Medicine and Health Sciences Commons^™

Severity Assessment Of Impairment In Spinal Cord Injury; A Systematic Review On Challenging Points About International Standards For Neurological Classification Of Spinal Cord Injury, Mahmoud Yousefifard, Mostafa Hosseini, Alireza Oraii, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI. Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI …

Protein Charge Parameters That Influence Stability And Cellular Internalization Of Polyelectrolyte Complex Micelles, Rachel A. Kapelner, Rachel S. Fisher, Shana Elbaum-Garfinkle, Allie C. Obermeyer

Advanced Science Research Center

Proteins are an important class of biologics, but there are several recurring challenges to address when designing protein-based therapeutics. These challenges include: the propensity of proteins to aggregate during formulation, relatively low loading in traditional hydrophobic delivery vehicles, and inefficient cellular uptake. This last criterion is particularly challenging for anionic proteins as they cannot cross the anionic plasma membrane. Here we investigated the complex coacervation of anionic proteins with a block copolymer of opposite charge to form polyelectrolyte complex (PEC) micelles for use as a protein delivery vehicle. Using genetically modified variants of the model protein green fluorescent protein (GFP), …

Systematic Review To Evaluate Algorithms For Reboa Use In Trauma And Identify A Consensus For Patient Selection., Amelia Walling Maiga, Rishi Kundi, Jonathan James Morrison, Chance Spalding, Juan Duchesne, John Hunt, Jonathan Nguyen, Elizabeth Benjamin, Ernest E Moore, Ryan Lawless, Andrew Beckett, Rachel Russo, Bradley M Dennis

Trauma and Acute Care Articles

BACKGROUND: Patient selection for resuscitative endovascular balloon occlusion of the aorta (REBOA) has evolved during the last decade. A recent multicenter collaboration to implement the newest generation REBOA balloon catheter identified variability in patient selection criteria. The aims of this systematic review were to compare recent REBOA patient selection guidelines and to identify current areas of consensus and variability.

METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of clinical practice guidelines for REBOA patient selection in trauma. Published algorithms from 2015 to 2022 and institutional guidelines from a seven-center …

The Impact Of Preoperative Neurological Symptom Severity On Postoperative Outcomes In Cervical Spondylotic Myelopathy, Gregory R Toci, Jose A Canseco, Brian A Karamian, Michael Chang, Giovanni Grasso, Kristen Nicholson, Emily M Pflug, Glenn S Russo, Daniel Tarazona, I David Kaye, Mark Kurd, Alan S. Hilibrand, Barrett I. Woods, Jeffrey A Rihn, D Greg Anderson, Kris E Radcliff, Christopher K Kepler, Alex R. Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

Study design: The study design is a retrospective cohort study.

Objective: To compare patient-reported outcomes between patients with mild versus moderate-to-severe myelopathy following surgery for cervical spondylotic myelopathy (CSM).

Summary of background data: Recent studies have demonstrated that decompression for CSM leads to improved quality of life when measured by patient-reported outcomes. However, it is unknown if preoperative myelopathy classification is predictive of superior postoperative improvements.

Materials and methods: A retrospective review of patients treated surgically for CSM at a single institution from 2014 to 2015 was performed. Preoperative myelopathy severity was classified according to the modified Japanese Orthopaedic Association …

Autonomous And Non-Autonomous Requirements For The C-Jun N-Terminal Kinase Signaling Pathway In Early Forebrain Development, Jessica G. Cunningham

Graduate Theses, Dissertations, and Problem Reports (ETD)

The cerebral cortex is responsible for a wide variety of high-level functions including cognition, sensory perception, fine motor control, and the orchestration of body movements. The cortex is comprised of cortical excitatory neurons and inhibitory interneurons, which are arranged in a highly organized fashion into different layers and regions. These two types of cells operate in a delicate balance between excitation and inhibition, which is critical for proper cortical circuitry. In order for the cortex to execute its numerous functions, it must both send and receive input to other brain regions through axonal connections. The organization within the cortex and …

Monitoring The Systemic Immune System To Understand And Improve The Efficacy Of Immunotherapy For Metastatic Osteosarcoma, Justin Edward Markel

Graduate Theses, Dissertations, and Problem Reports (ETD)

