Medicine and Health Sciences Commons^™

Hgf-Mediated C-Met Signaling In Human Corneal Epithelial Cells., Kate Tarvestad

Electronic Theses and Dissertations

Vision is often regarded as the primary sense of humans. The cornea is the main refractive tissue that permits light through to the retina, allowing a clear image. When the cornea sustains damage, it opens a pathway for infection and blindness through fibrotic processes. Healing the corneal tissue is critical for vision restoration and pain alleviation. Growth factors and their cognate receptors are currently under investigation as tools to restore proper corneal physiology. We hypothesize that manipulating the hepatocyte growth factor (HGF)/ c-Met signaling pathway is one route to promote quality corneal healing. This thesis investigates the signaling, trafficking, and …

Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson

Doctor of Nursing Practice Papers

Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.

Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.

Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …

The Impact Of Volatile Organic Compound Exposure On Subclinical Biomarkers Of Cardiovascular Injury., Breandon Taylor

Electronic Theses and Dissertations

Pollution has been identified as the leading environmental cause of non-communicable disease and premature deaths globally. Volatile organic compounds (VOCs) are gaseous chemical constituents of pollution derived from a variety of sources, including industrial solvents and byproducts, automobile exhaust, tobacco smoke, cleaning supplies, and personal care products. VOCs are also abundant at various Superfund and Hazardous Waste Sites. Emerging data suggest that VOC exposure is associated with several adverse health outcomes, including cardiovascular disease (CVD). VOCs and their metabolites can potentially damage the endothelial lining of blood vessels, resulting in perturbed vascular function and vascular inflammation. We hypothesize that VOC …

Metabolic Foundations Of Exercise-Induced Cardiac Growth., Kyle Fulghum

Electronic Theses and Dissertations

Regular aerobic exercise promotes physiological cardiac growth, which is an adaptive response thought to enable the heart to meet higher physical demands. Cardiac growth involves coordination of catabolic and anabolic activities to support ATP generation, macromolecule biosynthesis, and myocyte hypertrophy. Although previous studies suggest that exercise-induced reductions in cardiac glycolysis are critical for physiological myocyte hypertrophy, it remains unclear how exercise influences the many interlinked pathways of metabolism that support adaptive remodeling of the heart. In this thesis project, we tested the general hypothesis that aerobic exercise promotes physiological cardiac growth by coordinating myocardial metabolism to promote glucose-supported anabolic pathway …

Defining The Impact Of Clinically Modeled Hindlimb Stretching, Exercise, & Inactivity On Functional Recovery After Spinal Cord Injury., Greta Cesarz

Electronic Theses and Dissertations

Spinal cord injury (SCI) is a devastating, life altering event that affects approximately 282,000 Americans. The most obvious side effect of SCI is paralysis due to damage to the spinal cord that disrupts ascending and descending pathways as well as central pattern generating circuitry. In addition to paralysis, patients suffer from other debilitating side effects including altered cardiovascular function, autonomic dysreflexia, neuropathic pain, spasticity, and contractures. In contrast to humans, rodents display spontaneous locomotor recovery following incomplete SCI due to in-cage activity/training. Previously, our laboratory has studied the effect of lack of in-cage training by utilizing custom designed rodent wheelchairs. …

Investigating The Income Academic Achievement Gap: An Exploration Of The Roles Of Mindfulness And Self-Concept Clarity In Low-Income College Students., Natalie Burke

Electronic Theses and Dissertations

The purpose of the current study was to examine whether linguistic patterns previously associated with trait mindfulness and self-concept clarity in low-income college students’ application essays are associated with academic performance and psychosocial variables. The aims of the study were as follows: 1) Explore relations between linguistic markers that have been previously associated with higher mindfulness/self-concept clarity and GPA and 2) Explore relations between linguistic markers that have been previously associated with higher mindfulness/self-concept clarity and anxiety/depression. Participants were 54 undergraduate students in the Cardinal Covenant program (a scholarship program for students from low-income families) who began college in the …

A Mixed Methods Assessment Of Menstrual Hygiene Management And School Attendance Among Schoolgirls In Edo State, Nigeria., Madeline Tomlinson

Electronic Theses and Dissertations

Menstrual hygiene in lower-middle-income countries (LMICs) is limited and has been linked to many health, educational and social effects. However, the prevalence, details, and impact of menstrual hygiene management have not been well characterized in rural and peri-urban settings across Nigeria. The overall purpose of this research was to investigate menstrual hygiene management (MHM) among adolescent schoolgirls in peri-urban areas of Edo State, Nigeria; and to determine the educational consequences associated with poor MHM. MHM was measured using previously validated questions that were adapted after a formative assessment of MHM within the Edo State community. We used a mixed methods …

