Digital Commons Network^™

The Association Between Depression And Anxiety With Covid-19 Outcomes., Erica Miller

Electronic Theses and Dissertations

Previous studies have shown that mental disorders affect COVID-19 mortality. This study investigated the effect of depression and/or anxiety on COVID-19 outcomes. Depression/anxiety was defined by actively taking medication and/or diagnosis. The outcomes were ICU admission; ventilation; mortality; and time to mortality. Of 698 hospitalized patients, there were 204 (29%) defined to have either depression or anxiety. There were 109 deaths, and of those, 52 (48%) were diagnosed with depression/anxiety. Multivariable logistic regression and Cox proportional hazards models were used to examine associations. ICU admission and ventilation were not significantly associated with depression/anxiety. Depression/anxiety was associated with mortality (OR: 1.84, …

The Impact Of Statin Use On Outcomes Of Diabetic Adult Patients Hospitalized For Community Acquired Pneumonia., Joel Lanceta

Electronic Theses and Dissertations

BACKGROUND: Statins, a class of drugs that treat hyperlipidemia, may have an immunosuppressive effect for patients with community acquired pneumonia (CAP). Retrospective and in vitro studies have suggested an immunomodulatory, antioxidative and anticoagulant effects from statin use in patients with Type 2 Diabetes Mellitus (T2DM) hospitalized for CAP. Prospective studies that have tested any effect of statin therapy on patients with T2DM and CAP have not been found literature. To date, prospective studies showing of the effects statin therapy may have on T2DM patients hospitalized for CAP are not available. METHODS: This dissertation is a secondary analysis using deidentified data …

Exploring The Contextual Factors And Decision-Making Process Of Risky Sexual Behavior Among Homeless Adults In Louisville, Kentucky., Sarah C. Van Heiden

Electronic Theses and Dissertations

Homelessness is a complex public health issue; individuals who experience homelessness are said to engage in risky sexual behaviors at an increased rate and experience a higher prevalence of sexually transmitted infection (STI). While the sexual behaviors of homeless adolescents are commonly studied, little is known about the sexual behaviors of the growing population of older adults, or how they make decisions to engage in sex. Three aims guided this research: 1) to describe the sexual behaviors and sexual decision-making process of homeless older adults, 2) to examine how homeless older adults evaluate the outcomes associated with engaging in risky …

Impact Of Pank1 Deletion On Mitochondrial Acetylation And Cardiac Function During Pressure Overload., Timothy N. Audam

Electronic Theses and Dissertations

Recent studies have associated elevated protein acetylation levels with heart failure in humans. Although mechanisms promoting elevated acetylation levels are not fully known, excess acetyl-CoA may drive enzyme-independent acetylation of cardiac proteins. Accumulation of acetyl-CoA depends on the availability of sufficient CoA, whose production is regulated by pantothenate kinases in the CoA biosynthetic pathway. We show that cardiac proteins are hyperacetylated during heart failure in humans and tested in mice whether limiting CoA abundance would improve ventricular remodeling during pressure overload-induced hypertrophy. We limited cardiac CoA levels by deleting the rate-limiting enzyme in CoA biosynthesis, Pank1 (one of three PANK-encoding …

An Analysis Of Taste Neuron Morphological Variability: Influences Of Neuron Type And Plasticity., Lisa Christina Ohman

Electronic Theses and Dissertations

Taste neurons are functionally and molecularly diverse, but their morphological diversity was, until recently, completely unexplored. Taste neurons were considered relay cells, communicating information from taste-transducing cells to the brain without variation in morphology. Instead, individual taste neurons are tremendously morphologically variable. To determine how differences in branching relate to the number and types of taste-transducing cells providing neuronal input, I combined sparse cell genetic labeling with a whole-mount immunohistochemistry and analysis workflow. I found that the maximum number of taste-transducing cells capable of providing convergent input onto individual gustatory neurons varied with a range of 1-22 taste-transducing cells. Consistently, …

Hospital-Based Professional Spiritual Care: Evaluating The Utilization, Availability, And Impact Of Chaplains., Kelsey B. White

Electronic Theses and Dissertations

BACKGROUND: The Affordable Care Act, enacted in 2010, transformed healthcare policy and forced hospitals to reevaluate traditional methods for care delivery. Researcher advocated for patient-centered models of care to reduce costs, address inequitable access to services, and improve service quality. These models prioritize patient values, preferences, and beliefs inclusive of patients’ religious and spiritual needs. Professional chaplains provide religious and spiritual care within many hospital settings. This dissertation explored the characteristics of hospitalized persons using chaplains, the factors associated with a hospital reporting a chaplaincy department, and how those services impacted patient satisfaction. METHODS: The first analysis used a two-part …

