Digital Commons Network^™

Hispanic Agricultural Workers: The Nexus Of Demographics, Employment Characteristics, And Health, Ashley Michelle Bush

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

Agriculture, which is home to elevated occupational injury and illness rates, has a substantial demographic makeup of Hispanic workers. Hispanic farmworkers are at increased risk of poor occupational health outcomes due to the precarious nature of work and other socio-ecological influences. These adverse occupational health outcome counts are inadequate and undercounted, failing to capture the true scope of agricultural work. To gain more knowledge about agriculture, this capstone will focus on the personal and work characteristics of agricultural workers to help further understand disparities within the agricultural sector by: providing a literature review of agricultural worker health; examining missed work …

Hiv Risks, Intimate Partner Violence (Ipv), And Depression Among A Sample Of Women Who Have Sex With Men And Women (Wsmw), Krystal S. Frieson

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

Objective: The purpose of this study is to examine the associations between interpersonal partner violence (IPV), HIV risks, and depression among a sample of adolescent females who have sex with men and women.

Methods: A cross-sectional study was conducted using data from the Youth Risk Behavior Surveillance System (YRBSS). YRBSS data was obtained from representative samples of students in grades 9-12. The study sample was comprised of adolescent and young women who self-identified as having sex with men and women (WSMW)(N=526). The primary exposure was sexual behavior (having sexual intercourse with both male and female partners). The primary outcomes were …

Undiagnosed Hepatitis C Infection In An Urban Emergency Department, Naseem Ansari

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

Aim: To evaluate the prevalence of previously undiagnosed hepatitis C virus and associated patient risk factors in an urban ED through a universal, integrated screening program, to contextualize results found in terms of gaps in existing HCV screening models and to inform future sustainable and effective screening models.

Methods: ED patients, ages 18-71, that were medically stable, hadn’t had a prior HCV test, and were having blood drawn as part of routine clinical care, were offered (n=2,726) an anti-HCV test, of whom 1,945 accepted. An assessment of correlates to anti-HCV positivity was completed using a binomial logistic regression …

Pre-Antibiotic Therapy Of Syphilis, Charles T. Ambrose

Microbiology, Immunology, and Molecular Genetics Faculty Publications

The explosive increase in syphilis throughout China and Russia during the past several decades represents a global public health threat for several reasons. 1) Most cases are undertreated and thus collectively offer optimal conditions for the emergence of resistant strains of the syphilis spirochete, Treponema pallidum. No penicillin-resistant strains have been recognized to date, but strains resistant to the second line antibiotic agents are now common. 2) The recent discovery of plasmids in T. pallidumraises the likelihood of plasmid transfer from other bacteria of various resistance genes, especially those directed toward penicillin-type antibiotics, currently the drugs of choice for …

The Geopolitics Of Reproductive Healthcare: Latina Immigrants’ Experiences As Non-Citizens And Biological Citizena In Atlanta, Ga, Rebecca E. Lane

Theses and Dissertations--Geography

This dissertation examines the experiences of Latina immigrants in Atlanta, GA in accessing and receiving reproductive healthcare. Although Atlanta is a new destination city for immigrant labor, the state of Georgia has passed anti-immigrant legislation, including a 2011 law that allows local police to check immigrants’ documentation while investigating unrelated violations. This localization of immigration policing heightens immigrants’ risk of detention and deportability. In combination with media discourses of illegality, local immigration policing instills fear in immigrants, which deters them from going out in public in order to perform everyday tasks such as seeing a doctor. Latinas immigrants’ ascribed illegality …

Patient-Prisoners: Venereal Disease Control And The Policing Of Female Sexuality In The United States, 1890-1945, Evelyn A. Sorrell

Theses and Dissertations--History

Sexual politics were central in the United States’ venereal disease control movement in the early decades of the twentieth century. This dissertation analyzes the evolution of the venereal disease control movement from the Progressive Era reformers focus on creating a single standard of morality to the Public Health Service’s (PHS) concern over maternal and economic health during the Great Depression. I examine the intersections of public health, gender, sexuality, and citizenship through reactions and policies addressing venereal disease. In particular, the United States’ entry into World War I heightened fears of moral and health crises, as military physicals uncovered a …

In Vitro Activity Of Polymyxin B And Meropenem Alone And In Combination Against Carbapenem-Resistant Enterobacteriaceae, Brandon T. Kulengowski

Theses and Dissertations--Pharmacy

Background: Infections caused by carbapenem-resistant Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae are among the most urgent threats of the infectious disease realm. The incidence of these infections has only been increasing over the years and due to very limited treatment options, mortality is estimated at about 50%.

