Medicine and Health Sciences Commons^™

Perinatal Periods Of Risk: Examination Of Data Quality & Inclusion Criteria, New Unbiased Reference Groups, And A Nationwide County-Level Analysis, Carol S. Gilbert

Theses & Dissertations

Records of births, infant deaths, and fetal deaths are compiled by the US Vital Records System and used to monitor population health and guide health policy. The Perinatal Periods of Risk Approach (PPOR) relies on vital records data to address fetal and infant mortality in US cities. It uses reference groups to estimate preventable mortality by risk period. To avoid biased analyses due to poor data quality for small and early infant and fetal deaths, an expert committee recommended that PPOR analyses exclude fetal deaths delivered at gestational age (GA) <24 >weeks, and infant deaths and live births with birthweights (BW) …

The Effect Of Locally Applied Simvastatin On Clinical Attachment Level And Alveolar Bone In Periodontal Maintenance Patients, Lauren Krell

Theses & Dissertations

The purpose of this double-blinded, randomized, controlled trial was to determine if the local application of simvastatin (SIM), combined with minimally invasive papilla reflection and root preparation (PR/RP), is effective in improving clinical attachment level (CAL), primary outcome measure; probing depth (PD) reduction; increasing interproximal bone height (IBH); and reducing bleeding on probing (BOP) in persistent 6-9 mm periodontal pockets in patients receiving periodontal maintenance therapy (PMT). Fifty patients with Stage III, Grade B periodontitis (AAP, 2018) presenting with a 6-9 mm interproximal PD with a history of bleeding on probing (BOP) were included in the study. Experimental 2.2 mg …

A Collection Of Research In Transplantation Surgery: The Importance Of Assessing Outcomes In A Field Dependent On The Availability Of Limited Resources, Amy J. Hargrove

Theses & Dissertations

This thesis is a collection of three independent projects related to transplantation surgery. In summary, project I involves an assessment of long-term quality of life outcomes of intestinal transplantation in pediatric patients who are now in adulthood, with comparison to other solid organ transplant patients. Health related quality of life surveys were completed in 14 adult patients who underwent intestine, liver, or kidney transplants as children. Project II evaluates pre-surgical characteristics of patients undergoing liver transplant to assess predictive factors for the need of venovenous bypass utilization intraoperatively by assessing trends at the University of Nebraska Medical Center in 95 …

Strategies For Addressing Vaccination Disparities And Rates In The U.S Among Racial/Ethnic Minority Adults, Harpreet Kaur

Master's Projects and Capstones

As new and emerging infectious diseases surface, public health officials are working harder to close the immunization gap. Every year, thousands of adults in the U.S suffer adverse health outcomes and die from vaccine-preventable diseases. The COVID-19 pandemic has reminded us of the power of vaccines as they have been able to eradicate diseases, save lives, and create healthier communities. A literature review was conducted to identify the gaps in research as it relates to vaccine disparities among racial/ethnic adult populations.

The literature indicates that ethnic/racial minorities are at disproportionate risk for vaccine-preventable diseases and data has shown increasingly high …

Digital Equity Is An Environmental Justice Issue, Courtney B. Cooper

Master's Projects and Capstones

Digital equity has evolved into a more critical area of focus due to the novel coronavirus (COVID-19) pandemic. The COVID-19 pandemic exacerbated the existing digital divide, or the divide that exists between those who have access to the internet and those that do not, by moving many important services and resources online to reduce the spread of the virus. This shift has created more challenges for communities who either lack or have inadequate access to the internet. Furthermore, it is likely that internet utilization will only increase as we continue to recognize its capabilities. A lack of or inadequate access …

Lung Transplantation In A Patient With Covid-19-Associated Acute Respiratory Failure, Fatima Sajid, Taha Ahmed, Maher A. Baz, Michael I. Anstead

Internal Medicine Faculty Publications

Coronavirus disease 2019 (COVID-19) is currently a significant cause of acute respiratory failure worldwide, leading to irreversible fibrotic lung disease. In patients with persistent respiratory failure after acute COVID-19 infection, lung transplant is an emerging option. Here, we have presented a case where the patient required venovenous extracorporeal membrane oxygenation (VV-ECMO) support for 33 days until a bilateral lung transplant was performed on day 71 after the initial COVID-19 infection. The early outcomes have been favorable. Currently, no guidelines exist for an acceptable time period after initial COVID-19 infection, duration of negative COVID polymerase chain reaction (PCR) testing, or negative …

Dynamics Of Protein-Dna Interactions Characterized By Atomic Force Microscopy, Yaqing Wang

Theses & Dissertations

This thesis describes the nanoscale studies of protein-DNA interactions with different complexities using atomic force microscopy (AFM). One of the systems deals with DNA replication rescue. To maintain the genetic integrity, replication machinery needs to minimize the error rate, repair the damages, and restart the stalled replication caused by the attacks from the environment and inside the cell. The stalled replication rescue is orchestrated by a series of proteins, for example, the DNA helicases PriA and RecG and the ssDNA binding protein (SSB).

