Digital Commons Network^™

Therapeutic Targeting Of Leukemia Stem Cells To Prevent T-Cell Acute Lymphoblastic Leukemia Relapse, Meghan G. Haney

Theses and Dissertations--Molecular and Cellular Biochemistry

The survival rate of T-cell Acute Lymphoblastic Leukemia (T-ALL) relapse is a dismal 10% of affected adults and 30% of children, largely due to the relapsed disease being more aggressive and treatment resistant than the initial disease. Relapse is thought to occur because conventional chemotherapies are unable to reliably eliminate a unique cell type known as leukemia stem (or propagating) cells (LSCs). LSCs are the only cells within the leukemia with the ability to self-renew and remake or replenish the ALL from a single cell. Currently, the pathways governing self-renewal in LSCs are largely unknown, precluding our ability to successfully …

Substrate Trafficking Within The Type Vii Secretion Systems Of Pathogenic Mycobacteria, Zachary A. Williamson

Theses and Dissertations--Molecular and Cellular Biochemistry

Tuberculosis (TB), primarily caused by infection of Mycobacterium tuberculosis (Mtb) in the lungs, is the deadliest infectious bacterial disease killing 1.5 million people annually. A major determinant of virulence is active secretion through three specialized type VII secretion (ESX) systems; ESX-1, ESX-3, and ESX-5. A large group of substrates exported by the ESX systems is the PE (Proline-Glutamine) and PPE (Proline-Proline-Glutamate) families of proteins, which are highly expanded in the pathogenic species of Mycobacteria and encompass over 7% of Mtb’s genome coding capacity. PE and PPE proteins interact together to form PE-PPE heterodimers, and are secreted through …

Reversible Glucan Phosphorylation In The Red Alga, Cyanidioschyzon Merolae, Corey Owen Brizzee

Theses and Dissertations--Molecular and Cellular Biochemistry

Starch and glycogen are an essential component for the majority of species and have been developed to maintain homeostasis in response to environmental changes. Water-soluble glycogen is an excellent source of quick, short-term energy in response to energy demands. In contrast, plants and algae have developed the macromolecule starch that is elegantly suitable for their dependence on external circumstances. Semi-crystalline starch is water-insoluble and inaccessible to most amylolytic enzymes, thus plants and algae have developed a coordinated system so that these enzymes can gain access to the denser starch energy cache. Starch-like semi-crystalline polysaccharides are also found in red algae, …

Examination Of Sex- And Intensity-Specific Fatigue During Bilateral Leg Extension Exercise, Taylor Kayln Dinyer

Theses and Dissertations--Kinesiology and Health Promotion

The purposes of this study were to: 1) examine sex-related differences in the performance of repetitions to failure below (CL_-10%, CL_-20%) and above (50%, 60%, 70%, and 80% 1RM) the critical load (CL) to make inferences regarding the mechanisms responsible for variability in the performance of repetitions to failure at varying loads; 2) examine the time course of neuromuscular and muscle oxygen saturation responses during the performance of repetitions to failure below and above the CL; 3) to make inferences regarding motor unit activation strategies used to maintain force during the completion of repetitions below and …

Characterization Of Spontaneous Preeclampsia In The African Green Monkey (Chlorocebus Aethiops Sabaeus), Chelsea Christina Weaver

Theses and Dissertations--Biology

Hypertensive pregnancy disorders are a major contribution to maternal and neonatal mortality worldwide. Two of these disorders, preeclampsia and chronic hypertension in pregnancy, affect up to 10% of all pregnancies. These hypertensive disorders of pregnancy are associated with long-term, postnatal risk factors for both mother and offspring. Despite numerous recent advances in preeclampsia research, the underlying mechanisms are still not understood. This could be due to lack of a spontaneous animal model. This dissertation presents the African Green Monkey (AGM; Chlorocebus aethiops sabaeus) as the first known spontaneous animal model of preeclampsia and a highly translational model of chronic …

