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Dynamic Balancing Of Foraging And Defensive Effort Contribute To The Optimality Of The Honey Bee Robbing Strategy, Grayson James Grume Jan 2020

Dynamic Balancing Of Foraging And Defensive Effort Contribute To The Optimality Of The Honey Bee Robbing Strategy, Grayson James Grume

Theses and Dissertations--Entomology

The optimality of a foraging strategy shifts in response to dynamic ecological conditions and the need to devote effort to other tasks. Nest defense and foraging effort in the honey bee may trade off as both tasks are performed by a shared workforce of physiologically-specialized individuals in exclusive roles. Honey robbing is a foraging strategy predicted to benefit from simultaneous increases in foraging and defensive effort, but may be constrained by workforce specialization. We developed a methodology to induce robbing behaviors with uninhabited bait hives. We used this methodology to evaluate foraging and defensive effort before and during robbing by …


The Role Of Neural Precursor Cell Expressed Developmentally Down-Regulated Protein 9 In Enhanced Aggressiveness Of Hexavalent Chromium Transformed Bronchial Epithelial Cells, Peter Van Wie Jan 2020

The Role Of Neural Precursor Cell Expressed Developmentally Down-Regulated Protein 9 In Enhanced Aggressiveness Of Hexavalent Chromium Transformed Bronchial Epithelial Cells, Peter Van Wie

Theses and Dissertations--Toxicology and Cancer Biology

Hexavalent chromium (Cr(VI)) is classified as a confirmed human carcinogen by the International Agency for Research and Cancer (IARC) and by the U.S. Environmental Protection Agency (EPA). Chronic exposure to (Cr(VI)) causes malignant cell transformation in human bronchial epithelial BEAS-2B cells. These Cr(VI)-transformed cells exhibit a highly aggressive phenotype including increased migration, invasion, and angiogenesis. The Cas family protein neuronal precursor developmentally down regulated protein 9 (NEDD9/Cas-L/HEF1) was dramatically overexpressed in Cr(VI)-transformed cells compared to normal BEAS-2B cells. Knockdown of NEDD9 by its shRNA reduced migration and invasion in vitro measured by migration and invasion assays. shNEDD9 reduced tumor formation …


Noncontact Multiscale Diffuse Optical Imaging Of Deep Tissue Hemodynamics In Animals And Humans, Siavash Mazdeyasna Jan 2020

Noncontact Multiscale Diffuse Optical Imaging Of Deep Tissue Hemodynamics In Animals And Humans, Siavash Mazdeyasna

Theses and Dissertations--Biomedical Engineering

Blood flow (BF) impacts the delivery of oxygen and nutrients to tissues and the removal of metabolic byproducts from tissues. Imaging of BF distributions helps characterize many diseases associated with tissue hypoxia/ischemia. The purpose of this study was to develop and validate a novel, noninvasive, noncontact, high-density camera-based speckle contrast diffuse correlation tomography (scDCT) device for use in both animal and human studies. The scDCT uses a galvo-mirror to remotely deliver the focused point near-infrared light to source positions and a sensitive 2D camera to quantify spatial diffuse speckle fluctuations, resulting from the movement of red blood cells in deep …


Fluvial Sediment Organic Matter Degradation Identified With Elemental And Isotopic Fate During Laboratory Incubation, Brenden Riddle Jan 2020

Fluvial Sediment Organic Matter Degradation Identified With Elemental And Isotopic Fate During Laboratory Incubation, Brenden Riddle

Theses and Dissertations--Civil Engineering

Fluvial sediment is well recognized as a critical factor in both carbon and nutrient budgets within stream systems. However, we find very few studies of reactivity and isotope enrichment for stream water from agricultural and urban streams and the class of substrate known as fluvial sediment organic matter. This study investigated the hypothesis that fluvial sediment is subject to degradation even though many previous studies have considered this class of substrate generally inert. Therefore we qualify that elemental and isotopic signatures of fluvial sediment organic matter should be considered potentially non-conservative when used in tracer studies. Methods applied to this …


A Modeling Approach To Understanding Glyphosate Transport In The Belize River Watershed, Barbara Anmei Astmann Jan 2020

A Modeling Approach To Understanding Glyphosate Transport In The Belize River Watershed, Barbara Anmei Astmann

