Medical Specialties Commons^™

The Influence Of High Iq On Adhd Symptom Presentation And Outcomes In Children, David A. Lee

All-Inclusive List of Electronic Theses and Dissertations

Research suggests that a high intelligence quotient (IQ) may contribute to the underdiagnosis and misdiagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. High IQ may allow children to compensate for executive functioning-related deficits inherent in ADHD and/or may influence behaviors such as high activity level or not following rules that mimic ADHD symptoms. To gain a better understanding of the relationship between IQ and ADHD, the present study aimed to investigate how high IQ impacts symptoms of inattention and hyperactivity as well as outcomes related to academic performance, emotional regulation, and peer relationships in children. The study utilized archival data from …

A Phase 2 Trial Of Niraparib Plus Bevacizumab Maintenance Therapy Following First-Line Platinum-Based Chemotherapy With Bevacizumab In Advanced Ovarian Cancer: Final Analysis And Overall Survival Results From Ovario., Melissa M Hardesty, Thomas C Krivak, Gail S Wright, Erika Hamilton, Evelyn L Fleming, Jimmy Belotte, Shelby Gorman, Natalie Compton, Aine Clements, Heidi J Gray, Gottfried E Konecny, Richard G Moore, Debra L Richardson

Oncology Articles

OBJECTIVE: To report long-term outcomes from the OVARIO trial of niraparib plus bevacizumab maintenance following first-line platinum-based chemotherapy with bevacizumab in advanced ovarian cancer.

METHODS: The phase 2, single-arm, open-label trial enrolled adult patients with stage IIIB-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer (NCT03326193). Patients were required to have attempted debulking surgery and have a complete or partial response or no evidence of disease following first-line, platinum-based chemotherapy with ≥3 cycles of bevacizumab. The primary endpoint was 18-month progression-free survival (PFS) rate, per RECIST. Secondary endpoints included PFS, overall survival (OS), safety, and health-related quality of life (HRQOL) …

Factors Associated With Postpartum Depression Among Women Attending Postnatal Clinics In A Tertiary Care Hospital In Nairobi, Kenya, Cecilia Muthoni Njoga

Master of Medicine in Family Medicine

Background 

Postpartum depression (PPD) is a major mental health disorder affecting women during the postpartum period with a global prevalence of up to 17.22%. This prevalence has been shown to be higher in low and middle-income countries. In Kenya, about a fifth of women are affected. PPD can lead to poor infant growth and interference with maternal-child bonding. Additionally, women with PPD experience a lower quality of life and their children have an increased risk of developing and psychotic disorders later in life. Understanding the factors associated with PPD is crucial for early diagnosis and intervention. The study aimed to …

Factors Informing Referral Of Adult Patients To Palliative Care Services In A Tertiary Facility In Kenya: Physicians' Perspective, Donnah A. Opiyo

Master of Medicine in Family Medicine

Background The growing burden of chronic diseases underscores the urgent need for palliative care integration into healthcare systems worldwide. Despite its benefits, palliative care remains underutilized due to various barriers, including health system limitations, institutional challenges, infrastructure gaps, and individual provider factors. However, limited research has explored the specific factors influencing physicians' decisions to refer patients to palliative care. This study sought to fill that gap by examining the key determinants shaping referral practices in a tertiary facility in Kenya.

Design and Methods This exploratory qualitative study examined 22 physician specialists from five departments at Aga Khan University Hospital, Nairobi. …

Incidence Of Peripheral Intravenous Cannula Complications And Associated Factors Among Paediatric Patients At A Tertiary-Care Referral Hospital, Vanessa Minsari Ogega

Master of Medicine in Paediatrics and Child Health

Introduction: Peripheral intravenous catheters (PIVCs) are widely used in clinical practice and are a major source of procedure-related pain in children. Their use is associated with complications including occlusion, dislodgement, infiltration, extravasation, phlebitis, and, rarely, bloodstream infections.

