Medicine and Health Sciences Commons^™

The Role Of Genetic Alterations In Tumor Initiation, Progression And Transformation, Weiwei Zhang

Theses & Dissertations

Follicular lymphoma (FL) is the second most common lymphoma in the United States. Although it is generally an indolent lymphoma, FL is not curable, and, in about 30% of patients, the FL undergoes transformation into an aggressive lymphoma (tFL) with marked worsening of prognosis. To identify mutations preferentially present in tFL, we performed whole exome sequencing (WES) on paired FL and tFL arising in the same patients and developed a mutational analysis pipeline. After we identified potentially important genes that have been found to be mutated in our paired FL and tFL study, we constructed a custom capture platform including …

Squamous Cell Carcinoma Response To Cisplatin Exposure, Khanh V. Luong

Theses & Dissertations

Purpose: This thesis attempted to quantitatively analyze the individual cell fate choice in resistant head and neck UM-SCC38 cells exposed to cisplatin using the most current techniques available.

Methods: UM-SCC-38 cells were grown in Dulbecco’s modified Eagle’s medium (DMEM) supplemented with 10% fetal bovine serum (FBS). They were treated with cisplatin and ATM/ATR inhibitors of known dosages. Using live cell imaging, one hundred cells were tracked in each experiment and their behaviors were analyzed and entered into Microsoft Excel Spreadsheet to generate cell profile graphs. HaCaT cells, non-tumorigenic keratinocyte cell line, were also analyzed using live cell imaging and their …

Regulatory Roles Of Mical-L1 And Ehd1 In Cell Signaling And Mitosis, James B. Reinecke

Theses & Dissertations

Membrane trafficking is a basic cell biological process that controls the distribution of proteins and lipids. Our lab is particularly interested in delineating the cellular functions as well as the molecular mechanisms that regulate the C-terminal Eps15 Homology Domain (EHD) protein family of adenosine-5’-triphosphatases in mammalian cells. EHD1-4 are ubiquitously expressed in mammalian tissues and serve partially overlapping but also distinct functions in regulating membrane shaping and fission along the endocytic pathway. Specifically, EHD1 is recruited to tubular recycling endosomes (TREs) by Molecule Interacting with CasL Like-1 (MICAL-L1) and facilitates TRE fission and release of cargo from the perinuclear endocytic …

Postural Responses To Perturbations Of The Vestibular System During Walking In Healthy Young And Older Adults, Jung Hung Chien

Theses & Dissertations

It has been shown that approximate one-third of US adults aged 40 years and older (69 million US citizens) have some type of vestibular problems. These declining abilities of the vestibular system affect quality of life. Difficulties in performing daily activities (dressing, bathing, getting in and out of the bed and etc.) have been highly correlated to loss of balance due to vestibular disorders. The exact number of people affected by vestibular disorders is still difficult to quantify. This might be because symptoms are difficult to describe and differences exist in the qualifying criteria within and across studies. Thus, it …

Epacs: Epigenetic Regulators That Affect Cell Survival In Cancer., Catherine Murari

Theses & Dissertations

Cyclic adenosine monophosphate (cAMP) is a second messenger responsive to many external stimuli, playing an important role in cellular gene expression, metabolism, migration, differentiation, hypertrophy, apoptosis and secretion. All of these cellular functions are important in many diseases including cancer. Most of its effects were initially attributed to the classical protein kinase A (PKA) protein, but cellular functions such as proliferation and migration were found to be PKA independent and dependent on the newly discovered exchange proteins directly activated by cAMP (EPACs). EPACs are single polypeptides that primarily function as guanine exchange factors (GEFs) for Rap proteins that allow the …

Interaction Between Angiotensin Ii And Bdnf In Modulating Sympathetic Nerve Activity, Bryan K. Becker

