Medicine and Health Sciences Commons^™

Access To Medicines For Parkinson's Disease In Kenya: A Qualitative Exploration, Natasha Fothergill-Misbah, Juzar Hooker, Judith Kwasa, Richard Walker

Internal Medicine, East Africa

Background: The accessibility of Parkinson’s disease medicines is limited across sub-Saharan Africa,which can have negative health, social and financial consequences for people with Parkinson’s disease andtheir families. However, there is a stark gap in the literature regarding the impact of poor access to medicineson individuals.

Objectives: The study objective was to understand the accessibility of Parkinson’s disease medicines in Kenyafrom the perspective of people with Parkinson’s disease, their caregivers and neurologists.MethodsMethods: In-depth qualitative interviews were conducted with 55 people with Parkinson’s disease, 23 caregiversand 8 neurologists to understand their experience regarding challenges with accessing Parkinson’s diseasemedicines and the health, social …

Recreational Cannabis In Louisiana: Anticipating Potential Risks For Motor Vehicle Safety In The Short And Long Term, Aimee H. Moles, Andrew Burns, Ashley Tillison, Austin L. Matthews

Reports

This document, titled Recreational Cannabis in Louisiana: Anticipating Potential Risks for Motor Vehicle Safety in the Short and Long Term, provides a comprehensive analysis of the potential impacts that cannabis legalization could have on road safety in Louisiana. The document is written to equip policymakers and concerned citizens with the necessary knowledge to navigate the complex landscape of cannabis legalization and its implications for public safety.

Key Objectives and Scope: The primary purpose of this document is to evaluate the potential risks associated with recreational cannabis legalization on motor vehicle safety, drawing on data and experiences from Canada and states …

Exploring Healthcare Chatbot Information Presentation: Applying Hierarchical Bayesian Regression And Inductive Thematic Analysis In A Mixed Methods Study, Samuel Nelson Koscelny

All Theses

High blood pressure, also known as hypertension, significantly increases the risk of heart disease and stroke, which are leading causes of death in the United States. While contributing to over 691,000 deaths in 2021 alone in the United States (U.S.), it also imposes immense economic burden on the healthcare system, costing approximately $131 billion annually. One way to address this issue is for increased self-care behaviors and medication adherence, both of which require sufficient health literacy. Despite the importance of health literacy, 90% of U.S. adults struggle with health-related subjects. Overcoming the issues associated with health literacy requires addressing the …

Prognostic Factors On Preoperative Mri For Patient-Reported Outcomes After Posterior Medial Meniscus Root Repair, Sergio E Flores, Rawee Manatrakul, Christopher Anigwe, Chotigar Ngarmsrikam, Brian T Feeley, C Benjamin Ma, Thomas M Link, Drew A Lansdown

Faculty, Staff and Student Publications

Background: Repair of posterior medial meniscus root (PMMR) tears has demonstrated favorable outcomes and may prevent rapid progression of knee osteoarthritis; however, there is a paucity of data regarding prognostic factors affecting postoperative outcomes.

Purpose/hypothesis: The purpose of this study was to identify factors on preoperative magnetic resonance imaging (MRI) that predict postoperative outcomes after PMMR repair. It was hypothesized that patients with increasing levels of degenerative changes as evaluated through semiquantitative preoperative MRI scans would have worse postoperative patient-reported outcome (PRO) scores.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent PMMR repair between 2012 and …

Implementation Of Synchronous And Asynchronous Car-T Education For Emergency Room And Intensive Care Unit Nurses In Non-Oncology Units, Kylie Kuck

Doctor of Nursing Practice Scholarly Projects

Background: Chimeric antigen receptor T cell (CAR-T) therapy is a novel and promising cancer treatment for hematologic malignancies. This treatment is highly regulated by the Food and Drug Administration (FDA) and The Foundation for the Accreditation of Cellular Therapy (FACT) because of the known toxicities associated with treatment.