We demonstrated that SSB stimulates the restart process in two aspects. First, SSB facilitates the binding of …

Development Of Once-A-Year Injectable Formulation Of Cabotegravir For Prevention And Treatment Of Hiv Infection, Tanmay Abhay Kulkarni

Theses & Dissertations

Long-acting cabotegravir (CAB) extends antiretroviral drug (ARV) dosing to monthly for maintenance of human immunodeficiency virus type one (HIV-1) suppression and to every other month for prevention of viral transmission. However, injection dose volumes, site reactions, and clinical oversights that are required remain obstacles towards broad usage. To meet these needs, surfactant coated hydrophobic and lipophilic CAB prodrugs were created with controlled prodrug dissolution, hydrolysis and drug tissue penetration. To such ends, fatty acid ester CAB nanocrystal prodrugs with 14, 18, and 22 added carbon chains were synthesized then nanoformulated as NMCAB, NM2CAB, and NM3CAB. These nanocrystal formulations were tested …

Insights Into Cutaneous Squamous Cell Carcinoma Pathogenesis And Metastasis Using A Bedside-To-Bench Approach, Marissa Lobl

Theses & Dissertations

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer, affecting 1,000,000 people in the United States annually and causing approximately 9,000 deaths. SCC and basal cell carcinoma are the most common types of skin cancer arising in the superficial squamous cells or deeper basal cells of the epidermis, respectively. SCC is more likely to invade and metastasize, while basal cell cancer tends to grow locally. While the majority of cases of SCC are cured by surgery alone, approximately 2-5% of SCCs metastasize, at which point outcomes may be poor. Specific patient groups, particularly immunosuppressed patients, have a …

Molecular Pathogenesis Of A Novel Subgroup Of Peripheral T-Cell Lymphomas, Jiayu Yu

Theses & Dissertations

Peripheral T-cell Lymphoma (PTCL) consists of numerous distinct disease entities. With the current diagnostic criteria over a third of the cases cannot be further classified and are called "not otherwise specified" (PTCL-NOS). Using gene expression profiling (GEP) of tumors, we identified two novels PTCL-NOS molecular subgroups either characterized by high expression of GATA3 (33%), which is associated with Th2 cell differentiation, or high expression of TBX21 (49%) which regulates Th1 cell maturation. Therefore, stratifying patients for diagnosis and identifying the underlying genetic basis to improve clinical therapy becomes critical to prognosis.

First, we performed DNA copy number analysis by using …

Apixaban To Prevent Thrombosis In Adult Patients Treated With Asparaginase, Krishna Gundabolu

Theses & Dissertations

The outcomes of pediatric acute lymphoblastic leukemia (ALL) have improved dramatically after intensification of the multi-agent chemotherapy backbone over a period of time starting from 1960’s, and asparaginase (ASP) is an important part of this success story. Adoption of such strategy in adult ALL and other high grade lymphoid neoplasms had been difficult due to higher anticipated toxicities including thrombosis. Many thrombosis prevention strategies including antithrombin (AT) replacement, Enoxaparin, unfractionated heparin (UFH) was studied but there is no firmly established evidence-based approach yet. We report the safety and efficacy of thrombosis prophylaxis with apixaban 2.5 mg orally twice daily for …

Superoxide And Pulmonary Hypertension, Tammy Wichman

Theses & Dissertations

Pulmonary arterial hypertension (PAH) is a devastating cardiovascular disease, which is progressive and fatal despite advances in therapy. Animal models have shown that oxidative stress may be pathogenic in PAH. We hypothesize that oxidative stress, as measured by increased levels of a specific reactive oxygen species, superoxide (O₂^•-), mayplay a role in PAH in humans. Using a novel application of electron paramagnetic resonance (EPR) spectroscopy, we initially evaluated whether levels of O₂^•- from whole blood collected from the pulmonary artery collected during right heart catheterization (RHC) would correlate with O₂^•- levels in peripheral …

Development Of Macromolecular Prodrug Of Sinomenine For The Treatment Of Rheumatoid Arthritis, Roshni Mukundan

