University of Nebraska Medical Center
University of Nebraska Medical Center Research: DigitalCommons@UNMCNot a member yet
10909 research outputs found
Sort by
Transitions into GME Program Leadership Roles in Neonatal-Perinatal Medicine: Opportunities for Improvement
Get PDFIntroduction: Graduate Medical Education (GME) leadership can be a rewarding and valuable career path. Strong, skilled leadership is critical to the success of any training program. Despite this, there are few requirements and minimal guidance to prepare for GME leadership roles.
Aims: Identify pathways into Neonatal-Perinatal Medicine (NPM) GME leadership roles and describe the needs of incoming program leaders.
Methods: The Organization of Neonatal-Perinatal Training Program Directors (ONTPD) distributed an annual anonymous survey to all NPM programs in September 2024. Quantitative questions utilized descriptive statistics. For free text responses, thematic qualitative analysis was utilized to summarize the findings. Coding discrepancies were reconciled amongst the 3 independent reviewers.
Results: Leadership from 87 out of 105 (83%) of NPM programs responded. The majority of respondents were the program director (PD) 88%, with 65% of PDs having previously served as an Associate PD (APD), with a median of 2 years in the APD role (Table 1). Of program leaders, only half (55%) planned to have a career in GME, with a wide variety of situations leading to the leadership role (Figure 1). Leaders first joined GME leadership a median of 4 years after completing fellowship. Most program leaders had support for transitioning into the role (91%) including: mentoring from other PD/APDs (44%), meetings to review program tasks and timelines (43%), program coordinator assisted in preparing (41%), and previous program leader stayed in another program role (40%). Figure 2 showcases program leadership’s overall satisfaction or dissatisfaction with important elements of the transition. Thematic analysis identified 6 major themes as most helpful in preparing for a role in fellowship program leadership: mentorship, resources, support, experience, planned transition, and national conferences. Local mentorship, resources, and outgoing program director support were most commonly described and national resources and mentorship through ONTPD were frequently cited.
Conclusion: NPM program leaders need mentorship, resources, and support both locally and nationally. We identified areas of opportunity to optimize planned transitions for new leaders. We encourage division leaders to define roles, provide appropriate protected time for leadership in GME, and allocate divisional support and resources. These results reiterate the importance of national collaboration as a tool for new and successful GME leaders
Pearls for Surgical Dermatology: Common Sense Solutions for Common Problems
Get PDFIntroduction: Efficiency and precision in surgical dermatology are crucial for optimizing patient outcomes and procedural success. This study presents a collection of practical surgical pearls designed to address common challenges encountered in dermatologic surgery. By implementing these streamlined techniques, practitioners can improve hemostasis, enhance visualization, and reduce surgical tension while maintaining favorable cosmetic results.
Methods & Key Techniques: Several surgical pearls were compiled based on clinical experience and literature review. Key strategies include: Forceps-Assisted Cautery for Hemostasis: A technique that enhances efficiency by directing electrical current through forceps to neutralize bleeding vessels without additional clamps or sutures. Nasal Ala Hemostasis with Q-Tip Support: Utilizing a cotton-tipped applicator within the nares to provide back pressure and improve bleeding control. Plicating Stitch for Linear Closure: A subcutaneous suture placed before wedge removal to minimize scar length and maintain aesthetic outcomes. Towel Clamp & High-Tensile Sutures for Scalp Flaps: Methods to facilitate tension-free closure and expedite wound approximation. Q-Tip-Assisted Punch Biopsy Hemostasis: A simple technique for maintaining hemostasis while preparing sutures. Tragus Displacement for Conchal Bowl Procedures: A method using a rake retractor to improve surgical access and visualization.