Methods: To evaluate the in vitro activity of meropenem and polymyxin B against carbapenem-resistant Enterobacteriaceae, antimicrobial susceptibility testing and time-kill studies were performed on K. pneumoniae clinical isolates representing a wide range of meropenem resistance (MICs 4 – 128 mg/L).

Results: Regrowth was observed at clinically relevant concentrations of meropenem alone …

Acute Kidney Injury In Patients Treated With Vancomycin And Piperacillin-Tazobactam: A Retrospective Cohort Analysis, Wilbur Cliff Rutter

Theses and Dissertations--Pharmacy

Empiric antimicrobial therapy often consists of the combination of Gram-positive coverage with vancomycin (VAN) and Gram-negative coverage, specifically an anti-pseudomonal beta-lactam, such as piperacillin-tazobactam (PTZ). Nephrotoxicity is commonly associated with VAN therapy; however, recent reports demonstrate increasing nephrotoxicity rates among patients treated with the combination of VAN and PTZ. This study evaluated the effect of the VAN/PTZ combination on acute kidney injury (AKI), as defined by the RIFLE criteria, compared to VAN and PTZ monotherapies.

Overall, 11,650 patients were analyzed, with 1,647 (14.1%) AKI cases occurring. AKI was significantly more frequent in the VAN/PTZ group (21%) compared to either monotherapy …

Clinical Outcomes Associated With Time To Antimicrobial Therapy Change From Vancomycin To Daptomycin In Staphylococcal Bacteremia, Sarah J. Tennant

Theses and Dissertations--Pharmacy

Background: Staphylococcus aureus is an aerobic, Gram positive commensal organism that is capable of causing a wide spectrum of disease. This study contributes to previously published literature regarding daptomycin versus vancomycin use in S. aureus bacteremia (SAB).

Methods: Adult patients admitted between 2010 and 2014, billed for ICD-9 code V09.0, 038.11, 038.12, 041.11, or 041.12, and received vancomycin and daptomycin were included in this retrospective analysis. Patients were stratified by time to change in antibiotics from vancomycin to daptomycin to the early switch (1-3 days), intermediate switch (4-7 days), or late switch (8 days or later) group. The primary outcome …

Molecular And Biochemical Signaling Underlying Arabidopsis-Bacterial/Virus/Fungal Interactions, Mohamed H. El-Shetehy

Theses and Dissertations--Plant Pathology

Systemic acquired resistance (SAR) is a form of inducible defense response triggered upon localized infection that confers broad-spectrum disease resistance against secondary infections. Several factors are known to regulate SAR and these include phenolic phytohormone salicylic acid (SA), phosphorylated sugar glycerol-3-phosphate (G3P), and dicarboxylic acid azelaic acid (AzA). This study evaluated a role for free radicals nitric oxide (NO) and reactive oxygen species (ROS) in SAR. Normal accumulation of both NO and ROS was required for normal SAR and mutations preventing NO/ROS accumulation and/or biosynthesis compromised SAR. A role for NO and ROS was further established using pharmacological approaches. Notably, …

Endosymbiotic Bacteria In The Bed Bug, Cimex Lectularius L. (Hemiptera: Cimicidae), Mark H. Goodman

Theses and Dissertations--Entomology

The return of bed bugs to prominence as an urban pest has precipitated an emphatic research response from the scientific community in an effort to better understand their biology and management. However, not all aspects of bed bug biology have received equal attention. The role of symbiotic bacteria in the normal function and biology of insects is often underappreciated, and this is true of bed bugs. Bed bugs have two main endosymbiotic bacteria, a Wolbachia species and a poorly-characterized gamma-proteobacterium referred to as BLS. However, their interactions with the host are poorly understood. I explored various aspects of these symbionts …

A Controversial Bill (H.R. 897) To Mosquito Control Programs: A Policy Analysis, Charles Guissou