Objectives: To determine the incidence and risk factors associated with PIVC complications among paediatric patients aged 1 day to 18 years at Aga Khan University Hospital, Nairobi. The study also assessed the average survival time of PIVCs.

Methods: A prospective cohort study was conducted on 320 PIVCs among 192 children admitted between August and October 2024. Data collected included patient demographics, clinical characteristics, …

Kenyan Dietitians’ Knowledge Of Ketogenic Dietary Therapies For Drug-Resistant Epilepsy, Pauline Samia, Violet Naanyu, Perry Ndila, Helen Cross, Richard Idro, Paul Boon, Jo Wilmshurst, Stanley Luchters

Paediatrics and Child Health, East Africa

Background: Ketogenic dietary therapy (KDT) has been proven to be efficacious for people with drug-resistant epilepsy. However, it is rarely utilized in low-resource settings. Due to the complexity of implementation, dietitians play a crucial role in managing KDT.

Methods: We conducted a cross-sectional survey of 253 out of the 1,000 registered dietitians. We assessed their knowledge of and interest in further training in KDT.

Results: Most participants were female (78%), with a median age of 33 years (IQR=28–38). A total of 171 (67.6%) reported knowledge of KDT. However, only 13 respondents (7.6%) answered all five knowledge-specific questions correctly. A …

Exploring The Effect Of Social Determinants Of Health (Sdoh) Factors On The Time To Kidney Transplant Evaluation Completion For African American End Stage Renal Disease (Esrd) Patients, Kesha Levesque

MUSC Theses and Dissertations

Purpose – The purpose of this dissertation is to investigate the relationship between demographics and Social Determinants of Health (SDOH) variables on diagnostic testing time completion in patients being evaluated for kidney transplant waitlisting.

Aims - Compared to White Americans, African Americans who are eligible to receive a kidney transplant are less likely to complete the required testing in order to be placed on the kidney transplant waiting list which puts African Americans at risk for morbidity and mortality due to prolonged exposure to dialysis. The COVID-19 pandemic was directly associated with a decrease in the number of patients placed …

Resonant Disruptions: Understanding Canadian Nurses’ Practice With Youth Survivors Of Sexual Exploitation, Danielle E. Giebelhaus, Andrew Estefan Phd, Rpn

Dignity: A Journal of Analysis of Exploitation and Violence

The sexual exploitation of youth is a global concern. Youth survivors of sexual exploitation present to and require healthcare services, but most nurses do not feel effectively equipped to care for this population. There is currently little nursing literature to guide nurses in their practice with youth survivors. In this article, we report on a qualitative, hermeneutic study undertaken to explore nursing practice with youth survivors of sexual exploitation. Hermeneutics is concerned with understanding, and is a helpful way to conduct research when little is known about a topic. In this study, we asked the research question, “How might we …

Delusional Parasitosis With Depression, Hypertension And Migraine, Mouli Mandal, M Kishor, Mr Murali

Digital Journal of Clinical Medicine

Delusional Parasitosis (DP) , also known as Ekbom Syndrome, is a psychiatric disorder characterised by the unshakeable belief of infestation by parasites, insects or other organisms, despite the absence of objective medical evidence.
This case report presents a 49 year old female with a history of chronic headaches, progressively worsening insect crawling sensations. She was initiated on treatment and supportive psychotherapy.
This case highlights the importance of a thorough multidisciplinary approach in managing Delusional Parasitosis, emphasising the need to differentiate between primary and secondary forms, address the potential medical and psychiatric comorbidities, and implement appropriate pharmacological and psychotherapeutic interventions.

