Medicine and Health Sciences Commons^™

Development And Control Of A Pediatric Lower Limb Exoskeleton For Gait Guidance, Anthony Clarence Goo

ETD Archive

Several genetic, developmental and neurological disorders can cause various levels of gait impairment in the pediatric population. Powered lower limb orthoses, or exoskeletons, have recently been used to address gait impairment and afford therapists alternative solutions and strategies for gait therapy. Most exoskeleton research has focused on the adult population while the pediatric population remains underserved. The limitations of current pediatric exoskeletons make them impractical for use in both community and clinical settings. Furthermore, exoskeleton controllers suitable for these environments should promote human volitional control while guiding the subject towards a dynamically stable healthy gait pattern.

This dissertation presents the …

The Mentored Experience To Enhance Opportunities In Research (Meteor) Program., Lisa Schwartz, Naomi Luban, Alison Hall, Diane Mcquail, Yolanda Haywood

Health Sciences Education Research

PROBLEM: Medical students from groups that are underrepresented in medicine are less likely to pursue careers that incorporate research as compared to their white peers. Clinical and Translational Science Award (CTSA)-funded institutions encouraged centers to establish short-term, mentored summer research opportunities to motivate students underrepresented in medicine to enroll in medical school and ideally choose a career that incorporates research into their clinical practice.

APPROACH: The Mentored Experience To Enhance Opportunities in Research (METEOR) Program was established in 2012 in partnership with the Clinical and Translational Science Institute at Children's National (CTSI-CN) and The George Washington University (GW) School of …

Lifespan Benefits For The Combination Of Rapamycin Plus Acarbose And For Captopril In Genetically Heterogeneous Mice., Randy Strong, Richard A Miller, Catherine J Cheng, James F Nelson, Jonathan Gelfond, Shailaja Kesaraju Allani, Vivian Diaz, Angela Olsen Dorigatti, Jonathan Dorigatti, Elizabeth Fernandez, Andrzej Galecki, Brett Ginsburg, Karyn L Hamilton, Martin A Javors, Kerry Kornfeld, Matt Kaeberlein, Suja Kumar, David B Lombard, Marisa Lopez-Cruzan, Benjamin F Miller, Peter Rabinovitch, Peter C. Reifsnyder, Nadia Rosenthal, Molly A. Bogue, Adam B Salmon, Yousin Suh, Eric Verdin, Herbert Weissbach, John Newman, Francesca Maccchiarini, David E. Harrison

Faculty Research 2022

Mice bred in 2017 and entered into the C2017 cohort were tested for possible lifespan benefits of (R/S)-1,3-butanediol (BD), captopril (Capt), leucine (Leu), the Nrf2-activating botanical mixture PB125, sulindac, syringaresinol, or the combination of rapamycin and acarbose started at 9 or 16 months of age (RaAc9, RaAc16). In male mice, the combination of Rapa and Aca started at 9 months and led to a longer lifespan than in either of the two prior cohorts of mice treated with Rapa only, suggesting that this drug combination was more potent than either of its components used alone. In females, lifespan in mice …

Alcohol Use Disorder And Major Depressive Episodes: Findings From The National Survey On Drug Use And Health, Samantha Madler

Theses and Graduate Projects

Alcohol use disorder (AUD) is one of the leading causes of death and disability among individuals in the United States (Bergmann et al., 2013; Jung, 2019; Sliedrecht et al., 2019; Witkiewitz, 2019). A number of individuals reporting an AUD diagnosis also report difficulties related to numerous physical, social, and mental health consequences, most notably, major depression. Major depressive disorder (MDD) and AUD co-occur at high rates, and researchers have been investigating the negative consequences and outcomes related to these co-occurring illnesses (McHugh & Weiss, 2019; Tolliver & Anton, 2022). Using a large nationally representative sample of 18–36-year-olds, treatment completion within …

The Development Of A Novel Peptide-Drug Conjugate For Treating Triple-Negative Breast Cancer, Phi-Phung Than