Role Of Meibum And Tear Phospholipids In The Evaporative Water Loss Associated With Dry Eye., Samiyyah M. Sledge

Electronic Theses and Dissertations

It is generally believed that the tear film lipid surface film inhibits the rate of evaporation (Revap) of the underlying tear aqueous. It is also generally believed that changes in the composition of the tear film lipid layer is responsible for an increase in Revap in patients with dry eye. Both of these ideas have never been proven. The purpose of the current studies was to test these ideas. Revap was measured in vitro gravimetrically. Lipid spreading was measured using Raman spectroscopy and microscopy. The influence of the following surface films on the Revap of the sub phase of physiologically …

Perceived Social Support, Family Relationships, And Health-Related Quality Of Life Among Women With Breast Cancer In Jordan., Hedaya Rateb Hina

Electronic Theses and Dissertations

Introduction: Breast cancer is the most common cancer among Jordanian women. Perceived social support (PSS) and family relationships are strongly associated with positive psychosocial outcomes and health-related quality of life (HRQoL). This area was widely explored in Western countries, but little attention was devoted to investigate this area in Middle East region. Purpose: to investigate the interrelationships among PSS, family relationships, and HRQoL of women with breast cancer in Jordan using an exploratory cross-sectional design. Method: The contextual model of HRQoL designed by Ashing-Giwa (2005) provided the foundation for this study. A total of 140 women were …

Effects Of Chemosensory Experience And Context On Consummatory Behaviors., Saphira M. Chiu

Electronic Theses and Dissertations

Eating food generates associations between odors and tastes (i.e., flavor) that guide future choices. Experience with an odor-taste mixture links an odor with a taste’s quality and hedonic value, resulting in a preference for an odor paired with a palatable taste over an odor paired with an unpalatable taste. However, experience with a neutral stimulus (i.e., latent inhibition) or environment (i.e., context) can influence the formation of conditioned associations. Here, I used a two-bottle brief-access task to determine whether rats display an innate preference between unpaired odors (isoamyl acetate and benzaldehyde), how preexposure to the unpaired odors impacts mixture-dependent consummatory …

Preclinical Development Of Epicertin, A Novel Biotherapeutic For The Treatment Of Ulcerative Colitis., Micaela Ann Reeves

Electronic Theses and Dissertations

Epicertin (EPT) is a recombinant variant of the cholera toxin B subunit with a C-terminal KDEL endoplasmic retention motif. Previously, orally administered EPT demonstrated mucosal healing activity in acute and chronic dextran sulfate sodium colitis models, indicating its therapeutic potential for ulcerative colitis (UC) treatment. However, oral dosing with EPT requires neutralization of gastric acid prior to administration, hindering its facile application in the treatment of chronic diseases like UC. One solution to this issue is that EPT may also be administered intracolonically without losing efficacy. This work describes the determination of a target intracolonic dose of EPT for future …

Assessing The Role Of Arsenic Exposure And Mirna-186 In Skin Tumorigenesis And Chromosomal Instability., Angeliki Lykoudi

Electronic Theses and Dissertations

Chronic arsenic exposure through drinking water is a global health issue, affecting more than 200 million people. Arsenic is a group I human carcinogen and causes chromosomal instability (CIN). Arsenic exposure is the second most cause of skin cancer after UV radiation. MiR-186 is overexpressed in arsenic-induced squamous cell carcinoma relative to premalignant hyperkeratosis. Predicted targets of miR-186 are cell cycle regulators. Thus, we hypothesize that miR-186 overexpression drives malignant transformation of HaCaT cells by induction of CIN. Stable clones of HaCaT transfected with pEP-miR-186 expression vector or empty vector were maintained under puromycin selection were exposed to 0 or …

Collaborative Human-Machine Interfaces For Mobile Manipulators., Shamsudeen Olawale Abubakar

Electronic Theses and Dissertations

The use of mobile manipulators in service industries as both agents in physical Human Robot Interaction (pHRI) and for social interactions has been on the increase in recent times due to necessities like compensating for workforce shortages and enabling safer and more efficient operations amongst other reasons. Collaborative robots, or co-bots, are robots that are developed for use with human interaction through direct contact or close proximity in a shared space with the human users. The work presented in this dissertation focuses on the design, implementation and analysis of components for the next-generation collaborative human machine interfaces (CHMI) needed for …