Theses & Dissertations

Over activation of the sympathetic nervous system is prevalent in many forms of cardiovascular disease such as chronic heart failure (CHF) and hypertension. Although increased neuronal renin-angiotensin system activity in presympathetic neurons has been well implicated in mediating this sympatho-excitation, many of the neuronal effects of angiotensin II (Ang II) signaling remain poorly understood. One particular mechanism of Ang II-mediated increases in presympathetic neuronal activity is through reductions in voltage-gated K⁺ currents. Another pathway that has profound effects on neuronal K⁺ currents and that has been previously implicated in Ang II-signaling is brain-derived neurotrophic factor (BDNF) activity through …

The Effect Of Body Mass Index On Graft Function And Kidney Transplant Outcomes, Morgan Galle

Theses & Dissertations

Background: When determining eligibility for kidney transplantation, body mass index (BMI) is often a debatable criterion for transplant due to the clinical indication, an elevated BMI has adverse effects on kidney transplant outcomes. There is a current gap in research on the effect BMI has on kidney transplant outcomes.

Purpose: The purpose of this study was to determine the role BMI plays in post-kidney transplant clinical outcomes including delayed graft function, new onset diabetes after transplant, wound complications, hospital length of stay, albumin, and readmissions to the hospital from initial hospitalization and at six months following kidney transplantation. The primary …

Evaluation Of Upper Airway Changes Following Surgical Removal Of The Adenoids Using 3-D Cone Beam Ct, Christopher C. Schultz

Theses & Dissertations

Purpose: The purpose of this study was to evaluate the changes in volume, cross-sectional area and depth of the upper airway following the surgical removal of the adenoids.

Materials and Methods: 16 patients were diagnosed with hypertrophic adenoids and referred for surgical removal. Pre-surgical and post-surgical CBCT scans were taken on each patient. Volume measurements of the total airway, oropharynx and nasopharynx were recorded. In addition, cross-sectional areas and airway depths at the posterior nasal spine (PNS) and cervical vertebrae 2 were recorded. 15 patients diagnosed with no or mild adenoid hypertrophy were treated as the control group. The controls …

Antiviral Peptide Nanocomplexes As Potential Therapeutics For The Treatment Of Infectious Diseases, Jinjin Zhang

Theses & Dissertations

Hepatitis C Virus (HCV) is recognized as a major burden in global public health, which can be further exacerbated by several cofactors such as human immunodeficiency virus (HIV). Currently, there is no vaccine for HCV. The emergence of potent and highly specific direct-acting antivirals (DAA) has marked a new era in HCV therapy, however, the remaining issues like affordability, genotype dependency, and potential resistance still necessitate the development of additional therapeutic approaches to be used instead or in combination with DAA.

Recently, the antiviral peptide C5A (in our studies designated as p1) and its cationic derivative p41 have been identified …

Biodegradable Hybrid Nanogels For Combination Chemotherapy, Swapnil Desale

Theses & Dissertations

Combination chemotherapy is commonly used to treat cancer, because such a therapy regimens usually involve sequential administration of multiple drugs and allow targeting different cell signaling pathway. The co-delivery of drug combination at a controlled ratio via the same vehicle is offering the advantages such as spatial-temporal synchronization of drug exposure, synergistic therapeutic effects and suppression of drug resistance. Undoubtedly, there are several molecular and pharmacological factors that determine the effectiveness of drug combinations. A rationally designed drug combination is required since certain drug ratios and the definitive exposure to the targets of interest can only be synergistic while others …

Examining Employee Knowledge Of The Jennie Edmundson Hospital Active Shooter Policy, Mallory W. Darais

Theses & Dissertations

Nationally, there has been a large increase in the number of active shooter events within healthcare facilities such as hospitals. Due to this increase, government organizations have recently released documents to guide healthcare facilities on implementing active shooter policies and updating emergency operation plans. Currently, recommendations from government entities such as the Federal Bureau of Investigation and the Department of Homeland Security suggest the “Run, Hide, Fight” approach during an active shooter incident. Jennie Edmundson Hospital, located in Council Bluffs, Iowa, and affiliated with the Methodist Health System, currently has an active shooter policy in place. Data was collected from …

The Feedforward And Feedback Controls On Gait In Adults With Diabetes, Chun-Kai Huang

Theses & Dissertations

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback …

Association Between Recipient’S Preexisting Antibodies And Allograft Vasculopathy And Mortality In Heart Transplant Patients, Hoang Tran, Lorena Baccaglini, Jane L. Meza, Brian D. Lowes

Theses & Dissertations

Objectives: To evaluate the role of preexisting Angiotensin II receptor type I antibodies (AT1RAb) and anti-HLA antibodies in predicting mortality and cardiac allograft vasculopathy (CAV) among heart transplant patients.