Pharmaceutical Sciences (MS) Theses

Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with poor prognosis and is difficult to treat. A diagnosis of TNBC means that the three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and HER2– are not present in the cancer tumors. Since the tumor cells lack necessary receptors, common treatments like hormone therapies and targeted HER2 drugs are ineffective. The use of chemotherapies in treating TNBC is an effective option instead. However, chemotherapies are not selective, thus they cause severe side effects such as cardiotoxicity, myelosuppression, alopecia and gastrointestinal problems. A peptide-drug conjugate …

A Single Centre Experience Of Local Perforator Flaps In Oncoplastic Breast Surgery: A Cross-Sectional Study, Sana Zeeshan, Lubna Vohra, Uzma Shamsi, Nida Zahid, Danish Ali, Nargis Asad, Cristina Garusi

Section of General Surgery

Background & objectives: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women.
Materials & methods: This cross-sectional study was conducted from March 2019 to February 2021 enrolling …

Factors Affecting Health-Seeking Behaviour Among Men Who Have Sex With Men In Starehe Sub-County, Nairobi City County, Anthony Omariba

MSc in Advanced Practice Nursing

Men who have sex with other men (MSM) exist in Africa, as they do elsewhere. The continued proscription of MSM behavior leads to exclusion and discrimination. According to a global report, MSMs are responsible for most HIV transmission. MSMs in Kenya constantly fear being hurt because of their sexual orientation, and there is scant knowledge of their health-seeking behavior. There is a need to improve the health of this group to lower disease spread to achieve global HIV reduction. This study aims to explore MSM healthcare-seeking behavior, describe barriers to healthcare-seeking, and establish perceptions of the sexual risks associated with …

Impairment-Based Multidisciplinary Rehabilitation Management In Multiple Sclerosis In Pakistan, Sarah Razaq, Fahim Anwar, Wasim Wali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychiatric Manifestations Of Dengue Fever- A Case Report From Pakistan, Ifrah Hambal, Samrah Nasir, Tania Nadeem

Pakistan Journal of Neurological Sciences (PJNS)

A 29-year-old male presented to Aga Khan University Hospital with complaints of fever, body-aches, vomiting and one episode of gum bleeding. A Dengue antigen test done prior to presentation was positive. He was admitted for medical management. During hospital stay, the patient developed manic symptoms including over-talkativeness, expansive mood, disinhibited behavior, excessive planning, paranoia and aggression. He remained oriented to time, place and person and neurological examination was unremarkable. He was managed with anti-psychotics and benzodiazepines, and his psychiatric symptoms improved with improvement in his medical condition. This case highlights the possibility of psychiatric manifestations occurring in context of a …

Short, Medium And Long Term Neurological Manifestations And Outcome In Covid-19 Patients, Sajid Hameed, Bashir Soomro, Samar Iltaf, Abdul Malik, Anjum Farooq, Alam Ibrahim Siddiqi, Safia Awan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: There is a need to improve the understanding of Covid-19 neurological complications in a temporal manner. The objective of our study was to find out temporal relationship of neurological manifestations and outcome in Covid-19 Patients.

Methods: This was a multi-center observational study from six centers in Pakistan. Data of covid patients with six months follow up was retrospectively collected from the hospital records. Time periods were divided into short-term (< 1 month), medium-term (2-3 months) and long-term (>4 months). SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data.

Results: Neurological manifestations were reported in 208 out of 905 covid …

Decompressive Hemicraniectomy For Patients With Malignant Cerebral Venous Sinus Thrombosis, Sadaf Majid, Waseem Tariq Malik, Asfandyar Khan Niazi, Ehsan Ul Haq, Hina Yusuf, Raja Farhat Shoaib, Maimoona Siddiqui Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and may lead to the development of raised intracranial pressure due to edema, infarct or bleed. These patients may require decompressive hemicraniectomy to reduce the raised intracranial pressure. However, the evidence for hemicraniectomy in these patients is scanty. Our objective was to perform a retrospective chart review to describe the clinical characteristics of patients who underwent decompressive hemicraniectomy for malignant CVST and their outcomes.