Theses & Dissertations

Inflammation is a natural response of the body to infections or any potential threat to the body. But, sometimes the immune system attacks its own body causing persistent inflammation leading to inflammatory diseases. One of the common chronic inflammatory diseases is rheumatoid arthritis (RA) which causes inflammation of the synovial membrane. The current treatments for RA are effective in controlling the symptoms but they come with severe side effects and economic burden. Further, the management of pain is still a problem with these drugs. Sinomenine is a natural alkaloid obtained from the Chinese medicinal plant Sinomenium acutum that has been …

Evaluating Self-Management Of Adults With Multiple Chronic Conditions Residing In Rural Communities: A Descriptive Cross-Sectional Study, Jessica J. Miller

Theses & Dissertations

Background

Chronic diseases are the leading cause of death and disability in the United States and are on the rise. Multiple chronic conditions are increasing in frequency with 1 in 4 adults affected. Behaviors of adults from rural communities are at an increased risk of developing MCC because of limited access to health care resources and behaviors. Supporting the development of self-management skills can help adults be more active in their own health and promote healthy lifestyle behaviors. The Individual and Family Self-management was the guiding framework for this cross-sectional study.

Purpose

The purpose of this study was to determine …

Gene Expression Profiling Of Mapk Pathway Inhibitor Resistance In Cutaneous Melanoma: Can Bioinformatics Be Used To Select Better Melanoma Cell Lines?, Stephen Luebker

Theses & Dissertations

Melanoma is the deadliest form of skin cancer, and incidence has continued to increase. Half of all melanomas have a BRAF V600E mutation and respond to MAPK pathway inhibitors, including BRAF inhibitor therapy or BRAF/MEK inhibitor combination therapy, but nearly all patients develop treatment resistance. Melanoma cell lines produce variable results as models of MAPK pathway inhibitor resistance. To better understand how the genomic similarity of a melanoma cell line to patient-derived tumors affects resistance mechanisms, differences in DNA mutations and copy-number alterations were compared between melanoma cell lines profiled by the Cancer Cell Line Encyclopedia and cutaneous melanoma tumors …

Investigation Of Environmental Lead Exposures In Children At A Midwestern City With Superfund Site, Zijian Qin

Theses & Dissertations

Childhood exposure to lead is known to cause a host of adverse health effects in children, with no safe blood lead level indicated. Environmental lead contamination is prevalent throughout the United States and remains a threat to the healthy development of children living in these areas, including children in Omaha, Nebraska. The overall objectives of this dissertation were to characterize potential sources of lead in the community – where children play and where children live through the use of environmental exposure sampling. This dissertation also provides insight into current Nebraska children's blood lead levels and identifies local populational attributes that …

Daily Energy Expenditure Through The Human Life Course, Herman Pontzer, Yosuke Yamada, Hiroyuki Sagayama, Philip N Ainslie, Lene F Andersen, Liam J Anderson, Lenore Arab, Issaad Baddou, Kweku Bedu-Addo, Ellen E Blaak, Stephane Blanc, Alberto G Bonomi, Carlijn V C Bouten, Pascal Bovet, Maciej S Buchowski, Nancy F Butte, Stefan G Camps, Graeme L Close, Jamie A Cooper, Richard Cooper, Sai Krupa Das, Lara R Dugas, Ulf Ekelund, Sonja Entringer, Terrence Forrester, Barry W Fudge, Annelies H Goris, Michael Gurven, Catherine Hambly, Asmaa El Hamdouchi, Marjije B Hoos, Sumei Hu, Noorjehan Joonas, Annemiek M Joosen, Peter Katzmarzyk, Kitty P Kempen, Misaka Kimura, William E Kraus, Robert F Kushner, Estelle V Lambert, William R Leonard, Nader Lessan, Corby Martin, Anine C Medin, Erwin P Meijer, James C Morehen, James P Morton, Marian L Neuhouser, Teresa A Nicklas, Robert M Ojiambo, Kirsi H Pietiläinen, Yannis P Pitsiladis, Jacob Plange-Rhule, Guy Plasqui, Ross L Prentice, Roberto A Rabinovich, Susan B Racette, David A Raichlen, Eric Ravussin, Rebecca M Reynolds, Susan B Roberts, Albertine J Schuit, Anders M Sjödin, Eric Stice, Samuel S Urlacher, Giulio Valenti, Ludo M Van Etten, Edgar A Van Mil, Jonathan C K Wells, George Wilson, Brian M Wood, Jack Yanovski, Tsukasa Yoshida, Xueying Zhang, Alexia J Murphy-Alford, Cornelia Loechl, Amy H Luke, Jennifer Rood, Dale A Schoeller, Klaas R Westerterp, William W Wong, John R Speakman