Models And Algorithms For Trauma Network Design., Sagarkumar Dhirubhai Hirpara

Electronic Theses and Dissertations

Trauma continues to be the leading cause of death and disability in the US for people aged 44 and under, making it a major public health problem. The geographical maldistribution of Trauma Centers (TCs), and the resulting higher access time to the nearest TC, has been shown to impact trauma patient safety and increase disability or mortality. State governments often design a trauma network to provide prompt and definitive care to their citizens. However, this process is mainly manual and experience-based and often leads to a suboptimal network in terms of patient safety and resource utilization. This dissertation fills important …

Examining The Effects Of Npra Antagonist Anantin On Sci-Induced Ployuria., Lindsey Zipperer

Electronic Theses and Dissertations

Polyuria, or the over production of urine, is a prevalent condition that significantly impacts the quality of life in individuals suffering from a spinal cord injury (SCI). Post-SCI induced polyuria is thought to have been associated with altered levels of vasopressin (AVP), atrial natriuretic peptide (ANP), and natriuretic peptide receptor A (NPRA). In the present study, the function of NPRA was analyzed in the rat contusion model using anantin, an NPRA antagonist. A daily dose of either 100 µg of anantin or vehicle was administered intraperitoneally immediately following the SCI surgery and continued until termination, 4 weeks post injury (wpi). …

Bayesian Methods For Graphical Models With Neighborhood Selection., Sagnik Bhadury

Electronic Theses and Dissertations

Graphical models determine associations between variables through the notion of conditional independence. Gaussian graphical models are a widely used class of such models, where the relationships are formalized by non-null entries of the precision matrix. However, in high-dimensional cases, covariance estimates are typically unstable. Moreover, it is natural to expect only a few significant associations to be present in many realistic applications. This necessitates the injection of sparsity techniques into the estimation method. Classical frequentist methods, like GLASSO, use penalization techniques for this purpose. Fully Bayesian methods, on the contrary, are slow because they require iteratively sampling over a quadratic …

The Impact Of Pegylation On Cellular Uptake And In Vivo Biodistribution Of Gold Nanoparticle Mri Contrast Agents., Nagwa El-Baz

Electronic Theses and Dissertations

Gold nanoparticles (GNPs) have become a pivotal platform for the delivery of pharmaceutical and diagnostic agents as well as for general therapeutic purposes. Despite their potential for use in biomedicine, their interaction with serum proteins is crucial as it could change their biological profile due to the formation of a protein corona, which can affect their delivery to target tissues in the body. Grafting the GNPs with polyethylene glycol (PEG) is widely used in research to decrease opsonization of the particles by serum proteins and decrease the uptake by the reticuloendothelial system. Here in this dissertation, we have developed a …

The Role Of Mmp-3 In Copper Oxide Nanoparticle-Induced Pulmonary Inflammation And Fibrosis., Yuanbao Zhang

Electronic Theses and Dissertations

Copper oxide nanoparticles (Nano-CuO) are wildly used in medical and industrial fields and our daily necessities. However, the biosafety assessment of Nano-CuO is far behind their rapid development. This study was to investigate the potential mechanisms underlying Nano-CuO-induced pulmonary inflammation and fibrosis, especially to determine whether Nano-CuO exposure could dysregulate MMP-3, an important mediator in pulmonary fibrosis, and its roles in Nano-CuO-induced pulmonary inflammation and fibrosis. Aim 1 was to investigate whether exposure to Nano-CuO caused MMP-3 dysregulation in lung epithelial cells and the role of MMP-3 in Nano-CuO-induced alteration of cell junction-associated proteins. The potential mechanisms that might be …

The Role Of Generative Adversarial Networks In Bioimage Analysis And Computational Diagnostics., Ahmed Naglah

Electronic Theses and Dissertations

Computational technologies can contribute to the modeling and simulation of the biological environments and activities towards achieving better interpretations, analysis, and understanding. With the emergence of digital pathology, we can observe an increasing demand for more innovative, effective, and efficient computational models. Under the umbrella of artificial intelligence, deep learning mimics the brain’s way in learn complex relationships through data and experiences. In the field of bioimage analysis, models usually comprise discriminative approaches such as classification and segmentation tasks. In this thesis, we study how we can use generative AI models to improve bioimage analysis tasks using Generative Adversarial Networks …

Alpha, Beta-Unsaturated Aldehydes: The Underrepresented Markers Of Disease., Saurin Sutaria

Electronic Theses and Dissertations

The peroxidation of unsaturated fatty acids is a widely recognized metabolic process that creates a complex mixture of volatile organic compounds including aldehydes. Elevated levels of reactive oxygen species in cancer cells promote random lipid peroxidation, which leads to an increase in a variety of aldehydes. Many of these volatile aldehydes are exhaled and are of interest as potential markers of disease. Chapter 1 presents a review of reported aldehydes in the exhaled breath of lung cancer patients. alpha,beta-Unsaturated aldehydes, detected primarily when derivatized during exhaled breath preconcentration, are underreported in the reviewed articles. Chapter 1 concludes with our hypothesis …

Implementation Of Scripted Debriefings Following Neonatal Delivery Room Resuscitations., Kimberly M. Knott

Doctor of Nursing Practice Papers

Abstract

Background: The functioning of neonatal delivery teams can be affected by technical and non-technical skills of individual team members. The team in this project was challenged by varying knowledge and skill levels and did not have a standardized process for debriefing resuscitation events. The literature shows that debriefings can aid in improving knowledge, skills, teamwork, and communication of resuscitation teams.