Theses and Dissertations--Civil Engineering

Glyphosate is the most widely used herbicide worldwide and is often transported from application areas to surface water when solubilized in runoff or sorbed to eroded sediment. There is evidence that suggests both glyphosate and its main metabolite aminomethylphosphonic acid (AMPA) may pose a risk to human health, as well as cause adverse effects in the environment. However, consistent monitoring data is still limited, especially in developing countries. Belize is a developing nation with agriculture being a major sector of its economy and is heavily reliant on glyphosate. The widespread use of glyphosate in Belize may be resulting in glyphosate …


Investigation Into The Presence, Persistence, And Fate Of S. Aureus, And Its Mobile Genetic Elements, In Wastewater And The Surrounding Environment, Atena Amirsoleimani Jan 2020

Investigation Into The Presence, Persistence, And Fate Of S. Aureus, And Its Mobile Genetic Elements, In Wastewater And The Surrounding Environment, Atena Amirsoleimani

Theses and Dissertations--Civil Engineering

Currently, the world is engaged in a battle against very small parts of our environment that develop and share genes for resistance to multiple environmental conditions. Pathogenic infections caused by antibiotic-resistant bacteria have been impacting animal and human health and life. Increasing incidences of methicillin- resistant Staphylococcus aureus (MRSA) infections transmitted through the environment are rising faster than the discovery of new antibiotics. Multi-drug resistant S. aureus infections in healthy individuals without prior hospitalization have been increasing all around the world.

Many people carry S. aureus in their nose and on their skin, common niches for the bacteria to co-grow …


May Ayim's Blue Notes In Blues In Schwarz Weiss, Gabrielle Taylor Jan 2020

May Ayim's Blue Notes In Blues In Schwarz Weiss, Gabrielle Taylor

Theses and Dissertations--Modern and Classical Languages, Literature and Cultures

May Ayim has become a staple when it comes to Black German poetry within German Studies and continues to influence and challenge ideas of what it means to be black in Germany at the end of the 20th century. What is perhaps not challenged enough is the ways in which we, the readers and students of German literature and poetry, approach and study Ayim’s poetry as we move deeper into the 21st century. Her collection of poetry, Blues in Schwarz Weiss, can be seen through a significant word found in her collection’s title—blues. It is through blues, …


Landscape Ecology And Population Genomics Of Two Sympatric Pitviper Species Across A Fragmented Appalachian Landscape, Thomas Maigret Jan 2020

Landscape Ecology And Population Genomics Of Two Sympatric Pitviper Species Across A Fragmented Appalachian Landscape, Thomas Maigret

Theses and Dissertations--Biology

Understanding the link between landscape patterns and ecological and evolutionary processes is an important prerequisite for informed wildlife conservation and management, especially in rapidly changing landscapes. Until recently, the inaccessibility of spatial and genomic data sets of sufficient resolution limited our ability to incorporate the impacts of landscape patterns into predictions of ecological and environmental outcomes. In this dissertation, I utilized several high-resolution spatial and genomic data sets to address ecological questions in a rapidly fragmenting landscape in southeastern Kentucky. Overall, my results indicate that large-scale surface coal mining is causing widespread homogenization of landforms, resulting in a uniquely permanent …


Predicting Patterns Of Gene Family Evolution In Taxa With Similar Ecological Niches, Kim Vertacnik Jan 2020

Predicting Patterns Of Gene Family Evolution In Taxa With Similar Ecological Niches, Kim Vertacnik

Theses and Dissertations--Biology

To fully understand the genetic basis of adaptation, we need to know its predictability—the extent to which specific selective pressures and contexts can yield corresponding genetic changes. In particular, the repeated colonization of similar, specialized environments by different taxa is ideal for assessing the frequency of reoccurring changes in the same genes or functions. But compared to a growing body of literature on the convergent evolution of individual genes, far less is known about the repeatability of gene family evolution, where families (defined here as groups of genes that share sequence and functional similarity from common ancestry) can expand (gain …


The Role Of Melatonin In Biological Rhythms Of Songbirds, Clifford E. Harpole Jan 2020

The Role Of Melatonin In Biological Rhythms Of Songbirds, Clifford E. Harpole

Theses and Dissertations--Biology

In vertebrates, melatonin is a hormone that is produced and secreted at night and inhibited by light. This unique “darkness-only” expression profile makes it an intellectually appealing candidate for a means of transmitting temporal information to an individual, both time of day and time of year.

