detected through saliva. Many studies dealing with saliva have centered around detecting bacteria known for correlation with chronic periodontitis and caries. Fewer have focused on bacterial species that contribute to microbial shifts not strictly correlated with disease. Measuring the degree of disease progression or future susceptibility is not always possible with traditional clinical parameters alone.

Aggregatibacter actinomycetemcomitans (AA) is a bacterial strain that serves as …

A Guide For A Shared Governance Program, Lydia Joan Lefchuck

UNLV Theses, Dissertations, Professional Papers, and Capstones

Shared governance (SG) within an organization promotes professional growth with the expectation that employees will be active contributors in attaining organizational goals. Healthcare organizational leaders ultimately have a fiduciary responsibility to stakeholders to seek quality improvement initiatives. SG leads to a healthy workplace environment staffed by empowered nurses. Having a committed workforce practicing within SG leads to increased employee satisfaction and engagement, and longer nursing tenures with loyalty to their organization. The low nursing turnover rates, associated with a satisfied and engaged staff, translate into efficient productivity, continuous quality improvement, better patient outcomes, and operational cost savings.

Health systems administrators …

Acr Accreditation For Utah Valley Hospital’S Radiation Oncology Center, Remy Manigold

UNLV Theses, Dissertations, Professional Papers, and Capstones

Becoming an accredited clinic through the American College of Radiology (ACR) and their Radiation Oncology Practice Accreditation (ROPA) program will provide third-party evaluation of patient care to ensure the best treatment possible for patients.

Talk of getting ACR accreditation has occurred in the past for Utah Valley Hospital/American Fork Hospital, but at the time it was seen as something that did not provide sufficient value vs. the cost. The recent One Intermountain restructuring is intended to unify all of the Intermountain Healthcare radiation oncology centers in Utah so the Radiation Oncology Director has set the goal that all Intermountain radiation …

Is Easier, Better? A Reevaluation Of The Use Of Non-Remodeled Bone As A Histological Predictor Of Age-At-Death From The Femoral Midshaft Using Gis Software, Mariah Elaine Moe

UNLV Theses, Dissertations, Professional Papers, and Capstones

Traditional macroscopic methods for estimating age-at-death from human skeletal remains have been highly successful in practice but are notoriously inadequate when aging individuals over the age of 50 years. Skeletal histology has the potential to overcome these challenges to narrow the gap in age estimation and more accurately address older individuals.

Primary bone is produced during normal growth and development. Once fully matured, individuals undergo the lifelong process of remodeling wherein primary bone is replaced with microstructures called secondary osteons. As individuals age, the amount of primary bone tends to decrease. This study reexamined the use of percentage of primary …

Wearable Technology Devices: Heart Rate And Step Count Analysis, Jeffrey Montes

UNLV Theses, Dissertations, Professional Papers, and Capstones

The overarching purpose of this dissertation was to evaluate and analyze heart rate and/or step count measurements for six popular wearable technology devices: the Samsung Gear 2, FitBit Surge, Polar A360, Garmin Vivosmart HR+, Leaf Health Tracker, and the Scosche Rhythm+ in four separate conditions: free motion walking, free motion jogging, treadmill walking, and treadmill jogging. The four studies presented here utilized one test design and data collection protocol in which many measurements could be addressed simultaneously. Currently, there is no accepted standardized protocol to evaluate wearable technology devices. The test design utilized for this research series was introduced as …