Osteosarcoma (OS) is a complex tumor with no effective targeted therapies due to its genomic heterogeneity and pleomorphism. The immune response it creates, particularly against metastatic lesions, is considerable; however, various suppressive mechanisms induced by the tumor prohibit its effectiveness. The presence of infiltrating lymphocytes suggests that therapeutic disinhibition through checkpoint blockade could increase antitumor immunity, though none have been successful in clinical trials. The complexities of the immune response to OS tumors have yet to be unraveled; however, there is evidence to suggest that cell-mediated immunity (CMI, specifically T cells, Natural Killer [NK] cells, and myeloid-lineage cells [MLCs]) plays …

Implementation Of Standardized Handoff Reporting To Improve Communication Among Certified Registered Nurse Anesthetists And Postanesthesia Care Unit Nurses In The Postanesthesia Care Unit, Lauryn G. Macfawn

Graduate Theses, Dissertations, and Problem Reports (ETD)

Standardization of handoff reporting has been proven to increase the quality of information being transferred and improve patient safety. Poor quality handoff between providers increases morbidity and mortality, hospital length of stay, healthcare costs, as well as decreases patient satisfaction The aim of this Doctor of Nursing Practice quality improvement (QI) project was to implement the situation, background, assessment, recommendation (SBAR) handoff reporting tool in the postanesthesia care unit (PACU) at a hospital in Western Maryland. There was no standardized handoff process in place between certified registered nurse anesthetists (CRNAs) and PACU registered nurses (RNs) at the facility. The participants …

Implementation Of A Nonverbal Scrub Cap Identification System To Improve Communication And Perception Of Patient Safety Among Unfamiliar, De-Identified Staff Members In The Operating Room., Keri Ann Roskowinski

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Operating room (OR), professionals deliver patient care with brief introductions, and roles were not always identified, and although team members wear identification (ID) badges, they were usually covered by sterile gowns and other routine personal protective equipment (PPE). Purpose: The aim of this Doctor of Nursing Practice (DNP) project was to determine if a simple intervention to apply the individual’s name and role to a scrub cap could improve identification, OR team communication, and consequently, patient safety. The participants in this project consisted of nurses, physicians, anesthesia providers, scrub technicians, students, medical sales representatives, and those that identified as …

Prenatal And Pediatric Oral Health Education Among Dental Hygiene Programs In The United States, Denise M. Claiborne, Shillpa Naavaal

Dental Hygiene Faculty Publications

Purpose: Health care and dental providers must be prepared to address the oral health needs of mothers and children in order to reduce the burden of dental disease in these populations. The purpose of this study was to describe the curriculum and clinical experiences related to prenatal and pediatric oral health in the university and community college dental hygiene programs in the United States (US).

Methods: Dental hygiene program directors (PDs) from across the US were invited to participate in a cross-sectional electronic survey regarding the prenatal and pediatric oral health curriculum at their institution. In addition to program characteristics, …

Tumor-Targeted Ph-Sensitive Manganese Oxide Nanoparticle For Enhanced Detection Of Breast Cancer Using Mri, Celia Martinez De La Torre

Graduate Theses, Dissertations, and Problem Reports (ETD)

In the United States, approximately 287,850 new cases of invasive breast cancer will be diagnosed, and over 43,000 women will die because of it in 2022. Currently, mammography is the gold standard for breast cancer surveillance. Although this detection technique is relatively cheap and fast, it misses about 1 in 5 breast cancers in younger women with dense breast tissue, causing a delay in treatment. Compared to mammography, magnetic resonance imaging (MRI) has superior soft-tissue contrast that elucidates structural differences within soft tissue to detect more breast cancers. However, MRI still misses

NEMO particles were produced by synthesizing manganese oxide …

Implementation Of An Amiodarone Infusion Nurse Practice Guideline To Reduce The Incidence Of Phlebitis: A Quality Improvement Project, Kristen N. Cottrill

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Patients have an increased risk of developing phlebitis when amiodarone is delivered through a peripheral intravenous catheter. In a 32-bed cardiac surgery step-down unit, patients experienced phlebitis at a rate of 28.57% despite following manufacturer recommendations. Individual interventions targeted at amiodarone-related phlebitis have presented mixed results, however, when an amiodarone infusion practice guideline was established, the rate and severity of phlebitis consistently decreased across studies. Purpose: This project aimed to implement an evidence-based amiodarone infusion guideline to reduce phlebitis development or severity in cardiac-surgery step-down patients without a central venous catheter who received a peripheral intravenous infusion of amiodarone. …