Children’s Nutrition Research Center Staff Publications

Total daily energy expenditure (“total expenditure”, MJ/d) reflects daily energy needs and is a critical variable in human health and physiology, yet it is unclear how daily expenditure changes over the life course. Here, we analyze a large, globally diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 yr. We show that total expenditure is strongly related to fat free mass in a power-law manner and identify four distinct metabolic life stages. Fat free mass-adjusted daily expenditure accelerates rapidly in neonates (0-1yr) to ~46% above adult values at …

Protective Factors That Foster Resilience To Hiv/Aids: Insights And Lived Experiences Of Older Gay, Bisexual, And Other Men Who Have Sex With Men, Renato M. Liboro, Tammy C. Yates, Sherry Bell, Brandon Ranuschio, George Da Silva, Charles Fehr, Francisco Ibañez-Carrasco, Paul A. Shuper

Psychology Faculty Research

Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS …

Exploring Community Perceptions, Attitudes And Practices Regarding The Covid-19 Pandemic In Karachi, Pakistan, Anam Shahil Feroz, Naureen Akber Ali, Ridah Feroz, Noshaba Akber, Salima Nazim Meghani

Community Health Sciences

Background: The Government of Pakistan is facing difficulty to contain the surge of COVID-19 due to the country's social, political, economical and cultural context. Experiences from the previous epidemic suggest that community perceptions, social norms and cultural practices can impede COVID-19 containment. To understand social responses towards COVID-19, the study aims to explore the understanding of COVID-19 and the acceptance of control measures among community members.
Methods: We conducted an exploratory qualitative study using a purposive sampling approach, at two communities of Karachi, Pakistan. In-depth interviews were conducted with community members including, young, middle-aged and older adults of both genders. …

Social Determinants Of Health Assessment For Skilled Nursing Patients, Heather Welch

Master's Projects and Capstones

Section I: Abstract

Problem: Skilled nursing facility (SNF) patients are vulnerable, aging, and have complex medical histories. Readmissions from an SNF impact healthcare costs and hospital resources and indicate poorly coordinated transitions home. Patients discharging from SNFs are at risk for higher social determinants of health (SDOH) disparities, such as limited caregiver support, transportation, housing insecurity, and food access. These SDOH risks can significantly increase an SNF patient's risk for hospital readmissions. Assessing and addressing SNF patients' social needs to reduce 30-day post-SNF readmissions can improve health outcomes and positively impact healthcare costs and a patient's financial liabilities.

Context: Frailty, …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

An Optimized O9-1/Hydrogel System For Studying Mechanical Signals In Neural Crest Cells, Tram P Le, Xiaolei Zhao, Shannon Erhardt, Jianhua Gu, Huie Wang, Tina O Findley, Jun Wang

Faculty, Staff and Student Publications

Neural crest cells (NCCs) are vertebrate embryonic multipotent cells that can migrate and differentiate into a wide array of cell types that give rise to various organs and tissues. Tissue stiffness produces mechanical force, a physical cue that plays a critical role in NCC differentiation; however, the mechanism remains unclear. The method described here provides detailed information for the optimized generation of polyacrylamide hydrogels of varying stiffness, the accurate measurement of such stiffness, and the evaluation of the impact of mechanical signals in O9-1 cells, a NCC line that mimics in vivo NCCs.

Hydrogel stiffness was measured using atomic force …

Increasing Public Health Mosquito Surveillance In Hidalgo County, Texas To Monitor Vector And Arboviral Presence, Clarissa D. Guerrero, Steven Hinojosa, Diana Vanegas, Niko Tapangan, Matthew Guajardo, Sara Alaniz, Narda Cano, Christopher Vitek, John M. Thomas, Valerie Hernandez, Juan Garcia Jr.

School of Integrative Biological & Chemical Sciences (Formerly Dept. of Biology)

From 2016 to 2018, Hidalgo County observed the emergence of Zika virus (ZIKV) infections along with sporadic cases of Dengue virus (DENV) and West Nile virus (WNV). Due to the emergence of ZIKV and the historical presence of other mosquito-borne illnesses, Hidalgo County obtained funding to enhance mosquito surveillance and educate residents on arboviruses and travel risks. During this time period, Hidalgo County mosquito surveillance efforts increased by 1.275%. This increase resulted in >8000 mosquitoes collected, and 28 mosquito species identified. Aedes aegypti, Ae albopictus and Culex quinquefasciatus made up approximately two-thirds of the mosquitoes collected in 2018 (4122/6171). Spatiotemporal …

Maximizing Mobility In The Icu, Stephen Kupiec

Master's Projects and Capstones

Problem: In a large tertiary medical center in Northern California, the patients in the 20-bed ICU achieved averaged maximum mobility (AMM) scores well below the regional target. These patients had longer lengths of stay in the ICU and spent more days on ventilators, as compared to patients in other ICUs in the region. Barriers to mobilization included patient diagnosis, sedation practices, staff burnout, insufficient staffing, a knowledge deficit around the safety and benefits of mobility, lack of standard workflows, and lack of interdisciplinary collaboration.