Local problem: In 2022, FACT published guidelines requiring formal education for both oncology and non-oncology nurses who care for these patients, including emergency room and intensive care unit nurses.

Methods: This quality improvement project provided education to emergency room and intensive care unit care nurses who are caring for CAR-T cell therapy …

Rheumatic Mitral Valve Disease Successfully Managed With Mechanical Circulatory Support Before Mitral Valve Replacement Surgery, Jeremy Walder, Onur Sahin, Akhilesh Pillai, Marwan Jumean, Bindu Akkanti, Harish C Devineni, Alisha Young, Kha Dinh, Goutham Dronavalli, Ismael A Salas De Armas, Igor D Gregoric, Biswajit Kar

Faculty, Staff and Student Publications

No abstract provided.

Development Of A Thwarted Belonging Measure In Older Adults: An Application To Neighborhood Context And The Moderating Role Of Neuroticism, Jaclyn Elisa Keenoy

Theses, Dissertations and Culminating Projects

This research focuses on thwarted belonging (TB), its associations with the neighborhood contextual factors of social cohesion and physical disorder in older adults, and the moderating role of neuroticism. TB is a key component of the Interpersonal Psychological Theory of Suicide (IPTS) that has serious implications for health and well-being (Van Orden et al., 2012). Despite these implications, TB is less frequently investigated outside of the suicide literature. Thus, the first aim of this research was to create a valid measure of TB in a sample of 5,001 older adults using data from the Health and Retirement Study using a …

Engagement And Retention Of College Students With Anxiety And Depressive Symptoms In A Digital Mental Health Intervention Using A Brief Peer Support Model, Emily A. Kline

Theses, Dissertations and Culminating Projects

Digital mental health interventions (DMHIs) show promise in improving access to mental health care for college students suffering from depression and anxiety symptoms. Nonetheless, the usefulness of DMHIs is limited by high user attrition. Leveraging peer support among college populations may be a feasible and cost-effective option to improve DMHI engagement and improve mental health outcomes. This open pilot study evaluated the feasibility, acceptability, and initial efficacy of a skill-based peer support group in enhancing user engagement in a DMHI for depression and anxiety symptoms. Participants were 20 undergraduate students at a university in New Jersey with elevated depression and …

Exploring The Relationship Between Cognitive Inflexibility And Anxiety In Youth On The Autism Spectrum, Farah Mahmud

Theses, Dissertations and Culminating Projects

Anxiety symptoms are prevalent among autistic youth but frequently get overlooked due to issues of diagnostic overlap and atypical presentations of anxiety (Kerns et al., 2014; Wood & Gadow, 2010). Emerging literature suggests that cognitive differences specific to autism, such as cognitive inflexibility, may be associated with vulnerability of developing and maintain anxiety symptoms (Stark et al., 2021). Cognitive flexibility (CF), the ability to shift thinking and attention according to situational demands, is thought to be impaired in many autistic children, given the behavioral rigidity observed in this population (Geurts et al., 2009). However, further work is needed to tease …

Risk Factors For Malalignment After Intramedullary Nail Treatment Of Distal Tibia Fractures With Associated Fibula Fractures., Yash P Chaudhry, Jose M Gutierrez-Naranjo, Micheal Raad, Diane Ghanem, Luis M Salazar, Jason T Goodrum, Kitchai Luksameearunothai, Boris A Zelle, Erik A Hasenboehler

Orthopedic Surgery Resident Research

PURPOSE: Malalignment of distal tibia fractures can lead to malunion/nonunion or alter the limb mechanical axis which may cause arthritis. Proposed methods to decrease malalignment include fibular fixation or multiplanar interlocking screws, however these remain controversial. This study aimed to identify factors associated with malalignment in distal tibial fractures with associated fibular shaft fractures.