A Quality Improvement Initiative For Intraoperative Low Dose Ketamine Utilization In Thoracotomy, Jason Wampler

Graduate Theses, Dissertations, and Problem Reports (ETD)

The challenge of postoperative pain control following a thoracotomy is well noted among anesthesia providers. The intraoperative utilization of low-dose ketamine in several patient populations, including those undergoing a thoracotomy, has been deemed a viable intervention in the multi-modal analgesia plan at not only reducing postoperative pain scores for patients, but also reducing opioid consumption. This quality improvement project sought to increase provider awareness of this intervention among anesthesia providers in a community hospital with a goal to influence a practice change. This was completed using a pre-post design centered around an educational in-service, with an additional 60-day follow-up survey …

Looking Upstream For Factors Influencing Mental Illness In A Low-Resource Setting, Adewole Adebola Adefalu

Walden Dissertations and Doctoral Studies

An investigation into the upstream determinants of mental disorders could provide insight into pathways by which these risk factors could relate to different groups of mental illness. The study was a quantitative inquiry using constructs within the Rothman’s sufficient and component cause framework to examine the pathways existing between upstream risk factors for schizophrenic and mood disorders. The study population was drawn from a convenience sample of clients accessing services at the psychiatry departments of a secondary mental health institution in North-Central Nigeria. The mean age of the participants in this study was 35.5years. The majority were males (53.4%), single …

No Difference In Corticosterone Concentrations Between Missouri Three-Toed Box Turtles Living In An Urban And A Rural Site, Bennett A. Lamczyk, Jamie L. Palmer, Corinne P. Kozlowski, Stephen Blake, Sharon L. Deem

Human–Wildlife Interactions

Baseline health data for species of conservation concern are important for understanding threats to the long-term viability of populations. One indication of health is physiological stress among individuals. Corticosterone (CORT) is frequently used to quantify stress in free-living reptile populations, as high values may be associated with reduced fitness. Herein, we describe and validate methods for quantifying blood CORT levels in three-toed box turtles (Terrapene mexicana triunguis). We subsequently use this information to evaluate stress levels in 2 populations of free-living three-toed box turtles in Missouri, USA. To our knowledge, this is the first quantification of CORT levels …

Risk Factors Associated With Community-Onset Sepsis In Latino/Hispanic Adults, Joan Ivaska

Walden Dissertations and Doctoral Studies

Sepsis results in a significant public health burden globally, causing 20% of adult mortality worldwide and accounting for more than one third of deaths in hospitalized adults in the United States, making it one of the top 15 leading causes of death in the United States. Community-onset sepsis (COS) comprises nearly 80% of all sepsis cases occurring in the United States each year. Despite the widespread prevalence of COS, significant gaps in knowledge exist regarding the risk factors that lead to COS and sepsis mortality in Latino/Hispanic adults in the United States. The purpose of this secondary data study was …

Dehydration And Mortality Of Feral Horses And Burros: A Systematic Review Of Reported Deaths, John Derek Scasta, Eric Thacker, Jacob D. Hennig, Karl Hoopes

Human–Wildlife Interactions

Water is a requirement for all organisms, including equids. Dehydration-caused mortality of feral horses (Equus ferus caballus) is often cited as a cause of concern and as justification for management of feral horses, yet a paucity of information exists on the matter. We conducted a systematic review from September 1, 2020 through January 15, 2021 of available news reports of feral horse and burro (E. asinus) dehydration mortalities and public interventions to save horses using a public search engine with a priori defined search term combinations and additional snowball sampling. We found 15 uniquely reported mortality …

Typhoid Fever Among Low-Income Women Living In Gujranwala, Pakistan., Tehmina S. Khan

Walden Dissertations and Doctoral Studies

Approximately 21 million individuals suffer from typhoid fever (TF) globally, and most outbreaks occur in Southeast Asia. The incidence of TF is high in Pakistan, particularly in low socioeconomic areas, and a new drug-resistant strain makes it difficult to control the spread of TF. There is a pressing need for up-to-date and accurate data regarding the attitudes, beliefs, and habits leading to the spread of TF infection among individuals living in low socioeconomic areas of Pakistan. This qualitative, phenomenological study was grounded in the health belief model and explored factors that influence the spread of TF among women of childbearing …

