Medicine and Health Sciences Commons^™

Unveiling Healthcare Disparities By Addressing Historical Traumas To Build Inclusive Spaces For Marginalized Communities: An Autoethnographic Study, Helena Humphreys

Theses and Graduate Projects

This paper delves into the pervasive disparities within the healthcare system, rooted in historical injustices that are perpetuated by systemic biases, particularly affecting Black, Indigenous, and People of Color (BIPOC) communities, as well as the LGBTQIA2S+ community. Through a comprehensive literature review and autoethnographic study, the paper examines the deep-seated issues faced by these marginalized groups, including access barriers, discrimination, mistrust of healthcare providers, and the enduring impact these have on health outcomes. Historical traumas such as the Tuskegee Syphilis Study and the use of HeLa cells underscore the enduring impact of past injustices on present-day healthcare experiences. Moreover, the …

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 …

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 …

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 …

Respiratory Syncytial Virus In The United States: A Research Proposal For A Prospective Cohort Study Of Rsv Vaccines, Kenneth D. Chiu

Master's Projects and Capstones

Objective

This paper proposes a phase IV study to estimate the effectiveness of Abryvso and Arexvy in older adults against severe RSV disease. Additionally, the study aims to assess factors involved with low vaccine uptake for these RSV vaccines.

Methods

For the background literature review of this proposal, I conducted a search of the PubMed and CINAHL Ultimate databases for articles on older adults and RSV. I filtered out results within the period of 2020 to 2024 that were publicly available and focused on RSV burden, vaccinations, or knowledge in the United States.

The proposed phased IV study is a …

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)]. …

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 …

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 …

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 …

Agnotology Of The E-Cigarette Industry: How The E-Cigarette Industry Continues The Tobacco Industry's Legacy Of Creating Controversy And Confusion Within The Scientific Community And The General Population, Calvin Lewis

University Honors Theses

The purpose of this paper is to determine the extent to which the e-cigarette industry follows in the footsteps of the tobacco industry's attempts to disrupt science and cause controversy. Four tactics are described that the tobacco industry uses to disrupt science: funding research that is designed to show results that support their position, criticizing and suppressing research that goes against their position, changing risk assessment and scientific research standards to fit their aims, and spreading data created by their interest groups to politicians and the nonacademic press. Evidence is found to show that both the tobacco industry and e-cigarette …

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 …

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 …

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 …

Prospectus For Expected Discharge Date Accuracy (Edd) – Prepare To Go, Mary Jane D. Esmilla Msn, Bsn, Rn

Master's Projects and Capstones

Problem: Accurate Expected Discharge Date (EDD) estimates are not just numbers on a chart. They are crucial for optimizing operations, reducing readmission risk, creating safe, timely discharge plans, identifying obstacles, providing transitional care, and enhancing patient satisfaction (Piniella et al., 2023). A hospital-based organization conducted a quality improvement project to improve EDD predictions and discharges, significantly improving patient satisfaction and outcomes. The project had shown that a 12% increase in accuracy, achieving 60% from the baseline of 48%, can be achieved through strong collaboration, transparent communication, and commitment to real-time documentation.

Context: A team analysis improved EDD accuracy, patient satisfaction, …

Bridging The Gap Between Clinical Practice And Evidence For Hyolaryngeal Excursion Assessment During A Clinical Swallow Evaluation, Kelsey Murray

Dissertations, 2020-current

This study investigated current practices of subjective hyolaryngeal excursion (sHLE) assessment during a clinical swallow evaluation (CSE) among speech-language pathologists (SLPs) using a survey-based approach. A sample of 77 SLPs in the United States completed an online survey rating their perceived importance and practice of sHLE assessment during a CSE. Additionally, the survey inquired about inferred interpretations from assessing sHLE. Results indicated a strong positive correlation between the rated importance of sHLE assessment and the reported frequency with which it is completed, r_s(46) = .720, p < .001. However, the findings also suggested that some SLPs are not assessing sHLE during a CSE. This offers valuable insight into the prevailing practices of HLE assessment among SLPs, considering the limited evidence for HLE assessment and interpretation. Interpretation and generalizations of the findings is limited due to the small sample size. Findings, however, do support the need for future research investigating the validity of sHLE assessment performed during a CSE, with the aim of providing evidence to guide clinical best practices.

