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 …

Evaluating The Effect Of An Electronic Health Record Patient Portal On The Management Of Hypertension, Ashley Hall

DNP Projects

Background: Hypertension is the leading cause of cardiovascular disease and affects individuals globally, nationally, and locally. Consequences of uncontrolled hypertension include atherosclerosis, heart failure, stroke, and renal disease. The electronic health portal is a patient-specific, interactive tool that has been shown to promote adherence to provider recommendations and improve chronic disease management.

Purpose: The purpose of this project was to determine the effects of education via an electronic healthcare portal on the blood pressure management of adults at a primary care clinic in a small town in Kentucky.

Methods: This study was a one-group pre/post intervention designed to evaluate provider …

Identification Of Infant Feeding Practices In Eastern Kentucky And Southern West Virginia That Correlate With High Weight-For-Length, Havilah R. Adkins

DNP Projects

Background: Approximately 20% of children in the United States are obese. West Virginia and Kentucky rank in the top 10 for obesity rates in children as young as 2-4 years old. Obesity increases the risk for numerous short-term health problems and impacts long-term health, development, quality of life, and life expectancy. Research indicates that obesogenic behaviors can be addressed prior to the development of obesity or significant health problems to prevent, rather than treat. Interventions targeting caregivers of infants younger than 2-years can promote early development of healthy feeding habits that persist through the developmental stages of nutrition. Before a …

Population Assessment To Determine The Eligibility For Birth Center Care At University Of Kentucky Midwife Clinic, Dolores Polito

DNP Projects

Background: The COVID-19 crisis prompted patients to inquire about their options to avoid going to the hospital for birth. Outside of the hospital, birth center care has been identified as an evidence-based model for healthy women during pregnancy and birth, but it is not available in Kentucky.

Purpose The purpose of this study was to determine if there are women eligible for birth center care who have been part of a nurse midwifery service and given birth in a large, academic, tertiary care setting.

Methods: A retrospective chart review was used for this study. It involved a collection of …

Positive Reflective Journaling As A Tool For Managing Stress And Promoting A Healthy Work Environment In Nursing Academia, Roxanne Gall

DNP Projects

Abstract

Background: Teaching and nursing are consistently cited as the two occupations that work under the highest levels of occupational stress. Positive Reflective Journaling may be a tool that helps to manage stress and influence a healthy work environment in academic nursing settings.

Purpose: The purpose of this study was to investigate whether Positive Reflective Journaling could be used as an adjunct to reduce stress and support a healthy working environment in

nursing academia.

Methodology: Eighty-six faculty and staff from a University based School of Nursing were invited to participate in the study. A positive reflective journaling exercise was evaluated …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

Evaluating The Sustainability Of A Colorectal Cancer Screening Improvement Intervention, Kimberly Bastin

DNP Projects

Background: Sustainability is a domain or characteristic of quality in healthcare that is not just about what may be delivered to patients today, but what can continue to be delivered to patients in the long term. Evidenced based interventions and quality improvement (QI) initiatives have led to major advancements in health care and have become expected in every clinical setting. Despite the amount of QI work taking place, there is limited evaluation of the sustainability of initially successful quality improvement efforts and a lack of evidence supporting best strategies and measures to ensure that improvement of goals and outcomes are …

The Effect Of Multimethodological Emotional Intelligence Training On Emotional Intelligence Levels In Nurses At An Academic Medical Center, Chad Eldridge

DNP Projects

Background: Stress levels associated with the nursing career can be amplified by hostile social environments in the workplace, horizontal aggression, lack of leadership support, and poor communication. This can lead to poor retention rates and increased burnout.

Conversely, supportive work environments positively influence nursing sensitive quality indicators such as patient satisfaction, nosocomial infections, patient falls, pressure ulcers, and medication errors. Strong relationships enhance workplace social capital leading to an increased sense of belonging, strengthened mental health, and improved job satisfaction ratings.

Executive nurse leaders can promote an empowering environment dedicated to the physical, mental, and social well-being of their staff …

Effectiveness Of Point-Of-Care Ultrasound Education For Advanced Practice Providers, Nicole Brumfield

DNP Projects

Abstract

Background: Provider shortages and demands for inpatient providers have led to an increase in the utilization of Advanced Practice Providers (APPs). The increased use and specialization of APPs has brought attention to education and skills that have been instituted for other provider types but remains missing from the APP curricula. One such example is point-of-care ultrasound (POCUS) education. This technology and skill set have been shown to enhance clinical skills, confidence levels, and provide useful information for the provider to enhance clinical decision making for the patient.

Purpose: The purpose of this project was to evaluate the effectiveness of …

Improving Tobacco Cessation Counseling Documentation In The Primary Care Setting, Brittany Roher

DNP Projects

BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation …

Optical Seed Sorter-Based Selection Lowers Deoxynivalenol Accumulation In Soft Red Winter Wheat, William Jesse Carmack

Theses and Dissertations--Plant and Soil Sciences

Fusarium head blight (FHB) of wheat (Triticum aestivum L.) results in discolored grain contaminated with deoxynivalenol (DON). DON accumulation, an indicator of FHB resistance, can be quantified and used as the basis for direct phenotypic selection, but testing is expensive. The primary objective of this study was to evaluate an optical seed sorter as an alternative to DON testing for FHB resistance breeding. Three hundred F4 derived soft red winter wheat (SRWW) breeding lines were grown in an inoculated FHB nursery over several years in Lexington, KY. Grain from each breeding line was sorted using an optical seed sorter calibrated …

Evaluation Of Corn Agronomic Management Practices Following A Rye Cover Crop, Daniel John Quinn

Theses and Dissertations--Plant and Soil Sciences

Fall implementation of a rye (Secale cereale L.) cover crop (RCC) prior to spring corn (Zea mays L.) planting is a management practice used to improve soil conservation, water quality, and limit herbicide dependence. However, corn growth and yield following a RCC is often reduced due to early-season nitrogen (N) stress and decreased plant emergence, which can limit RCC adoption. The objective(s) of this research were to evaluate corn agronomic management practices (e.g., N and seeding rate management, in-furrow (IF) starter use) following a RCC and determine which management practices can be used to limit corn stress following …

Incorporation Of Summer Annual Mixtures Into Grazing Systems In Kentucky, Kelly Marie Mercier

Theses and Dissertations--Plant and Soil Sciences

Utilizing summer annual grass-legume forage mixtures has the potential to improve forage yield and nutritive characteristics, and/or animal performance during times when cool-season pasture growth is limited by high temperatures. Legumes can utilize atmospheric nitrogen, which can increase crude protein and forage digestibility in mixtures. As nitrogen application generally improves both the yield and nutritive characteristics of summer annual forages, but can have a negative effect on legume competitiveness, nitrogen fertilizer recommendations for legume-containing summer annual mixtures are not well established.

Two experiments were conducted to determine the feasibility of utilizing summer annual mixtures in Kentucky, USA. The first experiment …

Genomic Selection Strategies To Predict Grain Yield And Disease Resistance Traits In A Wheat Breeding Program, Virginia Laura Verges

Theses and Dissertations--Plant and Soil Sciences

Genomic selection (GS) is a form of marker-assisted selection (MAS) that simultaneously estimates all locus, haplotype or marker effects across the entire genome to calculate genomic estimated breeding values (GEBVs). Since its inception, it has had the attention of breeders keen on finding tools to accelerate genetic gain and reduce phenotyping costs in the breeding program. A first objective of this study was to evaluate strategies to design the training population (TP) and validating population (VP) to estimate GEBVs for grain yield and agronomic traits for wheat breeding lines. Our results demonstrate that, despite the small family size, an approach …

Bone In The Breast: A Case Report Of A Metaplastic Breast Cancer With Osseous Differentiation, Kyle Luo, Xiaoqin Wang

Radiology Faculty Publications

Metaplastic breast carcinoma is an uncommon malignant tumor with various pathologic subtypes. Diagnosis is often challenging due to the wide spectrum of clinical and imaging presentations. Here, we present the case of a very rare subtype of metaplastic breast carcinoma-a mixed-type metaplastic breast cancer with osseous differentiation in a 55-year-old female patient. The clinical presentation, imaging-pathology diagnosis, and treatment options are reviewed. Knowing this rarely reported but aggressive breast cancer is very important for clinicians to establish a timely diagnosis for effective management.