Methods: We retrospectively analyzed the medical records of patients with CVST who underwent decompressive hemicraniectomy between 2013 and 2020 at Shifa International …

Hurdles Of Intravenous Thrombolysis In Acute Ischemic Stroke At Balochistan, Anjum Farooq, Muhammad Essa, Nimra Shafique, Sakina Gull

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan.

Methods: A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data …

Multiple Sclerosis And Parkinson’S Disease: Poles Apart Or Cut From The Same Cloth?, Wajid Jawaid

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Diabetes Self-Management Education And Support: Understanding Knowledge And The Impact, Christina Dietz

All Dissertations

Diabetes has reached epidemic proportions in the United States. To address this, many organizations employ diabetes self-management education and support (DSMES) programs to aid in managing the impact of increasing prevalence. The purpose of this dissertation is to examine the impact of two Upstate South Carolina DSMES programs on several process and outcome measures for adults with diabetes, while also identifying current primary care provider DSMES knowledge and perceptions in an Upstate South Carolina health system.

This dissertation found inconclusive results on the impact of DSMES on PCP utilization, retinal exam screening, nephropathy attention, HDL, LDL, TC, and TG. DSME …

Role Of Macrophages In Ocular Surface Fibrosis, Alyanna Corpuz

Pharmaceutical Sciences (MS) Theses

The present study is designed to investigate whether irradiation as used for conditioning regimen to ablate recipient’s diseased bone marrow prior to transplantation could trigger macrophage activation and polarization and whether macrophages could cause the transdifferentiation of ocular surface fibroblasts into myofibroblasts, thus contributing to oGVHD-associated fibrosis.

Bone marrow cells were cultured in M-CSF to obtain M0 macrophages, which were subsequently polarized into M1 and M2 phenotypes using IFN-g + LPS and IL-4, respectively.

The macrophages were exposed to 7 Gy radiation. The effect of irradiation on macrophage activation markers, phagocytosis, and apoptosis was assessed using real-time PCR, confocal microscopy, …

The Ward Round: Friend Or Foe In Postgraduate Training? A Grounded Theory Study Of Residents’ Perspectives, Mariam Noorani

Paediatrics and Child Health, East Africa

The ward round has traditionally been a learning activity in medical education. Apart from education, ward rounds have multiple roles including patient care and communication. Some studies have described the ward round as an ideal place to learn patient management while others reported that little learning happens on rounds due to lack of time and patient volume. This study aimed to develop a deeper understanding of ward round learning from the perspec-tive of postgraduate trainees. A constructivist grounded theory approach was used and data was collected during focus group discussions. Data were analyzed by initial coding, then grouped into focused …

Ispad Clinical Practice Consensus Guidelines 2022: Assessment And Management Of Hypoglycemia In Children And Adolescents With Diabetes, Mary B. Abraham, Beate Karges, Klemen Dovc, Diana Naranjo, Ana Maria Arbelaez, Joyce Mbogo, Ganesh Javelikar, Timothy W. Jones, Farid H. Mahmud

Paediatrics and Child Health, East Africa

No abstract provided.

Acute Kidney Injury In Hospitalized Children With Sickle Cell Anemia, Anthony Batte, Sahit Menon, John Ssenkusu, Sarah Kiguli, Robert Kalyesubula, Joseph Lubega, Edrisa Ibrahim Mutebi, Robert Opoka, Chandy John, Michelle Starr

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifcations to the Kidney Disease: Improving Global Outcomes (KDIGO) defnition would infuence clinical outcomes of AKI in children with SCA hospitalized with a VOC.