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

The primary purpose of this paper was to analyze the legal, financial, and administrative burdens of the Pesticides General Permit on mosquito control programs from a policy perspective. Mosquito control is often highly controversial, particularly when it involves the use of pesticides that have their own potentially serious health and environmental impacts. In 2009, the Environment Protection Agency issued the permit to be obtained by pesticide applicators before pesticides could be discharged into waterways in addition to existing Federal Insecticides, Fungicides, and Rodenticides Act (FIFRA) regulations. Some provisions of the permit could impact mosquito control activities. Therefore, in response to …

Social Network Analysis Of Cellphone Surveillance Data For Ebola In Sierra Leone, Jia B. Kangbai

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

Aim: To explore and visualize the connectivity of suspected Ebola cases and surveillance callers who used cellphone technology in Moyamba District in Sierra Leone for Ebola surveillance, and to examine the demographic differences and characteristics of callers who make more calls as well as more likely to make at least one positive Ebola call.

Methods: Surveillance data for 393 suspected Ebola cases (192 males, 201 females) were collected from October 23, 2014 to June 28, 2015 using cellphone technology. UCINET and NetDraw were used to explore and visualize the social connectivity between callers and suspected Ebola cases. Poisson and logistic …

Evaluation Of Central Line Insertion Bundle Practices In A Trauma/Surgical Intensive Care Unit, Margaret A. Moore

DNP Projects

Central venous catheters, also known as central lines, serve an essential role in critical care settings across the globe. However, these lines put patients at an increased risk for hospital-acquired infections in the form of central line-associated bloodstream infections (CLABSI). In an effort to prevent these infections, evidence-based nursing interventions in the form of insertion and maintenance bundle are undertaken. It is the focus of this practice inquiry project to evaluate nurse adherence to central line insertion bundles before and after implementation of routine reporting of adherence rates within an ICU. The evaluation will provide insight to the degree of …

Differences In Rhodococcus Equi Infections Based On Immune Status And Antibiotic Susceptibility Of Clinical Isolates In A Case Series Of 12 Patients And Cases In The Literature, Praveen Gundelly, Yasuhiro Suzuki, Julie A. Ribes, Alice C. Thornton

Internal Medicine Faculty Publications

Rhodococcus equi is an unusual zoonotic pathogen that can cause life-threatening diseases in susceptible hosts. Twelve patients with R. equi infection in Kentucky were compared to 137 cases reported in the literature. Although lungs were the primary sites of infection in immunocompromised patients, extrapulmonary involvement only was more common in immunocompetent patients (P > 0.0001). Mortality in R. equi-infected HIV patients was lower in the HAART era (8%) than in pre-HAART era (56%) (P > 0.0001), suggesting that HAART improves prognosis in these patients. Most (85–100%) of clinical isolates were susceptible to vancomycin, clarithromycin, rifampin, aminoglycosides, ciprofloxacin, and imipenem. …

Intrahepatic Cholestasis Of Pregnancy With Severe Elevation Of Bile Acids In The Setting Of Acute Hepatitis C Infection, Megan L. Lawlor, Agatha S. Critchfield

Obstetrics and Gynecology Faculty Publications

Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate …

An Implementation Analysis Of Needle Exchange Programs In Kentucky: Implementation Barriers And Facilitators Identified By Stakeholders, Samantha Jane Harris

MPA/MPP/MPFM Capstone Projects

Kentucky law authorizes county health departments to implement harm reduction needle exchange programs given that the county receives approval from all governing authorities including the local and/or district boards of health, the county government, and the city government in the jurisdiction in which the exchange is intended to operate. As of April 2016, five county health departments operate needle exchange programs and around 20 other county health departments are seeking approval from their governing authorities or beginning to discuss engaging in this process.

I conducted qualitative interviews with key stakeholders in the implementation process to determine the facilitators and barriers …

In Search Of "Real" Migrants: The Effects Of County Level Factors On Enrollment In The Migrant Education Program In Kentucky, Thomas Hatton

MPA/MPP/MPFM Capstone Projects

Migrant laborers and their families have historically faced, and continue to face, major barriers in their education. The migrant population is, according to Dr. Michael Romanowski, “the most undereducated major subgroup in the United States” (Romanowski, 2003). The lack of educational attainment among migrant families can be attributed to numerous factors: above all, the disruptive migratory lifestyle of seasonal agricultural workers (Rosenthal & Banz-Spall, 2003), but also to socioeconomic burdens, mental and physical health issues, and more recently, linguistic and cultural barriers.