Optimization Of Gelatin-Based Cellular Coating Of Msc For Myocardial Infarction Therapy, Kara Amelle Davis

Theses and Dissertations--Chemical and Materials Engineering

Cardiovascular disease remains the number one threat to American lives. During an acute myocardial infarction (AMI), blood flow is blocked and results in the formation of scar tissue. As the body’s immune system responds, inflammatory signaling causes an increase in both scar tissue size and the patient’s risk for further chronic heart failure. In order to reduce the risk of continued heart disease inflammatory signaling must be reduced. Stem cell therapies have the ability to alter the immune system’s pro-inflammatory signal. However, stem cell retention is limited due to blood flow shear. Gelatin methacrylate (GelMA) based coatings have been shown …

Assessment Of A Decentralized Solution For Waste Plastic Management In Developing Regions, Chandniben Ashishkumar Joshi

Theses and Dissertations--Chemical and Materials Engineering

Rapid population growth, urbanization and availability of pre-packaged consumer goods have led to increased generation and consumption of plastic – so much so that it has become ubiquitous in the environment. An affordable, durable, and lightweight material of construction, plastic is used in innumerable products in every country on earth. However, this explosion of consumption coupled with the material’s significantly low degradability have led to serious plastic accumulation challenges, which are now an imminent threat to terrestrial and marine species globally. These challenges are especially acute in developing countries, where capital and infrastructure constraints, poor governmental regulation and lack of …

Interactions Of Lignin Dimers With Engineered Surfaces And Model Cell Membranes For Design Of Lignin-Based Materials, Mahsa Moradipour

Theses and Dissertations--Chemical and Materials Engineering

Capitalizing on byproducts of industrial and agricultural economies is among the utmost goals of sustainability. Of particular interest for commercial upgrading is lignin, a phenolic biopolymer found in the cell walls of plants which is the second most abundant biopolymer on Earth after cellulose. Due to its heterogeneous structure, deconstructing lignin to selected small molecules for use as chemicals or advanced materials has been elusive. This work capitalizes on a “bottom up” approach to the synthesis of lignin oligomers of known bond chemistry to better understand their interfacial interactions.

The potential pharmacological mechanism of lignin deconstruction components and their toxicological …

Clpxp Degradation System In Escherichia Coli, A Study Of Its Energy Sources And Its Applications In Managing The Expression Levels Of Targeted Membrane And Soluble Proteins, Thilini Abeywansha

Theses and Dissertations--Chemistry

ClpXP is an Escherichia coli protease that carries out energy-dependent intracellular proteolysis. In recent years, this system has been widely studied due to its importance as protein regulatory machinery and a virulence factor. Protein substrates of ClpXP contain degrons with a specific protein sequence. SsrA tag is one of the five degrons known to designate proteins for ClpXP degradation. SsrA is an 11 amino acid peptide added to the C-terminus of nascent polypeptide chains translated from aberrant messenger RNAs lacking stop codons via a process called trans-translation.