Spontaneous Postpartum Hypertension In The African Green Monkey, Patrick Rivera

Theses and Dissertations--Biology

Postpartum hypertension (PPHT) is a hypertensive disorder of the puerperium that occurs in women at a rate between 0.8-28% although the exact incidence is unknown due primarily to its transient presentation during a time of reduced medical supervision. The etiology of PPHT is currently unknown with no present experimental animal model. We present the African green monkey (Chlorocebus aethiops sabaeus; AGM) as a potentially translational NHP model of PPHT in humans. AGMs were identified as PPHT using Doppler sphygmomanometry and American Heart Association standards of hypertension for systolic blood pressure (systolic blood pressure > 140 mmHg). Disease characteristics were …

Cellular Bioenergetics Regulates Cell Proliferation During Mammalian Regeneration, Sandeep Saxena

Theses and Dissertations--Biology

Mammalian system consists of stress-sensing molecules that regulates their cellular response against damage, injury and oncogenic stress. During vertebrate regeneration, cells responding to injury re-enter the cell cycle and proliferate to form new tissue. Cell cycle re-entry or arrest is at least partly regulated by cellular senescence which negatively impacts the proliferative pool of cells during regeneration. What remains unclear is whether cells in regenerating systems possess an increased propensity to proliferate and are refractory to signals that induce senescence. My thesis work has focused on how fibroblasts from the ear pinna differentially regulate healing in highly regenerative mammals (e.g., …

Cloning And Functional Characterizations Of Circular Rnas From The Human Mapt Locus, Justin R. Welden

Theses and Dissertations--Molecular and Cellular Biochemistry

Under pathophysiological conditions, the microtubule protein tau (MAPT) forms neurofibrillary tangles that are the hallmark of sporadic Alzheimer’s disease as well as familial frontotemporal dementias linked to chromosome 17 (FTDP-17). In this work, I report that MAPT forms circular RNAs through backsplicing of exon 12 to either exon 10 or exon 7 (12→10; 12→7), and that these circular RNAs are translated into proteins.

Using stable cell lines overexpressing the circular tau RNAs 12→7 and 12→10, we have discovered that the tau circular RNA 12→7 is translated in a rolling circle, giving rise to multiple proteins. This circular RNA …

Pre-Clinical Advancements In Biomarkers, Tools, And Therapeutics For A Metabolic Neurodegenerative Disease, Zoë Simmons

Theses and Dissertations--Molecular and Cellular Biochemistry

Glycogen is the storage form of glucose and a highly important substrate for cellular metabolism. Characterization of the enzymes and mechanisms of glycogen metabolism began over 70 years ago and over the last 20 years, a previously unknown protein called laforin has emerged as an important contributor to glycogen metabolism homeostasis. Multiple labs demonstrated that laforin is a glycogen phosphatase and mutations in the gene encoding laforin cause the formation of aberrant glycogen-like aggregates called Lafora bodies (LBs). LBs are cytoplasmic, water-insoluble aggregates that drive neurodegeneration and early death in Lafora disease (LD) patients. The direct relationship between mutated laforin, …

Toward Intelligent Welding By Building Its Digital Twin, Qiyue Wang

Theses and Dissertations--Electrical and Computer Engineering

To meet the increasing requirements for production on individualization, efficiency and quality, traditional manufacturing processes are evolving to smart manufacturing with the support from the information technology advancements including cyber-physical systems (CPS), Internet of Things (IoT), big industrial data, and artificial intelligence (AI). The pre-requirement for integrating with these advanced information technologies is to digitalize manufacturing processes such that they can be analyzed, controlled, and interacted with other digitalized components. Digital twin is developed as a general framework to do that by building the digital replicas for the physical entities. This work takes welding manufacturing as the case study to …

Combining Approximate Computing And Adiabatic Logic For Low-Power And Energy-Efficient Iot Edge Computing, Wu Yang

Theses and Dissertations--Electrical and Computer Engineering

The growing data-intensive applications that run on IoT edge devices require the circuit to be low-power consumption and energy-efficient for limited resources. As conventional Complementary Metal-Oxide-Semiconductor (CMOS) scales down to the nanometer technology node, it reaches its limits, such as leakage and power consumption. Adiabatic logic and approximate computing are emerging techniques for the low-power circuit. Adiabatic logic can recycle energy which is a promising solution for building energy-efficient circuits. However, the power clock scheme and dual-rail structure of adiabatic logic increase the overall area. Power consumption is further reduced by applying approximate computing while reducing the complexity and size …