Strength Beyond Cancer: An Occupational Therapy Guidebook For African American Breast Cancer Survivors, Taihia A. Wilson

Student Capstone Papers

This capstone project aims to explore the nuanced and often underrepresented experiences of African American women (AAW) who have survived breast cancer (BC), with a specific focus on the recovery phase. By examining the physical, cognitive, and psychosocial obstacles encountered during survivorship, the project seeks to highlight significant gaps in care and support. The primary goal of this project is to develop an accessible and culturally responsive guidebook that provides healthy strategies to enhance quality of life (QoL), promote occupational wellbeing, and empower AAW to manage their overall health beyond treatment. This paper will begin by presenting the background and …

Extracorporeal Membrane Oxygenation (Ecmo) Neuromonitoring And Acute Brain Injury, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Advanced Interactions Of Directed Energy With Retinal Pigment Epithelial Cells And Their Photochemical And Photothermal Responses, Jin B. Ha

Theses & Dissertations

Excess optical radiation can injure the retina through either rapid heat deposition (photothermal damage) or cumulative photo‑oxidative stress (photochemical damage), yet current laser‑safety limits treat these mechanisms as independent. To test that assumption, this dissertation integrated systematic wavelength, duration and temperature‑controlled laser exposures with live/dead fluorescence imaging in a melanin‑loaded hTERT‑RPE1 monolayer model. First, concurrent 447 nm (blue) and 2 µm (infra‑red) beams delivered for 200 s demonstrated a strong thermal–photochemical synergy: each beam alone was sub‑threshold (≤25 % lethality) but together produced 100 % RPE death without exceeding 50 °C, proving that modest heating markedly lowers the photon dose …

Hardware And Software Design For A Portable Surgical Training Simulator, Victoria Nelson

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

More than 51 million surgeries are performed on patients annually in the United States. That number grows to 310 million surgeries performed globally each year. Most surgeons go through a minimum of five years of residency – where they train and hone their surgical skills. It is important during this time, and throughout their careers, that they get plenty of practice. Surgical training is time intensive, expensive, and frequently under-resourced. There are finite amounts of surgical training modules for students to share at their facilities. The problem of getting adequate surgical training time continues to exist after surgeons begin their …

A 65-Year-Old Man With Cough, Hypercalcemia, And Diffuse Opacities, Philip K Angelides, Oriana Salamo, Sujith V Cherian, Eduardo Yepez Guevara, Carlos A Jimenez, Saadia A Faiz

Faculty, Staff and Student Publications

Respiratory infections in patients with cancer are common. A low threshold for bronchoscopy with bronchoalveolar lavage (BAL) should be maintained in immunocompromised patients with pulmonary opacities on chest imaging to evaluate for opportunistic infections. In those with unresolving symptoms, transbronchial biopsies may add significant diagnostic value. Concomitant hypercalcemia in patients with cancer is typically related to underlying malignant disease. However, in those with persistent respiratory symptoms or atypical infiltrates then granulomatous inflammatory diseases should be considered. Diagnosing histoplasmosis in immunocompromised patients can be difficult. Antigen testing is often more sensitive, but tissue biopsy or culture may be needed. We describe …

Diagnostic Accuracy Of The Stopbang Questionnaire Against Polysomnography For The Screening Of Obstructive Sleep Apnea In A Tertiary Hospital In Kenya., Sandra Obaje Maseno

Master of Medicine in Internal Medicine

BACKGROUND: Obstructive sleep apnea is a syndrome of upper airway and neuromuscular dysfunction during sleep that subsequently causes interruption of normal breathing. Polysomnography is the reference test for the diagnosis of obstructive sleep apnea. Obstructive sleep apnea can be categorised as mild, moderate or severe based on an apnea-hypopnea index (AHI) on polysomnography. The recommended treatment using Continuous Positive Airway Pressure lowers morbidity and mortality rates. The STOPBANG questionnaire has been used as a screening tool for obstructive sleep apnea due to its easy and concise approach. However, even with the increasing prevalence of obstructive sleep apnea and its risk …

Perception And Experiences With Telemedicine Among Caregivers Of Children Requiring Outpatient Chronic Care, Maureen Wambui Kigara

Master of Medicine in Paediatrics and Child Health

Introduction Telemedicine is an expanding healthcare modality with potential to enhance access to paediatric specialist care, reduce healthcare costs, and minimize school and work disruptions. However, little is known about caregiver perceptions and experiences with telemedicine in low- and middle-income countries, especially in the context of chronic paediatric care.