ClpXP was known to targets only cytosolic proteins with degrons until recently, …

Rational Design Of Small Molecule Disruptors Of Protein-Protein Interactions: Pd-1/Pd-L1; C-Myc, Arid4b, Samuel Ofori

Theses and Dissertations--Chemistry

Protein-protein interactions (PPIs) are vital to many biological processes, including gene expression, and immune reactions to pathogens. There are approximately 650,000 PPIs in humans with pertinent physiological functions. Aberrant expression of PPIs lead to improper function and contribute to a plethora of disease conditions including cancer. Thus, PPIs represent an enormous target space for drug discovery and chemical probes. Direct targeting of clinically relevant PPIs with small molecules remains an unmet medical need. Development of small-molecule inhibitors of PPIs is a challenging enterprise and in most cases considered undruggable due to large protein surfaces, lack of deep binding pockets and …

Investigation Of Multidrug Efflux Transporter Acrb In Escherichia Coli: Assembly, Degradation And Dynamics, Prasangi Irosha Rajapaksha

Theses and Dissertations--Chemistry

The Resistant Nodulation Division (RND) super family member, tripartite AcrA-AcrB-TolC efflux pump, is a major contributor in conferring multidrug-resistance in Escherichia coli. The structure of the pump complex, and drug translocation by functional rotation mechanism have been widely studied. Despite of all these data, the dynamics of the assembly process of the pump and AcrB during functional rotation in the process of drug efflux remains poorly understood. My thesis focuses on understanding the pump assembly process, dynamics of AcrB in functional rotation mechanism, and also investigate the mechanism of degradation of AcrB facilitated by a C-terminal ssrA tag.

In the …

Probing The Assembly, Functional Relevance, And Dynamics Of Acra In Multi Drug Efflux In Escherichia Coli, Isoiza Ojo

Theses and Dissertations--Chemistry

Efflux pumps and low permeability of the outer membrane of gram-negative bacteria are major culprits in drug resistance. The most studied of these multidrug efflux pumps is the AcrAB-TolC, a complex of three proteins, the inner membrane transporter AcrB, the periplasmic adaptor AcrA and outer membrane factor TolC. This pump exports a wide range of molecules such as dyes, detergents, and antibiotics out of the bacteria system into the external environment. AcrB and TolC exist as obligate trimers, but the structure of AcrA during the assembly process is not well defined. My research aims to explore the functional and structural …

Design, Synthesis, And Anticancer Properties Of Ru(Ii) Complexes With Organometallic, “Expanded” Bipyridine, And O,O’-Chelating Ligands, Raphael Ryan

Theses and Dissertations--Chemistry

Cancer is a worldwide public health crisis that requires new and improved drugs to be developed to extend survival rates and improve quality of life for the patient. Platinum-based drugs are used in approximately 50% of cancer treatment regimens. These drugs are highly effective in many kinds of cancer; however, cancers can develop platinum resistance and these drugs have troubling side effects that reduced their use and efficacy. To overcome these disadvantages, many other metals have been studied for their anticancer properties. Notably, the anticancer properties of ruthenium-based agents have drawn considerable attention with multiple ruthenium complexes entering clinical trials. …

Tailoring Thermoresponsive Poly(N-Isopropylacrylamide) Toward Sensing Perfluoroalkyl Acids, Dustin Thomas Savage

Theses and Dissertations--Chemical and Materials Engineering

Widespread distribution of poly- and perfluoroalkyl substances (PFAS) in the environment combined with concerns for their potentially negative health effects has motivated regulators to establish strict standards for their surveillance. The United States Environmental Protection Agency issued a cumulative domestic threshold of 70 ppt for water supplies, and this bar is even lower in some local districts and other countries. Monitoring PFAS consequently requires sensitive analytical equipment to meet regulatory specifications, and liquid chromatography with tandem mass spectroscopy (LC/MS/MS) is the most common technique used to satisfy these requirements. Though extremely sensitive, the instrument is often burdened by pretreatment regimens, …

Development Of Novel Polymeric Materials For Their Application In Monitoring And Remediation Of Environmental Pollutants, Rishabh Shah