Machine Learning Approach For Vigilance State Classification In Mice, Anik Muhury

Theses and Dissertations--Electrical and Computer Engineering

Sleep has a significant impact on cognitive abilities such as memory, reaction time, productivity, and creative thinking; however, there are many aspects of this important activity that are not clearly understood. Over the last century, researchers have developed technology and animal models to assist in the study of sleep. Manual sleep scoring is time consuming, reduces productivity, and is impacted by human scorer subjectivity. On the other hand, automatic sleep stage categorization can enhance consistency and reliability, aiding professionals in identifying sleep related health problems.

In recent times various studies reported significant achievements for automatic vigilance detection and overcome the …

Accelerometer-Based Vigilance State Classification In Dairy Cows, Evan King

Theses and Dissertations--Electrical and Computer Engineering

Globally, dairy farming is a $700 billion industry, with more than 9 million dairy cows in the United States alone. Depriving cows of required activities such as sleep has been shown to negatively impact reproductive efficiency, decrease the volume of milk produced, and increase the risk of culling. Overcrowded herds can decrease individual animal health, demanding the need for automatic behavior detection that would provide insight into their state of health.

Using electroencephalography (EEG), electrooculography (EOG), and electromyography (EMG) to characterize the phases of sleep is a technique which has been used for decades. While these techniques are considered the …

Designing Novel Hardware Security Primitives For Smart Computing Devices, Amitkumar Degada

Theses and Dissertations--Electrical and Computer Engineering

Smart computing devices are miniaturized electronics devices that can sense their surroundings, communicate, and share information autonomously with other devices to work cohesively. Smart devices have played a major role in improving quality of the life and boosting the global economy. They are ubiquitously present, smart home, smart city, smart girds, industry, healthcare, controlling the hazardous environment, and military, etc. However, we have witnessed an exponential rise in potential threat vectors and physical attacks in recent years. The conventional software-based security approaches are not suitable in the smart computing device, therefore, hardware-enabled security solutions have emerged as an attractive choice. …

The Associations Among Parental Emotional States, Adolescent Emotional States, And A1c In Adolescents With Type 1 Diabetes, Jennifer L. Yenke

DNP Projects

Background: This study examined depression and diabetes distress (DD) in adolescents with type 1 diabetes (T1D) and in their parents. Depressive symptoms and DD are associated with poor glycemic control.

Objectives: To describe the prevalence of parental and adolescent depressive symptoms and DD in the sample and to evaluate correlations among depressive symptoms, DD, and A1c in parent-adolescent dyads in which the adolescents have T1D.

Methods: Thirty-two parent-adolescent dyads completed measures assessing depressive symptoms (Patient Health Questionnaire-9) and DD (Problem Areas in Diabetes- Parent of Teen and Teen versions), self-reported socio-demographic and clinical variables, and responded to questions about living …

Evaluation Of The Effectiveness Of Emergency Department Through-Put Based On Provider Type In A Critical Access Hospital, Deanna Faye Dingus Hamilton

DNP Projects

Abstract

Purpose: To evaluate effectiveness and timeliness of through-put in the emergency department based on provider type in a rural critical access hospital in eastern Kentucky.

Design: A retrospective, observational review was conducted at a small critical access hospital. Descriptive statistics including Mann Whitney and Chi square were performed to evaluate significance.

Methods: Pre-intervention 552 charts were abstracted and 1656 post-intervention charts were abstracted. Arrival time to triage, triage to provider and provider to disposition times in minutes were collected. A prospective survey regarding comfort level with performing advanced practice skills was given to the advanced providers who were working …

Promotion Of Most Forms Through Education About Importance Of Advance Care Planning In Seriously Ill Patients, Nidhi More

DNP Projects

Abstract

Purpose: To establish the importance of early Advance Care Planning (ACP) and improve the utilization of Medical Orders for Scope of Treatment (MOST) forms in seriously ill patients by educating providers and nurses to identify patients who meet specified criteria. The goals of this intervention are reduction of readmissions and better quality of life for this patient population.