Implementation Of A Risk Assessment Tool In The Cardiac Catheterization Laboratory To Identify High Bleeding Risk Patients On Dapt After Pci: A Quality Improvement Project., Ghulam Mughal

Doctor of Nursing Practice Papers

Bleeding is a risk among patients on dual antiplatelet therapy (DAPT) after the percutaneous intervention (PCI) in acute coronary syndrome (ACS). There is a need to accurately identify the patients with increased bleeding risk. Evidence shows that 1.7 cases bleed among 100 PCI patients, and 5% of patients are re-admitted for bleeding which increases subsequent death or MI within 60 days post-discharge bleeding. Evidence suggests that the internally and externally validated BLeeMACS bleeding risk instrument can be used to measure bleeding risk in this population. This quality improvement project aims to improve the awareness among healthcare providers of the bleeding …

Evaluation And Implementation Of A Video Intervention To Increase Adherence In A Rural Phase Ii Cardiac Rehabilitation Program., Holly Yahyawi

Doctor of Nursing Practice Papers

Background: In the U.S., heart disease affects over 30 million adults and is the leading cause of death. Cardiac rehabilitation (CR) decreases cardiac hospital readmissions, decreases the risk of additional cardiac events, and increases life expectancy. Environment: This project was implemented at a CR program which serves rural Indiana and Kentucky counties. Purpose: This QI project uses a Plan-Study-Do-Act framework to evaluate patient adherence to a rural CR program, implement a video intervention for patients, and measure patient’s perceptions. Procedures: CR patients watched four videos describing what CR is, what to expect at CR, CR benefits, and a patient CR …

Improving Pediatric Delirium Prevention To Decrease Pediatric Delirium Prevalence In The Pediatric Intensive Care Units., Kelsie Houchens

Doctor of Nursing Practice Papers

Background: Pediatric delirium has emerged as a common complication of childhood illness in the intensive care setting, with estimated delirium prevalence ranging from 15.9% to 65.6%. Critically ill pediatric patients in the ICU are at risk for pediatric delirium due to modifiable risk factors including mechanical ventilation, sedating medications, physical restraints, and nutrition. In 2019, the pediatric intensive care unit (PICU) in a Kentucky children’s hospital reported only 18 % of chart audits revealed that physicians activated the physician-directed pediatric ICUs Delirium Prevention and Treatment Order Set (DPTOS) on pediatric patients. A quality improvement (QI) project was developed to identify …

Evaluating Quality Of Life And Participant Satisfaction In A Cancer Support Community Yoga Program., Lauren Topp

Doctor of Nursing Practice Papers

Purpose: The purpose of this EBP project was to evaluate program processes and outcomes of an established cancer support community yoga program for persons impacted by cancer and explore the impact of the program on quality of life (QoL) in persons with cancer.

Design: This project was a quality improvement project with a pre-test/post-test design. QoL was explored through the EROTC QLQ C30 questionnaire. Descriptive and explorative methods were conducted through a survey of participants’ satisfaction with the yoga program. Feedback for future improvements around QoL services were provided.

Methods: Members of Gilda’s Club (440 persons) received an …

The Black Church, Social Media, And Vaccine Hesitancy: A Program Evaluation Of A Virtual Town Hall Meeting Intended To Educate, Empower And Expedite Covid-19 Vaccine Uptake Intent Among Black Americans., Nina Johnson

Doctor of Nursing Practice Papers

Background: Vaccines are among the most important public health interventions of the 20th century saving millions of lives each year. Notwithstanding, the United States has seen a growing resistance to vaccinations since the late 1990s. Vaccine hesitancy (VH) is a delay or decline to accept vaccines, despite the available of safe and effective vaccines (WHO, 2019). Combatting VH in Black communities is especially challenging, complex, and multifaceted due to an elevated sense of medical mistrust from persistent racial discrimination, injustices and medical malfeasance. The current coronavirus-19 disease (COVID-19) pandemic has further magnified the intersection of this structural racism, the associated …

Implementation And Evaluation Of A Quality Improvement Project To Increase Tdap Vaccination Rates For Primary Caregivers In The Neonatal Intensive Care Unit., Vickie Winner