Methods: We prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital …

Perceived Quality Of Senior Care In An Assisted Living Facility Following The Outbreak Of Covid-19, Kaylie Hill

Theses/Capstones/Creative Projects

The COVID-19 pandemic has posed a monumental obstacle to the healthcare field in terms of severely reducing the number of healthcare workers. Among the many industries affected by staffing shortages are assisted living facilities (ALFs), in which residents are dependent on care staff for daily assistance. This study sought to investigate whether long-term residents of ALFs perceive a difference in the quality of their care under the circumstances of the pandemic as opposed to those of pre-pandemic times. Semi-structured interviews were facilitated with 10 long-term residents who have been residing in an Omaha ALF since prior to the outbreak of …

Nursing News & Views - December 2022, Joanne Miller Rn

Nursing Newsletters

No abstract provided.

To Err Is Human; Acute Appendicitis A Mistaken Clinical Identity For Metastatic Follicular Thyroid Carcinoma, A Case Report, Ahmed Jusabani, Neelam Ismail, Zainab Fidaali, Ramadhani Mjejwa, Tausi Maftah, Ally Zain Ismail

Faculty of Health Sciences, East Africa

Introduction and importance: Thyroid cancer accounts for majority of endocrine cancers with follicular thyroid cancer the second most common. It tends to spread via hematogenous route with distant metastasis thus besides presenting as a neck mass it may also present with symptoms tallying to regions of metastasis which may misguide the diagnosis. We report a case of a 50-year-old man who presented with features of appendicitis only to discover metastatic right iliac bone follicular thyroid cancer. We describe our experience on diagnostic formulation, radiological work up, surgery, radioactive iodine therapy and follow up.

Case presentation: 50-year-old man presenting with acute …

A Structural Examination Of The Connection Between The Amygdala And Nucleus Accumbens In Adolescents With Clinical Anxiety, Alyssa Griffith

Biological Sciences Undergraduate Honors Theses

The prominence of anxiety disorders in today’s general population is a major public health concern. Advancing research of the underlying pathophysiology of anxiety disorders can lead to the discovery of effective treatment interventions to treat the mental and physical symptoms of anxiety, and thus improve quality of life. This study aimed to examine two brain areas in the limbic and reward systems, the amygdala and Nucleus Accumbens (NAcc), and the structural white matter connection between them. This neural circuit assigns affective valence to environmental stimuli and motivates behavior to avoid potential harm. This study utilized diffusion Magnetic Resonance Imaging (dMRI) …

Myocardial Infarction With Nonobstructive Coronary Arteries In New-Onset Inflammatory Bowel Disease, Benjamin B. Claxton, George Sun, Ritu Nahar, Christopher Henry

Division of Gastroenterology and Hepatology Faculty Papers

No abstract provided.

Heavy Metals As Risk Factors For Human Diseases - A Bayesian Network Approach, M Perrelli, R Wu, D J Liu, R G Lucchini, L Del Bosque-Plata, Michael Vergare, M P Akhter, J Ott, Claudia Gragnoli

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

Modern industrial agricultural processes expose human beings to multifactorial environmental pollution including heightened levels of heavy metals. The effects of acute heavy metal exposures at toxic levels are usually known; they are tested for and treated promptly. The effects of low/moderate-level chronic heavy metal exposures are less known as they may be subclinical, and pathogenic effects may only manifest clinically over time under the disguise of a diagnosable disease or miscellaneous symptoms attributed to aging. Consequently, the health impact of low-moderate heavy metal exposure is unlikely to be identified. Furthermore, established heavy metal safety levels often fail to recognize the …

Optimizing Diabetes Self-Management Using Continuous Glucose Monitoring And Improving The Transition Of Care For Adult Patients Discharged From The Hospital, Nikki Rose Angeles

Doctor of Nursing Practice

Background: Diabetes mellitus is a chronic medical condition that affects more than 34 million Americans (Centers for Disease Control and Prevention, 2020). The financial impact of diabetes is significant. Americans spend $327 billion on direct medical costs to treat the disease and its associated complications (American Diabetes Association, 2018). The management of diabetes requires a multidisciplinary approach that involves healthcare providers, diabetes self-management support resources, and a high level of commitment from the patient. Patients with diabetes discharged from the hospital often receive fragmented and inconsistent information about managing their health issues. As they transition from hospital to home, their …