Purpose: The purpose of this quality improvement project was to implement a scripted, post-resuscitation debriefing with the neonatal delivery team to improve non-technical skills of the resuscitation team and identify challenges to providing optimal care.

Method: Scripted, …

Trauma-Informed Schools: A Quality Improvement Project For A Rural Public-School System., Channing Kay

Doctor of Nursing Practice Papers

Abstract

Background: Adverse Childhood Experiences (ACEs) are traumatic events that occur from birth to adulthood and have shown to be significant in increasing the risk for both physical and psychological anomalies (Felitti et al., 1998). ACEs are not siloed to poor communities but were observed in 67% of adults throughout 25 US states (Felitti et al., 1998). Despite the significance found in the literature, few preventative measures are being implemented to protect against these experiences.

Setting: The project seeks to address mental health disparities associated with rural-underserved populations. The school system participating in the project is a rural community school …

Feasibility Of An Emergency Department Fall Screening Tool And Intervention Bundle Checklist On Nursing Fall Prevention Documentation: A Quality Improvement Project., Bailee E. Pope

Doctor of Nursing Practice Papers

Background: The World Health Organization (2018) and The Joint Commission (2015) define falling as a sudden, unplanned involuntarily advancement toward the ground, that may or may not result in injury. Fall rates are directly related to a facility’s mortality and morbidity rates, delayed patient care, additional diagnostic testing, and increased length-of-stay. Evaluating the practices of a local emergency department (ED), it was noted that ED nurses are not documenting their acknowledgment of a patient’s risk for falls, and also failed to chart interventions aimed at preventing falls. Failing to implement these practices into regular patient care can lead to negative …

Reducing The No-Show Rate At A Community Mental Health Organization., Philip E. Pippen

Doctor of Nursing Practice Papers

Relative to other outpatient healthcare specialties, appointment nonattendance (no-shows) is most prevalent in psychiatric settings. Upon meeting with a community-based mental health organization in Louisville, KY (LCMHO), referral no-shows for intake appointments were identified as a significant issue. LCMHO’s intake appointment no-show rate, estimated at 25 – 40%, exceeded nonattendance trends in the literature. The purpose of this evidence-based practice (EBP) project was to develop and implement a referral engagement reminder intervention for improving intake appointment attendance. A systematic approach guided by the Model for Improvement was applied to foster this evidence-supported practice change. The project’s findings included a 16% …

School Nurses’ Participation In Accommodations For Children With Epilepsy: A Quality Improvement Project., Paula A. Johnson

Doctor of Nursing Practice Papers

Abstract

Epilepsy is the most frequent, chronic, neurological condition in childhood, impacting 0.5 to 1% of the population. Documented learning problems associated with childhood epilepsy include memory problems, attention deficits, reading difficulties, and processing speed abnormalities. Epilepsy also impacts psychological health with poor self-esteem, a high incidence of bullying, and poor school performance. The Every Student Succeeds Act identifies the school nurse as a leader in chronic disease management; advocating for students to receive the resources and support they need to achieve academic success. The large Midwestern school system, studied in this capstone project, has 804 known students with epilepsy. …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

A Policy Project: Implementing Safe Firearm Storage Legislation In Kentucky., Maggie M. Wiser

Doctor of Nursing Practice Papers

Ensuring the safe storage of firearms in the home is a research-supported method of reducing the incidence of firearm injury and death, specifically unintentional injury and self-harm in the pediatric population. The American Academy of Pediatrics recommends keeping all firearms stored locked, unloaded, and separate from ammunition. While evidence shows that implementing laws regulating the storage of firearms can be effective to reduce morbidity and mortality, the state of Kentucky currently has no such regulations. For this DNP project, John Kingdon’s Multiple Streams Framework was used as a guideline for policy analysis with the intention of identifying opportunities to advocate …

Reducing Delirium In Medical Intensive Care Unit., Hope Kathryn Eppley

Doctor of Nursing Practice Papers

Background: Delirium in MICUs (medical intensive care units) is an acquired and detrimental condition patients often seen in MICU. This condition has a high prevalence and can result in increased risk of death, comorbidities and length of hospital stay. Prevention is critical to avoid an increased risk of mortality.