METHODS: A retrospective review was performed of distal tibia fractures with associated fibular shaft fractures treated with intramedullary nailing at two level one trauma centers between 2015 and 2019. Cases involving malalignment (> 5° of deviation from anatomic axis on either coronal/sagittal axis) on final follow-up …

Advanced Visualization In Minimally Invasive Spine Surgery: The Ergonomics, Economics, And Evolution Of Camera-Based Tubes And Retractors, Advith Sarikonda, Ahilan Sivaganesan, Sheeraz Qureshi

SKMC Student Presentations and Publications

BACKGROUND: Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.

OBJECTIVE: To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).

METHODS: This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular …

Peer Mentorship’S Effect On Nursing Students’ Perceived Stress, Collaboration, And Overall Well-Being, Brooklyn Loxtercamp

DNP Projects

Peer mentorship has proven benefits for undergraduate nursing students, such as improving a sense of belonging and teamwork, improving relationships, helping foster student-directed learning, improving leadership skills, and providing another layer of support for students (Andersen & Watkins, 2018). Because of these notable benefits, this project aimed to extend the work of these researchers to create a sustainable peer mentorship program at one Midwestern nursing program to decrease perceived levels of stress, increase collaboration, and improve students’ overall well-being. Participants (n=58) were recruited from the undergraduate nursing program and consent was obtained. The intervention included a month-by-month toolkit for mentors …

Supporting Nursing Care Transition For Late Preterm Infants From Nicu To The Level 1 Nursery, Megan R. Deans

DNP Projects

Late preterm births are increasing each year due to increasing rates of IVF, multiple births, and advancing maternal age (Visruthan et al., 2015). This group has been traditionally cared for in the NICU, but facilities may consider transitioning this care to the level 1 nursery due to the relative physiologic stability of this population (Visruthan et al., 2015). The transition, without appropriate planning, creates a potential for inconsistencies in caring for the diverse needs of 35.0-35.6 week late preterm infants (LPIs), including variations in education provided to parents and care of the LPI (Visruthan et al., 2015). This project aimed …

Evaluating Hmgb1 As A Biomarker For Metabolic Dysregulation And Progression Of Diabetes In A Mexican American Cohort, Peter Elvin, Walid Fakhouri, Craig Hanis, Cláudia Cristina Biguetti

School of Podiatric Medicine - Student Research

Aim/Hypothesis: This study focuses on HMGB1 to evaluate its association with the development and progression of diabetes within a Mexican American cohort of non-diabetic (ND), pre-diabetic (Pre-D), and diabetic (D) individuals.

Methods: Data from a cohort of 40 individuals, standardized by age (61.76±11.77), BMI (32.52±7.02), and sex (58% male, 42% female) was analyzed. We assessed several immunological markers utilizing ELISA assays from buffy coats. After excluding out of range samples, the remaining 20 individuals displayed statistical significance in HMGB1. Pearson's correlation coefficient examined the relationship between HMGB1 levels and glycemic changes (HOMA-IR, HOMA-B, HOMA-IS², and HbA1c). Statistical significance …

Environmental Factors (Rurality, Distribution Of Prescribers, And Altitude) Of People Who Died By Suicide In Montana, 2013- 2022, Anne N. Brown

Electronic Theses and Dissertations

Introduction: Suicide is increasingly prevalent in rural areas across the United States, especially in the western Rocky Mountain states. The connection between suicide and rural residency is not well understood, nor is the relationship between the distribution of prescribers, altitude, and suicide. Purpose: This retrospective quantitative study aimed to describe the characteristics of individuals who died by suicide in Montana and investigate the associations among rurality, distribution of prescribers, altitude, and suicide rate. Methods: Montana suicide mortality data for 2013-22 was used to describe individual characteristics. A second dataset was created for each Zip Code Tabulation Area (ZCTA) level in …

Investigation Of Study Strategies In Undergraduate Preparation For The Mcat And Optimizing Preparation According To Current Medical Students, Makayla Gordon