Fertility Control Options For Management Of Free-Roaming Horse Populations, Ursula S. Bechert, John W. Turner Jr., Dan L. Baker, Douglas C. Eckery, Jason E. Bruemmer, Candace C. Lyman, Tulio M. Prado, Sarah R. B. King, Mark A. Fraker

Human–Wildlife Interactions

The management of free-roaming horses (Equus ferus) and burros (E. asinus) in the United States has been referred to as a “wicked problem” because, although there are population control options, societal values will ultimately determine what is acceptable and what is not. In the United States, free-roaming equids are managed by different types of organizations and agencies, and the landscapes that these animals inhabit vary widely in terms of access, size, topography, climate, natural resources, flora, and fauna. This landscape diversity, coupled with contemporary socioeconomic and political environments, means that adaptive management practices are needed to …

Exposure To Malaria Awareness Messages And Preventive Health Behaviors Among Informal Workers In Ghana, Nora Larkai

Walden Dissertations and Doctoral Studies

Malaria is a global health issue that is most prevalent in Sub-Saharan countries such as Ghana. In the past, various studies have examined the use of malaria messages and malaria prevalence; however, very few Ghanaian studies focus explicitly on using various types of malaria-related messaging modalities and the impact of these messaging systems on lessening malaria contraction among the informal sectors. The aim of this study was to analyze the relationship between exposure to malaria awareness messages, place of residence, and preventive health behaviors controlling for sex, occupation group, marital status, and educational level among Ghanaian informal workers. This study …

Appraisal Of Institutional Antimicrobial Stewardship In Selected Public Health Facilities In Nigeria, Joshua Olusegun Obasanya

Walden Dissertations and Doctoral Studies

The misuse of antimicrobials (AM) constitutes a huge problem in developing countries, including Nigeria, posing severe public health threats to the populace’s health. Misuse contributes to the high consumption of AM, driving the emergence and spread of antimicrobial resistance (AMR). Establishing functional antimicrobial stewardship (AMS) programs at the health facility levels is recognized as an effective and efficient strategies to tackle AMR. Literature is replete with evidence of poor prescription practices, but few studies assessing the factors contributing to inappropriate use of AM in Nigeria exist. The purpose of this study was to improve the understanding of AMS practice at …

Educational Level As A Moderator Between Stress And Suicidal Ideation Among Law Enforcement Officers, Sittipong Permsookjit

Walden Dissertations and Doctoral Studies

Law enforcement officers are exposed to occupation-related stress at a level greater than any other occupation, save war combatants, such stress can lead to suicidal ideation. There is a growing trend of suicidal ideation among law enforcement officers. This trend will threaten the stability of society if it is allowed to continue. Educational level has been shown to improve quality of life and is considered a quantitative resource. Using the theoretical framework of appraisal theory, this study’s purpose was to examine the moderating effects of educational level on stress and suicidal ideation among law enforcement officers. A total of 72 …

Association Between Parental Socioeconomic Status And Childhood Obesity In The Southwest Geopolitical Zone Of Nigeria, Omatsola Aboyowa Sifo

Walden Dissertations and Doctoral Studies

AbstractGlobally, childhood obesity is a major social and public health concern characterized by complications such as high cholesterol and high blood pressure. The purpose of this quantitative cross-sectional study was to examine the association between childhood obesity in children age 6–12 years and the socioeconomic status of their parents in the Southwest geopolitical zone of Nigeria. Social cognitive theory served as the theoretical framework for the study. Questionnaire data were collected from 384 parents/guardians of children age 6–12 years across three states in the Southwest geopolitical zone of Nigeria. Data were analyzed using descriptive statistics and multiple logistic regression at …

Factors That Influence Seeking Prostate Cancer Preventive Care In African Immigrants, Millicent N. Seilenga

Walden Dissertations and Doctoral Studies

AbstractProstate cancer is a major public health problem, being the second leading cause of cancer deaths in U.S. men, but mortality can be prevented with the use of early detection strategies. African American men are more than twice as likely to die of prostate cancer as compared to Hispanic and White men. African immigrant men as compared to African American men born in the United States have higher mortality rates of prostate cancer due to not seeking preventive care. However, little is known about the factors that prevent African immigrant men living in the United States from seeking prostate cancer …

Legislative Efforts And Community Change To Combat Female Genital Mutilation In Egypt, Maryam Berkshire

