Medicine and Health Sciences Commons^™

Normal And Varied Morphological Structure Of The Fossa Ovalis And Its Clinical Relevance, Christian G. Valverde

Theses & Dissertations

Congenital heart defects are atop the list of the most common type of birth defects in modern obstetrics. According to the Center for Disease Control and Prevention, nearly 40,000 births each year are diagnosed with a congenital heart defect, composing an annual rate of 1%. Of those 40,000 births, roughly 1 in 4 are severe enough to require surgical intervention. Acknowledging that heart disease has been the leading cause of mortality for the past several decades, the former can certainly have additive effects toward this trend. There are several different etiologies and forms of heart defects that are often found …

Identifying The Molecular Determinants Of Lung Metastatic Adaptation In Prostate Cancer, Grace M. Waldron

Theses & Dissertations

Prostate cancer (PC) stands as the primary diagnosed cancer in men in the US at approximately 299,010 cases in 2024 and ranks second globally, posing a significant public health challenge. Clinical presentations vary widely, from indolent to aggressive forms, necessitating stage-specific treatment regimens. Understanding its metastatic nature is critical due to the impact of cancer cell dissemination on disease morbidity, with bone and visceral organs serving as key sites of metastasis. Despite bone metastasis being the most common site for metastasis, visceral metastases at sites such as the liver and lungs correlate with poorer survival, emphasizing the role of microenvironmental …

Genetic Drivers And Tumor Milieu Analysis In Mantle Cell Lymphoma, Sunandini Sharma

Theses & Dissertations

Mantle Cell Lymphoma (MCL) is a B-cell lymphoma characterized by t(11;14) leading to CyclinD1 (CCND1) overexpression with highly variable clinical response. Although the tumor intrinsic mechanisms have been fairly studied, the role of the tumor microenvironment (TME) in survival and therapeutic responses is marginally examined. Herein, we integrated high-throughput genomics and characterized TME using a highly multiplexed, spatially resolved, single-cell digital pathology approach termed imaging mass cytometry (IMC) to delineate the tumor-immune landscape. We identified eight MCL genomic subtypes with distinct signatures and prognoses. Subsets C2, C5, and C6 had poorer outcomes with a 5-year overall survival (OS) of 33-50% …

Pharmacodynamic Effects Of Zsj-0228 On Complement Protein Deposition In The Kidneys Of Focal Segmental Glomerulosclerosis-Afflicted Mice., Braeden Pinkerton

Theses & Dissertations

Chronic inflammation, when left untreated, may result in significant morbidity and in severe cases, mortality. While glucocorticoids (GCs) are still being extensively used clinically as a class of very potent anti-inflammatory agents, they are also notorious for diverse adverse side effects. To mitigate these side effects, we have developed a polyethylene glycol (PEG)-based prodrug (ZSJ-0228) of dexamethasone (Dex). When tested on rodent models of Lupus Nephritis and Focal Segmental Glomerulosclerosis (FSGS), ZSJ-0228 was found to provide potent and sustained therapeutic efficacy without any detectable typical GC-associated side effects. Given ZSJ-0228’s transient renal exposure after systemic administration, it is yet to …

Cardiovascular Disease Risk Reduction Program For Hispanics In The Us Midwest: A Culturally Adapted Intervention, Armando De Alba

Theses & Dissertations

Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs …

Major Injuries Sustained In Towable Watersports, Elijah J. Klein

Honors Thesis

Towable watersports are activities where a participant is being pulled by a motorized watercraft while wearing or holding onto a floating device. Watersports come with many known risks such as drowning, whiplash, and fatigue; however, other injuries are often overlooked or misunderstood. With this thesis, I aimed to explore injury records pertaining to towable watersports and attempted to identify prevalent injury trends in wakeboarding, waterskiing, and water tubing. Using the National Electronic Injury Survey System (NEISS), a public database with yearly injury records, I compiled information related to the relevant sports from 2013 to 2022. Included with the data is …

Assessment Of In-Vitro And In-Vivo Pre-Clinical Pharmacokinetics Of Epz015666; A Novel Small Molecule For Medulloblastoma Treatment, Pratiksha U. Kshirsagar