Objectives This study explored how caregivers of children with chronic health conditions perceive and experience telemedicine, and what factors influence its adoption. The findings aim to inform the design of patient-centered paediatric telemedicine services.

Methodology A cross-sectional qualitative study was conducted at the Paediatric Specialist Clinics of Aga Khan University Hospital. …

2024 Eacts/Eactaic Guidelines On Patient Blood Management In Adult Cardiac Surgery In Collaboration With Ebcp, Filip Casselman, Marcus Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Haumann, Anders Jeppsson

Anaesthesiology, East Africa

No abstract provided.

Prevalence And Risk Factors Of Cerebral Microhemorrhages And Superficial Siderosis In Cognitively Unimpaired Older Adults: Analysis From The Chariot-Pro Substudy, Sujin Kang, Dimitra Kafetsouli, Jamie Ford, Janice Wong, Luc Bracoud, Joyce Suhy, Parthenia Giannakopoulou, Chinedu Momoh, Tom Russ, Craig Ritchie

Brain and Mind Institute

Introduction: Cerebral microhemorrhages (CMHs) and superficial siderosis (SS) are relatively common side effects of anti-amyloid immunotherapies, termed amyloid-related imaging abnormalities (ARIA-H). They are also observed in treatment-naïve older adults. This study explored relationships with modifiable and non-modifiable risk factors.

Methods: This cross-sectional study included 1414 cognitively unimpaired, treatment-naïve individuals aged 60 to 85 years from the Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy. Relationships between CMHs/SS and cardiovascular risk factors, amyloid beta (Aβ) load, apolipoprotein E (APOE) ε4 status, educational attainment, and white matter hyperintensities were …

Ambulatory Blood Pressure Monitoring, European Guideline Targets, And Cardiovascular Outcomes: An Individual Patient Data Meta-Analysis, Dong-Yan Zhang, De-Wei An, Yu-Ling Yu, Jesus D. Melgarejo, José Boggia, Dries S. Martens, Tine W. Hansen, Kei Asayama, Takayoshi Ohkubo, Gladys E. Maestre

School of Medicine Publications

Background and aims: Hypertension is the predominant modifiable cardiovascular risk factor. This cohort study assessed the association of risk with the percentage of time that the ambulatory blood pressure (ABP) is within the target range (PTTR) proposed by the 2024 European Society of Cardiology (ESC) guidelines for blood pressure (BP) management.

Methods: In a person-level meta-analysis of 14 230 individuals enrolled in 14 population cohorts, systolic and diastolic ABPs were combined to assess 24-h, daytime, and nighttime PTTR with thresholds for non-elevated ABP set at < 115/65, < 120/70, and < 110/60 mmHg, respectively.

Results: Median 24-h PTTR was 18% (interquartile range 5-33) corresponding to 4.3 h (1.2-7.9). Over …

Cultural And Socioeconomic Determinants Of Hip And Knee Arthroplasty In The Medically Underserved Rio Grande Valley Community, Blake C. Martin, Juan C. Lopez Alvarenga, John M. Gaddis

School of Medicine Publications

Introduction: Joint arthroplasty is a common procedure that is increasing worldwide. In this study, we aimed to discover if there were differences in demographics and social factors associated with individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the Rio Grande Valley (RGV). We hypothesized that older individuals and those with higher body mass index (BMI) would have an increased risk of TKA.