Theses/Capstones/Creative Projects

The Medical College Admission Test (MCAT) is a pivotal assessment for aspiring medical students, serving as a measure of undergraduate readiness in preparation for this huge advancement in their academic careers. Success on the MCAT requires content mastery, but to do that, strategic study approaches that are tailored to the individual, and comprehension of the test’s unique format and demands are essential. It is a common misconception that there are limited ways to study for the MCAT, while also sacrificing a legitimate understanding of the content. This project investigates further into identifying effective study methods for MCAT preparation with promise …

Neural Interactions In Bottom-Up Communication, Prashant Chama Raju

Graduate Theses and Dissertations

The visual system’s remarkable ability to process vast amounts of sensory information rapidly and accurately is fundamental to cognitive neuroscience. This study investigates a key aspect of this capability: the compartmentalization of information into feature-specific subspaces during bottom-up communication. My primary question was: does Canonical Correlation Analysis (CCA) reveal a subspace that encodes color and direction of moving dot stimuli? I found that the first canonical component (CC1) does an excellent job decoding the stimuli, despite being one-dimensional while the stimuli were drawn from a two-dimensional space (red-green and up-down plane). I demonstrate that motion features are processed within distinct …

Potential Impact Of Curative And Preventive Interventions Toward Hepatitis C Elimination In People Who Inject Drugs-A Network Modeling Study., Lin Zhu, William W. Thompson, Liesl Hagan, Liisa M. Randall, Abby E. Rudolph, April M. Young, Jennifer R. Havens, Joshua A. Salomon, Benjamin P. Linas

Center on Drug and Alcohol Research Faculty Publications

BACKGROUND: Injection-equipment-sharing networks play an important role in hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Direct-acting antiviral (DAA) treatments for HCV infection and interventions to prevent HCV transmission are critical components of an overall hepatitis C elimination strategy, but how they contribute to the elimination outcomes in different PWID network settings are unclear.

METHODS: We developed an agent-based network model of HCV transmission through the sharing of injection equipment among PWID and parameterized and calibrated the model with rural PWID data in the United States. We modeled curative and preventive interventions at annual coverage levels of …

Buprenorphine Prescribing Characteristics Following Relaxation Of X-Waiver Training Requirements., Paul J. Christine, Rouba A. Chahine, Simeon D. Kimmel, Nicole Mack, Christian Douglas, Thomas J. Stopka, Katherine Calver, Laura C. Fanucchi, Svetla Slavova, Michelle R. Lofwall, Daniel J. Feaster, Michael Lyons, Jerel M. Ezell, Marc R. Larochelle

Center on Drug and Alcohol Research Faculty Publications

IMPORTANCE: Local-level data are needed to understand whether the relaxation of X-waiver training requirements for prescribing buprenorphine in April 2021 translated to increased buprenorphine treatment.

OBJECTIVE: To assess whether relaxation of X-waiver training requirements was associated with changes in the number of clinicians waivered to and who prescribe buprenorphine for opioid use disorder and the number of patients receiving treatment.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study uses an interrupted time series analysis of 2020-2022 data from the HEALing Communities Study (HCS), a cluster-randomized, wait-list-controlled trial. Urban and rural communities in 4 states (Kentucky, Massachusetts, New York, and Ohio) …

Associations Between Il-1Β, Il-6, And Tnfα Polymorphisms And Longitudinal Trajectories Of Cognitive Function In Non-Demented Older Adults, Karen A. Lawrence, Elana M. Gloger, Cristina N. Pinheiro, Frederick A. Schmitt, Suzanne C. Segerstrom

Neurology Faculty Publications

Inflammation is implicated in Alzheimer’s disease (AD), and specific single nucleotide polymorphisms (SNPs) in inflammatory cytokine genes are associated with increased AD risk. Whether the same polymorphisms also predict domain-specific cognitive change in cognitively healthy older adults is unclear. Specific SNPs in three cytokine genes, IL-1β (rs16944), IL-6 (rs1800795), and TNFα (rs1800629) were assessed for association with longitudinal trajectories spanning up to 16 years of global cognitive function, episodic memory, attention and working memory, and executive function in a sample of 324 non-demented older adults. Only rs1800629 (TNFα) was associated with significant change in global cognitive function over time [γ …