Methods: In this retrospective cohort study, we included 114 adults who received heart transplant from January 1^st, 2007 to December 31, 2014 and were followed up at Nebraska Medicine. 48 hours pre-transplant sera sample were used to detect antibodies. A cutoff of 10UL/ml was used for AT1RAb positive and mean fluorescence intensity of 3,000 and 1,500 were used for anti HLA class I and class II, respectively. Patients were …

Effect Of Diabetes Self-Management Education On Glycemic Control, Compared To Usual Care In Type 2 Diabetic Patients At The Family Medicine Clinic, Aga Khan University Hospital Nairobi, Catherine Wanjiku Gathu

Theses & Dissertations

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored.

Objective: To compare the …

The Relationship Between New Nurses Who Volunteer And The Caring Behavior New Nurses Exhibit In The Practice Setting, One Year Post Graduation, Nicolette Fiore-Lopez

Theses & Dissertations

Volunteering is engaged in by millions world-wide and nurses comprise a significant portion of those who provide their professional talents, unpaid, to the underserved in local, national and international efforts. Nurses who have engaged in volunteer activities anecdotally describe personally transforming experiences gained through their efforts and for many nurses volunteering becomes part of their professional mandate. Although many social disciplines have studied volunteering, to date there has been a paucity of research on nurses who volunteer. The purpose of this study was to describe the characteristics of novice nurses who volunteer and determine the influence of volunteering and associated …

Duty Hour Limitations And Educational Outcomes: Perspectives From A Community Hospital-Based Family Medicine Residency Program, Maria Eliza Marquise

Theses & Dissertations

In 2003, the Accreditation Council for Graduate Medical Education and the American Osteopathic Association introduced new models that established limits on residents’ duty hours in training programs across the United States (Miulli & Valcore, 2010; Philibert & Taradejna, 2011); more stringent limitations were implemented in 2011. If these physician training programs decreased the time residents’ spent in a formal learning environment and utilized experiential learning as one teaching method, did the duty hour limitations affect the residents’ learning outcomes? The purpose of this ex post facto, quantitative study was to determine if there were differences in ITE (In-Training Examination) scores …

Mentoring, Job Satisfaction, Job Dissatisfaction, And Organizational Commitment Among Graduate Nurses, Abisola Adeyomibo Santos

Theses & Dissertations

Shortage of bedside nurses has been researched for a long time. Many researchers have referred to different shortage percentages, but the American Nurse Association stated that the shortage of bedside nurses would increase in the range of 29% to 36% by 2020. It is also reported that a large number of newly graduated, newly hired nurses leave within one year as compared to newly hired experienced nurses. The purpose of this correlational study was to evaluate the influence of mentoring, mediating job satisfaction, job dissatisfaction, and, therefore, organizational commitment, on nurses who completed the nurse residency program between January 2010 …

The Knowledge, Attitude, And Self-Reported Behaviors Of Psychiatric Nurses Towards Obese Psychiatric Patients On Atypical Anti-Psychotic Medications, Marcia D. Williams-Hailey

Theses & Dissertations

Background/Purpose: Obesity has continued to increase over the years with increase in morbidity and mortality. The advancement of psychiatric treatment has resulted in a higher prevalence of obesity among the psychiatric population related to the side-effects of the newer atypical anti-psychotics. This study addresses nurses’ attitudes towards obesity and people who are obese, focusing on psychiatric patients. Negative attitudes and low knowledge about psychiatric patients on atypical anti-psychotics can interfere with psychiatric nurses’ therapeutic potential to support patients with health promotion behaviors. The purpose of this study was to develop an instrument to measure the knowledge, attitudes, and self-reported behavior …

