2014 UMKC Theses - Access Restricted to UMKC
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Item Relationship Between Hospital Procedure Volume and Complications Following Congenital Cardiac Catheteriazation: A Report from the IMPACT Registry(University of Missouri–Kansas City, 2014) Jayaram, Natalie M.; Williams, Karen B. (Karen Beth)The association between institutional volume and outcomes has been demonstrated for many procedures within the field of cardiology, but whether this relationship exists within the field of congenital cardiac catheterization is unknown. Using the IMPACT® (Improving Pediatric and Adult Congenital Treatment) Registry, we identified all congenital cardiac catheterizations between January 2011 and December 2013 at 64 institutions. Programs were categorized according to their annual catheterization lab volume as small (<150 cases per year), medium (150 to 300 cases per year), large (300- 500 cases per year), and very large (>500 cases per year). Hierarchical logistic regression, adjusted for patient and procedural characteristics, was used to determine the association between annual catheterization lab volume and occurrence of a major adverse event. Among the 33,825 catheterization cases included in the study cohort, a major adverse event occurred in 711 (2.1%) cases. In unadjusted analysis, major adverse events differed based upon annual volume, with a major adverse event occurring in 79 (2.8%) cases at small, 145 (2.3%) cases at medium, 234 (2.1%) cases at large, and 253 (1.9%) cases at very-large programs (p=0.01). After adjustment for patient and procedural risk factors, there was no association between annual procedure volume and occurrence of a major adverse event (odds ratio 0.96 [95% Confidence Interval=0.90, 1.04] per increase in annual volume of 100, p=0.32). There was no difference in the volume-outcome relationship by procedure severity (interaction p=0.49). The unadjusted risk of adverse events is lower in centers performing more catheterizations for congenital heart disease. However, after adjustment for patient- and procedure-level factors, we were unable to identify a significant association between center volume and outcome. The hospital sample size and low event rate may have limited our ability to detect significant differences.Item Whereof we cannot speak(2014) Bayless, Peter Neil DeubnerItem Machined Music(2014) Clifton, Brian; Bar-Nadav, HadaraIn this master thesis, the candidate presents his collection of original poems, accompanied by a critical introduction, which explains his writing and revision process. In the critical introduction, careful attention is given to his conception of what and how poetry does what it does as well as the process of revising the entire manuscript and what already published texts helped him the most in reworking, reordering and retitling the collection. The candidate asserts, through his critical introduction, and in the poems themselves, that his poetry is carefully constructed syntax artificially made to seem as a natural utterance and that this concept has developed during his graduate work at the University of Missouri – Kansas City.Item Association between cardiac rehabilitation participation and health status outcomes after acute myocardial infarction(2014) Kureshi, Faraz; Williams, Karen B. (Karen Beth)Cardiac rehabilitation (CR) is a class Ia recommendation and endorsed performance measure for the quality of care in acute myocardial infarction (AMI) survivors. While participation in CR after AMI is associated with reduced mortality, conflicting data exists on its association with health status outcomes. Using data from 2 prospective AMI registries (TRIUMPH and PREMIER), we identified patients for whom baseline and follow-up health status scores and documentation of CR participation (attendance of 1 or more sessions within 6 months post-AMI) were available. Health status was assessed by four Seattle Angina Questionnaire (SAQ) domain scores (quality of life [QoL], angina frequency [AF], treatment satisfaction [TS], and physical limitation [PL]), as well as SF-12 physical and mental health composite scores (PCS & MCS). We propensity-matched CR participants and non-participants to examine the association between CR participation with health status (6 and 12 months) and all-cause mortality (up to 7 years), using linear, mixed effects and proportional hazards models, respectively. Among 3,957 AMI patients from 31 sites, 2,015 patients (51%) participated in CR after discharge. Several differences were noted in baseline characteristics of CR participants and non-participants. CR participants were more frequently Caucasian (83.6% vs. 65.4%), had higher rates of health insurance (90.6% vs. 79.3%), and had lower rates of co-morbidities. Baseline health status domain scores were clinically similar for both groups with the exception of SAQ physical limitation scores being higher in CR participants. After propensity matching, all covariates were well-balanced (Standardized Difference <10) and the mean SAQ and SF-12 scores were clinically similar for CR participants and non-participants at 6 and 12 months after hospital discharge. However, a decrease in all-cause mortality was noted in the CR participant group (HR 0.59, 95% CI [0.46, 0.75]). In 2 large, multi-center AMI cohorts, we found that although CR participation was associated with improved survival, no additional health status benefits were conferred. Further investigation is required to identify if and how CR programs can further maximize the health status benefits to post-AMI participants.Item 1897 Exposition Congolaise, Tervuren: Colonialism and the Belgian Avant-Garde(2014) Jones, Karin Arlene; Connelly, Frances S.; Art and Art HistoryIn May of 1897, the Exposition Coloniale in Le Palais des Colonies, opened on the site of the Royal Park in Tervuren in conjunction with l'Exposition internationale de Bruxelles held at the same time in the city center. This exhibition satisfied King Leopold II’s longstanding interest in civic projects while the enthralling and exotic displays distracted Belgians from increasing evidence of the “reckless cruelty and greed” of his agents in the Congo. It developed out of the economic and political agendas of the sovereign, and allowed leading artists of the day to break with the past to create a new aesthetic mode for display in a highly visible public arena. The 1897 Exposition Coloniale established a national variant of Art Nouveau, known as le Style Congo. It was rooted in raw materials of the Congo, and incorporated cultural material already circulating throughout Belgium—the fetishes, tools and products collected by Belgian agents, and images reflected in popular publications. In the Salon d’Honneur, fine arts served as outright billboards for ivory, the most quintessential Congolese material. A textile cycle by Hélène de Rudder-du Ménil contrasted the “savagery” of the Congolese people with the civilizing benefits of Belgian intervention. In the adjacent Salle d’Ethnographie, a vast array of cultural material was incorporated into abstract displays that above all served the avant-garde architectural and design program of the Exposition Coloniale. The Exposition Coloniale developed out of the economic and political agendas of the sovereign, the forward-leaning aesthetic interests of his Secretary of State, and an exhibition venue that allowed leading artists of the day to break with the past to create a new aesthetic mode in a highly visible public spectacle. Belgian avant-garde artists incorporated the luxurious materials and aesthetic resources of the Congo into new artistic creations. Under the direction of Paul Hankar, the complex relationship of Belgian avant-garde artists to the imperialism of Leopold II was made manifest at the 1897 Exposition Coloniale. This thesis will examine the intersection of colonial propaganda and the promotion of the Belgian avant-garde objectives at the end of the nineteenth century, through an analysis of ivory sculpture and the textile cycle of Hélène de Rudder-du Ménil in the Salon d’Honneur, and the interior design and furnishings of Paul Hankar in the Salle d’Ethnographie.