Integrating Geriatric Assessment And Genetic Profiling To Personalize Therapy Selection In Older Adults With Acute Myeloid, Vijaya R. Bhatt

Theses & Dissertations

Integrating geriatric assessment for patient profiling and genetic profiling of leukemic cells represents an innovative approach to personalize therapy selection in older adults with acute myeloid leukemia (AML). We report results of a pre-planned interim analysis of a pragmatic phase II trial that utilized this strategy to personalize therapy. Patients ≥60 years with a new diagnosis of AML underwent geriatric assessment prior to initiation of treatment. Geriatric assessment of physical function, cognitive function and comorbidity burden were used to determine fitness for chemotherapy. Patients with good or intermediate-risk AML received intensive chemotherapy such as anthracycline and cytarabine (7+3) if determined …

Planning And Facilitating The Training Of Emergency Medical Services On The Safe Transport Of Patients With Highly Infectious Diseases, Mohammed Alhallaf

Theses & Dissertations

Emergency Medical Services (EMS) personnel are the first line of treatment and are the first exposed health care workers to infectious diseases (IDs). Consequently, the EMS setting is a relatively vulnerable environment for disease transmission and cross-contamination. Also, serious and emerging IDs, such as highly pathogenic viral hemorrhagic fevers and novel Coronaviruses, in a time of increased globalization, require comprehensive EMS training and preparedness. This project had the objective of identifying best practices for the EMS transport of patients with IDs. The methods for this project were done in two phases. In the first stage, we …

Effects Of Liquid Viscosity And Food Texture On Swallowing Sounds, Chun Feng

Theses & Dissertations

Cervical auscultation (CA) is a technique of monitoring swallowing performance according to swallowing acoustic signals utilizing a stethoscope or other measurement devices such as a microphone and an accelerometer. In the past few years, doctors have utilized the stethoscope to identify the swallowing sounds, which resulted in an inability to accurately diagnose the aspiration/penetration in patients with dysphagia when compared to the gold standard. A digital CA assessment records swallowing acoustic signals and extracts the specific features from the recordings. It has been proven that digital CA as a promising portable and low-cost tool can be used for identifying patients …

Effects Of Acute Intracranial Pressure Changes On Optic Nerve Head Morphology In Humnans And Pig Model, Sachin Kedar

Theses & Dissertations

The optic nerve head (ONH) is located at the interface of intracranial and intraocular compartments. It is comprised of lamina cribrosa (LC), a fenestrated connective tissue tethered to the posterior sclera across the scleral canal. Since LC is exposed to intraocular pressure (IOP) anteriorly and intracranial pressure (ICP) posteriorly, it is an ideal site for noninvasively detecting intracranial pressure (ICP) fluctuation. We hypothesized that the pressure differential between IOP and ICP across LC, will determine LC position and meridional diameter of scleral canal (also called Bruch’s membrane opening- BMOD). We tested our hypothesis in 19 human subjects undergoing medically necessary …

The Neural Oscillatory Dynamics Underlying Motor And Cognitive Abilities In Children And Adults With Cerebral Palsy, Rashelle M. Hoffman

Theses & Dissertations

Cerebral palsy (CP) is the most common neuromotor developmental diagnosis that can result in a myriad of activity impairments. The literature has primarily explored motor impairments in children with CP. Additionally, there is evidence of CP impacting several cognitive domains in children and adults with CP. Very little literature has explored if these impairments persist into adulthood, and the underlying neurophysiology serving these functions in individuals with CP is unknown.

The first purpose of this dissertation was to quantify the cortical oscillations serving hand movement with magnetoencephalography (MEG) and determine if differences were present as a function of age between …

The Role Of Central Ace2 And Nrf2 In Sympatho-Excitation: Responses To Central Angiotensin Ii, Anyun Ma

Theses & Dissertations

Sympatho-excitation is a key characteristic in cardiovascular diseases such as chronic heart failure (CHF) and primary Hypertension (HTN). Evidence suggests that increased sympathetic tone is closely related to activation of the Renin-Angiotensin-Aldosterone system (RAAS) in the central nervous system. An underlying mechanism for sympatho-excitation is thought to be oxidative stress resulting from Angiotensin II (AngII) type 1 receptor (AT1R) activation. Over the past several decades, pharmacological targeting of components of the RAAS have been used as standard therapy in CHF and HTN. However, additional therapeutic strategies are necessary to control these diseases. Oxidative stress is regulated, in part, by the …