A Neural Network Approach To Predict Opioid Misuse Among Previously Hospitalized Patients Using Electronic Health Records, Lucas Vega, Winslow Conneen, Michael A. Veronin, Robert P. Schumaker

Computer Science Faculty Publications and Presentations

Can Electronic Health Records (EHR) predict opioid misuse in general patient populations? This research trained three back propagation neural networks to explore EHR predictors using existing patient data. Model 1 used patient diagnosis codes and was 75.5% accurate. Model 2 used patient prescriptions and was 64.9% accurate. Model 3 used both patient diagnosis codes and patient prescriptions and was 74.5% accurate. This suggests patient diagnosis codes are best able to predict opioid misuse. Opioid misusers have higher rates of drug abuse/mental health disorders than the general population, which could explain the performance of diagnosis predictors. In additional testing, Model 1 …

Real-Time Cerebral Oximetry During Cognition, Sensorimotor Control, And Pneumotactile Perception In Neurotypical Adults, David J. Sanchez

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Continuous-wave functional near-infrared spectroscopy (cw-fNIRS) is a non-invasive brain imaging methodology designed to measure neural activity by detecting hemodynamic responses i.e., adjustments in blood flow and oxygenation to meet the brain’s metabolic needs. Findings on the use of cw-fNIRS by speech-language pathologists (SLP) and neuroscientists to assess cerebral hemodynamic responses during communication assessment and treatment are limited. This study aims to explore the brain’s metabolic response to various sensory processing tasks in neurotypical adults.

This research examines the relationship between cognitive load, sensorimotor control, and somatosensory processing, and hemodynamic modulation in the prefrontal cortex of 18 right-handed neurotypical adults. The …

Development Of An Egg-Specific Mass Spectrometry Targeted Method For Processed Food Matrices, Liyun Zhang

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Egg is a major food allergen in the United States, causing symptoms from mild reactions to severe anaphylaxis. An egg-free diet remains the only management approach for egg allergy. Therefore, individuals and families living with egg allergies rely heavily on allergen statements on packaged food products for informed food choices. Currently, no labeling regulations exist for unintentionally introduced allergens, posing risks to consumers with egg allergies. Therefore, it is critical to have an accurate and reliable detection method in allergen control and management to determine the concentration of total protein from allergenic food sources. Traditional enzyme-linked immunosorbent assays are routinely …

Development Of Feature Extraction Models To Improve Image Analysis Applications In Cancer, Yu Shi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Cancer poses a significant global health challenge. With an estimated 20 million new cases diagnosed worldwide in 2022 and 9.7 million fatalities attributable to the disease, the economic burden of cancer is immense. It impacts healthcare systems and imposes substantial costs for its care on patients and their families. Despite advancements in early detection, prevention, and treatment that have reduced overall cancer mortality rates, the growing prevalence of cancer, particularly among younger individuals, remains a pressing issue.

Recent advancements in medical imaging technology have progressed significantly with the help of emerging computer vision and artificial intelligence (AI) technology. Despite these …

The Effects Of Anchor Scheme On The Central And Peripheral Contributions To Performance Fatigability, Perceived Responses And Sensations, And Psychological Factors Following Sustained, Isometric Forearm Flexion Tasks To Failure, Robert Walker Smith

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The Effects of Anchor Scheme on the Central and Peripheral Contributions to Performance Fatigability, Perceived Responses and Sensations, and Psychological Factors Following Sustained, Isometric Forearm Flexion Tasks to Failure Robert W. Smith, Ph.D. University of Nebraska, 2024 Advisor: Terry J. Housh This study assessed time to task failure (TTF), performance fatigability (PF), neuromuscular responses, central and peripheral measures of fatigue, and perceived responses including sensations and psychological factors that contributed to task termination during sustained, isometric forearm flexion tasks anchored to ratings of perceived exertion (RPE) and the torque corresponding to RPE. Fifteen men (age = 21.5 ± 2.3 yrs; …

