University of Nebraska Medical Center
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Exploring the Efficacy of Pulmonary Artery Pressure Monitoring in Rural LVAD Patients: A Retrospective Cohort Study on Clinical Outcomes
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Follicular Mucinosis and Cutaneous T-Cell Lymphoma Association: A Clinicopathologic and Molecular Analysis of 19 Cases
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Is Medication Management in the First 28 Days of Life Associated With Acute Kidney Injury in Extremely Low Birthweight Neonates?
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Chemotherapy-Induced Modulation of Tumor Antigen Presentation
No full textPancreatic cancer is a lethal malignancy, with a five-year overall survival rate of just 13%. Current treatment approaches thus require modification and attention has shifted towards improving immunotherapy efficacy. Select chemotherapy drugs possess inherent immunomodulatory activity and could be used to initiate immunotherapeutic success, thereby restoring anti-tumor immunity in pancreatic cancer. In this work, I evaluated the impact of the chemotherapy drug gemcitabine on tumor antigen presentation by human leukocyte antigen class I (HLA-I). Gemcitabine regulated HLA-I expression on multiple levels, increasing pancreatic cancer cells’ HLA-I mRNA transcripts, total protein and surface expression, as well as surface stability. Temperature-dependent assay results suggested that the increased HLA-I stability may be due to reduced binding of low affinity peptides, and this was confirmed through immunopeptidome analysis via mass spectrometry. Computational prediction programs indicated that in addition to improved affinity, gemcitabine-exclusive peptides were also more immunogenic. Most of the gemcitabine-exclusive peptides originated from unique source proteins, and there was a notable overrepresentation of translation-related source proteins. Gemcitabine also induced expression of select immunoproteasome subunits, providing a potential explanation for its modulation of the HLA-I-presented peptidome. Moreover, regulation of HLA-I by gemcitabine seemed to be in part mediated by this drug\u27s nucleotide-disrupting activities. My work supports continued investigation of immunotherapies to be used in combination with gemcitabine as a new treatment modality for pancreatic cancer
Are You Ready? Assessing the Impact of Online Professional Development on Health Professions Educators\u27 Readiness and Knowledge for Online and Blended Teaching
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Telehealth for Healthy Aging: A Multi-Level, Multi-Methods Approach
No full textTelehealth, rapidly adopted during the pandemic, has shown its usefulness and limitations, yet was not designed with older adults in mind. This dissertation encompasses three interconnected studies exploring telehealth utilization for Medicare Annual Wellness Visits (AWVs) among older adults, provider perspectives on telehealth AWVs, and the impact of teleconferencing on primary care providers\u27 knowledge and confidence in geriatric care. The objectives are to determine patient characteristics using telehealth AWV (study 1), understand provider perspectives on telehealth AWV (study 2), and evaluate the effectiveness of geriatrics education through telehealth (study 3). Study 1 investigates the changes in AWV utilization among 18,405 patients aged 65 and older across 11 Patient-Centered Medical Homes clinics in Nebraska before and during the pandemic. Findings indicate that females, Hispanic patients, and those from larger clinics were more likely to adopt telehealth. In contrast, non-Hispanic Black patients and non-English speakers had lower odds of utilizing telehealth services, highlighting the need for targeted interventions to address these disparities. In Study 2, primary care providers’ perspectives on telehealth AWVs post-COVID-19 were explored using the Practical, Robust Implementation, and Sustainability Model through semi-structured interviews with 25 providers. Providers noted the advantages of telehealth in reducing transportation barriers, observing patients\u27 home environments, and being efficient in time. However, challenges such as difficulties in cognitive and mobility assessments and limited physical interactions were significant, emphasizing the importance of comprehensive training, pre-visit coordination, staff support, and robust infrastructure. Study 3 evaluated the Extension for Community Healthcare Outcomes model on its Geriatrics telehealth training in enhancing knowledge, confidence, and practical application of geriatric care principles among 100 interprofessional primary care providers over 18 months. Participants reported high satisfaction and significant increases in knowledge and confidence in applying the 4Ms framework. Despite time constraints, participants highlighted the benefits of the case conference, including interdisciplinary collaboration, community resources, and discussions. These studies provide a multi-level and multi-method approach to comprehensively understand and improve telehealth utilization among older adults, providing a foundation for targeted interventions and policy changes