The Migrant Education Program is a supplemental federal program that was created under Title 1 Part C of …

Selective Induced Altered Coccidians To Immunize And Prevent Enteritis, Helieh S. Oz

Physiology Faculty Publications

Microbiomic flora in digestive tract is pivotal to the state of our health and disease. Antibiotics affect GI, control composition of microbiome, and shift equilibrium from health into disease status. Coccidiosis causes gastrointestinal inflammation. Antibiotic additives contaminate animal products and enter food chain, consumed by humans with possible allergic, antibiotic resistance and enigmatic side effects. Purposed study induced nonpathogenic, immunogenic organisms to protect against disease and abolish antibiotics’ use in food animals and side effects in man. Diverse species of Coccidia were used as model. Immature organisms were treated with serial purification procedure prior to developmental stages to obtain altered …

Examining The Strain-Crime Relationship Among African American Women: An Empirical Test Of Agnew's General Strain Theory, Nathan Lowe

Theses and Dissertations--Sociology

Agnew’s (1992; 2006) general strain theory (GST) has become one of the foremost theories to explain crime in contemporary criminology. While it has undergone several empirical tests over the years, there remain many understudied aspects of the theory. The current study addresses some of these aspects by longitudinally exploring the relationship between multiple types of strain and drug and non-drug crime among a sample of African American women.

Data for this study were collected as part of a larger study on how drug use and criminality are related to health disparities, particularly HIV, and service utilization among African American drug-using …

The “Weight” Of Socio-Economic Status, Race/Ethnicity, And Gender: A Systematic Examination Of Obesity And Its Co-Morbidities, Gabriele Ciciurkaite

Theses and Dissertations--Sociology

Although extensive research exists on the association between SES and obesity and its patterning across separate gender and racial/ethnic groups, critical gaps remain. In particular, the majority of studies on the SES-BMI association have examined it in additive models without simultaneously considering the influence of gender and race/ethnicity. An additional limitation of the current obesity scholarship concerns the lack of scholarship addressing the interplay between social factors, such as SES, race/ethnicity, gender, and proximate health risk factors, such as BMI, in shaping obesity-related chronic health outcomes, especially considering that health outcomes may vary in the extent to which they may …

Elucidating Binding, Fusion And Entry Of Human Metapneumovirus, Edita M. Klimyte

Theses and Dissertations--Molecular and Cellular Biochemistry

Human metapneumovirus (HMPV) is a respiratory pathogen in the Paramyxoviridae family that infects nearly 100% of the world population. This enveloped RNA virus causes severe viral respiratory disease in infants, the elderly, and immunocompromised patients worldwide. Despite its prevalence and importance to human health, no therapies are available against this pathogen. Entry of paramyxoviruses into host cells generally requires the coordinated activity of the attachment glycoprotein, G, which interacts with a cell receptor, and the fusion glycoprotein, F, which promotes subsequent fusion of viral and cellular membranes. However, HMPV F is the primary viral protein mediating both binding and fusion …

Post Foley Removal Guideline Process And Outcome Evaluation, Sarah E. Gabbard

DNP Projects

When patients are admitted to a hospital patient safety should be a priority in all aspects of the care they receive. Preventing patients from acquiring hospital infections (HAIs) is one example of patient safety. All hospital employees have the responsibility to ensure that standard workflow and processes are in place to ensure this safety. The purposes of this Practice Inquiry Project (PIP) were to examine and develop interventions to decrease the risk of catheter associated urinary tract infections (CAUTIs), incorporate an effective process and standard workflow to implement evidence practice practices (EBP), and to evaluate the effectiveness of implementing the …

Impact Of The Advanced Practice Registered Nurse On The Stroke Patient Population, Jessica Moldenhauer

DNP Projects

PURPOSE: The purpose of this study is evaluate the APRN care model utilized for stroke patients by examining the pre and post impact on outcomes of the stroke clinical practice guidelines (CPGs), patterns of service use, stroke patient outcomes, and patient satisfaction.

METHODS: This study was a single-center, pre-post implementation retrospective study of the impact for the stroke APRN care model on the stroke patient population at Norton Brownsboro Hospital. The sample consisted of 145 patients for the pre-implementation period, March 2012 to August 2012, and 202 patients for the post-implementation period, March 2014 to August 2014.

