Digital Commons Network^™

Developing Radiosensitizers To Enhance Radiotherapy In Treating Gastroenteropancreatic Neuroendocrine Tumor, Zeta Chow

Theses and Dissertations--Clinical and Translational Science

Gastroenteropancreatic Neuroendocrine Tumor (GEP-NET) is a heterogeneous group of malignancies arising from multipotent neuroendocrine stem cells in the gastrointestinal tract. The incidence of GEP-NET continues to rise, possibly due to the advancement of imaging and biomarkers available for diagnosis. However, even though the majority of patients are diagnosed with low-grade and localized disease, a significant percentage of patients present with advanced-stage metastatic disease with poor prognosis in months to a few years. These advanced-stage GEP-NET patients can also present with a variety of debilitating symptoms that significantly impact their quality of life. The role of palliative-intent surgery is limited, and …

Evaluation Of The Cellular And Physiologic Impact Of Mitomycin C On Colon Cancer, Hannah Mcdonald

Theses and Dissertations--Clinical and Translational Science

Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) with Mitomycin C (MMC) has more than doubled the overall and disease-free survival in patients with peritoneal metastases (PM) due to colorectal cancer (CRC) over the past two decades. Although MMC is the most used HIPEC drug for PM due to CRC, dosing protocols vary dramatically between and within institutions across the world. Additionally, little is known about the impact of hyperthermia and MMC on intracellular pathways for CRC. The aim of this work is to determine the optimal dosing strategy in the clinical application of MMC and hyperthermia for treatment of …

Advancing Dysphagia Screening: A Comparison Of Patient-Reported Outcome Measures And Bolus-Driven Screenings In Aspiration Prediction, Arica Amie Rusco

Theses and Dissertations--Communication Sciences and Disorders

It is known that dysphagia impacts an individual’s health and quality of life. Due to this, early identification of dysphagia is crucial. There are many different dysphagia screening tools with no consensus. This study aimed to compare the two most frequently used dysphagia screenings, a patient-reported outcome measure (PROM), the EAT-10, and bolus-driven swallow screening, the Yale Swallow Protocol, to determine if one tool is superior in aspiration prediction on a videofluoroscopic swallow study (VFSS). This study also aimed to discover the best cutoff score on the EAT-10 for aspiration prediction. A total of 66 participants were recruited after physician …

The Effects Of Exercise-Based Voice Therapy On Swallowing Outcomes: A Pilot Study Framework, Jenna F. Johnson

Theses and Dissertations--Communication Sciences and Disorders

In a 2019 study analyzing dysphonic patients in relation to coexisting dysphagia, approximately 11.8% of clients receiving treatment for voice disorders reported difficulty swallowing. However, the literature exploring the use of voice exercises to improve swallow function is limited to a small amount of voice treatment approaches, which does not reflect the wide range of evidence-based treatment approaches that may be prescribed for treatment of one’s voice complaints. This project proposes a descriptive study that would identify if completion of prescribed voice therapy exercises has implications on swallowing function in clients with co-occurring voice and swallow impairments. A pilot study …

The Relationship Between Sleep, Physical Activity, And Musculoskeletal Injury, In Us And Saudi College Students, Abdulaziz Hasan Alameer

Theses and Dissertations--Rehabilitation Sciences

According to the National Sleep Foundation, individuals should sleep 7-9 hours every night. Recently, insufficient or poor sleep has been linked to diabetes, cardiovascular illness, stroke, obesity, and Alzheimer's disease. Insufficient sleep for college students can negatively impact academic performance and mental health. In addition, especially for collegiate athletes, there is evidence that insufficient sleep is associated with an increased risk of musculoskeletal injury. However, it is uncertain if the link between sleep and injury varies between populations, types of individuals (athletes vs non-athletes), sports or types of exercise, or training volume. Despite the health risks of inadequate sleep, up …

Using Inertial Measurement Units (Imus) To Assess Fatigue-Related Changes In Running: Applications In Training Load Management, Reiley Thomas Bergin

Theses and Dissertations--Rehabilitation Sciences

The inertial measurement unit (IMU) is the most researched wearable technology in running. Yet, few studies have validated IMU-derived measures against accepted laboratory standards, such as three-dimensional (3D) motion capture and force plates. IMUs have the potential to provide information that can guide training load management decisions; however, no study has explored their capability to assess fatigue-related changes in running across consecutive days of training. Therefore, the purpose of this project was to evaluate the validity and reliability of IMU-derived measures and assess their capability for detecting fatigue-related changes in running in the days following an intensified training bout. The …