Methods: A quasi-experimental design was used for evaluation of an Educational intervention to promote MOST forms, Advance Directives (AD) and Palliative Care (PC) consults. A retrospective and prospective chart review was conducted to determine the number of patients who met criteria …

Improving Multidisciplinary Adherence To A Daily Goals Checklist In The Icu: A Quality Improvement Initiative, Chelsea Mccarty

DNP Projects

Abstract

Background: In November 2019, the University of Louisville Hospital merged and assumed operations of all KentuckyOne facilities. During the transition, a spike in hospital acquired infection rates ensued at Jewish Hospital, notably amongst the critical care units. In January 2020, a daily checklist was introduced to the critical care department. A Daily Checklist is a tailored communication tool designed to reduce communication error and improve adherence to patient safety measures. There continues to be a gap in adherence to the U of L daily checklist from both nurses and providers. Purpose: The purpose of this project was to improve …

The Effect Of An Acuity Adaptable Unit On Efficiency In Non-Critical Trauma Patients, Rebecca Charles

DNP Projects

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient …

Care Coordination Of The Geriatric Traumatic Fracture Patient: A Multimodal Approach To Pain Management, Alexandra Keough

DNP Projects

Introduction: Traumatic fractures are increasing in incidence across the country, particularly in the aging population. Geriatric patients who are admitted to the acute care setting for traumatic fractures are a unique population that require acute pain management, while also managing other comorbidities. While there are several guidelines on pain management for patients who are admitted to the acute care setting, there are no specific guidelines on the best practices to manage acute pain in the geriatric traumatic fracture population. Evidence supports a multimodal pain management strategy using pharmacologic and non-pharmacologic means as the best way to care for this population. …

A Multi-Faceted Intervention To Reduce Low Value Diagnostic Studies In A Medical Intensive Care Unit., Jessica Caicedo

DNP Projects

Routine daily chest x-rays (CXRs) and laboratory studies have been identified as low-value care practices that contribute to the rising cost of healthcare without improving quality or outcomes. There is a large body of evidence as well as recommendations from multiple professional organizations for providers to not order unnecessary daily or routine diagnostic studies. Rather, these should be ordered in an on-demand fashion as a response to a specific clinical query. Despite the strength of recommendations, practice remains variable across the U.S. The reasons for resistance to practice change as well as the most effective strategies for implementing sustainable change …

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Home Point Of Care Inr Testing In Left Ventricular Assist Device Patients: A Clinical Evaluation, Emily Corsentino

DNP Projects

Purpose: The purpose of this project was to evaluate the complications and adverse events in left ventricular assist device (LVAD) patients when comparing those using home point of care (POCT) international normalized ratio (INR) testing versus lab testing. Additionally, the time in therapeutic window for both these groups was studied. A cost benefit analysis was performed. All this data was compiled into a provider education evaluated by a pre and post-survey design.

Methods: The project is a single-center study that will occur at the University of Kentucky Chandler Medical Center. It is a cross-sectional, pre/post-test design. Data will be collected …

The Impact Of Identifying And Addressing The Social Needs Of Patients With Type 2 Diabetes Mellitus In A Primary Care Clinic, Shelby Roberts

DNP Projects

BACKGROUND: A key aspect of successful Diabetes management is addressing social needs. Patients prefer individualized care that is tailored to their specific needs.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to screen patients regarding their diabetes distress and social needs requirements to develop and implement individualized social needs interventions.

