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Trauma-Informed Care: Needs Assessment In A Pediatric Intensive Care Unit, Christine Young

DNP Projects

It is estimated that over 60 percent of children and adolescents in the United States have experienced one or more traumatic event (Saunders & Adams, 2014) resulting in increased psychosocial needs. Trauma-Informed Care (TIC) involves recognizing and validating the effects of trauma and promotes for effective treatment. The purpose of this Doctor of Nursing Practice (DNP) project was to describe the frequency of neglect and trauma, including abuse and accidental events, among patients admitted to a pediatric intensive care unit and identify types of interventions and referrals documented by providers in the medical record. This project was based on a …

A Survey Of Providers And Patients Assessing The Need For And Use Of Prevention Practitioners To Combat Obesity In The Primary Care Setting, Amanda R. Lyons

DNP Projects

Purpose: The overall aim of this project was to gather information from two groups of stakeholders, providers and patients, on the feasibility of implementing prevention practitioners in the primary care system to address overweight and obesity.

Methods: This study utilized a quantitative descriptive design through the use of electronic surveys. Provider surveys were explained and presented during a monthly provider meeting. Patient flyers were posted in exam rooms and surveys were accessible through a provided link and QR code.

Results: Providers (N=10) agreed that they saw a need for the use of a prevention practitioner (Mean=4.44, SD=.88) as well as …

Evaluation Of Emergency Department Use By Adult Patients With Established Primary Care Provider, Sherry Tolentino

DNP Projects

BACKGROUND: Overutilization of the Emergency Department (ED) contributes to the unnecessary use of healthcare resources. One common cause is related to barriers to Primary Care access. Patients use the ED for conditions that can be managed in primary care due to the perception of urgency and convenience.

PURPOSE: The purpose of this project was to evaluate factors contributing to the use of the ED for adult patients with primary care providers (PCP). METHODS: A retrospective chart review was completed on 280 randomly selected patients over the age of 18 who presented to the ED between January and June 2018. Only …

The Effect Of A Behavioral Health Specialist Program On Providers’ Perceptions Of Mental Illness, Self-Efficacy And Satisfaction In The Inpatient Medical Unit., Trinity D. Thomas

DNP Projects

PURPOSE: The purpose of this DNP project was to assess the effect of a Behavioral Health Specialist (BHS) program on providers’ perceptions of mental illness, self-efficacy and satisfaction in the inpatient medical unit.

METHODS: This DNP project used a mixed-methods approach to obtain data, which included a pretest-posttest design, and key informant interviews. The survey data was obtained from provider responses to an email that was forwarded from managers of four targeted medical-surgical floors. A cover letter was included in the email which further provided information about key informant interviews and the contact information for the principle investigator to arrange …

The Relationship Bewteen Noise Exposure And The Risk Of Occupational Injury Among Workers In Kentucky, Kenneth M. Alea

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: To examine for an association between the occurrence of work­ related trauma injuries in the state of Kentucky and occupational noise exposure.

Methods: Using the Kentucky Trauma Registry, work-related trauma injuries were identified between the years of 2013 and 2017. Subjects were assigned noise scores based on O*NET noise exposure data by occupational industry. Associations between the occurrence of occupationally-related injuries and noise scores were assessed using linear regression analysis.

Results: A total of 1,808 work-related traumatic injuries were identified from the trauma registry over the five years of data reviewed in the study. The majority of occupational injuries …

Association Between Pm2.5 And The Coexistence Of Chronic Obstructive Pulmonary Disease And Coronary Heart Disease, Shan Gao

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To identify PM2.5 as a risk factor for chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) respectively, and to explore the magnitude of the association of PM2.5 with the coexistence of CHD and COPD, by using the combined dataset of 1999-2014 EPA Air Data and 2017 BRFSS SMART data (age 18 and older).