Walden Dissertations and Doctoral Studies

Female genital mutilation is recognized as a violation of human rights as it violates the bodily rights of young girls by cutting part of their bodies without their consent and leaves long term psychological, physical and sexual harm to women who were exposed to the practice. The World Health Organization estimates that 130 million girls and women are subjected to Female Genital Mutilation/Cutting (FGM/C) in African and Middle Eastern Countries. According to a UNICEF 2020 report, Egypt will not meet the SDG goal of eradicating FGM as the decrease in the practice is too slow despite the policy and community …

Exploring Parent Support For School-Based Health Programs To Reduce Childhood, Alaphiah Delaney Campbell Byfield

Walden Dissertations and Doctoral Studies

The rise in childhood obesity rates continues globally despite the design and implementation of social programs aimed at curtailing that phenomenon. The government of Jamaica has indicated that a whole-of-government, whole-of-society approach is needed to control obesity. The literature has shown that in Jamaica, support for being fluffy impedes progress toward addressing the problem of childhood obesity; being fluffy is considered attractive and a sign that one has a good life. Studies have shown that obese or overweight children are at risk for developing psychosocial (e.g., having low self-esteem, and underperforming academically) and medical problems (e.g., noncommunicable diseases such as …

The Double Burden Of Intra-Household Malnutrition Among Mother–Child Dyads In South Africa, Puveshni Crozier

Walden Dissertations and Doctoral Studies

Household-level double burden of malnutrition (HL-DBM) challenges traditional South African vertical malnutrition programs. Research has associated a household with an overweight/obese mother of reproductive age and her under 5-year-old child with signs of undernutrition (wasting, stunting, or thinness) with socioeconomic levels, maternal characteristics, features of the household, and child’s demographics. Grounded in the social determinants of health conceptual framework, this study aimed to investigate the determinants of HL-DBM in South Africa across the reproductive-child health continuum. Using the representative 2017 Wave 5 South African National Income Dynamics Study survey secondary data, a total sample of 314 homes met this non-experimental …

Predictors Of Glycemic Control Among Type 2 Diabetes Mellitus Patients In Owerri, Nigeria, Jideuma Ikenna Egwim

Walden Dissertations and Doctoral Studies

Diabetes mellitus (DM) is a significant public health concern globally and in Owerri, Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin (HbA1c) levels greater than 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking on specific risk factors associated with poor glycemic control among DM patients in Owerri. With health insurance assuming a significant position in healthcare service delivery in Nigeria, addressing this …

Nicu Services For Preterm Babies: Experiences Of Aghem Women Of Northwest Cameroon, Deudonne Kum Amuam

Walden Dissertations and Doctoral Studies

The experiences of women with health care services continue to be a challenge for health care workers in providing quality care. Women’s poor impressions of health care services in sub-Saharan Africa stems from the negative behavior of health care workers during the provision of care to mothers and their preterm babies. The lack of data on women's experience with health care services in Cameroon was the problem this study addressed. The study's purpose was to understand Aghem women's experience with health services provided for their preterm babies in the neonatal intensive care unit (NICU) and how they perceived that their …

Experiences Of Bsn Graduates Integrating Cultural Competence When Caring For Multicultural Patients, Judith A. Daniels

Walden Dissertations and Doctoral Studies

Registered nurses entering the workforce with baccalaureate of science degrees in nursing (BSN) are expected to be knowledgeable and skilled in planning and caring for multicultural patients, but there is little information on what experiences new nurses have in implementing culturally competent care. The purpose of this descriptive phenomenological study, guided by the Campinha-Bacote process of cultural competence in the delivery of health care services model, was to understand the lived experiences of BSN graduates with one year or less experience in implementing cultural competence in planning care for their multicultural patients. The research question directly addressed this purpose. Ten …

Perspectives Of Girls, Families, And Healthcare Workers On Accessing Services For Adolescents With Perinatal Hiv In Nigeria, Joseph Fabian Inyang

Walden Dissertations and Doctoral Studies

Adolescents living with Human Immunodeficiency Virus (HIV) include those who were infected from their mother perinatally (PHIV) and those who were infected through sexual behaviors or drug use. Nigeria contributes the largest burden of children born with HIV globally, due to poor implementation of its prevention of mother-to-child transmission program. With advances in antiretroviral therapy (ART), more children and adolescents with HIV survive into adulthood. However, there are challenges to ART including access, uptake, adherence, and risks of long-term exposure. Using the social ecological model and a phenomenological approach, this qualitative study was designed to understand the experiences of adolescent …