Conclusion: These surgical pearls offer low-cost, high-impact modifications that can be seamlessly integrated into dermatologic surgery to enhance efficiency and patient outcomes. By incorporating these techniques, clinicians can reduce procedural complexity, improve hemostasis, and optimize cosmetic results while maintaining patient comfort.https://digitalcommons.unmc.edu/emet_posters/1041/thumbnail.jp
Coxiella burnetii Manipulation of Membrane Contact Sites in the Intracellular Niche
Get PDFCoxiella burnetii is a highly infectious and environmentally persistent bacterium that causes the disease Q Fever. Its intracellular home, the Coxiella-Containing Vacuole (CVV), is formed from fusion of host-derived vesicles and is rich in sterols - yet cholesterol accumulation in the CCV is bacteriolytic. Our lab’s goal is to understand how Coxiella manages intracellular cholesterol levels and survives within the host. One way Coxiella may modulate CCV cholesterol is through membrane contact sites (MCS), areas where molecular complexes bridge two organelles and exchange lipids. This thesis explores how Coxiella uses both a mammalian lipid transfer protein and bacterially-encoded effector proteins to control MCS with the endoplasmic reticulum (ER). The mammalian protein, ORP1L, localizes to the CCV and mediates CCV-ER MCS. ORP1L localization depends on the Coxiella Type 4B Secretion System (T4BSS), which secretes bacterial effector proteins into the host cytosol to manipulate pathways and increase bacterial survival. I showed that Coxiella uses ORP1 to lower CCV cholesterol and increase bacterial growth in macrophages. Additionally, our lab identified nine Coxiella T4BSS effector proteins with putative FFAT motifs, special protein sequences that indicate potential interaction with VAPs, a family of ER proteins known to form MCS. I found that one of these proteins, CBU1751, interacts with VAPA and VAPB through a two-hybrid assay but not by co-immunoprecipitation. Future work will clarify the mechanism by which ORP1 lowers CCV cholesterol and interrogate whether CBU1751 interacts with VAPs to form plasma membrane-ER MCS
Knowledge Discovery in Databases of Proteomics by Systems Modeling in Translational Research on Pancreatic Cancer
Get PDFBACKGROUND: Knowledge discovery in databases (KDD) can contribute to translational research, also known as translational medicine, by bridging the gap between
METHODS: This framework includes the data collection of a composition model (various research models), processing model (proteomics) and analytical model (bioinformatics, artificial intelligence/machine leaning and pattern evaluation), knowledge presentation, and feedback loops for hypothesis generation and validation. We applied this workflow to study pancreatic ductal adenocarcinoma (PDAC).
RESULTS: We identified the common proteins between human PDAC and various research models
CONCLUSIONS: This systems modeling workflow can be a valuable method for KDD, facilitating knowledge discovery in translational targets in general, and in particular to PADA in this case
Dissecting MUC16 in Pancreatic Cancer: Imaging Targetability, Oncogenic Signaling and Immune Suppression
No full textPancreatic ductal adenocarcinoma (PDAC) accounts for more than 90% of all pancreatic cancers and is extremely lethal. Late-stage presentation increases the need for standard-of-care regimens including gemcitabine/Abraxane or FOLFIRINOX, which have negligible benefit, as evidenced by the five-year overall survival rate of an abysmal 13%. Driver mutations in the KRAS oncogene are a defining feature of this malignancy. KRAS acts, at least in part, by increasing the expression of a cell-surface glycoprotein called Mucin-16 or MUC16. MUC16 (absent in the normal pancreas) is expressed in \u3e65% of PDAC cases and associated with poor survival. MUC16-expressing tumor cells have higher activation of ErbB-1/2/3, PI3K/AKT, MAPK, and NF-κB pathways that promote cancer progression. Chapter 2 of this dissertation focuses on using MUC16 as a tumor-specific biomarker for diagnostic imaging. We show the design and synthesis of a MUC16 -binding antibody-based MRI probe conjugated to a gadolinium-based contrast agent that facilitates the detection of early- and late-stage PDAC lesions in preclinical mouse models. In Chapter 3, we demonstrate that the aberrant glycoforms of MUC16 exacerbate aggressive behavior in PDAC cells and mediate signaling through a4b1 integrins and downstream integrin-linked kinase (ILK) and focal adhesion kinase (FAK) to increase the migratory properties of PDAC cells, fueling metastatic progression. Targeting MUC16 using the antibody AR9.6 perturbs such oncogenic signaling/migration. In Chapter 4, we uncover a novel role for MUC16 in mediating immunosuppression. The PDAC tumor microenvironment has immunosuppressive cells, of which macrophages form the bulk. We demonstrate that loss of MUC16 causes diminished tumor burden. MUC16KO tumors have low numbers of M2-like CD206+ or Ym1/2+ macrophages, compared to the MUC16-competent tumors. We identify CCL2 and Serpin-E1 as mediators of macrophage infiltration. Lastly, we show that sustained clodronate liposome administration facilitates macrophage depletion in the spleen, and influences tumor burden – specifically lowering tumor burden in KPC (MUC16-expressing) tumors. However, splenic regulatory T cell appearance is a possible mechanism of resistance to long-term myeloid depletion. Hence, we discuss the utility of immune reprogramming strategies like CD40 agonists in combination with anti-MUC16 strategies to facilitate long-term tumor regression