An Interprofessional Prediabetes And Diabetes Self--Management Education Quality Improvement Project Among Vulnerable Populations At A Tuberculosis Hospital, Robert Saul Castro Natal

Doctor of Nursing Practice

Background. Patients greatly benefit from diabetes self-management education (DSME) as it boosts knowledge and self-efficacy, decreases body weight, fasting blood sugar, and hemoglobin A₁C levels, and improves overall health outcomes in a cost-effective manner. Unfortunately, many individuals with prediabetes and diabetes who qualify for DSMEs do not attend these classes nor receive sufficient prediabetes and diabetes support elsewhere to attain guideline recommended metrics. However, individuals from vulnerable populations and without DSME education experience disproportionate diabetes-related complications worsening health outcomes. Aims: Increase general prediabetes and diabetes knowledge, facilitate behavior change, improve glycemic, metabolic, and lipid values, and increase …

Implementing Food Insecurity Screening On A College Campus, Norma Martinez

Doctor of Nursing Practice

Background. Students attending universities have higher rates of food insecurity than U.S. households. Most college campuses do not routinely screen students for food insecurity, which can affect students’ health and school performance. Currently, the university health clinic does not screen students for food insecurity. Purpose. To screen all students who present to the university clinic for food insecurity and evaluate students with food insecurity for malnutrition. Evidence. Foreman et al. (2018) and Abu and Oldewage-Theron (2019) found that food insecurity was present at some of the largest Texas universities at rates higher than the national average. Project Objectives. To screen …

Addressing Obstacles In Following Prescribed Medication Regimens In Patients With Type 2 Diabetes Mellitus, Cristina Sarro

Doctor of Nursing Practice

Background. Type 2 diabetes is the ninth leading cause of death in the United States. Micro/macro vascular complications are common in diabetes. Purpose. To implement an evidence-based protocol addressing obstacles for patients with type 2 diabetes in following their prescribed medication regimens to reduce glycosylated hemoglobin levels. Evidence. Failure to follow treatment plans increases diabetes complications. Perceptions and complexities of treatment plans, side effects of therapies, and cost contribute to patients not taking their medications as prescribed. Goals. To increase the number of patients with type 2 diabetes who follow their prescribed medication regimen and reach their targeted glycosylated hemoglobin. …

Implementing The Depression Screening Tool Phq-9 In The Annual Wellness Exam Of Concierge Family Medicine, Eric Iglesias

Doctor of Nursing Practice

Abstract

Background: Depression has been one of the most common mental health disorders that our population fact but is underdiagnosed and undertreated. Primary care providers are often the first line of defense in detecting depression. Because of this, implementing a depression screening tool in a primary care setting will improve holistic management of care and improve quality of life.

Project Aim: The aim of this project was to increase the number of clients who are evaluated for depression by using the PHQ-9 screening tool during their annual wellness exam and initiate treatment according to the Veteran’s Affairs/Department of Defense Depression …

Patient Care Management Of Hypertension Through Improving Follow-Up And Reducing Missed Appointments In A Primary Care Clinic: A Qi Project, Victoria Idubor

Doctor of Nursing Practice

Background. Missed follow-up appointments constitute significant problems clinics and health centers face nationwide. A significant portion of primary care providers’ patients will require follow-up appointments to manage their chronic illnesses. About 20 to 40% of patients seen at this clinic have a history of hypertension. Uncontrolled hypertension has been shown to increase the risk of certain cardiovascular disease events and mortality. Follow-up appointments are crucial for patients with hypertension to monitor for more life-threatening signs and manage their overall care. Purpose. The purpose of this project is to improve the timely management of care for patients with hypertension …