Methods: Cross-sectional study was designed to identify the association between PM2.5 exposure and COPD and CHD. The PM2.5 exposure values were adapted from the county-level EPAAir Data, the yearly mean values of PM2.5 were used to determine the association. Characteristics of sex, age, race, …

Retrospective Policy Analysis Of Kentucky House Bill 1, Sarah E. B. Covey

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: In 2011, the Centers for Disease Control (CDC) coined the phrase, “opioid epidemic” in response to the staggering increase in opioid use and opioid- related deaths. Kentucky House Bill 1 (HB1) passed in 2012, attempted to stifle the impact of the opioid epidemic on the citizens of the Commonwealth by imposing supply-side restrictions on the prescription and dispensing of opioid pills. Objective: The primary objective of this analysis is to evaluate the effectiveness of HB1 on the reduction of opioid-related deaths, opioid prescription rates, and intravenous opioid drug use rates. Methods: This analysis employed Eugene Bardach’s framework for policy …

A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Access to clean water and sanitation is known to decrease childhood mortality, improve health outcomes, and decrease risk of water-borne diseases. However, access to clean water is often restricted in impoverished or indigenous communities. This cross-sectional study evaluated the primary source of drinking water for forty homes, the Est. Cheche river, a local spring, and a local school in the TsáChila indigenous community of El Bua, Santo Domingo, Ecuador. This analysis focused on the presence of coliforms and E. coli in the water source (well or city/piped), the physical parameters of the water and the type of sanitation …

Disparities In The Risk Of Subsequent Primary Cancer Diagnosis And Recurrence Among Women With Breast Cancer (First Primary) In Kentucky, Pierre Fwelo

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and objectives

Breast cancer is one of the most common malignancies among women in the United States. Women residing in the state of Kentucky have breast cancer incidence and mortality rates greater than the national average. Recent studies suggest an association between breast cancer subtypes/hormone receptor (HR) status and the risk of recurrence and the onset of subsequent primary cancer, however, limited research has focused on Kentucky or its Appalachian region.

Investigating these associations may potentially save lives by providing information that can be used in breast cancer education in Kentucky, assessing the population at greater risk of recurrence …

A Brain-Computer Interface For Closed-Loop Sensory Stimulation During Motor Training In Patients With Tetraplegia, Sarah Helen Thomas

Theses and Dissertations--Biomedical Engineering

Normal movement execution requires proper coupling of motor and sensory activation. An increasing body of literature supports the idea that incorporation of sensory stimulation into motor rehabilitation practices increases its effectiveness. Paired associative stimulation (PAS) studies, in which afferent and efferent pathways are activated in tandem, have brought attention to the importance of well-timed stimulation rather than non-associative (i.e., open-loop) activation. In patients with tetraplegia resulting from spinal cord injury (SCI), varying degrees of upper limb function may remain and could be harnessed for rehabilitation. Incorporating associative sensory stimulation coupled with self-paced motor training would be a means for supplementing …

High School Engineering Students’ Identities And Interest In Stem, Morgan Lane

Theses and Dissertations--Science, Technology, Engineering, and Mathematics (STEM) Education

With a national push toward improving STEM education, it is imperative for researchers to study what makes students want to pursue STEM education and STEM careers. To learn about this in the context of one high school’s engineering program, this study used student interviews to gain insight into how student identities influence their interest and experiences in STEM. Five components of student identities were revealed to be influential on a student’s interest in STEM: (1) an early interest/skill in STEM, (2) familial involvement in STEM, (3) self-motivation, (4) gender, and (5) socioeconomic status.Race/ethnicity, peer influence, and teacher influence did not …

A Possible Link Between R-Wave Amplitude Alternans And T-Wave Alternans In Ecgs, Sahar Alaei

Theses and Dissertations--Biomedical Engineering

Sudden Cardiac Death (SCD) is the largest cause of natural deaths in the USA, accounting for over 300,000 deaths annually. The major reason for SCD is Ventricular Arrhythmia (VA). Therefore, there is need for exploration of approaches to predict increased risk for VA. Alternans of the T wave in the ECG (TWA) is widely investigated as a potential predictor of VA, however, clinical trials show that TWA has high negative predictive value but poor positive predictive value. A possible reason that TWA has a large number of false positives is that a pattern of alternans known as concordant alternans, may …

Calibrated Short Tr Recovery Mri For Rapid Measurement Of Brain-Blood Partition Coefficient And Correction Of Quantitative Cerebral Blood Flow, Scott William Thalman

Theses and Dissertations--Biomedical Engineering

The high prevalence and mortality of cerebrovascular disease has led to the development of several methods to measure cerebral blood flow (CBF) in vivo. One of these, arterial spin labeling (ASL), is a quantitative magnetic resonance imaging (MRI) technique with the advantage that it is completely non-invasive. The quantification of CBF using ASL requires correction for a tissue specific parameter called the brain-blood partition coefficient (BBPC). Despite regional and inter-subject variability in BBPC, the current recommended implementation of ASL uses a constant assumed value of 0.9 mL/g for all regions of the brain, all subjects, and even all species.