Evaluating the Impact of the Occupation-Centered Intervention Assessment on Client-Centered Care in Inpatient Brain Injury Rehabilitation: A Pilot Study
Get PDFBackground: Occupational therapy practitioners (OTPs) recognize the value of evidence-based practice, however, incorporation of client-centered practice as a component of evidence-based practice is challenging, despite the known advantages. This pilot study evaluated the use of the Occupation Centered Intervention Assessment (OCIA) in increasing practitioner ability to provide client-centered care in inpatient rehabilitation facilities with adults with an acquired brain injury (ABI).
Method: A mixed methods design was employed, using four forms of data collection (OCIA, The Measure of Processes of Care for Service Providers [MPOC], MPOC- Service Providers [MPOC-SP], and interviews) to determine changes in observed and perceived client-centered practice following OCIA training for OTPs.
Results: There were no statistically significant differences in the practitioners’ or clients’ perceptions of care from the MPOC or MPOC-SP. However, qualitative findings support changes in practitioners’ ability to provide client-centered care from the OCIA training and use along with interview data.
Discussion: Preliminary findings suggest clinically significant improvement in client-centered practice after OCIA training, highlighting its potential to enhance treatment sessions.
Conclusion: Results should be interpreted with caution, but preliminary findings suggest that the OCIA supports practitioners with providing client-centered interventions. Future research should include additional settings and a larger sample to increase the generalizability of the findings.
Knowledge Translation Takeaway: The OCIA shows promise as a valuable tool for improving client-centered care in brain injury rehabilitation by increasing practitioner awareness and facilitating occupation-centered interventions
Enhancing Care Through Occupational Therapy: Implementing Services at the UNMC SHARING Clinic
Get PDFThis is an abstract from the Spotlight on Scholarship event in 2025
Cardiac-Specific Knock-out of PDHA1 Leading to Mitochondrial Dysfunction and Progressive Heart Damage
Get PDFBackground Genetic mutations that create pyruvate dehydrogenase complex (PDHc) deficiencies are a primary cause of congenital lactic acidosis (CLA). CLA is a rare genetic disorder in which the mitochondrion is unable to effectively metabolize excess amounts of pyruvate and lactate. It is estimated that ~250 – 300 live births per 1,000 are affected in the U.S each year. Mutations found in the X-linked gene for the E1α subunit of pyruvate dehydrogenase (pdha1) account for the majority of PDHc deficiency conditions. As pyruvate dehydrogenase acts to convert pyruvate into Acetyl CoA to be further utilized in generating ATP within the mitochondria, disruptions in this process can result in an ATP energy crisis, which acts as a contributing factor in the pathogenesis of a range of disease conditions.
Objectives A transgenic model was created to study the effects of the loss of the E1 subunit of pyruvate dehydrogenase and its subsequent effects on cardiac remodeling and cardiac glucose metabolism.
Methods Adult female Pdha1flox8 mice were bred to adult male αMHC-MerCreMer mice to create a tamoxifen-inducible knock-out of the pdha1 gene within cardiomyocytes. Cre-recombinase directed deletion of pdha1 was carried out by intraperitoneal injections (0.1mL/mouse) of Tamoxifen or Vehicle (15% ethanol in sunflower oil) in αMHC-MerCreMer:Pdha1flox/flox mutant mice at 16 weeks of age. Transthoracic echocardiography was performed on anesthetized mice at baseline (prior to injection), and the 1-month, 2-month, and 3-month timepoints following IP injection. Mitochondrial respiration measurements were obtained in 0.5 – 2 mg of permeabilized cardiac muscle fibers. A substrate-uncoupler-inhibitor titration (SUIT) protocol was performed to examine mitochondrial oxygen consumption at different respiratory states Cardiac tissues were collected from the pdha1 KO and vehicle mice at 3 months to perform western blot analysis to validate various metabolic and mitochondrial protein expression.