Theses & Dissertations

Group 3 medulloblastoma (MB) has the worst prognosis of the MB subgroups associated with elevated MYC expression and a 5-year survival rate of

Quantitation of EPZ was performed on a Shimadzu LC-MS/MS system utilizing electrospray ionization operated in positive mode. The validated assay was linear from 0.2 to 500 ng/mL. Metabolic stability studies demonstrated slow intrinsic clearance of EPZ in mouse and human liver microsomes, suggesting no CYP-mediated metabolism. Additionally, EPZ exhibited low binding affinity to plasma and brain proteins and high apparent permeability across artificial membranes, indicating efficient membrane penetration. Drug transporter studies identified EPZ as a substrate of …

Facilitators And Barriers To Implementing Effective Interprofessional Education: A Mixed Methods Study Of Academic Health Institutions With Centralized Interprofessional Education Administrative Structures, Liliana Bronner

Theses & Dissertations

Interprofessional education (IPE) is pivotal in preparing future healthcare professionals for collaborative practice, yet its effective implementation remains challenging. The purpose of this mixed methods study of multiple academic health institution cases was to explore and understand how early and late IPE adopters perceive effective IPE implementation in academic health institutions. Combining frameworks for complex innovation implementation and curriculum development with surveys and interviews reveals the facilitators and barriers of effective IPE implementation. Consistent with the framework for complex innovation implementation, leadership and administrative support, resource allocation, logistical planning, and program evaluation emerged as key facilitators of effective IPE implementation. …

Promoting Physiologic Birth By Improving Access To Doulas, Karen Schwartz

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Birth in the United States (U.S.) leans towards a medicalized approach, overlooking the advantages of physiologic birth. Physiologic birth is a natural approach to childbirth, without medical interventions. Intrapartum nurses play an integral role in caring for women during labor by providing continuous labor support. Competing nursing tasks, exacerbated nursing shortages and increased nurse to patient ratios have made it increasingly challenging for intrapartum (IP) nurses to provide continuous labor support to their patients. The aim of this DNP project is to gain insight into the beliefs of IP nurses regarding childbirth and how these beliefs impact their approach to …

Toxicological Impacts Of River Chemical Spills In Affected West Virginia Counties, Janice Lorraine Taylor Peters

Walden Dissertations and Doctoral Studies

Factors such as geographical location/proximity and exposure to external environmental events, as well as poor regulatory processes, are known to increase the risk for cancers among affected populations. There is still a gap in the literature related to the incidence of cancers in specific regions with heavy industrialization and environmental health hazards. In West Virginia, chemical contamination events have occurred in or near water systems. The goal of this quantitative, retrospective study was to discover whether there were any differences in the incidence of disease or adverse health effects and cancers due to chemical contamination in four counties (Kanawha, Mingo, …

Molding The Self: Understanding Adoptees' Identity Formation, A Literature Review, Carolyn Brazil

Expressive Therapies Capstone Theses

The topic under investigation focuses on the complex process of identity formation in adoptees, particularly those in transracial and international adoption scenarios. Grounding this topic in theory, the author draws from psychological and sociological perspectives. The literature illustrates key factors in adoptees' identity formation, and it emphasizes the importance of family involvement and cultural connections in integrating identities, as well as the role of cultural ties in understanding racial identities. The conclusion from this study reveals the complexities and clinical considerations of adoptee identity formation, showing their challenges in combining birth and adoptive cultures. It underscores the value of art …

Pricks And Pills, Anna A. Charles

Theses and Dissertations

"Pricks and Pills" is a collection of audio pieces designed for an online platform where individuals with diabetes can listen to and find emotional support from others who share their experiences. This audio project provides an intimate look into the lives of people navigating the challenges of diabetes. Through heartfelt interviews with individuals and their families, the podcast highlights their journeys, showcasing both their struggles and triumphs.