The …

Biomechanical Effects Of A Hip Orthosis On Lumbo-Pelvic Coordination, Matthew Ballard

Theses and Dissertations--Biomedical Engineering

Abnormal lumbar movement has been observed in individuals who have a history of low back pain (LBP). Affected individuals display a reduction in lumbar spine rotation during trunk movement tasks, while pelvic rotation increases to compensate. Reduced lumbar contribution to forward bending is associated with increased compressive forces and increased shearing demand of the task on the lower back. This abnormal lumbo-pelvic coordination (LPC) can persist beyond LBP symptom alleviation and may contribute to further occurrences or more severe cases of LBP. This study serves as a first step in investigating if abnormal LPC can be corrected with a hip …

Noninvasive Multimodal Diffuse Optical Imaging Of Vulnerable Tissue Hemodynamics, Mingjun Zhao

Theses and Dissertations--Biomedical Engineering

Measurement of tissue hemodynamics provides vital information for the assessment of tissue viability. This thesis reports three noninvasive near-infrared diffuse optical systems for spectroscopic measurements and tomographic imaging of tissue hemodynamics in vulnerable tissues with the goal of disease diagnosis and treatment monitoring. A hybrid near-infrared spectroscopy/diffuse correlation spectroscopy (NIRS/DCS) instrument with a contact fiber-optic probe was developed and utilized for simultaneous and continuous monitoring of blood flow (BF), blood oxygenation, and oxidative metabolism in exercising gastrocnemius. Results measured by the hybrid NIRS/DCS instrument in 37 subjects (mean age: 67 ± 6) indicated that vitamin D supplement plus aerobic training …

Improving Safety Performance Of Highway Maintenance Crews Through Pre-Task Safety Toolbox Talks, Zamaan Al-Shabbani

Theses and Dissertations--Civil Engineering

The dangerous work environment in the construction industry and the inherent high risks associated with construction work make it the focus of safety training and regulations. Highway construction and maintenance has unique hazards but seemingly less directly applicable safety standards, regulations, and programs. Department of Transportation (DOT) employees working in highway maintenance are exposed to a variety of unique hazards specifically associated with their work and not relating to the adjacent traffic. Yet, highway construction and maintenance work has not received sufficient attention in terms of safety research and programs. The lack of safety training and education in highway construction …

Hazard Recognition And Risk Perception Among Union Electricians, Elyas Jazayeri

Theses and Dissertations--Civil Engineering

Hazard recognition and risk perception are two important factors that are a focus of most safety training programs. According to previous research, unrecognized hazards could lead to underestimation of risks, which ultimately could lead to injuries and fatalities. The primary objective of this research was to assess hazard recognition and safety risk perception skills in the electrician trade among electricians in unions. Another goal of this study was to find possible correlation between level of engagement in safety training and hazard recognition and risk perception skills. The research objectives were accomplished by gathering data from sixty-seven apprentices and journeymen across …

Use Of Functionalized Bimetallic Membranes For Treatment Of Contaminated Groundwater At A Hazardous Waste Site In Kentucky, Lucy C. Pacholik

Theses and Dissertations--Civil Engineering

Providing access to clean drinking water will continue to be a challenge for civil engineers for generations to come. Since many communities around the world rely on groundwater as a source of drinking water, remediation technologies must be implemented at sites where groundwater contamination exists due to years of mismanagement of hazardous waste. Using nanosized zero-valent metals such as iron and zinc embedded within and on the surface of functionalized (PAA) membrane filters has shown to be an effective dechlorination technique for contaminated groundwater. Introducing a noble metal such as Pd or Ni increases reaction rates by acting a catalyst …

Connected And Autonomous Vehicles Effects On Emergency Response Times, Austin William Obenauf

Theses and Dissertations--Civil Engineering

Emergency response times have been shown to be directly correlated with mortality rates of out-of-hospital patients. Studies have been conducted to show the relationship between time and mortality rates until patients receive the proper treatment. With more cardiac arrests and other life threatening illnesses occurring in the United States, more emergency calls will be required as well. As of today, technological advancements have been made to reduce response times, but human factors still require certain procedures, causing delays in the run time and increasing the rate of mortality. Here we show the results of emergency response times with the market …

