Medicine and Health Sciences Commons^™

The Sick Ones., Christian Loriel Lucas

Electronic Theses and Dissertations

This thesis consists of a collection of linked short stories, connected at the intersections of medicine, public health, race, gender, and socioeconomics. The Sick Ones was completed during a time of social unrest and the emergence of the Covid-19 virus. Inspired by medicine’s history of exploiting sick, poor, and racialized bodies, The Sick Ones explores the treatment of illness and societal woes in a near-speculative future. Each story is plot-driven, but complimented by a protagonist who keeps the narrative grounded, as they attempt to survive unprecedented circumstances. Some of the protagonists are complicit in their own medical exploitations, while others …

Development Of A Pediatric Cardiac Assist Maglev Pump For Use With A Universal Driver System., Landon Heath Tompkins

Electronic Theses and Dissertations

Heart failure (HF) remains the leading cause of death, affecting 26 million adults worldwide and 6.5 million adults in the United States. Pediatric HF patients have been a historically underserved population with few options for mechanical circulatory support (MCS) therapy, a leading treatment as an alternative to heart transplantation. To address this clinical need, the Inspired Universal MagLev System is being developed; a low cost, universal magnetically levitated extracorporeal MCS system with interchangeable single-use pumps that will ultimately provide adult and pediatric patients ventricular and respiratory assist therapies. The Inspired Pediatric VAD is the first single-use pump application for this …

Characterization Of Adiposity And Inflammation Genetic Pleiotropy Underlying Cardiovascular Risk Factors In Hispanics., Mohammad Yaser (Anwar)

Electronic Theses and Dissertations

The observed overlap between genetic variants associated with both adiposity and inflammatory markers suggests that changes in both adiposity and inflammation could be partially mediated by common pathways. The pervasive but sparsely characterized “pleiotropic” genetic variants associated with both adiposity and inflammation have been hypothesized to provide insight into the shared biology. This study explored and characterized the genetic pleiotropy underpinning adiposity and inflammation using genetic and phenotypic observations from the Cameron County Hispanic Cohort (CCHC). A total of 3,313 samples and >9 million single nucleotide polymorphisms (SNPs) were examined in this study. Mixed model genome-wide association studies (GWAS) were …

The Green House Nursing Home Model: The Gh Elements And Their Impact On Quality Of Care In Nursing Homes., Deborah Kaminka Niyongabo

Electronic Theses and Dissertations

Nursing homes (NHs) have been described as hospital-like facilities where residents are more likely to experience isolation or abuse. The Green House (GH) model is a type of culture change which focuses on deinstitutionalizing traditional NHs to provide better quality of care and quality of life to NH residents. The two main objectives of this study are: to describe the GH model and its elements and to identify which GH elements impact the quality of care. This study also seeks to identify organizational theories used in the GH analysis. The next objective is to analyze the impact of the GH …

Evaluating The Effects Of Pcbs In Non-Alcoholic Fatty Liver Disease & Diabetes And The Role Of Ahr In Regulating The Hepatic Proteome And Lipid Metabolism., Jian Jin

Electronic Theses and Dissertations

Polychlorinated biphenyls (PCBs) are persistent organic pollutants associated with non-alcoholic fatty liver disease (NAFLD) and diabetes. Based on their ability to activate the aryl hydrocarbon receptor (AhR), PCBs are subdivided into two classes: dioxin-like (DL) and non- dioxin-like (NDL) PCBs. This study not only evaluated the chronic effect of DL PCBs (PCB126), NDL PCBs (Aroclor1260 mainly contains NDL), and the DL/NDL PCB mixture (PCB126/Aroclor1260 mixture) on liver, but also explored the acute hepatic effects of DL PCB and potential mechanisms in NAFLD and the role of AhR in regulating hepatic proteome and lipid metabolism, and whether the process independent of …

Predicting Dental Student's Performance On National Board Dental Examination (Nbde) Part I: Exploring Demographic Factors, Dental Admission Test (Dat) Factors, Pre-Program Academic Factors, And Dental Program Academic Performance., Wei-Shao Lin