Occurrence, Inputs, And Ecological Significance Of Antibiotics And Pharmaceuticals In Western Nebraska Streams, Katelyn F. Glause

School of Natural Resources: Dissertations, Theses, and Student Research

Few emerging environmental contaminants are as concerning as antibiotics. Human and animal health benefits greatly from the prudent use of antibiotics, yet we give little thought to environmental release of these biologically active compounds. Environmental occurrence of these and other pharmaceutical compounds must be measured in different environmental compartments such as municipal wastewater and in the vicinity of large animal feeding operations to understand potential effects. This study reports the results of a monitoring study in western Nebraska, with a large population of livestock and smaller but more concentrated population of humans, comparing the relative environmental concentrations and loading from …

The Use Of Fourier-Transformed Infrared Spectroscopy With An Infrared Biotyper To Establish Classifiers For Major Serogroups Of Moraxella Bovis Based On Spectral Profiles, Jordyn Bailey Schommer

Honors Program: Senior Projects (Public)

A classifier tool was created to identify major serogroups of Moraxella bovis based on spectral profiles collected from bacterial cells through the use of Fourier transformed infrared spectroscopy. M. bovis strains were selected from a group of previously sequenced and genotyped isolates, which provided the pilin sequence type for each isolate. The obtained spectroscopic profiles were analyzed through artificial neural networks to create a classifier tool that could identify the PilA type for unknown strains. Once a sufficient spectral library was obtained, the isolates were split into a training and a validation group, each containing spectra from isolates of five …

Child And Caregiver’ Perspective On Barriers To Asthma Management At A Tertiary Referral Hospital In Kenya, Joan Kwesigabo Ahimbisibwe

Master of Medicine in Paediatrics and Child Health

Background: Asthma is one of the most common chronic conditions in children, with significant morbidity and mortality, especially in Africa. Achieving adequate asthma control in children remains challenging due to gaps between standard recommended management strategies and treatment practices. This study explored barriers to asthma management as perceived by children and their caregivers in a private tertiary care setting in Kenya.

Methods: An exploratory phenomenological qualitative study was conducted at Aga Khan University Hospital (AKUH), Nairobi. Children aged 6–18 years with a confirmed diagnosis of asthma and their caregivers were recruited. Participants had been receiving treatment for at …

A Quality Improvement Project On The Evaluation Of A Community Gastroenterology Advanced Practice Providers’ Update On The Utilization Of The American College Of Gastroenterology (Acg) Recommendation For Annual Depression Screening In Patients With Inflammatory Bowel Disease, Yolanda Levy Dnp, Fnp-Bc

All Dissertations

Inflammatory bowel disease (IBD) is an autoimmune disease that can result in chronic inflammation in the gastrointestinal tract (Farbod et al., 2021). The two most common types of IBD are called Crohn’s disease and Ulcerative Colitis. There have been several studies that have shown how the psychological disorders, including depression, can be associated with flares of IBD (Farraye et al., 2017). The American College of Gastroenterology (ACG) published clinical practice guidelines in 2017, which recommended gastroenterology (GI) healthcare providers screen for depression in all patients with IBD at least once annually (Farraye et al., 2017). This quality improvement did show …

A Descriptive Study: Aging In Place In The Rural Southeastern United States, Dama G. Cooley

Electronic Theses and Dissertations

Older Americans will soon outnumber children and younger adults. In 2022, there were 58 million older adults. By 2050, older adult numbers will grow to 82 million, and by 2060, 100 million. The National Institute on Aging calls for ongoing research on the impact that a historically large aging population will have on health, well-being, and quality of life. A key concern is how to meet needs while decreasing costs associated with institutional long-term care.

Most of these elders reside in the community and wish to live in their homes throughout their lives, but they will experience an increased need …