The Impact Of Technology-Enhanced Learning Activities On Nursing Student Engagement In The Classroom, Alicia A. Stone

Theses & Dissertations

Educating student nurses in the present environment requires professors to stay current with new methodologies as well as innovations in technology. The question is how to address both the impact of technology and the skills of clinical reasoning, and keep the students involved in the material. If there can be integration of each aspect through the use of technology-enhanced learning activities on the internet and preparation to approach the issue, then perhaps this can increase success. This is a quasi-experimental intervention study that explored the impact of a case study blogging assignment on the engagement of students enrolled in a …

The Lived Experience Of Observant Jewish Nursing Students: A Phenomenological Study, Toby Bressler

Theses & Dissertations

Background: With expanding cultural diversity in the United States (U.S. Department of Health and Human Services, 2009), it is essential to increase the diversity of the nursing profession to match the patients who are being cared for in our healthcare system (IOM, 2003; Sullivan Commission, 2004). Despite improvements to the demographic composition of the nursing workforce in recent decades, the nursing workforce has remained predominantly homogeneous and to meet the current and future health needs of the public while providing culturally relevant care, the nursing workforce needs to increase its diversity (IOM, 2010). This demographic shift creates a social imperative …

School Design To Promote Physical Activity, Jeri Brittin

Theses & Dissertations

Increasing children’s physical activity (PA) at school is a national focus to address childhood obesity. Research has demonstrated associations between school built environments and students’ PA, but has lacked a comprehensive synthesis of evidence. Chapter 1 presents new evidence-, theory-, and practice-informed school design guidelines, including evidence substantiality ratings, to promote PA in school communities. These guidelines delineate strategies for school designers, planners, and educators to create K-12 school environments conducive to PA. They also engage public health scientists in needed transdisciplinary perspectives.

There have been few longitudinal studies to verify causal relationships between the school built environment and PA. …

Psychiatric Comorbidities And Bmi: An Exploratory Analysis, Nicholas Guenzel

Theses & Dissertations

Background: Individuals with most forms of mental illness have higher rates of obesity than members of the general public putting them at an increased risk for many physical health problems that reduce both quality of life and life expectancy. The presence of multiple comorbid psychiatric disorders has been associated with poorer clinical outcomes in other mental health measures such as disability and sobriety and is proposed as a risk factor for elevated BMI (body mass index) in this study.

Objective: Determine if multiple psychiatric comorbidities are associated with elevated BMI and, if so, which combinations are linked with the greatest …

Understanding Access To Health Information: The Role And Measurement Of Social Location, Megan S. Kelley

Theses & Dissertations

The purpose of this research is to explore how application of social location theory may improve data collection on health information access in order to better inform and improve the effectiveness of health communication and messaging. This dissertation proposes a framework to understand how people obtain health information based on the idea of social location, Ritzer and Bell’s (1981) levels of social reality, and Dahlberg & Krug’s (2002) social ecological model. This research addressed the extent to which three studies of health information access support the use of such a framework, and if so, how its application could improve our …

Polymeric Nanocarriers For Treatment Of Melanoma And Genetically Modified Mesenchymal Stem Cells To Improve Outcome Of Islet Transplantation, Vaibhav Mundra

Theses & Dissertations

Melanoma is a lethal malignancy with limited treatment options for advanced metastatic stages. New targeted therapeutic options with discovery of BRAF and MEK inhibitors have shown significant survival benefit. Despite the recent progress, inefficient tumor accumulation and dose limiting systemic toxicity remains pressing challenges for treating metastatic melanoma and there is a need for drug delivery approach to improve therapeutic index of chemotherapeutics. Nanoparticle based drug delivery represents promising approach to enhance efficacy and reduce the dose limiting systemic toxicity. Nanoparticles can be formulated either by physical encapsulation of drugs or by covalent conjugation of drugs to the polymeric backbone. …

Prevention Of Experimental Periodontitis In Rats With A Simvastatin Prodrug, Aaron Bradley

Theses & Dissertations

Introduction: Simvastatin (SIM) is a hypolipidemic drug that has been shown to have anti-inflammatory and bone anabolic properties. The aim of this study was to examine the effects of novel locally-applied SIM conjugated with methoxypolyethylene glycol to form micelles (SIM/SIM-mPEG) in an experimental periodontitis model in rats using micro-computed tomography (µ-CT) and histologic evaluation.