In passerine birds, “time of day” information is certainly transmitted via melatonin secretion. The primary producer of systemic melatonin in this family of birds is the pineal gland, and surgical removal of it causes a bird to become arrhythmic in constant conditions. I find that as pinealectomized house sparrows (Passer domesticus) become …


Investigation Into The Roles Of Her9 And Capn5 During Retinal Development And Regeneration, Cagney Coomer Jan 2020

Investigation Into The Roles Of Her9 And Capn5 During Retinal Development And Regeneration, Cagney Coomer

Theses and Dissertations--Biology

The formation of a healthy and functioning eye requires coordinated interactions between numerous signaling pathways and gene regulatory networks within the developing neural retina. Tight regulation of gene expression is required for cell specification and differentiation in this multilayered, light sensitive tissue. The photoreceptors are the light detecting cells of the retina, capable of functioning in both intense sunlight and dim light at night. When pigment cells of the photoreceptor outer segment are activated by light, a complex chain of events called phototransduction leads to the electrical signal cascade that is transmitted through the retina and ultimately to the brain …


Limb Development In Salamanders: An Evolutionary Perspective To The Tetrapod Limb, Sruthi Purushothaman Jan 2020

Limb Development In Salamanders: An Evolutionary Perspective To The Tetrapod Limb, Sruthi Purushothaman

Theses and Dissertations--Biology

Vertebrate limb is an ideal model to study growth, patterning and morphogenesis and the interplay between these processes. The developing limb bud is a three-dimensional structure and its outgrowth depends on the interaction between 2 important signaling centers: the Apical Ectodermal Ridge (AER) at the junction of the dorsal and ventral halves of the limb bud and the Zone of Polarizing activity (ZPA) in the posterior mesenchyme. These centers produce their respective key molecules and the close interplay between them specifies structures along the anterior-posterior (thumb to pinky), proximal-distal (shoulder to fingertips) and dorsal-ventral (knuckle to palm) axes.

Developmental biologists …


Becoming Gentrifier/D: Aesthetics, Subjectivities, And Rhythms Of Gentrification In Seoul, South Korea, Myung In Ji Jan 2020

Becoming Gentrifier/D: Aesthetics, Subjectivities, And Rhythms Of Gentrification In Seoul, South Korea, Myung In Ji

Theses and Dissertations--Geography

Gentrification has been extensively studied beyond Euro-American societies. In particular, previous research of Seoul’s residential gentrification has broadened our understanding of the role of the developmental state and property speculation in urban clearance and renewal. However, little attention has been paid to the contemporary retail gentrification in Seoul that has different aesthetics, subjectivities, and rhythms compared to residential gentrification. In retail gentrification, old urban neighborhoods are no longer demolished but cherished with their nostalgic landscapes and atmospheres. In this context, this dissertation project explores Seochon, a gentrifying neighborhood in Seoul, that was designated as a cultural heritage site in 2010. …


Reserved For The Whole Earth: Forms Of Evidence, Ought Anxiety, And The Futures Of Geographic Inquiry, Eric M. Robsky Huntley Jan 2020

Reserved For The Whole Earth: Forms Of Evidence, Ought Anxiety, And The Futures Of Geographic Inquiry, Eric M. Robsky Huntley

Theses and Dissertations--Geography

This dissertation examines geographic forms of evidence in the practices of landscape architects and geographers. I analyze evidence not only as an epistemic phenomenon, but as an aesthetic one, as well. Convincing an audience that the world is (or should be) one way and not another requires that knowledges be stacked, extended, and stitched together in a manner admissable to an audience. In the first two chapters, I use the case of the landscape architect Ian McHarg to examine how his approach to integrating scientific knowledge---a aesthetic response to what I theorize as 'ought anxiety'---grew alongside the environmental bureaucracy in …


Street Musicians, Soundscapes And Hearing The State In Urban Public Spaces Of Istanbul, Lacin Tutalar Jan 2020

Street Musicians, Soundscapes And Hearing The State In Urban Public Spaces Of Istanbul, Lacin Tutalar

Theses and Dissertations--Geography

This study explores street musicians’ routines and associations with public space in Istanbul, Turkey between 2014 and 2016, a period which corresponds to a new, more conservative routine in the aftermath of a time of political contention in 2013. The study overall takes up a rhythmanalytical perspective, following the cultural geography’s interest based on Henri Lefebvre’s use of the term. I contribute to that interest by paying attention to changes in the composition of an urban public in Istanbul through a mix of institutional (e.g. bureaucratic, capitalist and religious) and corporeal (e.g. tourists, musicians, young people, audience, street maintenance, refugees, …