Methods: We conducted a retrospective chart review using the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2018, to July 1, 2024. Individuals were selected using Current Procedural Terminology codes …

Chronic Cluster Headache Is A Rare Disease: Implications For Diagnosis, Treatment And Public Health, Hsiangkuo Yuan, Jan Hoffmann, Elena Ruiz De La Torre, Michael J. Marmura, Mario F. P. Peres

Department of Jefferson Headache Center Papers and Presentations

Cluster headache (CH) is a rare and painful primary headache disorder characterized by severe unilateral pain and cranial autonomic symptoms. This perspective examines the epidemiological evidence supporting the classification of chronic cluster headache (CCH) as a rare disease, noting a prevalence of CH of approximately 124 per 100,000 individuals, with only 3.5-13.7% manifesting CCH. This prevalence meets criteria established by both the US Food and Drug Administration and European Medicines Agency for rare disease designation. The rarity of CCH creates substantial clinical and research challenges, including prolonged diagnostic delays, limited research funding and a dearth of approved treatments. The economic …

Therapeutic Potential Of Sglt2 Inhibitors In A Repeated Love Dose Cisplatin Model., Dianet C. Sanchez

Electronic Theses and Dissertations

Cisplatin is a potent chemotherapeutic, thirty percent of patients develop Acute Kidney Injury (AKI). These patients are ten times more likely to develop chronic kidney disease (CKD). Sodium-glucose-cotransporter-2-inhibitors (SGLT2i), FDA approved for diabetes, has shown protection in multiple mouse models of AKI-CKD. We hypothesize SGLT2i can protect the kidney in a model of repeated low dose cisplatin with/without cancer. B6:129 mice with/without lung adenocarcinoma (Lung-adeno) were treated daily with SGLT2i dapagliflozin (10mg/kg)/vehicle control. After seven days, weekly cisplatin (7mg/kg)/vehicle control was initiated for 3-4 weeks. Following final cisplatin dose, kidney function, injury, fibrosis, inflammation was assessed. SGLT2i treatment attenuated alterations …

Applications Of Preclinical Magnetic Resonance Imaging In The Treatment Of Traumatic Brain Injury And Understanding Carotid Artery Atherosclerosis, Evan Timothy Curtis

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

Advances in magnetic resonance imaging (MRI) provide the opportunity to investigate research questions that have been left unanswered. In the cases of traumatic brain injury (TBI) and carotid artery atherosclerosis, MRI is a resource for non-invasively viewing the phenomena taking place. Additionally, potential interventions and treatments can be observed without harm to the subject. This dissertation expands the understanding of two preclinical applications of MRI: traumatic brain injury and carotid artery atherosclerosis in mouse models.

TBI is a leading cause of death and disability for individuals between 15–45 years of age and effective pharmaceutical interventions for treating the secondary damage …

The Tree That Would Not Fall: An Educator’S Autoethnographic Journey Of Healing Through Words, Raeanna Marie Carlson

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

To say the world has changed since the 2020 COVID-19 shut down is to minimize the micro and macro social changes that infiltrated the school system. In the wake of it all, we find a landscape marred by a both rising teacher attrition and struggling student motivation. This autoethnographic dissertation explores the deeply personal experience tethered to a deeply problematic system that contributes to not only teacher burnout but what I came to know as teacher demoralization. Personal traumas of teachers profoundly impact their experience in the classroom, and as I examined my own near departure from the classroom, I …

Outcomes And Resource Utilization In Hyperkalemic Emergency Department Patients Treated With Patiromer Or Sodium Zirconium Cyclosilicate., William Frank Peacock, Zubaid Rafique, Julie Gayle, James Neuenschwander, Harold Brown, Jennifer Kammerer, Jeffrey Budden, Ning Rosenthal

Ambulatory and Primary Care Articles

OBJECTIVES: Hyperkalemia (HK) is a life-threatening condition commonly treated in emergency department (ED). Real-world outcomes associated with ED administration of potassium binders are limited. This study assessed ED discharge disposition and resource utilization in hyperkalemic ED patients treated with patiromer or sodium zirconium cyclosilicate (SZC).