The Impact Of The News2 On Self-Confidence And Anxiety In Nursing Students, Ashley Barnes

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

The purpose of this pre-and post-interventional design study was to determine the impact of the National Early Warning Scale 2 (NEWS2) on self-confidence and anxiety levels of undergraduate Associate of Science in Nursing (ASN) and Bachelor of Science in Nursing (BSN) senior level nursing students during a clinical deterioration simulation. New graduate nurses and experienced nurses report a lack of self-confidence and increased anxiety when caring for a patient experiencing clinical deterioration or decline. Senior level nursing students self-reported their self-confidence and anxiety levels using the Nursing Anxiety & Self-Confidence with Clinical Decision Making (NASC-CDM^Ó ) scale before and …

Prevalence And Predictors Of Secondary Traumatic Stress In A National Sample Of Emergency Nurses: A Cross-Sectional Study, Christian Paige Owen

Dissertations and Theses (Open Access)

Background: Emergency nurses experience traumatic situations as part of their professional role, leaving them vulnerable to secondary traumatic stress (STS). The distressing behaviors and symptoms of STS negatively impacts their well-being and ability to provide high quality care. Studies report that emergency nurses experience high levels of STS but less is known about how STS is influenced by their coping strategies and work-related factors. Further evidence is needed to better understand predictors of STS in order to support strategic efforts to improve the well-being and retention of nurses working in trauma-prone environments.

Aims: The specific aims of this study sought …

Bioactive Glass Bead Characterization: Further Applications In Passive Drug Delivery, Marie O. Sykes

Physics and Astronomy Honors Papers

Bioactive glass beads were discovered for their bone repair properties in 1969. This properties, along with their bactericidalness, high ability to be engineered, bioactiveness and their versatile structures, mark them as excellent candidates for explorations in other biomedical applications in addition to bone repair. One alternative application includes passive drug delivery, especially when the biomaterial is in a porous, microsphere structure. In this work, we first explore various samples of bioactive glass compositions and structures in order to target the best bead for the application of drug delivery. The targeted beads are then thoroughly characterized using optical microscopy, Scanning Electron …

Examining The Relationship Between Patient Engagement With Digital Inhaler Technology And Asthma Control, Tanisha D. Hill

Walden Dissertations and Doctoral Studies

Asthma is a chronic lung disease that has significant public health and economic impact. Nonadherence to asthma medications can lead to poor treatment response and poor asthma outcomes. Digital health technologies have been shown to improve asthma medication adherence as well as asthma outcomes. The purpose of this quantitative research study was to examine the relationship between patient characteristics and mobile app engagement and the relationship between patient engagement with a digital inhaler app and asthma control in adult patients with uncontrolled asthma who were assigned to use a digitally enabled asthma medication and accompanying app for asthma therapy. Several …

Improving Nurses’ Communication Skills Using The Situation-Background-Assessment-Recommendation Model, Leslie Gonzalez

Walden Dissertations and Doctoral Studies

Lack of effective communication among health care providers results in negative health outcomes, low patient satisfaction, and compromised patient safety. An educational intervention to improve communication skills was implemented with staff including licensed practical nurses, registered nurses, and nurse practitioners. The project was implemented and evaluated for improved patient outcomes and satisfaction. The framework for the project was the situation-background-assessment-recommendation (SBAR) model. Pre- and postimplementation surveys were used to assess nurses’ knowledge of the effectiveness of SBAR on communication skills and patient satisfaction. Descriptive statistics and inferential analysis, including the Wilcoxon sign test, were employed to analyze pre- and postintervention …

Evaluation And Education Of Enhanced Recovery After Surgery Protocols For Total Knee Arthroplasty, Lauren Hunt, Jessica Prost

Doctor of Nursing Practice Projects

Enhanced recovery after surgery (ERAS) utilizes a multimodal, multidisciplinary perioperative protocol to minimize hospital length of stay, surgical complications, readmissions, and patient hospital costs (Frassanito et al., 2020). The protocols were initially established for abdominal and colorectal surgical patients; however, ERAS protocols are now widely used in other areas, including orthopedic surgery (Kaye et al., 2019). To achieve the maximum benefits, ERAS protocols must contain preoperative, intraoperative, and postoperative components. A rural critical access hospital in Eastern Illinois, Crawford Memorial Hospital, serves numerous patients requiring total knee arthroplasties (TKA). While the providers utilize some aspects of ERAS protocols for these …

Identifying Srnas Individual Learning Preferences Utilizing The Vark Learning Inventory Tool, James Eads