Theses and Dissertations--Chemical and Materials Engineering

Remediation of environmental pollutants from water is one of the major challenges in the 21st century. Utilizing novel polymeric materials to accomplish this challenge has garnered a lot of interest in recent times. Flexibility in synthesizing as well as functionalizing makes them attractive for their application in pollutant remediation. This work is based on development and characterization of novel crosslinked polymeric as well as linear polymeric materials from biphenyl-based monomers, biphenyl based crosslinker and a temperature responsive monomer (Nisopropylacrylamide (NIPAAm)) for their application in remediation of toxic pollutants such as polychlorinated biphenyls (PCBs), polyaromatic hydrocarbons (PAHs) and iron oxide nanoparticle …

Developing Synthetic Strategies For Multifaceted Applications Of Stable Gold-Based Complexes, Randall Tyler Mertens

Theses and Dissertations--Chemistry

Development of stable gold-based complexes has been a rapidly advancing field due to the popularity of gold complexes, particularly for use in biomedical research and catalytic transformations. Given that auranofin, a gold(I) complex with FDA approval for the treatment of rheumatoid arthritis is used in the clinic, the development of stable gold-based molecules of clinical relevance is urgently needed. Herein are reported, synthetic strategies used for the development of new classes of gold(I) and gold(III) complexes for advancement in mitochondrial modulation for use as chemotherapeutics as well as application to gold catalysis due to the unique geometry of complexes presented …

Computational Insights On Medicinal Chemistry Targeting Cyp450s, Alexander D. Fenton

Theses and Dissertations--Chemistry

Modern-day medicinal chemistry has provided researchers with a wide variety of tools to not only gather greater insight from their data, but also to generate data in new ways. One such tool is the construction of computational protein models from crystallographic datasets, and their subsequent use to understand the structure-activity relationships of protein-ligand complexes. These models can be utilized for their predictive power to inform the synthesis of, and improvement of, lead compounds. It is the goal of this work to employ such models to the CYP450 enzyme system such that potent and selective inhibitors can be designed, evaluated biologically, …

Associations Between Identity And Future Parenthood Among Lgbtq+ Asian/Pacific Islander Americans, Kay Simon

Theses and Dissertations--Psychology

In recent years, the number of lesbian, gay, bisexual, transgender, and queer (and additional identities; LGBTQ+) identified people and the number of Asian Pacific Islander Americans (APIA) have been increasing in the United States (Movement Advancement Project 2019; Newport, 2018). As the individuals in these demographic groups develop over their lifespan, many will become parents and form families, but little work is currently available on the experiences of LGBTQ+ APIA individuals and future parenthood. Here, I report findings on the perceptions and importance of future parenthood, identity development, identity integration, and microaggressions and/or discrimination (as they relate to racial-ethnic and …

Physiological Stress Responding During Negative Memory Recollection And The Habitual Use Of Psychological Coping Strategies, Kyle P. Rawn

Theses and Dissertations--Psychology

Coping represents an important process for stress: how effectively one copes dictates how a person experiences stress. However, research has not yet examined how a person’s long-term coping habits are related to their physiological stress responding during a particular situation. The current study addresses this through examination of skin conductance level (SCL) trajectories and coping tendencies (i.e. habitual use of coping strategies) during an autobiographical interview. 167 college students completed questionnaires assessing their demographics and their frequency of use for fourteen coping strategies. SCL was collected while participants recalled and discussed a negative family memory from their childhood. Multilevel modeling …

Religious Beliefs And Behaviors As Predictors Of Substance Use In First-Year College Students: A Longitudinal Study, Hannah B. Mcgee

Theses and Dissertations--Psychology

Substance use is prevalent on college campuses (e.g., Douglas et al., 1997) and can create significant negative consequences (Kodjo & Klein, 2002; NIAAA, 2006). Research suggests that religious beliefs and religious behaviors interact to predict risky substance use in first-year undergraduate students, such that students with religious beliefs but no corresponding behaviors are at risk for significant alcohol use and related problems (Brechting et al., 2010; Cole et al., 2020). However, these studies have only been cross-sectional in nature.

The current study assessed longitudinally if the interaction of religious beliefs/behaviors influenced first-year undergraduate student substance use across the early adjustment …