The Critical Need For Early Language Access For Deaf And Hard Of Hearing Children, Kinya D. Embry-Wright

Theses and Dissertations--Rehabilitation Sciences

According to the American Speech-Language-Hearing Association (ASHA), speech-language pathologists (SLPs) are referred to as the experts of communication (ASHA, n.d.) utilizing their specialized training, extensive education, and clinical expertise to work with individuals across the lifespan with a variety of different speech and language delays, disorders, and deficits. However, when working with deaf or hard of hearing (DHH) children, there is often precedent given to speech and listening (M. L. Hall et al., 2019). For example, ASHA only recently updated their DHH portal to include American Sign Language (ASL), though they still list it on some webpages as an Augmentative …

Exploration Of Burn Survivors’ Experiences With Nutrition During The Rehabilitation Phase Of Burn Injury Recovery: A Qualitative Study, Alyaa M. Zagzoog

Theses and Dissertations--Rehabilitation Sciences

Approximately 500,000 people in the United States are affected by a burn injury and seek care every year. With medical innovation, however, the burn injury survival rate has increased to 97% in the United States. Burn survivors undergo two phases of recovery: acute and rehabilitation.With advances in burn treatment and care, the focus has shifted from the expectation of survival to improving outcomes. Nutritional care, including assessment and education, plays a major role in burn survivors’ wellness, facilitating wound healing and promoting recovery, but nutritional guidelines and polices appear limited during the rehabilitation phase,with literature suggesting nutritional assessment has historically …

Abl1/2 And Ddr1 Cooperate To Stabilize Braf/Craf To Drive Erk1/2 Reactivation And Promote Mek Inhibitor Resistance In Nras-Mutant Melanomas, Anastasia Lyon

Theses and Dissertations--Pharmacology and Nutritional Sciences

This study addresses the escalating incidence of NRAS-mutant melanomas, a type of skin cancer lacking FDA-approved targeted therapies. Despite ongoing research targeting the RAF/MEK/ERK pathway, existing drugs fail to enhance progression-free survival due to acquired resistance. This project identifies a novel role for ABL1/2 and DDR1 kinases in driving drug resistance and proliferation of NRAS-mutant melanoma cells. ABL1/2 and DDR1 cooperate to promote RAF homodimerization and protein stability in order to reactivate MEK/ERK signaling to drive MEK1/2 inhibitor (MEKi) resistance and promote survival of resistant cells. By targeting ABL1/2 and DDR1 with nilotinib, a FDA-approved anti-leukemic inhibitor, we …

The Function Of The Insulin Receptor In Liver Subcell Types And Its Dichotomous Role In Hepatic Dysfunction, Wang-Hsin Lee

Theses and Dissertations--Pharmacology and Nutritional Sciences

Insulin resistance and metabolic dysfunction-associated steatotic liver disease (MASLD) have become significant health issues worldwide. Increased prevalence of hepatic insulin resistance and MASLD worsens the threat of its progressive complications, such as liver fibrosis, which can lead to cirrhosis and death if left untreated. Treatments for MASLD-induced liver fibrosis are mainly insulin sensitizers. However, activating insulin signaling leads to a higher death rate in end-stage liver fibrosis. This dissertation discusses the emerging insights into hepatic insulin resistance and potential treatment targets in the heme degradation pathway for reversal. We also investigated the mechanisms that the insulin receptor (INSR) regulates in …

Exenatide As Chronopharmacotherapy For T2dm Associated Complications: Targeting Nondipping Blood Pressure And Sleep Insufficiency, Aaron Chacon

Theses and Dissertations--Pharmacology and Nutritional Sciences

Although largely impacted by age, race and ethnicity, and socioeconomic factors, Type 2 Diabetes Mellitus (T2DM) is primarily driven by obesity, currently affecting ~30 million in the U.S and ~463 million globally. T2DM carries numerous complications, including high prevalence of hypertension and nondipping blood pressure (BP), sleep insufficiency and fragmentation. Nondipping BP is an inadequate drop in BP (≤ 10%) during sleeping hours compared with waking hours. Lending to this, sleep disturbance acts as both precursor and consequence of metabolic dysregulation, greatly impacting circadian rhythmicity. To model these conditions, we utilized diabetic (db/db) mice. These mice carry a point mutation …

Mitigating Risks For Dementia In Apoe4 Mice: Efficacy Of Prebiotic Inulin, Probiotics, And Fecal Microbiota Transplants, Ya-Hsuan Chang