Doctor of Nursing Practice Projects

Abstract

All graduates of a doctoral anesthesiology program are required to successfully pass the National Certifying Exam (NCE). Since 2011, the national average passage rate has decreased from 89.1% to 84.1% in 2021 (NBCRNA, 2023). Yamaguchi’s 2022 study revealed that students are positively impacted academically when they implement individual learning preferences. The purpose of this project was to identify individual learning preferences for students enrolled in the U.S. Army Nurse Anesthesiology program. The hypothesis was that students who recognize their preferred learning and incorporate preferred learning techniques would result in an increased percentage of passage rate scores for the NCE. …

A Behavioral Intervention Checklist To Reduce Re-Hospitalizations In Residents With Mental Illness, Jeffery Davis

Doctor of Nursing Practice Projects

Skilled nursing facilities are an essential component of the continuum of care and, with the rapidly aging population, represent an increasing cost to the healthcare system. The policies beginning in the 1960s promoting the deinstitutionalization of mental health institutions have resulted in increasing numbers of individuals with serious mental illnesses now residing in skilled nursing facilities. The complex needs of individuals with mental illness have been associated with an even greater cost of care, deficient quality, and safety concerns. This quality improvement project analyzed the impact of an evidenced-based, structured behavioral intervention checklist on rehospitalization rates in individuals with mental …

Hepatitis C Management For Individuals In Custody, Oluronke D. Akinola

Doctor of Nursing Practice Projects

The hepatitis C virus (HCV) is a pathogen that spreads through blood and causes hepatitis C disease, a liver infection. Early infection symptoms are rare, making it a silent killer. HCV, the chronic liver disease accounts for half of all hepatocellular carcinoma cases and is the leading cause of liver transplantation in the US. This quality improvement project aimed to create an educational toolkit for the Department of Correction staff working with individuals in custody refusing HCV treatment. The education tools comprised an infographic flyer (English and Spanish) to teach individuals in custody about HCV treatment and a PowerPoint presentation …

Addressing Air Quality Mitigation As A Key Factor In Asthma Management And Prevention, Julia Buckles, Jewel Radford

Doctor of Nursing Practice Projects

Asthma is the most prevalent disease in childhood and disproportionately affects African American (AA) populations in terms of prevalence and frequency of exacerbations. Air quality and environmental factors are strongly associated with the diagnosis and management of asthma and AA children are more likely to live in areas with poor air quality. An air quality flag program was implemented in a daycare located in a county with a predominantly AA population with a high prevalence of asthma diagnoses. The goal of the intervention was to increase staff awareness of air quality and the impact it can have on asthma diagnosis …

Implementing Pain Management Policies And Procedures At A Rural Pain Clinic, Jamie Swearingen

Doctor of Nursing Practice Projects

The United States is facing an uprising in opioid use disorder and a rise in overdoses due to the disorder. Due to the high addiction potential of opioids and the potential for overdose, providers must be cautious and conservative in their opioid prescribing practices. In 2022, the Centers for Disease Control (CDC) updated the Clinical Practice Guidelines for Prescribing Opioids for Pain to help in prevention of developing opioid use disorder and unintentional overdoses. The lack of an opioid use disorder risk screening tool, random urine drug screens, and clear pain management contracts were identified as issues at one rural …

Increasing Oral Health In A Midwest Elementary School: Quality Improvement Project, Dee Young

Doctor of Nursing Practice Projects

Marginalized communities experience barriers to accessing oral healthcare in the United States (US). Due to this, many children are left to use the emergency department (ED) for dental care. The purpose of this Doctor of Nursing Practice (DNP) project was to improve oral health services access in children at one suburban Midwest elementary school. The objectives of this project were: a) to improve the efficiency of students registering in Fall 2023 to access available oral health exam services, b) to increase the number of students who receive an oral health exam compared to the number in the previous school year. …

Nurse Anesthesiology Education For Regulators, Jonathan Alvarado, Kevin Stein

Doctor of Nursing Practice Projects

Governmental and regulatory entities like the state board of nursing have an active role in regulating all nursing fields, including anesthesiology. The lack of a required nurse anesthesiology representative on the board presents a potential knowledge gap related to anesthesiology practice. Board members and staff must make decisions related to nurse anesthesiology that may cause anxiety due to its complexity. The lack of education in this area allows one to make wrong decisions or spend extended time looking for the correct information.   The main objective of this project was to provide an educational module on nurse anesthesiology practice to the …