Keywords: hyolaryngeal excursion, speech-language pathologist, clinical swallow evaluation, dysphagia, palpation

Abstract …

Are Hearing Aids Designed For All Parts Of The World? An Ecological Momentary Assessment Study, Preeti Pandey

Dissertations, 2020-current

The affordability of hearing aids (HA) is a significant barrier to ownership in low-and middle-income countries (WHO, 2021). Crowded living conditions in developing countries intensify the complexity of listening environments compared to developed nations. No existing literature compares the listening environment and HA outcomes using real-world measures across these regions. This study aims to 1) compare HA outcomes and listening environments between India and the USA, and 2) evaluate the benefit of premium HAs over basic HAs in both locations. In an observational, multi-location, single-blinded study, nineteen hearing aid users (mean age 69.6 years) participated. Ecological momentary assessments (EMA) were …

The Impact Of Minimally Processed High Fat Meals On Postprandial Glucose, Lipids And Metabolic Index In Pre-Diabetics, Oluwafemi Ayoola

Masters Theses, 2020-current

There is an increasing global prevalence of prediabetes, commonly diagnosed through increased fasting glucose (GLU). Elevated levels of GLU and triglycerides (TRG) have also been linked with more severe diabetes-related complications. Even a single high-fat meal (HFM) may result in adverse metabolic outcomes, in healthy individuals and prediabetics, which are a better predictor of disease risk than measuring fasting levels. Therefore, reducing these metabolic outcomes after a typical HFM often consumed in the Western diet is of critical importance to reduce chronic disease risk. The aim is to determine whether incorporating polyphenols and dietary fiber into an HFM would reduce …

Central Tracking And Billing System For Insurance Bills, Kehinde Alabi

Harrisburg University Dissertations and Theses

In this article, we introduce a new centralized billing platform designed for insurance bills including auto insurance, health insurance, home insurance, life insurance, etc. This system consolidates all bills for individual users eliminating the need for them to manage and pay bills separately. Users stand to benefit from significant time and effort savings each month, reducing the likelihood of missed payments and associated late fees. Insurance billing organizations and banks can also capitalize on timely payments and reduced physical mailings, leading to cost savings and environmental benefits. The proposed system offers users the ability to track and review their historical …

Reducing Same-Day Case Cancellation By Implementing 72 Hours Preop Phone Calls, Debbie Sharon Centeno

Master's Projects and Capstones

Problem: The increased frequency of same-day surgical cancellations affects patient care quality, causes loss of expenses for patients and facilities, and causes non-compliance with block utilization against regional standards.

Context: A collaborative effort was undertaken to reduce same-day case cancellations in the Ambulatory Surgery Unit (ASU). Patients received preoperative instructions 24 hours before surgery through email or phone call. Data collection revealed that the common causes of same-day cancellations were avoidable reasons (not NPO, patient ill, request for another schedule, no ride), indicating the need for improvement in delivering preoperative phone calls.

Interventions: This included educating preoperative nurses, creating a …

Enhancing Teamwork With Cliftonstrengths, Lauren A. Lelaidier

Master's Projects and Capstones

Abstract

Problem: Poor teamwork has a negative impact on patient safety, patient outcomes, patient satisfaction, healthcare work environments, and staff satisfaction. Effective teamwork is therefore critical but can be challenging.

Context: At a large, non-profit, academic healthcare system in San Francisco, all staff members working in the clinical research services (CRS) department identified teamwork as an area of concern. Teamwork survey results also indicated that teamwork could be improved.

Interventions: A literature review provided evidence that many types of team training are effective in multiple settings. Team training for all CRS staff included three interventions: a CliftonStrengths assessment, a one-on-one …

An Initiative To Improve Ssi Bundle Metrics Adherence Specific To Post-Op Warming And Temperature Documentation Practices In The Post-Anesthesia Care Unit, Dorothy Vergel

Master's Projects and Capstones

Abstract

Problem: Over the past year, the department failed to meet SSI Bundle Metrics scores consistently due to process identification failures and documentation lapses.