Characterization Of Novel Animal Models For Parkinson’S Disease, Mohannad Almikhlafi

Theses & Dissertations

Parkinson’s disease (PD) is neurodegenerative disorder characterized by dopaminergic neuronal loss in the substantia nigra (SN) pars compacta. Mutations in DJ-1, PINK1 and Parkin lead to PD in humans; however, in mice, mutations or knockout of these genes do not lead to disease. Development of small animal models mimicking PD pathogenesis would enable better understanding of the disease. Here, we examined two approaches using laboratory rats. First, DJ-1 knockout rats have been reported to develop movement disorders and loss of neurons similar to human PD. Comprehensive analysis of mitochondrial proteomic alteration in isolated synaptic mitochondria from DJ-1 knockout rats using …

Exploring Paramedic Students’ Level Of Preparedness For Disaster Response In Hajj 2019, Nawaf Albaqami

Theses & Dissertations

Objectives: 1) to gain further understanding of the paramedic students' level of preparedness before their clinical training at Hajj. 2) To shed more light on what paramedic students need when responding to a disaster. 3) To determine the need to recommend a change in the current practice with respect

Method: The data collection for this study was a cross-sectional survey using the REDCap electronic data capture tools. It was a convenience sample of 40 respondents. For the analyses, descriptive statistics, including frequencies and percentages, were used, and the Mann Whitney U test.

Results: The main findings in this study were …

Ocular, Neural, And Cellular Biodistribution Of Multifunctional Antioxidants, Damian Daszynski

Theses & Dissertations

Aging is a complex biological process which stems from a growing imbalance between the regenerative capacity of an organism and endogenous as well as exogenous damaging factors. This imbalance leads to the slow deterioration of individual cells, organs, and eventually the entire organism. The free radical theory of aging combines the evolutionary and mechanistic aspects of aging, postulating that the innate process is caused by deleterious, irreversible, and inevitable changes in biological systems caused by oxidative damage that accumulates over the lifespan. Evidence of this phenomenon is supported by the pathogenesis of age-related diseases, such as age-related macular degeneration and …

The Escape Pod: Utilizing Escape Room Methodologies To Train Public Health Volunteers On Open Point-Of-Dispensing Operations, Melanie R. Thompson

Theses & Dissertations

Mobilizing Points-of-Dispensing (PODs) during a mass dispensing of medication event at a local health department will require a large amount of personnel, both staff and volunteers. Training the volunteers prior to this type of event is ideal to ensure that POD operations flow quickly and properly. This project aimed to create an affordable and fun training that engaged volunteers and other interested stakeholders while increasing their knowledge of POD operations. Methodologies used in commercial escape rooms were employed in this training to enhance the participants’ understanding of POD operations. Participants to worked in groups to solve puzzles and challenges in …

Development Of Fluorescent Hyaluronic Acid Nanoparticles For Intraoperative Tumor Detection, Nicholas E. Wojtynek

Theses & Dissertations

Surgical resection remains to be the primary treatment for the majority of solid tumors, including breast cancer. The complete removal of the primary tumor, local metastases, and metastatic lymph nodes dramatically improve a patient’s treatment outcome and prognosis. Nevertheless, surgeons are limited to tactile and visual cues in distinguishing malignant and healthy tissue. This can result in a positive surgical margin (PSM), which occurs when tumor goes undetected and is left behind in the surgical cavity. PSMs decreases a patient’s prognosis and necessitate additional treatment in the form of surgery, radiation, and chemotherapy. An emerging imaging modality, known as fluorescence-guided …

Self-Management For Individuals Using Long-Term Urinary Catheterization, Lisa Krabbenhoft

Theses & Dissertations

Many individuals with adult neurogenic lower urinary tract disorder require long-term urinary catheterization for bladder management. The daily use of urinary catheterization increases the risk for chronic complications including catheter associated urinary tract infections. Previous studies have used self-management interventions to reduce chronic complications in the community setting. However, there are limited intervention studies focused on reducing chronic complications after discharge from a rehabilitation hospital. The purpose of this dissertation study is to examine the feasibility and impact of a self-management intervention on individuals after leaving rehabilitation hospital for home within the community.