Risk Factors For Hepatitis A Hospitalizations And Mortality In Kentucky's 2018 Hepatitis A Outbreak, Tanya Campbell

Walden Dissertations and Doctoral Studies

In 2018, the state of Kentucky faced an outbreak of Hepatitis A virus (HAV), which led to a significant increase in HAV cases, hospitalizations, and fatalities. The social-ecological model (SEM) was used in a cross-sectional design to identify the factors associated with this outbreak. This approach employed secondary data extracted from the National Notifiable Disease Surveillance System (NNDSS). Logistic regression was used to test hypotheses determining homelessness, drug use, and HAV vaccine status were related to HAV hospitalizations. There was a statistically significant association between the covariate age and HAV hospitalization (p = 0.004), and between homelessness and hospitalization (p < .001); however, associations between drug use and HAV vaccine status were not statistically. Intervention programs should target homeless populations; such targeting can lead to a reduction in HAV infections and HAV outbreaks. Implications for positive social change include motivation for policymakers and public health officials to assist in curtailing hospitalization and mortality rates caused by HAV in high-risk groups. Targeted prevention and intervention measures can mitigate the incidence of HAV in high-risk populations and enhance their health prospects.

The Experience Of Remediation For At-Risk, Pre-Licensure Baccalaureate Student Nurses, Nicole Jager

Walden Dissertations and Doctoral Studies

At-risk students face academic challenges that can affect nursing program progression. Remediation strategies can increase student success. The research problem addressed through this study is a lack of information surrounding the students' remediation experience in an at-risk, pre-licensure baccalaureate student nurse population. Individualizing remediation to the student population can increase success; however, the student perspective is needed to correctly identify and tailor the remediation activities to fit the students’ needs. The purpose of this descriptive qualitative study was to explore the experience of remediation among at-risk, pre-licensure baccalaureate student nurses. Mezirow's transformative learning theory grounded this study. The research design …

The Association Of Discrimination And Coping Style On Cardiovascular Health Among South Asian Individuals In The Masala Study, Raji Pillai

Dissertations and Theses (Open Access)

Objectives: South Asian individuals (SAs) are found to have a heightened state of inflammation contributing to increased cardiovascular disease (CVD). Additionally, social determinants like discrimination are also associated with risks for CVD in SAs. This study examined the associations between discrimination and inflammation and whether an association between discrimination and self-rated health (SRH) is moderated by coping styles among SAs living in the United States to inform effective coping strategies against discrimination.

Design: This secondary data analysis used data from 1164 SAs (mean age = 57 years, SD 9.4, 48% women) enrolled in the Mediators of Atherosclerosis in South Asians …

Implementation Of A Validated Suicide Screening Tool In A University Student Health Center, Tessa Welniak, Bailey Coslor, Cathrin Carithers

Doctor of Nursing Practice Projects: College of Nursing

Purpose. Suicide is the second leading cause of death among adults in the United States and Nebraska. Death by suicide impacts millions of adults every year in the United States but warning signs are often missed during visits with primary care providers. The University of Nebraska at Kearney (UNK) Student Health Center (SHC), like many other primary care clinics, did not routinely screen patients for suicide risk. According to the Joint Commission, all patients over 12 years of age should be screened for suicide using a validated screening tool if the visit is for any behavioral health concern. The project’s …

Implementation Of A Doula-Supported Postpartum Wellness Toolkit In A Black Community-Based Maternal Wellness Program, Janice Luethje, Leslie Torres

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to expand the areas of focus within a maternal wellness program at a Black community center and to evaluate the satisfaction levels of the doulas who utilized the material during postpartum home visits. The toolkit covers a range of postpartum topics in the areas of nutrition, exercise, sexual health, mindfulness, and social support as well as a postpartum mental health screening tool.

Design: This quality improvement project included three distinct phases: The pre-implementation phase, the implementation phase, and the post-implementation phase.

Setting: The project location was a Black community center in Lincoln, Nebraska. …