Electronic Theses and Dissertations

Dental students need to successfully challenge a national licensure examination to be able to practice dentistry. Dental educators currently have difficulty in identifying candidates who are at risk of failing this examination. This non-experimental quantitative study examined existing dental student data from the 2017, 2018, and 2019 graduating classes, using a retrospective and correlational approach to identify possible markers for at risk students. Demographic factors, dental admission test (DAT) factors, pre-program academic factors, dental program academic performance, and National Board Dental Examination (NBDE) Part I performance. A series of independent t-tests and One-Way analysis of variances (ANOVAs) were used to …

Implementing A Standardized Pediatric Bone Marrow Transplant Orientation., Erika L. Shell

Doctor of Nursing Practice Papers

Nurse orientation programs focus on establishing a nurse’s ability to perform skills necessary in the organization’s setting. The purpose of this project was to develop a unit-specific orientation program for the experienced registered nurse transitioning into providing care for pediatric bone marrow transplant (BMT) patients at a local children’s hospital to enhance nurse knowledge and satisfaction. Melnyk and Fineout-Overholt’s rating system for the hierarchy of evidence was used in the selection of articles with high levels of evidence for the critical appraisal of the supporting literature for the program development. The best practices for orientation content provide constructive effects on …

Soluble Epoxide Hydrolase Inhibition: A Novel Therapeutic Strategy In Alcoholic Liver Disease., Jeffrey Barr Warner

Electronic Theses and Dissertations

Emerging evidence suggests that soluble epoxide hydrolase (sEH) inhibition is a valuable therapeutic strategy for the treatment of numerous diseases. sEH rapidly degrades cytochrome P450-produced epoxygenated lipids (epoxy-fatty acids, epFAs), which generally exert beneficial effects on several cellular processes. sEH hydrolysis of epoxy-fatty acids produces dihydroxy-fatty acids which are typically less biologically active than their parent epoxide. sEH inhibition has shown efficacy in treating numerous pathologies associated with non-alcoholic liver disease, yet no efforts to date have tested the efficacy of sEH inhibition in alcoholic liver disease (ALD). Herein, we measured the levels of sEH expression and epFAs in human …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Tumor-Derived Exosomes Drive Immunosuppressive Macrophages In A Pre-Metastatic Niche Through Nf-Kβ Dependent Glycolytic Metabolic Reprogramming., Samantha M. Morrissey

Electronic Theses and Dissertations

The formation of a pre-metastatic niche is a fundamental requirement for primary tumor metastasis. One of the defining characteristics of a pre-metastatic niche is infiltration of immunosuppressive macrophages. However, how these macrophages acquire their immunosuppressive phenotype remains largely unexplored. Here, we demonstrate that tumor-derived exosomes (TDE) polarize macrophages towards an immunosuppressive phenotype characterized by increased PD-L1 expression through NF-kB-dependent metabolic reprogramming in mice and humans. While NF-κB has previously been shown to act as a direct transcription factor for PD-L1, we report a novel mechanism where TDE-induced NF-κB activation drives PD-L1 expression by augmenting the glycolytic capacity of macrophages through …

Plasmodium Impairs Antibacterial Innate Immunity To Systemic Infections In Part Through Hemozoin-Bound Bioactive Molecules., Christopher Lynn Harding

Electronic Theses and Dissertations

Despite efforts to decrease the global health burden of malaria, infections with Plasmodium species continue to cause over 200 million episodes of malaria each year which resulted in 405,000 deaths in 2018 [1]. One complication of malaria is increased susceptibility to invasive bacterial infections. Plasmodium infections impair host immunity to non-Typhoid Salmonella (NTS) through activities of heme oxygenase I (HO-I) )-induced release of immature granulocytes and myeloid cell-derived IL-10. Yet, it is not known if these mechanisms are specific to NTS. We show here, that Plasmodium yoelii 17XNL (Py) infected mice had impaired clearance of systemic Listeria monocytogenes (Lm) during …

Application Of Machine Learning Technologies For Detection Of Proximal Lesions In Intraoral Digital Images: In Vitro Study., Rohit Vadlamani