Context: A microsystem assessment focused on metrics-that-matter to determine the focus of this quality improvement project. …

Early Specialty Palliative Care For High Mortality Cancers, Dulce E. Alcantara

Master's Projects and Capstones

Problem: Patients with stage IV cancer have a high mortality rate. Evidence shows that patients have a better quality of life when they receive specialty palliative care (SPC) services. In the microsystem of focus for this project, referrals to SPC are not automatic, and there are no triggers to help the oncologist decide when to refer during a patient’s terminal illness trajectory. Siloes between oncology and SPC exist, which leads to a lack of communication and coordination of care, ultimately affecting patient access to support services from SPC.

Context: A multi-disciplinary SPC clinic and a referring oncologist within the …

Communication Strategies To Promote Infection Control Compliance: My Health Is In Your Hands, Ezra Macabio

Master's Projects and Capstones

Abstract

Problem: The facility has less than 70% adherence to handwashing hygiene every week. Moreover, staff does not comply with the required PPE, affecting their infection-control performance and compliance to circumvent COVID-19. Furthermore, the microsystem lacks information flow and communication systems focusing on hand hygiene, and PPE usage significantly affects the healthcare staff's ability to perform such vital practices.

Context: Herman Health Care Center provides multiple services to its residents depending on medical needs after patient hospitalizations, such as short-term rehabilitation and long-term skilled nursing services. The COVID-19 pandemic had a remarkably negative impact on the skilled nursing facility. The …

Eservice-Learning During Covid-19: How Community-Engaged Learning Courses At The University Of San Francisco Responded To The Pandemic, Erin I. Hassett

Master's Projects and Capstones

During the COVID-19 pandemic, universities and colleges had to quickly transition their courses from in-person to online. This switch to online learning heavily impacted community-engaged learning (CEL) courses because it meant that internships with community partners had to become remote as well as the coursework. The University of San Francisco (USF) requires their undergraduate students to take at least one CEL course during their four years there as a way to connect them to the school’s Jesuit Catholic values, so pivoting these courses to a remote setting and keeping them available to students throughout the pandemic was imperative. This paper …

The Impact Of Nurse-Led Initiative Interventions On Cauti, Dalveer Kaur

Master's Projects and Capstones

Problem: National Healthcare Safety Network (NHSN) has reported U.S. hospitals having 0.2 to 4.8 per 1000 catheter-days for adult inpatient units. The insertion of a catheter and delay in removal have a significant impact on morbidity, mortality, length of stay, and reimbursement.

Context: Post-Acute Care Unit (PACU) is a microsystem that provides rehabilitation services for a patient with various post-surgical procedures. The staff of this unit was well aware of policies of catheterizations that led to prolonged use of urinary catheters and an increased rate of CAUTIs in the last quarter of this year. This project aims to increase staff …

Guiding Change: A Multidisciplinary Framework For Interventions Addressing Systemic Racism In Healthcare, Lavette D. King

Master's Projects and Capstones

The relationship between systemic and institutional racism in the U.S., and health outcomes in people of the African Diaspora have been well documented (Bailey et al., 2017). Distrust in the healthcare system is the result of generational trauma compounded by an ongoing issue that has yet to be fully addressed (Scharff et al., 2015). For decades people of African descent have expressed concern about negative experiences with the U.S. healthcare system. Often the encounters leave them feeling, mistreated, unheard and or criminalized. These feelings result in trepidation over using the healthcare system which often further compounds health issues (Washington, 2008). …

U.S. Cosmetic Policy Reform: A Growing Need To Protect Communities Of Color From Exposure To Toxic Chemicals, Amna Haslam

Master's Projects and Capstones

Women of color are at a higher risk of exposure to toxic chemicals because of their use of more personal care products when compared to white women. A literature review was conducted focusing on mercury, a highly toxic heavy metal, found in some skin lightening creams used in Latinx, Black, and Southeast Asian communities to evaluate the impact of toxic chemicals used in communities of color. The use of skin lightening products is associated with the perception of beauty and social advantage. Further, women of color regardless of educational attainment experience the same social pressures to lighten their skin. This …