Context: The post-op warming temperature documentation and practices project focused on addressing critical quality issues related to documentation and education gaps in the post-anesthesia care unit (PACU) microsystem. This project took place in a 249-bed hospital in Northern California, which includes 15 post-surgical bays. The PACU primarily serves patients needing acute care post-surgery, with surgical cases handled, including general surgery, plastic surgery, neurosurgery, orthopedic and spine surgery, vascular surgery, and urology.

Interventions: The design …

Increasing Resiliency In Front-Line Nurse Managers, Adrianne N. Bunyard-Fallquist

Master's Projects and Capstones

Problem

According to Membrive-Jimenez et al. (2020), 29% of nursing managers experience emotional exhaustion due to work overload, conflict mediation, and a lack of support from senior leadership. In a central California hospital, front-line nurse managers struggle to meet organizational goals and support their teams, with 64% indicating dissatisfaction in their roles in fall 2023. This highlights the need to improve job satisfaction and retention.

Context

A large healthcare system in Northern California has implemented Caring Science (Foss et al., 2015) and HeartMath® (HeartMath, 2023) techniques in a rural hospital to improve nurse manager retention and job satisfaction. The project …

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 …

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. …

Addressing The Increased Prevalence Of Gestational Diabetes Among Hispanic/Latino Pregnant Persons In The Central Valley Of California, Kathleen Janise Farrell Wardell

Master's Projects and Capstones

Gestational Diabetes (GDM) is a preventable noncommunicable disease that has been on the rise over the last 60 years. Pregnant persons with gestational diabetes are 10 times higher of acquiring Type 2 Diabetes after pregnancy (Ionannou et al., 2024). There is an urgent need to address this public health threat because of its increase in mortality. To address this complex chronic disease, this literature review explored multi-level interventions using the socioecological model to mitigate GDM in the Central Valley’s, Tulare County. Tulare County is disproportionately affected by chronic diseases like diabetes especially among the Hispanic and Latinx communities. Therefore, it …

Improving Firefighter Health Through Education In Sleep Science, Elisabeth J. Filiss

Master's Projects and Capstones

Sleep impacts all aspects of life, from mental health to physical well-being to job performance. Nowhere is this more important than in the fire service, where extreme working conditions are the norm. One of 44 stations in a large fire department (XFD), Firehouse X, has 21 full-time members, six on duty per shift. A microsystem assessment of Firehouse X revealed poor sleep habits and environmental factors that are not conducive to quality sleep. The role of sleep in the fire service has recently been examined, and interventions aimed at improving firefighters’ sleep have been recommended.

This quality improvement project implemented …

Decreasing Inappropriate Wound Consults, Arpita Hinton

Master's Projects and Capstones

Abstract

Background: This project was centered around the wound nurses and their workload. It also highlighted the opportunity for education for frontline staff. The wound nurses at this northern California hospital are a group of five nurses that support the whole hospital. Usually there are two staffed per day to support a facility that continues to have three to four overflow areas open to accommodate its high census.

Problem: My project focused on decreasing inappropriate wound consults. There are many consults places that do not need the intervention of a skilled wound nurse. These consults lead to time that is …

Implementing The "Baby Drop Bundle", Natalie Aguirre

Master's Projects and Capstones

Problem: Falls are a preventable type of trauma that may lead to serious injury, prolonged hospital stays, and non-reimbursable costs to the organization. While there are established fall prevention policies for ambulatory patients, infants dropped by their caregivers are largely excluded.

Context: This quality improvement project aims to decrease newborn drops by implementing the “Baby Drop Bundle”. The bundle allows caregivers and bedside providers to partner in creating a safe environment for the patient.

Interventions: The Clinical Nurse Leader (CNL) will provide a brief in-service during the morning safety huddle to introduce the bundle to staff. The bundle includes educational …