METHODS: Patients were included in the study if they had a Hemoglobin A1C >9. Patients were screened, provided additional check in points and social needs were addressed in conjunction with the patient’s primary care provider and onsite social worker. Post intervention …

Anxiety Screening In Children & Adolescents With Type 1 Diabetes Using The Gad-7 Tool, Allison B. Reynolds

DNP Projects

BACKGROUND: Children and adolescents with type 1 diabetes (T1DM) can encounter a variety of factors that affect proper management of their diabetes, including mental health. Youth with diabetes have significantly higher rates of depression, anxiety, and mental health problems compared to the general population. Anxiety is especially prevalent. PURPOSE: The objective of this project was to evaluate anxiety screening of children and adolescents with T1DM during their routine diabetes visits. Specifically, to assess for any trends in anxiety levels and patient characteristics including demographics, insulin regimen and A1C levels. METHODS: A cross- sectional, retrospective review of ambulatory electronic health records …

The Impact Of A Change In Leadership, Taylor Collins

DNP Projects

Abstract

Background: Unmitigated stress in nursing results in moral distress, burnout, turnover and poor patient outcomes. Authentic leaders can improve the nurses’ work environment and satisfaction by improving communication and implementing supportive measures.

Purpose: The purpose of this study was to determine whether a change in executive leadership at BSW Grapevine Medical Center reduced nursing job stress as evidenced by improved nurse satisfaction, nurse retention, nurse engagement, patient satisfaction and care outcomes.

Conceptual Framework: Watson’s Theory of Human Caring

Design: This study is a quantitative, descriptive retrospective measurement of two points in time, before and after …

Evaluation Of A Spontaneous Breathing Trial Extubation Protocol On Patient Outcomes, Joshua Caldwell

DNP Projects

Background: Evidence correlates better patient outcomes with shorter ventilator days therefore, without contraindications, patients should be removed from continuous mechanical ventilation as soon as safely possible. Exactly how to assess readiness to extubate and when to extubate is still up in the air.

Purpose: Evaluation of a 30-minute spontaneous breathing trial extubation protocol on patient outcomes and to also evaluate staff education of the 30-minute spontaneous breathing trial extubation protocol on adherence and patient outcomes

Methods: This is a retrospective and prospective evidence-based quality improvement project comparing patient outcomes before and after staff education as well as patient outcomes between …

S.A.F.F.E.R. Airway Management: Evaluating The Effectiveness Of Checklist Implementation On Reducing Peri-Intubation Complications In An Air Medical Transport Service, Rachael M. Croley

DNP Projects

Background: Advanced airway management via endotracheal tube placement in the critically ill and injured is tenuous and presents a multitude of challenges that threaten patient safety. The potential for procedure-associated hypoxia, hypotension, and cardiac arrest during the peri-intubation period can be detrimental to overall patient outcomes. Purpose: The purpose of this project is to evaluate the effectiveness of the Standardized Airway Flow For Engineered Resuscitation (S.A.F.F.E.R.) checklist in reducing peri-intubation complications and provider perception of checklist implementation when performing advanced airway procedures.

Methods: A case-control analytical observational design study which included retrospective and prospective electronic medical record review to determine …

End-Of-Life Nursing Consortium To Improve The Gap In Palliative Care, Emma Kroger

DNP Projects

Abstract

Objective: The purpose of this project is to implement a palliative care education intervention with a pre- and post-survey to assess knowledge, emotional preparedness, and confidence in undergraduate nursing students at the University of Kentucky.

Aim: The aim of this project is to address the gap in palliative care education by increasing professional knowledge, emotional preparedness, and confidence levels in regards to palliative care of future nurses at the University of Kentucky.

Background: The terms “hospice” and “palliative” are often used interchangeably in the healthcare setting. However, palliative care focuses on symptom management in all stages of acute, chronic, …

Sustainability Of A Dnp Qi Project On Bmi Screening And Weight Management Documentation In Primary Care, Assal Moori Shir Mohammadi

DNP Projects

Background: Nurses with a Doctor of Nursing (DNP) degree are prepared at the highest level of expertise to provide safe and efficient health care to patients and help bridge the gap between research and evidence-based health care. Although DNP students invest significant effort, time and resources to implement quality improvement (QI) projects, the sustainability of the outcomes of these is not well studied and empirical evidence on sustainability of quality improvement interventions is very limited.

Objective: To assess the sustainability of the QI project titled: “Using Rapid Cycle Improvement to Improve Weight Management” over time and evaluate the characteristics of …