Electronic Theses and Dissertations

Background: Interpretation of bitewing radiographs is influenced by factors such as acquisition parameters (e.g. exposure, type of sensor), clinical technique, visualization (e.g. monitor type and calibration) and the observer (e.g. experience and fatigue bias). We hypothesized that the use of artificial intelligence (AI) will reduce visualization and observer factor in bitewing interpretation and improve diagnostic accuracy. Objective: The purpose of the present study was to evaluate the use of AI in the form of a machine-learning algorithm to detect and quantify proximal lesions compared with human trained observers. Methods: 16,000 anonymized, digital bitewings of patients were hand searched and non-bitewing, …

Evaluating Family Satisfaction On An Advanced Certification Palliative Care Unit., Ruby Aebersold

Doctor of Nursing Practice Papers

Inpatient palliative care programs with The Joint Commission (TJC) Advanced Certification for Palliative Care are accountable for evaluating multiple health outcomes, including family satisfaction. A midwestern urban hospital’s palliative care unit received certification in January 2019. To comply with TJC standards, a clear data management and evaluation plan for family satisfaction data was needed. Investigation of the previous family satisfaction measure processes revealed areas in need of improvement in the satisfaction survey distribution, data collection, and evaluation processes. Satisfaction surveys were often unable to be distributed to families of deceased patients because the documented mailing address was a nursing facility. …

Nursing And Caregiver Satisfaction And The Implementation Of A Discharge Education Roadmap For Newly Diagnosed Pediatric Oncology Patients., Sable Iglesias

Doctor of Nursing Practice Papers

The initial diagnosis of a pediatric cancer is a stressful and overwhelming experience. During this time, distressed caregivers are expected to learn about the diagnosis, treatment plan, and how to care for their child at home. Simultaneously, parental reactions to a new cancer diagnosis often make learning a difficult process. The discharge education process is often a responsibility of the nursing staff. However, there are currently no evidence-based, systematic guidelines to direct the discharge education process of newly diagnosed pediatric oncology patients. Consequently, there is a lack of standardization across institutions, resulting in considerable variability in content provided in teaching …

Alcohol Misuse And Abuse Among College Students: An Implementation Of A Screening Program., Tiffany Slaughter Newcomb

Doctor of Nursing Practice Papers

Excessive alcohol use in the United States creates serious economic, health, and mortality problems (CountyHealthRankings, 2018). College students experience high rates of use, binge drinking, and 20% of college students meet the criteria for alcohol use disorder [AUD] (NIH, 2014). Screening by healthcare providers (HCPs) in the student health setting is critical and a recommended strategy for reducing negative consequences of alcohol use experienced by college students (US Preventive Services Task Force, 2018).

Aims: The objective of this project was to implement an alcohol screening program among college-age undergraduate students in a university student health center.

Methods: HCPs …

Modulation Of Inflammatory Pathway By Inflammatory Inhibitor Jsh-23 Mitigates Diabetic Retinopathy., Rubens Petit Homme

Electronic Theses and Dissertations

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). Its pathology is consisted of the breakdown of the blood-retinal barrier (BRB), particularly the inner blood-retinal barrier (iBRB). The exact mechanism that leads to the iBRB impairment and the development of DR has not been elucidated yet. However, chronic inflammation that is hallmark of the type I DM has recently become a key focus in DR study. Hyperglycemia causes dysregulation of nuclear factor-kappa B (NF-kB); and its constant activation increases the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and intercellular adhesion molecule-1 (ICAM-1) in the …

Mechanisms Of Chromate-Induced Suppression Of Rad51: A One Environmental Health Approach., Rachel M. Speer

Electronic Theses and Dissertations

Lung cancer is the leading cause of cancer death. Lung cancer is commonly associated with smoking, however, 1 in 5 women and 1 in 12 men who develop lung cancer are never-smokers. Environmental exposures, therefore, account for a significant portion of lung cancer cases. Hexavalent chromium [Cr(VI)] is a global environmental contaminant and known human lung carcinogen. Cr(VI) and other carcinogenic metals induce chromosome instability, an early event in lung cancer. Structural chromosome instability arises in part due to failed DNA repair. Particulate Cr(VI), the most potent form of Cr(VI), induces DNA double strand breaks and inhibits the high-fidelity DNA …

N-Acetyltranserase 2 (Nat2) Genotype Polymorphism In Cryopreserved Human Hepatocytes And Chinese Hamster Ovary (Cho) Cells., Mariam Refaat Zaky Habil