METHODS: We performed a retrospective cohort study using discharge data from 230 hospitals in the Premier PINC AI Healthcare Database. ED patients were included if they were ≥18 years old, had potassium ≥5 mEq/L, and received patiromer/SZC during January 1, 2019 to December 31, 2021. Descriptive statistics and multivariable logistic regression analysis were used to …

Hormonal Modulation Of Sexual Approach And Avoidance Among Women With A History Of Sexual Trauma, Anneliis Susan Sartin-Tarm

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

A history of sexual trauma places women at a high risk for sexual dysfunction and other health sequelae, yet the influence of ovarian hormones in this population is poorly understood. This dissertation tested the theory that the effects of ovarian hormones are mediated by cognitive approach-avoidance systems to shape sexual well-being, and that this process is moderated by sexual trauma history. This was investigated across three studies examining the menstrual cycle, hormonal contraceptive use, and menopause. Across each chapter, I present complementary evidence demonstrating that hormones interact with the interpretation of ambiguous internal and external cues with respect to sexual …

Chronic Pain After Traumatic Brain Injury: Treatment Experiences And Effects On Cognition And Functioning, Rachael L. Snyder

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

Traumatic brain injury (TBI) can contribute to changes in cognitive and emotional functioning, quality of life, and psychosocial reintegration. Chronic pain is a common consequence of TBI which can uniquely impact such outcomes. Still, the exact nature of the contribution of pain on post-TBI outcomes remains unclear, and there are few existing studies exploring the treatment journey for chronic pain and injury rehabilitation through qualitative methods, specifically individual interviews with TBI survivors. This study aimed to document these narratives and to identify precisely how the experiences of TBI survivors seeking treatments, rather than the treatments themselves, impact outcomes. It also …

Egg White Hydrolysate In Hypertension: A Mechanistic Investigation Of Gut Microbiota Dependent And Independent Pathways, Emerson David Nolasco

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

Cardiovascular diseases are one of the leading causes of mortality worldwide in which hypertension is a risk factor. Present pharmacological interventions require long-term adherence to the therapy and are often associated with undesirable side effects. Moreover, treatments have overlooked the role of the microbiome in the development of hypertension. Egg white hydrolysate (EWH) has exhibited antihypertensive properties with potential to be used as a natural alternative for the prevention and management of hypertension. However, EWH peptide’s effect on the gut microbiome remains yet to be elucidated. Studies have described that a portion of the ingested protein can remain undigested as …

Experiences Of Disclosure Among Transgender And Gender Diverse Sexual Assault Survivors, Merle E. Huff Ii

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

Around half of TGD people have experienced sexual assault victimization (Abern et al., 2023; Clements-Nolle et al., 2006; James et al., 2016; Martin et al., 2022; Risser et al., 2005; Stotzer, 2009), which leads to higher rates of depression and PTSD (Grant et al., 2011; Grocott et al., 2023; Fernández-Rouco et al., 2017; Hawkey et al., 2021; Matsuzaka & Koch, 2019; Parr, 2020; Ussher et al., 2020). Disclosure of victimization may be important among TGD survivors. The current study was guided by minority stress theory (Meyer, 2003) and the gender minority stress and resiliency model (Testa et al., 2015) to …

Complex Factors Impacting Smoking Behavior In Cancer Survivors With Food Insecurity, Madeline C. Castele, Kareena Shah, Avianna Thompson, Jin E. Kim-Mozeleski

Faculty Scholarship

Objectives: Tobacco use remains prevalent among people with social needs, such as food insecurity. In this study, we aimed to understand the complex experiences of low-income cancer survivors with food insecurity who smoke tobacco, to identify the unique smoking cessation needs for this group. Methods: We conducted in-depth, semi-structured qualitative interviews with 40 adults experiencing food insecurity who continued smoking after a cancer diagnosis. Interviews focused on smoking behaviors, cessation interest, cancer experiences, and financial circumstances. We analyzed the data using reflexive thematic analysis. Results: In this sample of cancer survivors (50% female, mean age 42 years, 60% black/African American, …