Doctor of Nursing Practice Papers

Pertussis (whooping cough) is a highly contagious deadly disease for neonates. The Centers for Disease Control and Prevention (CDC) identifies primary caregivers (anyone caring for the infant in the home environment) as the most common source of neonatal pertussis. The CDC therefore recommends primary caregivers receive a booster tetanus, diphtheria, acellular pertussis (Tdap) vaccine to reduce the transmission of pertussis to neonates. The purpose of this quality improvement (QI) project is to implement and evaluate an intervention to increase Tdap vaccination rates among primary caregivers of NICU patients. The specific aims of this quality improvement project are to 1) implement …

Why Targeted Testing Matters: Evaluation Of A Practice Change In Pediatric Ingestion Screening., Emily Neal

Doctor of Nursing Practice Papers

Background: The drug epidemic is plaguing the United States and more Americans than ever have been identified to use illicit substances regularly, including while caring for children. The practice of obtaining a standard urine or serum drug screen is outdated and ineffective in determining if children have been exposed to illicit substances. Often these immunoassay drug screens are negative despite pediatric patients having symptomatic responses to illicit drug exposures. Immunoassay drug screens are not designed for testing in children who are often passively and directly exposed as bystanders to adult drug use in their environment. This means that a “negative” …

Improving Patient Safety During The Emergency Department Discharge Process With The Use Of Two Patient Identifiers., Hannah English

Doctor of Nursing Practice Papers

Nurses are not always confirming two patient identifiers while conducting a patient discharge, resulting in patient identification errors. This problem has been shown to significantly affect patient safety and satisfaction, decreasing both when errors are made. These errors also have heavy financial and legal consequences on the affected facility and on the discharging nurses, warranting a need for improvement. The purpose of this quality improvement project was to decrease patient-identification errors at discharge by increasing nurse use of two patient-identifiers through the implementation of an education program. This ten-week program involved education sessions that presented evidence-based material specifically focused on …

Hair Toxicology Testing Among Children Evaluated For Physical Abuse: Evaluation Of A Practice Change., Ashley Dejarnette

Doctor of Nursing Practice Papers

Background: Despite a complete medical evaluation for child physical abuse, many suspected victims have indeterminant findings. The lack of a definitive diagnosis can impede child protection agencies’ ability to protect those children at high risk for abuse, leaving them vulnerable to subsequent injuries and potentially escalating violence by caregivers. Oftentimes, allegations of child physical abuse are accompanied by concerns for substance abuse by the caregiver as well. While we know that children living in homes where caregivers use illicit substances are at substantially higher risk for physical abuse, drug testing children for environmental exposure to illicit substances is not yet …

Using Simulation To Prepare Nursing Students To Care For Covid-19 Patients., Erika Keithley

Doctor of Nursing Practice Papers

Background: The COVID-19 pandemic has impacted the state, nation, and globe resulting in significant death and healthcare strain. To minimize risks associated with potential illness and educational interruptions, nursing students have often been prohibited from caring for COVID-19 patients during clinical experiences. Simulation-based education immerses students in a realistic clinical environment providing a safe learning environment for novice practitioners.

Purpose: The purpose of this project was to implement simulation-based education related to acute care of COVID-19 patients for pre-licensure nursing students. Project objectives included: (a) to educate nursing students on the care of COVID-19 patients; (b) to assess competency through …

Development Of 3d-Bioprinted Scaffolds For Oral Probiotic Application., Jhanvi Patel

Electronic Theses and Dissertations

Background: Porphyromonas gingivalis adheres to and invades gingival epithelial cells, resulting in decreased cell viability. Previous studies have indicated that probiotics are effective against dental pathogens; however, few approaches provide sustained-delivery of active agents in the oral cavity. Hypothesis: Probiotics will limit P. gingivalis effects on Telomerase Immortalized Gingival Keratinocyte (TIGK) cells and 3D-printed scaffolds will prolong probiotic release. Methods: Lactobacillus acidophilus, Lactobacillus reuteri, and Bifidobacterium bifidum were assessed with adhesion and antibiotic protection assays to limit P. gingivalis effects on TIGKs. Scaffolds were printed with a select probiotic and evaluated for release kinetics. Results: Free L.a., …

Trends In Hysterectomy In Hospital And Ambulatory Settings In Kentucky 2017-2020., Felicia A. Pugh

Electronic Theses and Dissertations

Hysterectomy is the most common treatment for benign uterine conditions in the United States. Data suggest that one in nine women will have the procedure in their lifetime (1). Previous studies indicate that abdominal hysterectomy rates for non-malignancies are declining as alternative methods are increasing for decades; however, those trends do not apply for all women in the country (2-5). In this cross-sectional study, hysterectomy procedures completed between 2017-2020 are described in Kentucky Cabinet for Health and Family Services data. Multivariable logistic regression is used to assess the odds of abdominal hysterectomy for benign indications in Kentucky. Conclusion: Rates of …