Theses and Dissertations--Pharmacology and Nutritional Sciences

Apolipoprotein E4 allele (APOE4) carriers show early metabolic changes, heightening the genetic risk of late-onset Alzheimer's Disease (AD), characterized by amyloid-β and tau tangle plaques and neurodegeneration. Its development is influenced by age, environment, and genetics, with Mild Cognitive Impairment (MCI) often preceding AD, providing a crucial window for early intervention. Factors in AD progression include sex differences and gut microbiome imbalances, with women disproportionately affected and APOE4 carriers showing early metabolic and cognitive changes. This study explores the potential of prebiotic inulin, probiotic Bifidobacterium animalis, and fecal microbiota transplants (FMT) from healthy donors to mitigate AD …

Cell-Based Cardiac Repair And The Natural Cardiac Healing In Regenerative Adult Mammal, Hsuan Peng

Theses and Dissertations--Pharmacology and Nutritional Sciences

Heart failure (HF) following myocardial infarction (MI) remains a significant global health concern, with the initial ischemic injury often leading to microvascular damage and infarct expansion, exacerbating the overall cardiac impairment. Despite extensive research, there are currently no effective therapies to limit myocardial damage post-MI, resulting in a substantial number of patients progressing to HF. Stem cell therapy has emerged as a promising approach to modulate cardiac injury and promote healing. However, clinical trials have shown only modest success, underscoring the need for improved strategies to enhance efficacy. Additionally, the lack of significant ventricular regeneration highlights the necessity of targeting …

The Delineation Of Platelet Pathology In Cardiometabolic Disease, Chi Peng

Theses and Dissertations--Pharmacology and Nutritional Sciences

Obesity is a multifactorial disease with many comorbidities leading to multiorgan dysfunction. Current studies point towards dysregulation of platelet signaling as a driver for increased risk of cardiovascular disease and stroke. The exact mechanisms remain elusive due to the complex interplay of factors involved, warranting the need to further understand how platelets are affected. Our preliminary data evaluating changes in platelet and coagulation parameters from bariatric patients showed that obesity did not affect platelet count or clotting time as demonstrated in INR values. However, female patients had increased bleeding events before surgery that were decreased after surgery. Due to limitations …

Characterization Of Bowel Dysfunction After Spinal Cord Injury In Mice, Olivia Wireman

Theses and Dissertations--Physiology

Most individuals who suffer a spinal cord injury (SCI) will experience some form of bowel dysfunction. Trauma to the spinal cord can result in severe constipation and/or incontinence, otherwise known as neurogenic bowel. Constipation requires extensive bowel routines typically involving the help of another person. Still, many living with SCI are hospitalized due to bowel complications such as fecal impaction. While neurogenic bowel has been well characterized in the clinic, pre-clinical models of neurogenic bowel after SCI are still in development. Most pre-clinical studies in bowel dysfunction after SCI are published in rat models. Studies existing in mice, to our …

Maternal-Adolescent Communication About Sex And Risky Sexual Behaviors: A Cross-Cultural Comparison Of Czech, Spanish, And Taiwanese Youth, Mckinley Hall

Theses and Dissertations--Family Sciences

This present study aimed to test the relationship between perceived maternal-adolescent communication about sex and risky sexual behaviors, while also considering the links between perceived maternal-adolescent closeness and maternal-adolescent conflict with risky sexual behaviors, across three culturally distinct countries, namely the Czech Republic (N=878, mean age of 17.93), Spain (N =1024, mean age of 18.79), and Taiwan (N =1443, mean age of 16.48). Samples of adolescents from each country were used and statistical analyses were conducted to test the hypothesized relationships. Based on path analysis carried out on each sample, the results revealed that Czech adolescents reported the highest levels …

Indoor Pests And Human Health: Characterizing Contaminants And Improving Mitigation, Johnalyn Gordon

Theses and Dissertations--Entomology

Much of the United States population spends the majority of their time indoors and within the home. Not only are indoor arthropod pests an unsightly nuisance in our homes, but they can have serious impacts on human health, especially with chronic exposure. In addition to negative health impacts, costs associated with these medical impacts can be tremendous. For these reasons, it is critical to develop comprehensive strategies for pest reduction and mitigation of associated health impacts. The work outlined in this dissertation represent examination of the distribution of a hypothesized bed bug allergen within the indoor environment, identification of a …

Addressing The Trade-Offs Of Pest Protective Row Covers For Integrated Pest Management In Vegetable Production, Kathleen Fiske

Theses and Dissertations--Entomology

The success of many integrated pest management (IPM) strategies is limited by trade-offs with economic, cultural, and environmental factors. While some IPM strategies reduce pests, they may harm pollinators, reduce the efficiency of weed or disease management, or may increase costs relative to revenue. Pest protective row covers, in the form of fine-mesh netting (referred to as mesotunnels), are an effective alternative to pesticide use, but they are not without their challenges. While row covers exclude insect pests and the pathogens they vector, it is unknown how well non-vectored diseases can be managed underneath the row cover. The exclusion of …