Aim: The purpose of quality improvement (QI) project was to implement a delirium bundle in a medical intensive care unit (MICU) to reduce delirium by 20% over an 8-week period.

Method: This QI project utilized the IHI rapid cycle quality improvement model, using two cycles of the Plan-Do-Study-Act (PDSA) model …

Implementation And Evaluation Of A Mental Health Referral Pathway For School Nurses., Jessica Rivera

Doctor of Nursing Practice Papers

Nearly one in six American children between the ages of six and 17 have a treatable mental disorder (American Academy of Family Physicians [AAFP], 2020). Still, less than half do not receive help from a mental health professional (Whitney & Peterson, 2019). School nurses have an opportunity to bridge the gap by improving youth access to mental health care. Purpose: The purpose of this quality improvement project was to implement and evaluate a mental health referral pathway for school nurses. The specific aims were to improve school nurses' preparedness to recognize and address mental health concerns and to increase the …

Multicomponent Approach To Delirium Prevention In The Acute Care Setting: An Evidence-Based Quality Improvement Project., Kelley James

Doctor of Nursing Practice Papers

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of …

Neonatal Developmental Care Makes Sense: Implementation Of An Evidence-Based Guideline For Developmentally Appropriate Multi-Modal Positive Sensory Exposures., Nicole Moseley Jaeger

Doctor of Nursing Practice Papers

Background: There is increasing awareness of the contribution of the neonatal intensive care (NICU) environment and the importance of developmental care (DC) interventions to long-term outcomes in high-risk infants. Care at the project site reflected that given at many hospitals, where positive sensory experiences and negative sensory mitigation are done but inconsistently. There was not a guideline in place for DC interventions.

Setting: The project site housed a newly renovated single-family room (SFR) NICU with 12 licensed Level II beds and ability to flex to 19 beds. Neonates at gestational ages ≥28 weeks, requiring critical care for a …

Reducing Weekly Screen Time Use In College Students., Anna Louise Davidson

Doctor of Nursing Practice Papers

Background: Screen time overuse is a serious problem currently affecting college students. Studies have shown that too much screen time use can contribute to symptoms of depression and anxiety as well as stress, insomnia, and sedentary behavior contributing to obesity and cardiometabolic issues. Though much research has been devoted to assessing and reducing screen time use in children and adolescents, there are fewer published studies on interventions specific to college students. Therefore, the interventions for adolescents (ages 13 to 17) were reviewed and synthesized, as college students are close in age and brain development to late adolescent stage.

Setting: The …

Improving Trauma-Informed Education And Parenting For Resource Parents At A Foster Care Agency., Courtney Albers

Doctor of Nursing Practice Papers

675,000 children nationwide were involved with the foster care system in 2019, and nearly all children within the foster care system are actively suffering from the effects of trauma. Resource parent trauma-informed trainings, such as Resource Parenting Curriculum (RPC) developed by The National Child Traumatic Stress Network, are associated with improved parental perceptions towards trauma-informed care, improved child outcomes, and placement stability. Foster care agencies have trauma-informed state-based curriculum, but it does not meet the needs of resource parents, specifically those caring for children with developmental delays or disorders. The project was implemented at a therapeutic foster care agency for …

Development Of A Project To Improve Prenatal Education At A Rural Medically Assisted Treatment Center Focused On Neonatal Abstinence Syndrome And Parenting Skills., Tracey Brink

Doctor of Nursing Practice Papers

Abstract

Background: Many women who suffer from substance use disorder syndrome (SUDS) have low self-esteem and can be labeled as “unfit parents” which can impede infant bonding and maternal sobriety. Parent and self-efficacy are associated with improved maternal-infant attachment and sobriety (Adams, et.al. 2021). The earlier prenatal education is implemented, the more empowered the mothers will feel to be able to help their infants and themselves.

Setting: A medically assisted treatment center (MAT) for pregnant women who presents with SUDS. The six-bed inpatient facility is in a rural county in central Kentucky.

Purpose: To create an educational program about parent …

Implementing A Diabetes Risk Screening Protocol In The Primary Care Setting., Anna Marks

Doctor of Nursing Practice Papers

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 …

Quality Improvement For Timely Extubation In An Urban Community Icu., Connor Epperson

Doctor of Nursing Practice Papers

Background: Prolonged duration of mechanical ventilation (MV) is associated with higher morbidity, mortality, and increased resource utilization. Research has shown that the coordination of spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) through standardized protocols increases frequency of readiness to extubate assessments, thus reducing time on MV.

Purpose: The purpose of this project was to improve weaning protocol adherence by re-educating RN staff about the current weaning protocol and the importance of interdepartmental communication to perform coordinated SATs/SBTs, thus reducing MV duration.

Intervention: Education was provided to nursing staff on the current weaning protocol and the …