Methods: Experimental periodontitis was induced using silk ligatures around the maxillary right second molar (M2) in 40 Sprague-Dawley rats. Rats were divided into five groups using SIM/SIM-mPEG at 0.5, 1.0, or 1.5 mg SIM doses, mPEG-alone or no drug (ligature-alone) injected into the palatal M1-M2 gingiva …

Development Of Hypoxia Trapping Enhanced Bb2r-Targeted Radiopharmaceutics For Prostate Cancer, Zhengyuan Zhou

Theses & Dissertations

The Gastrin-Releasing Peptide Receptor (BB2r) has been investigated as a diagnostic and therapeutic target for prostate and other cancers due to the high expression level on neoplastic relative to normal tissues. A variety of BB2r-targeted agents have been developed utilizing the bombesin(BBN) peptide, which has shown nanomolar binding affinity to human BB2r. However, as with most of the low-molecular weight, receptor-targeted drugs, a major challenge to clinical translation of BB2r-targeted agents is the low retention at the tumor site due to intrinsically high diffusion and efflux rates. Our laboratory seeks to address this deficiency by developing synthetic approaches to selectively …

The Impact Of Gasoline Prices On Medical Care And Costs Of Motor Vehicle Injuries, He Zhu

Theses & Dissertations

Background Traffic safety has placed a tremendous economic and social burden on individuals and nations. Gasoline prices have been linked to traffic safety in the recent studies. Higher gasoline price may prompt people to reduce expenses by changing travel distance and frequency, transportation mode, or driving behaviors.

Objective This study aims to examine the relationship of gasoline prices to hospital utilization and cost for motorcycle and non-motorcycle motor vehicle injuries in the United States.

Methods Data on inpatient hospitalization for motor vehicle injuries were obtained from the 2001-2010 Nationwide Inpatient Sample, which is part of the Healthcare Costs and Utilization …

Electronic Health Record Optimization For Cardiac Care, Lisa A. Grabenbauer

Theses & Dissertations

Electronic health record (EHR) systems have been studied for over 30 years, and despite the benefits of information technology in other knowledge domains, progress has been slow in healthcare. A growing body of evidence suggests that dissatisfaction with EHR systems was not simply due to resistance to adoption of new technology but also due to real concerns about the adverse impact of EHRs on the delivery of patient care. Solutions for EHR improvement require an approach that combines an understanding of technology adoption with the complexity of the social and technical elements of the US healthcare system. Several studies are …

Physical Activity Behaviors Of Prehypertensive And Stage I Hypertensive African American Women, Hope Jackson

Theses & Dissertations

The purpose of this study was to describe the physical activity (PA) behaviors and PA biomarkers of prehypertensive and stage I hypertensive African American women (AAW) and to examine the relationships between PA and personal factors and selected behavior-specific influences (perceived barriers to and interpersonal support for PA). Pender’s Health Promotion Model was the conceptual framework for the study.

A cross sectional design and convenience sample were used. Personal factors examined were: systolic and diastolic blood pressure [BP], body mass index [BMI], and waist circumference. Other variables measured were: International Physical Activity Questionnaire, 400 meter walk test, Borg perceived exertion …

Association Between Adverse Events In Childhood And Bmi Among People With Schizophrenia And Bipolar Disorder, Nicholas Guenzel

Theses & Dissertations

Background: People with schizophrenia and bipolar disorder die significantly earlier than members of the general public (16-18 years and 12-13 years, respectively). Diseases associated with obesity such as diabetes, heart disease, and stroke account for much of this discrepancy. People with mental illness often have difficulty losing weight despite intensive interventions. As a result, nurses caring for patients with mental illness need to monitor their weight diligently and implement individualized interventions to promote achieving or maintaining a healthy weight. Because intensive interventions come with some risk and expense, programs must target individuals with the most potential to develop obesity. In …