Electronic Theses and Dissertations

Arylamine N-acetyltransferases, NAT1 and NAT2, catalyze the detoxification and/or activation of drugs and aromatic amine carcinogens. Single nucleotide polymorphisms or SNPs result in different human NAT2 genotypes thus dividing the population into rapid, intermediate, and slow acetylators. We hypothesize allelic variants of NAT2 genotype will decrease levels of N-acetylation, cytotoxicity, oxidative stress, DNA adduct formation, and mutagenesis compared to the reference allele NAT2*4. Cryopreserved human hepatocytes expressing different NAT2 genotypes and NER-deficient Chinese hamster ovary (CHO) cells transfected with human CYP1A2 and human NAT2*4, NAT2*5B or NAT2*7B have been used to investigate N-acetylation of different xenobiotics. In …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Tissue-Resident Myeloid-Derived Suppressor Cells Modulate Immune Homeostasis In Healthy Adipose., Katlin Brooke Stivers

Electronic Theses and Dissertations

Our goal with this study was to gain insight into the homeostatic immune cell network in healthy adipose tissue. Specifically, we sought to determine if the immature myeloid cells found in healthy and inflamed adipose were, in fact, tissue-resident myeloid-derived suppressor cells (MDSCs). Using various in vitro and in vivo methods, we have uncovered a population of CD11b^Hi Ly6C^Hi Ly6G^- MDSCs resident in healthy adipose tissue. To the best of our knowledge this is the first time that these cells have been investigated and described in healthy adipose tissue. Systemic MDSC depletion lead to the accumulation of …

Epithelial Responses To Porphyromonas Gingivalis In The Community Context., Zackary Ray Fitzsimonds

Electronic Theses and Dissertations

Porphyromonas gingivalis, a keystone pathogen for periodontal disease, initiates a complex molecular dialogue with gingival epithelial cells, leading ultimately to disruption of host signaling pathways. Dysbiotic host responses are also thought to contribute to the initiation and progression of oral squamous cell carcinomas. Recently, the homeostatic commensal Streptococcus gordonii has been shown to antagonize P. gingivalis-induced epithelial cell signaling events in host cells, such as proliferation and migration. The aim of this study was to characterize pathways that P. gingivalis targets to disturb host signaling, with a specific focus on pathways that S. gordonii can restore to homeostatic …

Identification And Structural Characterization Functional Motifs In The Porphyromonas Gingivalis Mfa1 Short Fimbria., Mohammad K. Roky

Electronic Theses and Dissertations

Porphyromonas gingivalis is a causative agent of periodontal disease, initially colonizes the oral cavity by adhering to commensal streptococci. Adherence requires the interaction of the minor fimbrial protein (Mfa1) of P. gingivalis with streptococcal antigen I/II (Ag I/II). A peptide derived from Ag I/II peptide has been well characterized and shown to significantly reduce P. gingivalis colonization and bone loss in vivo, suggesting that this interaction represents a potential target for therapeutic intervention. However, the functional motifs of Mfa1 involved in the interaction with Ag I/II remain uncharacterized. A series of N- and C-terminal peptide fragments of Mfa1 were …

Implementation Of A Central Line Bundle As A Quality Improvement Priority., H. Anthony Flood

Doctor of Nursing Practice Papers

Background: Central-line associated blood stream infections (CLABSI) are a major threat to patient morbidity and mortality. Kentucky Continue Care Hospital (KCCH), a long-term acute care hospital, experienced a significant increase in CLABSI in 2018; therefore, implementation of a central-line bundle to reduce CLABSI was identified as a quality improvement priority. Methods: This author used the Quality Improvement Model to plan, study, and evaluate the implementation of a central line bundle in KCCH following University of Louisville Institutional Review Board (ULIRB) approval, staff were educated on the new process and the audit tool using a self-study module over a 2-week period …

Feasibility Of Implementation Of An Evidence-Based Trained Service Dog Provider Assessment Guide., Cassandra Lee

Doctor of Nursing Practice Papers

American healthcare is costing more, and patients are living with more complex chronic conditions. For many, alternative therapies such as trained service dogs provide a valuable complement to standard treatments. Many providers are unaware of the role a service dog can play in healthcare outside of visual impairment, as well as contraindications and concerns their use may bring. The use of service dogs is still considered by some to be complementary and alternative medicine (CAM) since it is not a part of usual medical practice and is not commonly taught within conventional medical education. The purpose of this project was …