Adapting Crash Modification Factors For The Connected And Autonomous Vehicle Environment, Federico Valentin Lause Iii

Theses and Dissertations--Civil Engineering

The Crash Modification Factor (CMF) clearinghouse can be used to estimate benefits for specific highway safety countermeasures. It assists safety professionals in the allocation of investments. The clearinghouse contains over 7000 entries of which only 446 are categorized as intelligent transportation systems or advanced technology, but none directly address connected or autonomous vehicles (CAVs). Further, the effectiveness of highway safety countermeasures is assumed to remain constant over time, an assumption that is particularly problematic as new technologies are introduced. For example, for the existing fleet of human-driven vehicles, installation of rumble strip can potentially reduce “run-off-road” crashes by 40%. If …

Decomposing A Watershed’S Nitrate Signal Using Spatial Sampling And Continuous Sensor Data, Evan Clare

Theses and Dissertations--Civil Engineering

Watershed features, physiographic setting, geology, climate, and hydrologic processes combine to produce a time-variant nutrient concentration signal at the watershed outlet. Anthropogenic influences, such as increased agricultural pressures and urbanization, have increased overall nutrient loadings delivered to the fluvial network. The impact of such increased nutrient loadings on Kentucky’s drinking water remains a potential threat to the region.

By coupling spatial sampling of nitrate concentrations in surface water with contemporary nutrient and water quality sensor technology, a decomposition of the Upper South Elkhorn watershed’s nitrate signal and an estimation of source timing and loading in the watershed was completed. The …

Improving Bicycle Infrastructure With The Use Of Bicycle Share Travel Data, Jennifer Mintao Weast

Theses and Dissertations--Civil Engineering

Bicycling as a mode of transportation has been increasing in recent years due to its environmental and health benefits. The availability of bicycles through bicycle share programs has made bicycling a more viable option. With this increase, there is a need for complementary improvements of bicycle infrastructure. Many local and regional transportation agencies are recognizing this need and developing a master plan or safety action plan to improve the city’s bicycle and walking facilities. This study examines bicycle travel demands and travel patterns in Lexington, Kentucky as generated by SPIN bicycle share users. It is hypothesized that the SPIN users …

Biological Selenium Control: Selenium Reduction By Shigella Fergusonii Strain Tb42616 And Pantoea Vagans Strain Ewb32213-2 In Bioreactor Systems, Yuxia Ji

Theses and Dissertations--Civil Engineering

Se(VI) and Se(IV), as the two major species of selenium in water, are toxic to aquatic lives and may cause adverse health effects to humans at high levels. Biological reduction of Se(VI) is a two-stage process first from Se(VI) to Se(IV) and then from Se(IV) to Se(0) with potential accumulation of the more toxic Se(IV) due to the slower rate of the second stage.

Selenium reduction was first evaluated with batch cultures of Shigella fergusonii strain TB42616 (TB) and Pantoea vagans strain EWB32213-2 (EWB) isolated in our laboratory from sludge and coal slurry sediment samples, respectively. In order to facilitate …

Synthesis, Design, And Evaluation Of The Fluorescent Detection Of Polychlorinated Biphenyls(Pcbs) In Aqueous System, Irfan Ahmad

Theses and Dissertations--Chemical and Materials Engineering

The exposure to halogenated persistent organic pollutants (POPs), such as polychlorinated biphenyls (PCBs), has been linked to numerous inflammatory diseases, including diabetes, cancer and lowered immune response. PCBs have low solubility in water, and they interact with other contaminants, making their detection quite challenging. While, there have been several attempts at improving the ease of detection and sensing of PCBs, gas chromatography-mass spectrometry (GC-MS) remains the gold standard. However, despite its ubiquitous use, GC-MS is a challenging technique that requires high skill and careful sample preparation, which are time-consuming and costly. As such, there is still a need to develop …

Understanding The Structure-Property-Performance Relationship Of Silicon Negative Electrodes, Jiazhi Hu

