2018 UMKC Theses - Access Restricted to UMKC
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Item Health Status Implications for Comorbid Diabetes in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry(University of Missouri -- Kansas City, 2018) Patel, Krishna Kaushik; Smolderen, Kim G.Patients with peripheral artery disease (PAD) and coexisting diabetes mellitus (DM) have an increased rate of PAD progression and reduced walking performance as compared with non-diabetic PAD patients. It is unknown, however, whether patients with PAD and comorbid diabetes also experience worse PAD-specific health status (symptoms, functional status, quality of life) and how that changes over time. The Patient-centered Outcomes Related to Treatment practices in peripheral Arterial disease: Investigating Trajectories (PORTRAIT) is a 16-center international registry that includes patients with exacerbated or new-onset symptomatic PAD presenting to specialty clinics. PAD-specific health status was measured at the time of initial PAD evaluation and 12 months later using the Peripheral Artery Questionnaire (PAQ). Multivariable linear regression, initially adjusted for demographics (partially adjustment) and then additionally adjusted for socioeconomic factors, PAD severity, comorbidities, psychosocial characteristics (fully adjusted), was used to assess the association between DM and health status at baseline and at 12 months. Interaction of diabetes with invasive PAD treatment on 12-month health status was tested to assess for the differential effect of treatment on follow-up health status by diabetes status. Of 1,204 patients, 397 patients had diabetes (96% Type II). Patients with PAD and DM had lower unadjusted PAQ summary scores at baseline, 3, 6 and 12 months, compared to patients with PAD without diabetes (46.1 vs. 50.8, p < 0.001; 63.6 vs. 68.2, p < 0.01; 65.6 vs. 71.7, p < 0.001; 65.3 vs. 72.6, p<0.001). After adjusting for age, sex, race and country; patients with diabetes had worse PAQ summary scores at baseline (mean difference= -4.04 (-6.58, -1.50), p <0.01) and at 12 months (mean difference= -6.06 (-9.13, -2.99), p<0.01). After additionally adjusting for socioeconomic, comorbidities, psychosocial characteristics and PAD severity (fully adjusted), the effect of diabetes on PAQ summary score at baseline (adjusted mean difference= -1.80 (-4.42, 0.82), p=0.18) and 12 months (adjusted mean difference= -2.11, (95% CI: -5.32, 1.11; p=0.20)) was no longer significant. There was no differential effect of invasive treatment on 12-month PAQ scores by patient diabetes status (diabetes*invasive treatment p≥0.32).In conclusion, patients with PAD and co-existing DM have poorer health status at initial visit and a year later. This finding was mostly explained by the differences in their socioeconomic, psychosocial, comorbidities and disease characteristics. Patients with diabetes and PAD experience similar improvement in health status with invasive PAD treatment as their non-diabetic counterparts. PAD patients with DM should be offered similar treatment options as those without DM as they have similar health status gains with time.Item To turn on every light(University of Missouri -- Kansas City, 2018) Weishar, Lindsey; Stewart, Robert, 1946-This collection of poems focuses on the interior and exterior landscapes of a speaker in relationship with objects, with others, and with God. The poems seek to explore these relationships through a symbolic lens, so that even the smallest details—a rose, an poppy, a piece of thread—take on larger significance when examined. Though this mode of thought originated in the medieval world, the poet seeks to translate this mode of thought into a way of seeing that enriches the ordinary moments of modern life with meaning. This manuscript is rooted in hope—in beauty and in the goodness of life, despite the pain of existence. The poems presented here are the product of listening—to teachers and mentors both within and outside of the MFA program at the University of Missouri-Kansas City, to whom I am indebted.Item The Cherry Orchard(University of Missouri -- Kansas City, 2018) McBride, Max Logan; Hodgen, Christie, 1974-Similar to the namesake of this manuscript, Anton Chekhov’s play The Cherry Orchard, the poems that make up this collection explore loss—loss of home, loss of time, loss of loved ones, loss of self. Some of the poems originate from personal experiences, while others utilize modes like the ekphrastic to draw upon known works of art, yet despite the varied roots of each poem, the ultimate goal is that this collection exists as a participatory experience not a passive medium, a work of literature that goes further than merely entertaining the reader—a dialogue rather than a monologue. No matter how public or private a topic may be, the poems make themselves accessible to the reader, but also require active engagement. Both as a collection and as individual pieces, my hope for these poems is to add another voice to the greater conversation that spans time and media in its examination of how we experience grief and pain, how we live despite the constancy of loss and tragedy, and how we remember the times and people no longer with us.Item On Earth, As It Is(University of Missouri -- Kansas City, 2018) Thompson, Jermaine; Bar-Nadav, HadaraThis manuscript of poems addresses the collisions of the body—what is often meant when we say intersectionality. These poems take on the politics of race, religion, gender, and history and employ the filters of persona, pop-culture, social media, and letters. This manuscript is a culmination of the lessons in craft, theory, and literature based coursework offered by the noble Creative Writing Department at the University of Missouri—Kansas City. These poems draw on my deep Southern upbringing and collaborate with the music, mythology, and dire mundaneness of everyday living.Item Wishful Thinking(University of Missouri -- Kansas City, 2018) Kaleugher, Jon Fitzgerald; Hodgen, Christie, 1974-The novel interrogated what it means to live in a midwestern college town while not being in college. What it means to have stayed in one place long enough that everyone who left has decided to come back. What it means to be the one left behind. Among those who come back are a cousin who married into wealth and a former lover of hers who has come back with a mountain of wealth of his own. Peter is caught in the riptide of the prevalent hipster culture and new reality of social media. He is thrown into the deep end, confronted with the question: should he stay or should he go?