Reducing Nurse Burnout In The Acute Care Setting., Christopher Reynolds

Doctor of Nursing Practice Papers

This paper examines nurse burnout in intensive care unit (ICU) nurses. The quality improvement (QI) project was conducted at the University of Louisville Hospital (ULH) in a ten bed medical intensive care unit (MICU) over the course of one month. The Maslach Burnout Inventory (MBI) survey and a demographic questionnaire were administered to nurses pre and post intervention. The intervention consisted of a uninterrupted, 30 minute work break during a nurse’s twelve hour work shift. The MBI survey was used to determine nurses’ level of burnout using three subscales; emotional exhaustion, depersonalization, and personal accomplishment. A paired t-test was used …

Breastfeeding Education In The Postpartum Period., Kiersten Proctor

Doctor of Nursing Practice Papers

Breastmilk is the best source of nutrients for an infant, yet many mother-infant dyads do not sustain breastfeeding past initiation. Breastfeeding education and support offered to the motherinfant dyad in the postpartum period have the potential to increase maternal breastfeeding selfefficacy, and attribute to a longer duration of breastfeeding. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement breastfeeding education and support in the postpartum period to mothers who have initiated and maintained breastfeeding by the time of the newborn well-child check, occurring at two to eight days postpartum. This project aimed to increase …

Breathing Easier: Indoor Air Quality Education Program., Sarah Kuner

Doctor of Nursing Practice Papers

Background: Exposure to indoor air pollutants increases the risk for poor health outcomes and health disparities among vulnerable groups such as children. The purpose of this evidence-based project was to implement an indoor air quality program that would: 1) improve caregiver awareness of indoor and outdoor environmental health exposures and 2) increase the intention to reduce exposures to indoor household pollutants. The target population included caregivers of preschool children, ages 3 to 5 years, who currently attend the Ohio Valley Education Cooperative. Methods: This project used a pre and post test study design that included two, virtual-learning modules that reviewed …

Early Initiation Of Therapeutic Hypothermia In The Emergency Department., Taylor Purnsley

Doctor of Nursing Practice Papers

Therapeutic hypothermia (TH) is a treatment initiated by critical care providers for the management of cardiac arrest. It has been shown to lower the body temperature, reduce the inflammatory response, and suppress many of the pathways leading to delayed cell death. The American Heart Association (AHA) has strongly recommended to initiate cooling within 4-6 hours after return of spontaneous circulation (ROSC); however, despite the recommendation, the use of TH in emergency departments (ED) is not routine and it is commonly delayed. The purpose of this project was to evaluate the impact of an educational intervention on the timing of initiation …

Improving The Rates Of Smoking History Documentation In The Electronic Medical Record., Megan Mccleese Vitellaro

Doctor of Nursing Practice Papers

Lung cancer is the leading cause of cancer related deaths in the United States, and Kentucky leads the nation in lung cancer deaths. Lung cancer care also contributes billions of dollars a year to the cost of health care in this country. The U.S. Preventive Services Task Force (USPSTF) recommends low-dose computed tomography (LDCT) for lung cancer screening with a grade B recommendation, which is a covered service under the Centers for Medicare and Medicaid Services (CMS) guidelines. In order to qualify, patients must have an appropriately documented smoking history. A primary care office was identified within a major healthcare …

Strategies To Increase Hpv Vaccine Uptake In Primary Care., Katelyn Brandel

Doctor of Nursing Practice Papers

Purpose: The purpose of this project was to increase HPV vaccination initiation rates in a primary care setting. This was accomplished through evidence-based provider and parental education using presumptive language and distribution of a customized toolkit. Design: The project protocol was designed using a theoretical approach about chosen health behaviors from the Health Belief Model. Outcomes included initiation rates, efficacy of a toolkit intervention, efficacy of a recall system, and provider satisfaction. Methods: A two-sided Fisher’s Exact Test was performed. Primary outcome results indicated a non-significant increase in vaccination rates. Of the 24 patients who received the toolkit, 25% chose …