This dissertation comprises two studies, the first …

Immersive Virtual Reality Training Improved Upper Extremity Function In Patients With Spinal Cord Injuries: A Case Series, Anqi Zhang

Theses & Dissertations

Virtual reality (VR) is an emerging treatment tool to engage people in environments that appear and feel similar to real-world objects and events.¹ There are various levels of evidence that VR can potentially promote functional activity and neuroplasticity in patients with neurological disorders like spinal cord injury (SCI).^2,3

In this case series, we explored the feasibility of using commercially available immersive VR technology as an augmented treatment in the SCI population and compare participant’s suitability for this intervention. Three male SCI participants were recruited in a subacute inpatient rehabilitation facility and participated in VR intervention twice a week …

The Role Of Extracellular Vesicles In Cancer-Related Fatigue And Its Co-Occurring Symptoms, Dilorom M. Sass

Theses & Dissertations

Cancer survivors report many debilitating symptoms associated with cancer and its treatments. About 30% will report long-term cancer-related fatigue (CRF) which often co-occurs with depressive symptoms, sleep disturbances, cognitive fatigue, and poor overall health-related quality of life. The underlying causes of these co-occurring symptoms have been related to systemic processes such as inflammation. Extracellular vesicles (EVs) contain systemic markers such as genetic and protein materials that inform about cell-to-cell interactions that influence immune signaling and inflammatory processing. No study to date has explored the associations of EVs with cancer-related symptoms. So, the purpose of this dissertation was to investigate the …

Development Of Hyaluronic Acid-Derived Macromolecular Agents For Multimodal Imaging Probes And Nanomedicine, William M. Payne

Theses & Dissertations

Cancer, one of the most challenging maladies facing modern medicine, is a complex family of diseases that requires a multifaceted treatment regime. In recent years, increased research effort has been placed on the development of nanoscale formulations as a potential method to improve therapeutic efficacy and offer better treatment. Both drug formulation and biomedical imaging has benefitted from the development of new, nanoscale agents. Hyaluronic Acid (HA), a naturally occurring glycosaminoglycan, is a promising platform for the development of new drug delivery systems. Furthermore, hyaluronic acid is the principal ligand for the cell surface receptor CD44, which is overexpressed on …

Effect Of Protein, Fat, And Both Protein And Fat On The Glycemic Response Of A High Glycemic Index Meal, Muhammed Taai

Theses & Dissertations

Research Focus: Elevated blood glucose (BG) levels from a diet high in refined carbohydrates, even in the absence of diabetes, may increase the risk for chronic diseases including cardiovascular disease, type 2 diabetes, and obesity. The purpose of this study was to determine if supplementation of a high glycemic load breakfast with protein, fat, or a combination of the two attenuates the glycemic response in non-diabetic subjects.

Research Methods: Thirteen healthy adults, age 24.7±4y, BMI 25.1±4.5 completed four trials, having fasted 8-12h for this randomized, double-blind crossover study.

Fasting BG was measured, then subjects consumed 2 slices of white …

Assessment Of Activity Levels And Perceived Barriers Or Facilitators To Physical Activity In Pregnancy At Aga Khan University Hospital, Nairobi, Kenya, Zoya Virji Lalani

Theses & Dissertations

Introduction: Physical activity (PA) during pregnancy significantly reduces the risk of pregnancy related complications and positively influences maternal health and wellbeing. The American College of Obstetricians and Gynaecologists (ACOG) recommends that pregnant women can exercise moderately for 30 minutes on most days of the week, however no study has ever examined the extent to which Kenyan women are meeting these recommendations. Furthermore, attitudes and perceptions of pregnant women towards PA shape their eventual behaviour. Whilst these influencing factors have not been explored, understanding them is essential for implementing effective interventions to improve exercise participation antenatally.