Freakish Taxonomies: How The American Freak Show And Its Literature Redefine The Archive, Megan E. Pillow Jan 2020

Freakish Taxonomies: How The American Freak Show And Its Literature Redefine The Archive, Megan E. Pillow

Theses and Dissertations--English

The American freak show, which dominated the entertainment landscape from 1840 to 1940, is considered by some disability studies scholars to be off limits for critical engagement. In Freakish Taxonomies: How the American Freak Show and its Literature Redefine the Archive, I argue that by casting the freak show solely as an exploitative institution, we overlook its capacity to serve as a model for reinterpreting the relationship between literary studies and the archive. By recognizing the freak show not just as an exploitative institution but also as a dynamic archive of marginalized lives—one that utilizes an imperfect, often deceptive …


Relevant Angry Affect Slows Response Time To Commands, Aleah Combs Jan 2020

Relevant Angry Affect Slows Response Time To Commands, Aleah Combs

Theses and Dissertations--Linguistics

Previous research has found that emotional prosody can interact with speech perception and listeners’ processing of the meaning of particular word/emotion pairings(Kim and Sumner, 2017). What remains unclear is how this interactive processing can affect behavioral responses such as responses to imperatives. To answer this question,71 participants were presented with a series of commands given in a relevant affect.Commands were read either with angry prosody, happy prosody, or neutral prosody (control) and the participants were instructed to press the requested button on a response box as quickly and accurately as possible. All emotional states were simulated and normed for perceived …


An Intonational Description Of African American Language In Princeville, Nc, Christopher M. Dale Jan 2020

An Intonational Description Of African American Language In Princeville, Nc, Christopher M. Dale

Theses and Dissertations--Linguistics

This thesis uses data from the Princeville, NC section of the Corpus of Regional African American Language (CORAAL) in order to address two topics concerning language: first, what the intonation of the Princeville participants of the CORAAL looks like acoustically; and second, if intonation is the salient feature that categorizes a speaker as Black or non-Black. The acoustic analysis software, Praat (Boersma & Weenink 2019), is used to take average, minimum, and maximum f0 measurements for 16 participants (9 women and 7 men) across three age groups. From these measurements, the rate of change is calculated in Hz/second to determine …


“Home Is More Than Just A Place”: Oral Personal Narrative Storytelling In Central Appalachia, Brandon Jent Jan 2020

“Home Is More Than Just A Place”: Oral Personal Narrative Storytelling In Central Appalachia, Brandon Jent

Theses and Dissertations--Linguistics

This project seeks a linguistic understanding of oral personal narrative storytelling in Central Appalachia, particularly as it manifests in Eastern Kentucky, with aims of providing insight into the Appalachian storyteller trope (e.g., Montgomery 1998). Structural and discursive elements of oral personal narrative were identified and positioned within their sociocultural context through discourse analysis and narrative studies. Data were collected from story circles, a methodology first implemented in cultural and community organizing spaces in the South and throughout Appalachia (Roadside Theater 2014, Junebug Productions n.d.). The collected stories were transcribed and analyzed through a discourse analysis framework that combines discourse pragmatics, …


The Coulter Principle: For The Good Of Humankind, Marshall Graham Jan 2020

The Coulter Principle: For The Good Of Humankind, Marshall Graham

Theses and Dissertations--History

The atomic bombings of Hiroshima and Nagasaki in August 1945 made Wallace H. Coulter abruptly comprehend the critical need for rapid and accurate blood-cell counts in providing care for victims of radiation exposure. This thesis documents the unwritten story of his journey from that comprehension through his invention and implementation of the Coulter Principle, its commercialization in the first widely available automated blood-cell counter, and elaboration of that ground-breaking counter into increasingly sophisticated instrumentation for analysis not only of blood cells, but of particles involved in many other scientific disciplines. International cold-war politics and the burgeoning of increasingly powerful nuclear …


Voices “Herd”: A Social And Sentiment Analysis Of Consumers Perceptions Of Fair Oaks Farms, Jacelyn De'nae Nesmith Jan 2020