Concurrent Reporting Of Adverse Childhood Experiences Among Perspectives Of Adolescents And Caregivers., Katie J. Berghuis

Electronic Theses and Dissertations

The consequences of Adverse Childhood Experience (ACE) events in youth have predominantly been studied through retrospective studies that assess adults’ first 18 years of life or caregiver report of ACEs in youth. Reliance on only caregiver report to discern ACEs is a limitation amongst prior studies as research has found that caregivers tend to underestimate ACEs among their children, and there is even a greater discrepancy of reporting between caregivers and youth 12 years and older. Therefore, this study investigated concurrent reporting of self-report ACE scores in adolescents – defined in this study as 12 to 20 years old – …

Multilateration Index., Chip Lynch

Electronic Theses and Dissertations

We present an alternative method for pre-processing and storing point data, particularly for Geospatial points, by storing multilateration distances to fixed points rather than coordinates such as Latitude and Longitude. We explore the use of this data to improve query performance for some distance related queries such as nearest neighbor and query-within-radius (i.e. “find all points in a set P within distance d of query point q”). Further, we discuss the problem of “Network Adequacy” common to medical and communications businesses, to analyze questions such as “are at least 90% of patients living within 50 miles of a covered emergency …

Decreased Kidney Mitochondrial Content And Pgc-1Α Following Repeated Low-Dose Cisplatin-Induced Kidney Injury., Andrew Joseph Orwick

Electronic Theses and Dissertations

Cisplatin is highly effective and one of the most commonly used chemotherapeutic agents in the treatment of a number of different solid organ tumors. Unfortunately, the dose-limiting nephrotoxicity occurs in up to 30% of patients, which requires alterations to treatment regimens that are often less effective. The kidney’s function is to provide fluid homeostasis, and this is an energy-intensive process. Proper renal function is dependent on functional mitochondria. PGC-1α regulates mitochondrial number, respiratory capacity, and mitochondrial proteins in proximal tubule cells. We delivered low-dose cisplatin to mice via intraperitoneal injections once a week for 4 weeks. The mice were then …

Oligodendrocyte Responses After Spinal Cord Injury., George Zach Wei

Electronic Theses and Dissertations

Recent studies demonstrate that neuroprotection strategies targeting the proteostasis network and components of its effector signaling pathways improve cell survival and motor recovery outcomes in several models of neuronal injury and degeneration. However, the individual contributions of these signaling pathways to the pathogenesis of spinal cord injury (SCI), white matter damage, and motor recovery have not yet been determined. Here, I explored the role of the HIF prolyl hydroxylase domain proteins (PHD/EGLN), effectors that can modulate stress responses activated by the proteostasis network, on motor function recovery after SCI. Furthermore, I identified previously unknown candidate mechanisms in an unbiased manner …

Development And Validation Of Biosafety Climate Scale And Survey-Based Analyses Of Safety Perceptions In Biological Research And Teaching Laboratories At Public Universities In The Usa., Sivarchana Mareedu

Electronic Theses and Dissertations

Biosafety plays a key role in ensuring safety of researchers’ as well as the public from unintentional exposures to infectious agents. However, the occurrence of lab acquired infections, exposures, and safety lapses in biological laboratories underscores challenges in biosafety program management. The raise in emerging and reemerging infectious diseases and the ongoing COVID-19 pandemic reiterates the need for biosafety and research community to work together. Literature recommends the application of safety climate in measuring safety culture. The goal of this dissertation is to quantify biosafety climate and examine associated factors to understand the gaps between research and biosafety professionals in …

“And The Next Day, You Are In Charge”: Policy Recommendations Stemming From A Qualitative Investigation Into The Professional Development Of Early Career Peer Support Specialists In Kentucky., Diane Zero

Electronic Theses and Dissertations

Over the last twenty years, the peer support segment of the behavioral health workforce has grown rapidly. However, few researchers have studied the effects on individuals from transitioning into the role. Likewise, there is limited research examining the professional development process of early career peer support specialists. To begin to fill these gaps in the literature, I conducted a qualitative research study examining workforce development experiences of peer support specialists in Kentucky. This dissertation reports on its findings and includes a policy paper with recommendations for improving policy and practice. Chapter one offers an introduction to the peer support workforce …