Objectives: This study examined …

The Relationahips Between Health Behaviors Of Women And Health Locus Of Control Among Black Caribbean Women And Black American Women With Hypertension, Camelle Charles

Theses & Dissertations

Background

Millions of Caribbean women have migrated to the United States, and a sizeable number of these women and Black American women suffer from hypertension and other cardiovascular health problems. This research showed the comparison of health behaviors of both groups of women and the difference in their health outcomes. Today, there are more migrants in the world than ever before; an estimated 272 million international migrants in 2019, which is an increase in 51 million since 2010 (United Nations, 2019) and Caribbean migrants are a substantial portion of this pool. Approximately 4.4 million Caribbean immigrants reside in the U.S. …

Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis, Soraiya Manji

Theses & Dissertations

Background: Chronic kidney disease is highly prevalent in the world with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.

Objective: The primary objective of this study was to determine the association between the dialysate sodium concentration and interdialytic weight gain …

Temporal Pain Pattern Sequencing In The Older Adult After Joint Replacement Surgery, Jennifer B. Withall

Theses & Dissertations

Background

Large joint replacement surgery, including hip and knee arthroplasties, are two of the most common surgical procedures that American adults aged 65 years and older undergo annually. While postoperative pain is expected, if it is not properly managed, it can have deleterious effects on postoperative recovery, including an increased length of stay, increased risk for postoperative complications, and decreased patient satisfaction.

Problem

Postoperative pain is primarily managed pharmacologically, typically with opioid pain medications are administered as needed (i.e., pro re nata [PRN]). Patients request pain-relieving medications when they are experiencing escalating pain, which can be challenging to maintain comfort …

Local Anaesthetic Wound Infusion Versus Thoracic Epidural Analgesia For Post-Operative Pain Control Following Elective Laparotomy: A Randomised Controlled Trial, Daniel Gathege Mwangi

Theses & Dissertations

Background: Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients

Objective: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients.

Design: A randomised, single-blind, controlled clinical trial.

Setting: Aga Khan University Hospital, Nairobi, Kenya.

Population: Patients undergoing elective laparotomy.

Methods: Thirty eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous …

Prior Mammographic Screening: What Is Its Effect On The Clinical Stage In Newly Diagnosed Breast Cancer Patients At Akuhn., Jillo Bika

Theses & Dissertations

Introduction: Breast cancer is now the leading cancer amongst women in Kenya according to GLOBOCAN 2018. It is also a leading cause of cancer deaths in Kenya, after esophageal and cervical cancer. Mammography is the gold standard in the screening of breast cancer. For screening to be effective, however, it has to be offered to the right patients at the appropriate time and intervals. Up until February of 2019, there were no local guidelines to guide the screening of breast cancer in Kenya. The objective of this study is to assess if prior mammographic screening had an effect on the …

Case Study Describing Access To Palliative Care In Pakistan, Salma Amin Rattani

Theses & Dissertations

Around the world, cancer is a leading cause of death and the burden of cancer is expected to increase in low-and middle-income countries (LMICs), where 82% of the world’s population resides. In these countries, which include Pakistan, aspects of the culture and traditions, inaccessibility to diagnostic and treatment facilities impede access to palliative care. In many cases, people do not reach treatment facilities until they are at the stage when the person is at the end-of-life and is dying. This paints the picture of cancer as a deadly disease and as soon as it is diagnosed nothing can be done …

Knowledge Of Inhaler Use Among Medical Officers In The Management Of Asthma In Children In Dar Es Salaam, Tanzania, Hannah Moore

Theses & Dissertations

Background: The inhaled route is the preferred first line method for administration of asthma medication. It is however documented that oral and intravenous routes are the commonly adopted methods of administering asthma medication in children, and the knowledge of the use of inhalers and inhaler devices has not been well documented in middle and low-income countries. Knowledge of inhaler technique among medical personnel ensures effective education of its use to patients to provide the desired results in managing asthma in children. Studies in developing countries have demonstrated a generally low level of knowledge of inhaler use among Medical Doctors …

Utility Of Glasgow-Blatchford Scoring System In Identification Of Low Risk Patients With Upper Gastrointestinal Bleeding In Emergency Departments In Dar Es Salaam Hospitals, Tanzania, Selestin D. Mpiri