Voices “Herd”: A Social And Sentiment Analysis Of Consumers Perceptions Of Fair Oaks Farms, Jacelyn De'nae Nesmith

Theses and Dissertations--Community & Leadership Development

Americans are searching for more information than just cost and quality of their food. Today, consumers are searching for information regarding the production practices and how animals are treated during the process. As consumers do not always have a first-hand source for this information, they are often referring to social media to have their questions answered. Social media has the reputation to negatively influence public perceptions of the agricultural industry. An example of an organization experiencing the consequences of social media influencing public opinion is Fair Oaks Farms. In 2019, an undercover animal rights activist group made accusations of poor …


An Examination Of Single-Sex Secondary Agricultural Education Classrooms: The Effects Of Teacher Expectancy, Brett Morris Wasden Jan 2020

An Examination Of Single-Sex Secondary Agricultural Education Classrooms: The Effects Of Teacher Expectancy, Brett Morris Wasden

Theses and Dissertations--Community & Leadership Development

The effectiveness of single-sex classrooms in the United States remains unclear. To address this issue, the purpose of this quasi-experiment was to examine single-sex classrooms in secondary agricultural education classrooms in Kentucky. Data were collected through quantitative pretests and posttests from student participants (n = 168) and teacher participants (n = 8). The findings indicated that student participants in single-sex classrooms had higher academic performance, better attendance, and an increased gain in interest in the agriculture, food, and natural resources career pathway. Students participants in coeducational classrooms had less discipline referrals. Teacher participants’ expectation were related to student …


Measuring The Effects Of Lobinaline-N-Bioxide (419) On Alcohol Consumption, Nicotine Locomotor Sensitization, And Conditioned Place Preference In Mice And Rats, Cocanut M. Suhail Jan 2020

Measuring The Effects Of Lobinaline-N-Bioxide (419) On Alcohol Consumption, Nicotine Locomotor Sensitization, And Conditioned Place Preference In Mice And Rats, Cocanut M. Suhail

Theses and Dissertations--Medical Sciences

Objective: Novel drug 419 was examined to see the effect it has in vivo mice and rats on alcohol consumption, nicotine locomotor sensitization, and conditioned place preference (CPP) models regarding behavioral tests on dopamine transporter activity.

Methods: Mice and rats were used to see how they react to the drug 419 and control vehicle, in each of the models. The animals were assessed to pre- and post- drug administration of novel drug 419. We examined each model to see the association between how drug 419 will help with treating drug abuse.

Results: We found that in alcohol consumption model the …


Involvement Of The Sigma-1 Receptor In Methamphetamine-Mediated Changes To Astrocyte Structure And Function, Richik Neogi Jan 2020

Involvement Of The Sigma-1 Receptor In Methamphetamine-Mediated Changes To Astrocyte Structure And Function, Richik Neogi

Theses and Dissertations--Medical Sciences

Methamphetamine is a highly addictive psychostimulant drug. There are currently no FDA-approved pharmacological treatments for methamphetamine addiction. Pharmacologically, (+)-methamphetamine is a dopamine releasing agent and dopamine transporter substrate that redistributes dopamine from intracellular vesicles via the vesicular monoamine transporter 2 (VMAT2) and reverses the direction of dopamine transport in the dopamine transporter. Methamphetamine, cocaine, and other drugs of abuse are also sigma-1 receptor ligands, and previous studies have demonstrated the role of the sigma-1 receptor in modulating the behavioral and cellular effects of these drugs. However, almost all these studies were conducted in cell culture systems or with emphasis on …


Elucidating The Complex Signaling Events Driving Intestinal Stem Cell Plasticity Following Injury, Evan Lynch Jan 2020

Elucidating The Complex Signaling Events Driving Intestinal Stem Cell Plasticity Following Injury, Evan Lynch

Theses and Dissertations--Microbiology, Immunology, and Molecular Genetics

Signaling events governing intestinal stem cell (ISC) homeostasis maintain the delicate balance of active self-renewal and passive differentiation to replenish intestinal epithelial cells (IEC) every 3-5 days. However, under certain contexts, ISC function is irreversibly compromised—requiring committed IEC lineages to dedifferentiate and regain “stemness”. In the current studies, we examine the signaling events driving epithelial cell responses to injury to expose pathologic failures in the healing response. Our specific goal is to tease out the cellular contexts that promote dedifferentiation to design effective therapeutics for disease conditions compromising ISC function.