Practical Challenges In Delivering Dsrna For Woody Plant Protection, Zachary Bragg

Theses and Dissertations--Entomology

Unprecedented weather events associated with climate change, coupled with extensive anthropogenic stresses, have reduced the effectiveness of traditional forest pest management approaches, which can no longer keep pace with invasive species overwhelming naïve landscapes and native pests experiencing eruptive and expansive outbreaks. Double-stranded RNA-(dsRNA) mediated gene silencing, a type of RNA interference (RNAi), has been coopted for use as a biopesticide against a multitude of agricultural and horticultural pests and could serve as a powerful tool for woody plant protection. While effective initiation of gene silencing and subsequent mortality have been demonstrated in multiple tree pests, effective and efficient methods …

Increased Social Support And Maintained Weight Loss Among Post Metabolic And Bariatric Surgery Patients Following A Support And Nutrition-Based Program, Sydney Mae Mcintosh

Theses and Dissertations--Nutrition and Food Systems

Obesity, a prevalent health condition nationwide, has now been recognized as a diagnosable chronic health disease. With that prevalence we have seen a rise in obesity-related comorbidities which can be attributed to excess weight. Therefore, to combat obesity and related comorbidities, metabolic and bariatric surgery is becoming a more accepted and utilized treatment for individuals with obesity. Metabolic and bariatric surgery is the most effective and safest treatment for weight loss in individuals with obesity. However, metabolic, and bariatric surgery is a restrictive and/or malabsorptive procedure that requires significant lifestyle changes before and after the procedure. Patients who undergo metabolic …

Links Between Perceived Mother-Adolescent And Father-Adolescent Conflict And Low Self-Control: A Cross-National Comparative Study, Tory Thomas

Theses and Dissertations--Family Sciences

The influence of parent-adolescent relationships and adolescent adjustment have been well-documented. Self-control has emerged as a key probabilistic construct in understanding adjustment, well-being, and life success. The present study tests the links between adolescent perceptions of maternal and paternal conflict and self-control. In addition, to understand the extent to which cultural developmental context impacts these associations, the study will employ a cross-cultural comparative lens to test whether cultural context moderates these links. Self-report data were collected from N = 4,924 adolescents (Mage = 16.97 years, 54.08% female) across four countries (China, Czech Republic, Turkey, and the United States). In by …

Consequences Of Abiotic And Anthropogenic Stressors In The Antarctic Midge, Belgica Antarctica, Jack J. Devlin

Theses and Dissertations--Entomology

The ability to tolerate stress is key to maintaining fitness in extreme environments such as the polar regions. Subject to a myriad of extreme year-round abiotic conditions, invertebrates inhabiting the terrestrial ecosystems of Antarctica provide an excellent system to investigate adaptations to stress. Understanding the response of these species to abiotic and novel stressors is crucial in a world with rapidly occurring climate change and increasing anthropogenic activity. In this dissertation, I investigated physiological and molecular responses to naturally occurring and human-derived stresses in the midge Belgica antarctica, which is Antarctica’s only endemic insect.

In my first research chapter, I …

Malleability Of Abortion Attitudes, Allison Leip

Theses and Dissertations--Family Sciences

Although abortion attitudes have been thoroughly investigated and population-level attitudes have not changed much over the past half-century, polls and research inquiring about abortion attitudes tend to ask isolated questions about if, and in what circumstances, abortion should be legal. The purpose of this study was to examine the extent to which abortion attitudes both varied and changed according to several contextual factors. A multiple-segment factorial vignette was conducted with 530 respondents in the state of Kentucky. Overall, most respondents held strong attitudes on access to abortion, both before the rationale was provided and regardless of the rationale provided. However, …

Nutrient Profile Assessment Of A Meal Program Impact On Older Adults' Diet Quality And Food Security Status, Millicent Yaa Gyasiwaa Ms

Theses and Dissertations--Nutrition and Food Systems

The rise in food insecurity globally has ignited institutions and organizations to implement policies and programs to reduce the burden on vulnerable people including older adults and people living in underserved areas. Though programs such as congregate, home-delivered meals, and pantries have been initiated to contribute to reducing food insecurity the nutrient content of these meals including recovered meals and their effect on food security status, food quality, and health has not been widely studied. The current study, Meals on Wings (MOW), assessed the nutrient profile of the free meals offered 4 times per week for 3 months, from May …