Theses & Dissertations

Background: Acute upper gastrointestinal bleeding (UGIB) remains a common cause of visits to the Emergency Department (ED). To stratify the risk of complications, rebleeding, need for clinical intervention, or death, several clinical scores are in use. Glasgow-Blatchford Score (GBS) is an excellent risk assessment tool and has shown to accurately identify patients with a low risk of death or requiring intervention. In urban Tanzania, there is a lack of standardized protocol and a well-validated risk assessment tool for analyzing patients presenting with UGIB symptoms. Good performance of GBS score and its use will help to reduce unnecessary emergency endoscopies …

Validation Of Kiswahili Version Of World Health Organization Quality Of Life-Hiv Bref Questionnaire Among People Living With Hiv/Aids In Tanzania., Nuru Abdallah Kondo

Theses & Dissertations

Background: WHO has developed an HIV specific quality of life tool (WHOQOLHIV-BREF) for assessing Quality of life of HIV positive individuals. This tool takes to account the different cultural variations that exist worldwide and hence enable assessment of the quality of life across different cultures/context. This tool has been validated in different cultures and is cross-culturally a promising tool. It is simple to use in routine clinics as it is self-administered. Despite its sound validity and reliability from several studies, the developers recommend it to be validated in different cultures to fully assess its psychometric properties before its adaptation.

Objectives: …

Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centres In Dar Es Salaam, Tanzania, Neelam Akber Ismail

Theses & Dissertations

Introduction: Disclosure of HIV status is important for HIV prevention and maintenance of health for People living with HIV (PLWHIV), their spouses and the community. Despite the benefits of disclosure, there are PLWHIV who delay in disclosing their status thus increasing the risk of transmission of the disease. Objective: This study aimed at determining the barriers to timely disclosure of HIV serostatus among HIV seropositive individuals in Dar es Salaam and what motivated them to disclose.

Methods: A qualitative descriptive study using in depth individual interviews was conducted. Ten participants attending the care and treatment centres took part. Qualitative content …

Referral Patterns Affecting Age At Orchidopexy For Undescended Testis At A Tertiary Hospital In Nairobi., Muthua Ken Njoroge

Theses & Dissertations

BACKGROUND: Undescended Testis is the most common urological congenital anomaly with significant burden of disease especially in our local context. Management relies on early diagnosis, in the perinatal period, and prompt referral to an appropriate surgical unit. Spontaneous descent, while possible, doesn’t occur beyond 6 months and thus surveillance should not proceed beyond this age. Current guidelines recommend surveillance up to 6 months, referral by 9 months and, most importantly, orchidopexy by 1 year of age. Despite these clear guidelines, achieving them has proven difficult globally with low rates of orchidopexy by 1 year. The most common cited cause has …

The Association Of Maternal Sociodemographic Factors With Stress In Pregnancy, Maheshwari Andhavarapu

Theses & Dissertations

Introduction: Antenatal stress has been linked to maternal morbidity and preterm birth (PTB). One of the pathophysiological processes leading to PTB is thought to be via activation of the hypothalamus-pituitary-adrenal axis resulting in cortisol production. Hair cortisol has recently been shown to be a stress marker in the pregnant and non-pregnant population. Some determinants of hair cortisol have also been studied but more research is needed in this area, especially in pregnancy. Understanding the risk factors of antenatal stress may guide institution of preventative or screening measures to reduce the risk of adverse birth outcomes. As the effect of stress …

The Burden Of Urinary Incontinence Among African Diabetic And Non-Diabetic Women Seeking Care At The Aga Khan University Hospital, Nairobi, Martin Kimemia Mbuthia

Theses & Dissertations

Introduction: Female urinary incontinence is a common and chronic condition with devastating psychosocial effects. It can occur at any age and is specifically more common in older women. It has a prevalence of up to 55% depending on the age-group and the target population studied. About 9% of adults globally have diabetes and a greater number live in LMICs. Diabetes is twice as prevalent in blacks and three to four times higher in South-Asian populations compared to Caucasian populations. In women with Type 2 DM, urinary incontinence is 30% to 70% more common than among women with normal glucose levels. …