First, we generated a novel transgenic animal using the epithelial-specific …


Residential Radon Exposure, Its Contribution To Lung Cancer, And Social Determinants Of Radon Testing, Stacy Stanifer Jan 2020

Residential Radon Exposure, Its Contribution To Lung Cancer, And Social Determinants Of Radon Testing, Stacy Stanifer

Theses and Dissertations--Nursing

Lung cancer is a highly preventable form of cancer. Cigarette smoking is the leading cause of lung cancer followed by radon gas exposure and exposure to secondhand smoke. Kentucky leads the nation in both incidence and mortality from lung cancer. Tobacco use in Kentucky continues to be a major public health concern as nearly one-quarter of adults report current tobacco use and just over one-third of Kentucky homes with children lack rules which prohibit smoking in the home. Radon, a colorless, odorless radioactive gas, occurs naturally from the decay of uranium found in rocks and soil and is harmful when …


Tobacco Use And Nicotine Withdrawal Among Patients With Mental Illness, Yazan Daher Al-Mrayat Jan 2020

Tobacco Use And Nicotine Withdrawal Among Patients With Mental Illness, Yazan Daher Al-Mrayat

Theses and Dissertations--Nursing

People with mental illness (MI) are disproportionately affected by tobacco use compared to the general population. In fact, it is estimated that people with MI consume approximately 44% of cigarettes smoked in the United States. Moreover, the MI population is at greater risk for the negative social, economic, and health consequences associated with tobacco use and are reported to have 25-year shorter life expectancies than the general population. The impact of tobacco use is further noticeable among patients with MI who require psychiatric hospitalization. Quitting smoking in this population has been linked to fewer discharges against medical advice, better quality …


Relationship Between Initial Prescription Opioid Exposure Length And Future Opioid Use Disorder Diagnosis In Opioid Naive Adolescents, Eric Lindahl Jan 2020

Relationship Between Initial Prescription Opioid Exposure Length And Future Opioid Use Disorder Diagnosis In Opioid Naive Adolescents, Eric Lindahl

Theses and Dissertations--Pharmacy

Objectives: The long-term risks associated with the use of short-term prescription opioids in opioid naïve adolescents in not well characterized. The purpose of this study was to explore the potential association between the days’ supply of the initial prescription opioid exposure and the rates of diagnosed OUD in the subsequent 3-year period. Methods: We conducted a retrospective cohort study using a nationwide database of commercially-insured adolescents aged 12-17 at the time of the index opioid fill. A multivariable Cox Proportional Hazard regression model was developed to analyze the association of interest while accounting for known risk factors for the development …


The Impact Of Bone Marrow Transplantion On Patients With Psychiatric Diagnoses: Medication Adherence Assessment, Brittany Galop Jan 2020

The Impact Of Bone Marrow Transplantion On Patients With Psychiatric Diagnoses: Medication Adherence Assessment, Brittany Galop

Theses and Dissertations--Pharmacy

Objectives: We investigated whether there is a measurable difference in medication utilization for psychiatric conditions before and after bone marrow transplantation (BMT). Previous studies have identified a potential association between psychiatric conditions and immune function. We hypothesized that medication utilization for psychiatric diagnoses would be impacted by BMT.

Methods: This study was a retrospective, quasi-experimental cohort design. De-identified data was compiled from the Truven database for patients ranging from January 2009 through December 2016. Two measurements of medication utilization, proportion of days covered (PDC) and medication possession ratio (MPR) were calculated for each included Medispan-defined class of medications before analyzing …


Antiresorptive Bone Therapy Use In Advanced Lung Cancer And Associated Outcomes, Noor Naffakh Jan 2020

Antiresorptive Bone Therapy Use In Advanced Lung Cancer And Associated Outcomes, Noor Naffakh

Theses and Dissertations--Pharmacy

Background/Rationale: Studies have shown antiresorptive agents decrease skeletal related events in metastatic non-small cell lung cancer. However, two prevalence studies have found low utilization rates of antiresorptive therapy in advanced lung cancer. The first study reported a rate of 14.8% during the 1995-2009 time period, while the second study reported a 33% usage rate during the time frame of 2002-2011. We believe these low utilization rates are associated with the poor prognosis of these patients. The prognosis of advanced lung cancer has improved significantly since these trials were conducted, and the utilization of denosumab has not been evaluated. We hypothesize …