Acting On Routine Outcome Monitoring, Virginia Courtney

Theses and Dissertations--Family Sciences

This thesis explores the application of an Acceptance and Commitment Therapy (ACT) informed approach in achieving clients’ therapeutic objectives via systematically tracking client progress over the therapy process. The study utilized the Marriage and Family Therapy Practice Research Network (MFT-PRN), a specific tool that aids the tracking of therapy progress, to gather relevant client data. The data consisted of therapy progress for 27 individuals the author worked with, 1,001 individuals from the Individual Relational and Finance Therapy Clinic, and 4,424 individuals from the MFT-PRN-Network. Upon collecting this data, progress trajectories were generated using Microsoft Excel to compare the author’s clients’ …

Division Of Labor And Relationship Satisfaction: Examining The Mediating Role Of Self Esteem, Ellen Keith

Theses and Dissertations--Family Sciences

As a result of feminist movements, rejections of gender roles, and changing economic conditions, profound changes have occurred within the structure of American families. This study delves into the intricate dynamics of divisions of household labor (DoL), self-esteem, and relationship satisfaction within the context of contemporary relationships. Drawing on data from the Panel Analysis of Intimate Relationships and Family Dynamics (Pairfam), this study tested five hypotheses, and investigates how perceptions of fairness in DoL tasks influence self-esteem and relationship satisfaction. Significant associations were found between reported share of DoL and indicated fairness of DoL, indicated fairness of DoL and relationship …

Sex Differences In Pediatric Hypertension: Obesity, Stress, And The Renin-Angiotensin System, Allyson Dyar

Theses and Dissertations--Nutrition and Food Systems

Pediatric hypertension, linked to long-term cardiovascular risks, shows increasing prevalence and varying patterns between boys and girls. This study explores sex-based differences in hypertension among 251 children aged 6-18 from Kentucky Children’s Hospital. Using 24-hour ambulatory blood pressure monitoring (ABPM) and assessing plasma renin, aldosterone, and cortisol, we examined blood pressure severity by sex. Girls showed a higher incidence of severe hypertension and elevated cortisol levels, whereas boys had higher mean systolic blood pressure. Aldosterone was associated with night systolic blood pressure in girls, while night diastolic blood pressure was linked to aldosterone in both sexes and renin in girls. …

Examining Anxious Attachment And Its Effects On Sexual Behaviors In Adulthood, Justin Graham

Theses and Dissertations--Family Sciences

The current study aimed to investigate the relationship between anxious attachment and adult sexual behaviors. The study utilized pairfam, a nationally representative German sample, as a secondary data set for its quantitative analysis. Participants responded to two anxious attachment scales and questions regarding sexual desire, sexual confidence, and age at first sexual experiences. Analyzing data from 5561 individuals, averaging 29.27 years old, a path analysis was conducted to assess variable effects. Findings indicate that higher anxious attachment correlates with reduced sexual confidence and earlier onset of sexual intercourse. Future studies should investigate additional attachment scales and include a more diverse …

The Relationships Between Maternal And Paternal Inconsistent Parenting And Cyberbullying Victimization, Anxiety And Depressive Symptoms Among Adolescents, Lynn Maamari

Theses and Dissertations--Family Sciences

The present research investigated the associations between maternal and paternal inconsistent parenting and cyberbullying victimization, anxiety, and depression. It also tested the extent to which these relationships were moderated by sex. It was expected that inconsistent maternal and paternal parenting would be positively associated with cyberbullying victimization, anxiety, and depressive symptoms. It was also expected that the links between maternal and paternal inconsistent parenting and cyberbullying victimization, anxiety as well as depression symptoms would not be moderated by sex. Data were collected from 500 14–18-year-old Czech teenagers, with a mean age of 14.4 years; 54% of the participants were female. …

Examining The Feasibility Of Implementing Farm To School Programs In Rural Kentucky Schools: Barriers And Successes Of Initiating Programming As Identified Through Teacher’S Observations, Christina Wilson

Theses and Dissertations--Nutrition and Food Systems

Farm to School (FTS) programs provide experiential learning opportunities to children that have the potential to shape eating patterns and, in turn, improve health and learning outcomes. Participation in FTS programs in Kentucky is growing. However, programming varies widely across schools, and few have an edible school garden. This study examined the feasibility of establishing an edible school garden while incorporating FTS programming by evaluating teachers' observations and experiences. Six rural Kentucky schools were selected to receive a $5,000 grant to initiate an edible school garden and incorporate FTS programming. A Qualtrics survey measured six categories regarding implementation. The results …