Results Tamoxifen induction of the pdha1 knock-out within cardiomyocytes revealed a time course of progressive cardiac dysfunction tracked by structural and functional changes of the heart through echocardiography. Parameters of both systolic and diastolic function are severely impacted at 3 months post tamoxifen, as shown by an average ejection fraction of 18.4%. Measurements of mitochondrial oxygen consumption revealed a decline in oxidative phosphorylation capacity and CI-linked respiration at 1 month post tamoxifen that preceded significant changes in hypertrophic remodeling and diminished cardiac function that ultimately resulted in heart failure. Initial western blot analysis confirmed the validity of the transgenic model used, but no other protein expression differed significantly between vehicle and pdha1 KO animals, aside from significantly decreased expression of SERCA2a, an ATP-dependent Ca2+ pump responsible for muscle relaxation; this was likely impacted from a loss of contractility and greater stiffness in the failing cardiac muscle.https://digitalcommons.unmc.edu/surp2025/1001/thumbnail.jp
Improving Occupational Health for Tribal Buffalo Workers
Get PDFOccupational health and safety of Tribal buffalo workers is essential to many Tribal food sovereignty initiatives taking place within Tribal nations across the country, supporting the broader effort to bring the buffalo home. In response to requests from Intertribal Buffalo Council (ITBC) members, we developed occupational health cards identifying top zoonotic disease risks to improve patient–clinician communication. Each card links via QR code to a comprehensive clinician guidance booklet that includes etiologic agents, transmission routes, symptoms, occupation-specific screening questions, and reporting resources. Using a One Health approach, we mapped county-level data for ITBC buffalo herds, including elevation, ecosystem type, and seasonal climate averages, and compiled human and animal zoonotic disease data (2020–2025) by state. These were cross-referenced with emerging and existing agricultural diseases to identify the highest-risk threats and analyzed correlations between geography and disease occurrence in agricultural occupations. Findings and interventions were presented at the 2025 Buffalo Worker Safety and Herd Health Roundtable for community feedback, and finalization is ongoing.https://digitalcommons.unmc.edu/surp2025/1003/thumbnail.jp
Assessing Cervical Cancer Health Literacy Among Karen Women in the Omaha Area
Get PDFCervical cancer is one of the leading causes of death among Karen women, a predominant ethnic group in Myanmar. One of the largest and fastest growing Karen populations in the United States is located in Omaha, Nebraska. The objective of our study is to evaluate cervical cancer health literacy among Karen women and explore potential knowledge gaps that could be addressed with an educational intervention in the future. A survey was given to Karen women at the Karen Student Association at the University of Nebraska Omaha (UNO) and members of the Karen Christian Revival Church in Omaha, NE. The survey inquired about personal and medical history and evaluated health knowledge pertaining to the female reproductive system and cervical cancer. The results were significant in that a majority of Karen women rated their confidence in understanding health terminology as ‘good’, but most women answered the knowledge questions incorrectly or as \u27I don\u27t know.’ Only 13.3% and 6.7% of Karen women have received a pap smear or HPV vaccine, respectively, in their lifetime which is much lower than the average rates for women living in the United States. These results demonstrate the potential discrepancy between presumed health literacy and true female reproductive health knowledge, and the room for growth available within cervical cancer screening in the Karen population. The next steps in our research project will be to provide educational materials about the female reproductive system, cervical cancer, and cervical cancer screening to the Karen population at the Karen Student Association at UNO and Karen Christian Revival Church. Afterwards, we will then re-survey the participants to evaluate the effectiveness of our educational intervention and its impact on health literacy, with an overall goal of improving health outcomes in the Karen population.https://digitalcommons.unmc.edu/com_msrs/1004/thumbnail.jp