Theses and Dissertations--Chemical and Materials Engineering

Rechargeable lithium ion batteries (LIBs) have long been used to power not only portable devices, e.g., mobile phones and laptops, but also large scale systems, e.g., electrical grid and electric vehicles. To meet the ever increasing demand for renewable energy storage, tremendous efforts have been devoted to improving the energy/power density of LIBs. Known for its high theoretical capacity (4200 mAh/g), silicon has been considered as one of the most promising negative electrode materials for high-energy-density LIBs. However, diffusion-induced stresses can cause fracture and, consequently, rapid degradation in the electrochemical performance of Si-based negative electrodes. To mitigate the detrimental effects …

Bioinformatic And Experimental Analyses Of Axolotl Regeneration, Nour W. Al Haj Baddar

Theses and Dissertations--Biology

Salamanders have an extraordinary ability to regenerate appendages after loss or amputation, irrespective of age. My dissertation research explored the possibility that regenerative ability is associated with the evolution of novel, salamander-specific genes. I utilized transcriptional and genomic databases for the axolotl to discover previously unidentified genes, to the exclusion of other vertebrate taxa. Among the genes identified were multiple mmps (Matrix metalloproteases) and a jnk1/mapk8 (c-jun-N-terminal kinase) paralog. MMPs function in extracellular matrix remodeling (ECM) and tissue histolysis, processes that are essential for successful regeneration. Jjnk1/mapk8 plays a pivotal role in regulating transcription in response to cellular stress stimuli, …

Temporal And Spatial Variability In Groundwater Flow And Chemistry Along The Cumberland River, Artemus, Kentucky, Amanda Rachelle Sherman

Theses and Dissertations--Earth and Environmental Sciences

Groundwater in the Kentucky Appalachian region is constrained by physiography and lithology. Lithostratigraphy, groundwater flow, and chemistry were delineated in the alluvial aquifer along the Cumberland River at H.L. Disney Training Center. To assess groundwater-river interactions and water quality, 11 monitoring wells were installed and sampled quarterly, plus the river and an existing bedrock well. Analytical results were evaluated for temporal and spatial trends. Collected soil cores were analyzed for bulk chemistry and grain size. Solute speciation and saturation indices were calculated and hydraulic conductivity estimated from grain-size analyses. Pumping and slug tests were performed to estimate hydraulic conductivity and …

Holocene Hydroclimatic And Vegetation Reconstruction In The Sierra Nevada Using Pollen And Stable Isotopes From Convict Lake, Morgan Black

Theses and Dissertations--Earth and Environmental Sciences

The forested environments of the subalpine and upper montane zones of the eastern Sierra Nevada mountains (California) are biodiverse and valuable ecosystems that are sensitive to hydroclimate changes. The history of high-altitude vegetation changes in the eastern Sierra Nevada is underexplored, and this knowledge gap can be addressed using a paleolimnological approach. In this study, we use a long (~9.5 m) sediment core from Convict Lake, a glacial lake situated in the upper montane zone of California’s Sherwin Range, to assess Holocene changes in terrestrial vegetation. The core was dated using radiocarbon, and studied with palynology, elemental analysis, and stable …

The Links Between Gulf Of Mexico Seafloor Characteristics And Petroleum Hydrocarbons Following The Deepwater Horizon Oil Spill, Kimberly J. Schindler

Theses and Dissertations--Earth and Environmental Sciences

The Gulf of Mexico (GoMx) is among the most productive regions for offshore oil and natural gas recovery. In 2010, the Deepwater Horizon (DWH) drilling rig exploded, burned for three days, sank, and released over 4 million barrels of oil in the subsequent 84 days before it was capped. Some oil was buoyant enough to float to the ocean surface, where some was removed via a myriad techniques. Importantly, a plume of oil remained suspended in the water column at approximately 1,100 m water depth, where it drove a marine snow event, and deposited large quantities of oil on the …

Setting The Stage: Resident Experiences With Enforcement, Rescue And Spectacle In Lampedusa, Elisa Sperandio

Theses and Dissertations--Geography

Located 127 miles from the shores of Sicily and only 70 from Tunisia, the island of Lampedusa is home to a population of 6000. Residents are largely reliant on a centuries-old fishing economy, a booming tourism industry and, most recently, the sustainment of a complex apparatus of border enforcement. Since the early 2000s, with the hardening of the southern border of Italy and the European Union, a multitude of actors have converged to Lampedusa: from migrants, to agents of enforcement, to NGO personnel, along with journalists, researchers and tourists. In this thesis, I center the experiences of island residents to …