RESULTS: No differences …

Evaluating Hepatitis C Screening In Primary Care, Nicole A. Brink

DNP Projects

Purpose: The purpose of this study was to evaluate primary care provider screening for hepatitis C virus (HCV) in three high risk populations. The specific aims were to determine the percentage of patients born between 1945-1965 who had a one-time screening for HCV, to determine what proportion of patients with a history of human immunodeficiency virus (HIV) or intravenous drug use (IVDU) have been screened for HCV, and to examine providers’ thoughts on their HCV screening practices.

Methods: A retrospective chart review of patient electronic medical records (EMR’s) from 2015 was conducted in an urban primary care site. SPSS was …

Community Level Assessment For Breastfeeding In The Gateway District, Vanessa Flannery

DNP Projects

Purpose: To assess community level support for breastfeeding in the Gateway District of eastern Kentucky.

Methods: A descriptive study was conducted to identify institutional support of breastfeeding women. Data collected during interviews included community level support based on the framework of the Ten Step program from the Baby-Friendly Hospital Initiative (BFHI) (WHO & UNICEF, 2009) and the Mother-Friendly Worksite Initiative (Texas Department of State Health Services, 2012). Respondents answered questions to determine breastfeeding support from the healthcare, education and business communities.

Results: Of the ten organizations whose representatives were interviewed, 100% perceived health benefits for mothers and infants from breastfeeding. …

An Evaluation Of The Screening And Management Of Patients With Type 2 Diabetes, Laura A. Cahoe

DNP Projects

Purpose: This purpose of this project was to evaluate preventive screening practices and adherence to guidelines for patients with type 2 diabetes (T2DM) as recommended by the American Diabetes Association (ADA) and United States Preventive Services Task Force (USPSTF) in the primary care setting. The specific aims were to: 1) determine the percentage of patients who received recommended screenings from the ADA, 2) determine the percentage of patients who received recommended screenings from the USPSTF, and 3) determine if the proportion of patients to receive the recommended screenings met established benchmarks set by Healthy People 2020 (HP2020).

Methods: A retrospective …

Bioactive Poly(Beta-Amino Ester) Biomaterials For Treatment Of Infection And Oxidative Stress, Andrew L. Lakes

Theses and Dissertations--Chemical and Materials Engineering

Polymers have deep roots as drug delivery tools, and are widely used in clinical to private settings. Currently, however, numerous traditional therapies exist which may be improved through use of polymeric biomaterials. Through our work with infectious and oxidative stress disease prevention and treatment, we aimed to develop application driven, enhanced therapies utilizing new classes of polymers synthesized in-house. Applying biodegradable poly(β-amino ester) (PBAE) polymers, covalent-addition of bioactive substrates to these PBAEs avoided certain pitfalls of free-loaded and non-degradable drug delivery systems. Further, through variation of polymer ingredients and conditions, we were able to tune degradation rates, release profiles, cellular …

In Vivo-Expressed Proteins Of Virulent Leptospira Interrogans Serovar Autumnalis N2 Elicit Strong Igm Responses Of Value In Conclusive Diagnosis, Veerapandian Raja, Santhanam Shanmughapriya, Murugesan Kanagavel, Sergey Artiushin, Sridhar Velineni, John F. Timoney, Kalimuthusamy Natarajaseenivasan

Maxwell H. Gluck Equine Research Center Faculty Publications

Leptospirosis is a serious zoonosis that is underdiagnosed because of limited access to laboratory facilities in Southeast Asia, Central and South America, and Oceania. Timely diagnosis of locally distributed serovars of high virulence is crucial for successful care and outbreak management. Using pooled patient sera, an expression gene library of a virulent Leptospira interrogans serovar Autumnalis strain N2 isolated in South India was screened. The identified genes were characterized, and the purified recombinant proteins were used as antigens in IgM enzyme-linked immunosorbent assay (ELISA) either singly or in combination. Sera (n = 118) from cases of acute leptospirosis along …

The Role And Impact Of School Nurses And Intentions To Delegate Diabetes-Related Tasks Amidst Budget Cuts And Legislative Changes, Michelle J. Lineberry

Theses and Dissertations--Kinesiology and Health Promotion

As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding …