Medicine and Health Sciences Commons^™

Management Of The Sensitized Cardiac Transplantation Recipient, Michael Mazzei, Suresh Keshavamurthy, Olga Timofeeva, Yoshiya Toyoda

Surgery Faculty Publications

Preoperative sensitization of the cardiac transplant recipient, defined as the presence of anti-Human Leukocyte Antigen (HLA) antibodies before transplant, represents a significant management challenge for physicians. Sensitization prolongs the pre-transplant wait time and is associated with postoperative transplant complications and death. It is critical that sensitized heart transplant candidates be identified and optimized before surgery. In this review, we describe the risk for sensitization, discuss the means through which sensitization may be diagnosed, and highlight some of the new therapeutic options for managing the sensitized cardiac transplant patients.

2020 Kentucky Nursing Workforce Report, Sydney P. Thompson

Center of Excellence in Rural Health Infographics

No abstract provided.

Magnetic Resonance And Ct Imaging Biomarkers For Prediction Of Acute And Chronic Radiation-Induced Xerostomia, Anastasia Katsavochristou, Dimitrios Koumoulis

Oral Health Practice Faculty Publications

Xerostomia is a common adverse effect of radiation therapy at the head and neck area. Radiation-induced xerostomia can be severe and detrimental for the quality of life. Clinicians and radiologists have focused on the prevention of xerostomia as feasible, which has been significantly improved in the recent decades with the use of the contemporary radiation technology. However, radiation-induced xerostomia still remains one of the most devastating side effects of radiation therapy. Clinical risk factors have been identified, but the variation of its incidence and presentation has turned the focus on the investigation of parameters that would be able to predict …

Effect Of Blood Flow Restriction Training On Functional And Self-Reported Outcomes In Female Runners With Patellofemoral Pain, Lauren Nicole Erickson

Theses and Dissertations--Rehabilitation Sciences

Background: Patellofemoral pain (PFP) is the leading cause of lower extremity injury in female runners, significantly limiting running ability and becoming chronic in nearly 50% of the cases. This condition, which presents as pain around (peripatellar) or behind (retropatellar) the patella, is associated with significant weakness of the quadriceps and gluteal musculature, as well as altered movements mechanics. The challenge for clinicians is designing an effective treatment program to reduce pain and improve function without causing symptoms to flare. Blood flow restriction training (BFRT) is a relatively new training method within rehabilitation that involves placing a pressurized cuff to the …

Maternal Proximity To Mountaintop Removal Mining And Birth Defects In Appalachian Kentucky, 1997-2003, Daniel B. Cooper

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

Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence …

Patient Engagement In Patient Portals In Appalachia Versus Surrounding Us Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017 - 2020, Heather Lea Tudor

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

OBJECTIVE: Those living in the Appalachian regions face more significant healthcare disparities than those in the US. Patient portals can decrease disparities and increase health outcomes and health literacy. The purpose of this study was to determine if those living in the Appalachian region were offered access to and used their patient portals differently than the surrounding US Census region. Additionally, we aimed to determine if there was a difference in reported reasons for non-use of patient portals.

METHODS: This was a descriptive study using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) data (2017-2020) to …

Racial Disparities In Syringe Exchange Program Access In Kentucky, Ankur Bhargava

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

Non-white Kentuckians use syringe exchange programs (SEPs) at lower rates than white Kentuckians. This analysis begins by documenting this disparity and then explores several potential causes. Access to SEPs is limited by law as only health departments may operate them. Areas of the state in which SEPs face political opposition are therefore underserved. A consequence of this legal limitation is distance to a SEP may be a barrier to access. Analysis of publicly available data indicates non-white drug users in Kentucky are located closer to syringe exchange programs in urban areas but farther away in rural areas. Proximity to a …

The Witness Project In Whitehall, Oh, Freda Allyson Hucek

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

Abstract

The Witness Project (WP) is an evidence-based breast cancer screening intervention that will be implemented in Whitehall, Ohio, at three different churches by the Franklin County Health Department. The WP will target African American women 50-74 years old who are non-compliant with current United States Preventative Services Task Force (USPSTF) breast cancer screening recommendations. African American women face disproportionately higher mortality rates from breast cancer when compared to other racial and ethnic groups in the United States and in Whitehall. African American women are less likely to discuss breast cancer and preventive screening services within their community. The WP …

Epigenetic States Regulate Tumor Aggressiveness And Response To Targeted Therapies In Lung Adenocarcinoma, Fan Chen

Theses and Dissertations--Toxicology and Cancer Biology

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide, 85% of which are lung adenocarcinomas (LUAD). Although molecular studies of NSCLC identified targetable mutations of some oncogenes including BRAF, EGFR and ALK, no targeted therapies exist for most cases. Cancer epigenetics is the study of epigenetic modifications, including histone modifications, that control gene expression in cancer. Recent advances have revealed numerous epigenetic abnormalities in human cancers, and targeting epigenetic regulators could be effective at reversing dysregulated epigenetic programs or driving sensitivity to other targeted therapies.

Inhibitors of the histone methyltransferase EZH2 have recently been approved as …

Science-Based Regulation Of Pharmacological Substances In Competition Horses, Jacob Machin

Theses and Dissertations--Toxicology and Cancer Biology

Current testing methodologies within equine forensic toxicology focus on arbitrary thresholds and zero-tolerance policy. Modern analytical chemistry’s limits of detection are low enough that oftentimes femtogram-per-milliliter amounts of a substance can readily be identified in both blood and urine of a horse. For most pharmacologically relevant compounds, these concentrations have no relevance to pharmacological effect. It is therefore crucial that testing methodologies to determine appropriate thresholds and cut-offs be developed that are driven by biological activity rather than arbitrary limits of detection. This dissertation looks to address this by suggesting a system of calculated Effective Plasma Concentrations by which a …

Biofilm And Cell Adhesion Strength On Dental Implant Surfaces Via The Laser Spallation Technique, James D. Boyd, Arnold J. Stromberg, Craig S. Miller, Martha E. Grady

Statistics Faculty Publications

OBJECTIVE: The aims of this study are to quantify the adhesion strength differential between an oral bacterial biofilm and an osteoblast-like cell monolayer to a dental implant-simulant surface and develop a metric that quantifies the biocompatible effect of implant surfaces on bacterial and cell adhesion.

METHODS: High-amplitude short-duration stress waves generated by laser pulse absorption are used to spall bacteria and cells from titanium substrates. By carefully controlling laser fluence and calibration of laser fluence with applied stress, the adhesion difference between Streptococcus mutans biofilms and MG 63 osteoblast-like cell monolayers on smooth and rough titanium substrates is obtained. The …

Commentary: Use Of Bactrac Proteomic Database-Uromodulin Protein Expression During Ischemic Stroke, Gabriella-Salome K. Armstrong, Jacqueline A. Frank, Christopher J. Mclouth, Ann M. Stowe, Jill M. Roberts, Amanda L. Trout, Justin F. Fraser, Keith R. Pennypacker

Neurology Faculty Publications

Introduction: Uromodulin (UMOD) is a glycoprotein expressed by the epithelial cells of the thick ascending limb of Henle's loop in the kidney. Research has shown that increased uromodulin expression may be associated with lower risk of cardiovascular disease in adults. Utilizing the Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC) (clinicaltrials.gov NCT03153683), a continuously enrolling tissue bank, we aimed to examine the associations between serum uromodulin, age, and high BMI (BMI> 25) and its relationship to stroke in patients.

Methods: Arterial blood distal and proximal to the thrombus was collected during a thrombectomy procedure using the BACTRAC protocol and sent …

2020 Kentucky Dental Workforce Update, Sydney P. Thompson, Melissa Slone, Frances J. Feltner

Center of Excellence in Rural Health Infographics

No abstract provided.

Investigations Into The Genetics Of Mixed Pathologies In Dementia, Adam Dugan

Theses and Dissertations--Epidemiology and Biostatistics

Alzheimer’s disease (AD) is an irreversible, progressive brain disorder that leads to a loss of memory and thinking skills. While tremendous progress has been made in our understanding of the genetics underlying AD, currently known genetic variants explain only approximately 30% of the heritable risk of developing AD. One hurdle to AD research is that it can only be definitively diagnosed at autopsy, making cruder, clinic-based diagnoses more common. In recent years, several brain pathologies that mimic AD’s clinical presentation have been identified including brain arteriolosclerosis, hippocampal sclerosis (HS), and, most recently, limbic-predominant age-related TDP-43 encephalopathy (LATE). It has become …

An Assessment Of Kentucky Birth Records, Focusing On Early-Onset Hypertensive Disorders Of Pregnancy, Environmental Metal Exposures, And Geocoding Precision, 2008-2017, Courtney J. Walker

Theses and Dissertations--Epidemiology and Biostatistics

Using live and stillbirth records from Kentucky (2008-2017), this dissertation assessed the county-level prevalence and geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP); examined the geocoding precision of addresses recorded on birth records, and evaluated the association between individual risk factors and environmental metal exposures on eHDP prevalence. After adjusting for maternal demographic factors and pre-existing health conditions, we observed that eHDP prevalence was 38% higher (aPR=1.38, 95%CI:1.16, 1.64) in counties with the highest prevalence of married women (> 53.8%) compared to lower prevalence areas (31.6%) had a 20% higher prevalence of eHDP(aPR=1.20, 95%CI:1.00, 1.44) compared to counties with …

Cognitive Abilities In Hearing Loss: Perceived And Performance Abilities Of Adults Related To Attention, Memory, And Social Cognition, Karah Gottschalk

Theses and Dissertations--Gerontology

Hearing loss is the most common sensory deficit noted in aging adults. It is commonly known to reduce an individual’s ability to detect, identify, and localize sounds and speech and to cause issues in communication. However, there are other less commonly discussed impacts that hearing loss has beyond the auditory system. Literature suggests a correlation between hearing loss and cognition in aging adults. Similar to hearing loss, the domains of cognition experience performance and functional changes across the life span. In an aging adult, changes related to cognition are also suggested to be associated with hearing loss. This study aimed …

Unboxing The Japanese Sojourning Mom’S Pediatric-Going Experience: A Phenomenological Study Of Culturally And Linguistically Appropriate Health Services, Carolyn Oldham

Theses and Dissertations--Education Sciences

This study explores how twelve former Lexington-area Japanese sojourning mothers define culturally and linguistically appropriate services and how culture, gender and language shaped their health care beliefs, behaviors and experiences in pediatric settings. It is a naturalistic, pragmatic line of inquiry born in collaboration with Japanese sojourning moms across cups of matcha 末茶 and mugicha 麦茶. Framed by constructivist and intersectionality research lenses, this phenomenological study seeks to understand how study participants perceived the cultural and linguistic appropriateness of their interactions with Lexington-area pediatric offices and to begin to ascertain the meanings they created based on their subjective experiences. Its …

Decreasing Test Anxiety In Nursing Students Using Cute/Funny Animal Videos, Lynn Kelso

DNP Projects

Abstract

Background: Stress, test anxiety and worry continue to increase in nursing students. As successful completion of course exams is required for nursing students to complete their program of study, these increased levels of stress, anxiety and worry can hinder their ability to perform at their best. Purpose: The aim of this project is to show that using cute/funny animal videos prior to an exam can decrease test anxiety (TA) and improve performance. Project Improvement Framework: The plan-do-study-act, PDSA, quality improvement framework was used for the final, modified project. Method: A video was embedded into three of …

The Outcomes Of Cope, A Cognitive Behavioral Therapy Program, In Patients Awaiting Lvad Implantation, Aaron G. Harris

DNP Projects

PURPOSE: The purpose of the Doctor of Nursing Practice (DNP) project was to pilot Creating Opportunities for Personal Empowerment (COPE), an evidence based cognitive behavioral therapy (CBT) intervention, with patients diagnosed with advanced heart failure who are awaiting Left Ventricular Assist Device (LVAD) implantation or those who have had one recently implanted before they are discharged home. METHODS: A cross-sectional study design was used for this Pilot project. Patients were identified for potential participation by LVAD coordinators and represent a convenience sample. The patients were screened for anxiety and depression using the GAD-7 and PHQ-9 screening tools. If patients scored …

Relationship Between Preoperative Frailty And Postoperative Outcomes After Lvad Implantation, Katherine L. Wilhelm

DNP Projects

Abstract

Background: Frailty is common in many patients with advanced heart failure, including those who undergo left ventricular assist device (LVAD) implantation. Frailty has been associated with worse outcomes after other cardiac surgeries; however, little is known about the effect of frailty on postoperative outcomes after LVAD implant.

Purpose: The purpose of this project was to evaluate whether preoperative frailty [as determined by either short physical performance battery (SPPB) score ≤ 7/12 or 6-minute walk test (6-MWT) <200 >meters] is associated with poorer postoperative outcomes after LVAD implantation than non-frailty in adults with advanced heart failure.

Setting and Sample: This project …

Risk Factors For Workplace Sexual Harassment In Female Truck Drivers, Kimberly Marie Riddle

Theses and Dissertations--Nursing

Sexual harassment is one of the most common forms of workplace violence in the United States. Sexual harassment is defined as unwanted verbal and physical behaviors of a sexual nature (e.g., physical advances, requests for sexual favors, inappropriate sexist or sexual comments or jokes, pornography, or other unwanted conduct) that creates an uncomfortable working environment or interferes with the employee’s job responsibilities. In general, it is estimated that nearly one in every two women have experienced sexual harassment at the workplace over their lifetime. In male-dominated occupations, such as truck driving, law enforcement, firefighting, and construction, females may have a …

Complications In Cardiac Surgery, Christine Williamitis

Theses and Dissertations--Nursing

Quality of care and outcomes from cardiac surgery have always been of primary importance to providers and the entire health care team when caring for cardiac surgical patients. Providers in cardiac surgery have had a long history of tracking procedural morbidity and mortality rates in programs nationally and internationally. Morbidity and mortality rates vary widely among hospitals. In most studies in which procedural outcomes from cardiac surgery are evaluated, the focus has been on operative morbidity and mortality and the probability of death after a cardiac surgical procedure. Less attention has been paid to predictors of perioperative complications, and sample …

Factors Associated With Lifestyle Modification For Type 2 Diabetes Self-Management And Prevention, Leigh Anne Koonmen

Theses and Dissertations--Nursing

Diabetes is the seventh leading cause of death in the United States, affecting roughly 13% of U.S. adults aged 18 years or older. Type 2 diabetes accounts for 90-95% of all diabetes cases and is characterized by the progressive development of insulin resistance leading to sustained elevated blood glucose levels. Management of type 2 diabetes includes risk-reduction strategies and continuous medical care to prevent the development of complications.

Lifestyle is a major contributing factor to morbidity and mortality rates in the United States. Preventative health behaviors, such as engaging in physical activity, maintaining a healthy weight, and following a healthy …

Dietary Assessments And Their Association With Psychological Factors, Inflammation, And Cardiovascular Health Outcomes, Junghee Kang

Theses and Dissertations--Nursing

Cardiovascular diseases (CVDs), a group of disorders of the heart and blood vessels, are the leading cause of death worldwide, causing one-third of deaths each year. Diet is one of the most important behavioral risk factors for CVD. The effects of behavioral risk factors, such as diet, may lead to increased blood pressure, increased blood glucose, raised blood lipids, and overweight and obesity. Inflammation contributes to the development of CVD and can be influenced by diet. Dietary assessment indices can measure diet quality from an individual's dietary intake by scoring food and nutrient intakes. However, the mediation effects of diet …

Dexamethasone Serum Concentrations After Intravenous Administration In Horses During Race Training, S. Mcclure, C. K. Fenger, Bradley Brown, George Maylin, W. Duer, L. Dirikolu, Kimberly Brewer, Jacob Machin, Thomas Tobin

Maxwell H. Gluck Equine Research Center Faculty Publications

Dexamethasone (DXM) sodium phosphate is a widely used corticosteroid for inflammatory conditions in horses, regulated in racing jurisdictions in the USA by a 0.005 ng/ml serum/plasma threshold. This study seeks to describe serum concentrations of DXM at 48 and 72 h after intravenous administration of 20 mg DXM sodium phosphate over 1 to 5 days, and to identify a possible source of DXM overages. 74 horses (39 Thoroughbreds, 13 Standardbreds, 22 Quarter Horses) in active race training received 20 mg DXM sodium phosphate. Serum was collected before injection, at 48 and 72 h post last injection, and analysed by LC/MS-MS …

Covid-19 Stakeholder Experiences In The Commonwealth Of Kentucky, Center Of Excellence Of Rural Health, University Of Kentucky, Center For Rural Health Research, East Tennessee State University

Center of Excellence in Rural Health Reports

Key Points:

Healthcare providers reported that many in-person services had stopped and that other services were delivered remotely or via telehealth. Some services that were still in-person moved to curbside delivery, including family planning visits. Others described a shift in roles within the community, primarily to support COVID testing.

When asked about the impact of COVID-19, educators described an expansion of roles among staff and a rapid adoption of new technology. Educators also described their staff as being dedicated to meeting the needs of their students including assuring access to food and learning materials for those without reliable internet.

Community …

Workplace Lactation Support And Breastfeeding Practices In Employed Mothers, Robin Ray

Theses and Dissertations--Nursing

Low rates of breastfeeding are a global public health issue. Despite national and international health agency recommendations for breastfeeding until infants are six months of age when solid foods are introduced and continued breastfeeding until 12 months of age or older, many mothers in the United States discontinue breastfeeding at an early age. Return to work after childbirth is one of the leading contributing factors to early cessation of breastfeeding in employed mothers. Understanding the association between individual and organizational factors and breastfeeding practices in employed mothers is essential for the development, implementation, and evaluation of programs and policies to …

Precision Nutrition And Advanced Culinary Medicine, Sara B. Police

Pharmacology and Nutritional Sciences Textbook Gallery

This electronic textbook (eBook) accompanies NS801, Precision Nutrition and Advanced Culinary Medicine, a 1-credit, 8-week online medical elective course for the University of Kentucky College of Medicine Office of Medical Education. The eBook provides module-based background information including text, tables, and figures to support each module of the online course:

1. Introduction
2. Culinary Challenges Preparation
3. Emerging Concepts in Precision Nutrition
4. Cardiovascular Disease & Nutritional Considerations
5. Neurological and Mental Health Disorders & Nutritional Considerations
6. Cancer & Nutritional Considerations
7. Gastrointestinal (GI) Health, Microbiome & Nutritional Considerations
8. Renal Conditions & Nutritional Considerations

As an open access textbook supported by the University of Kentucky Libraries …

A Multiple Goals Perspective On Burnout Disclosure And Support Among Attending Physicians, Alison N. Buckley

Theses and Dissertations--Communication

Burnout is a common experience among physicians and has been identified as a precursor to substance abuse and suicide ideation. When not addressed, burnout can have many negative personal, relational and professional consequences. Research about the burnout experience is limited due to the taboo nature of the topic. The present study used a multiple goals theoretical perspective to examine how physicians disclose burnout in order to access social support. Attending physicians from various specialties (N = 30) participated in one-on-one interviews and were asked to discuss their burnout experience, conversational goals during burnout disclosure, catalysts and barriers for disclosure, and …

Exploring Health And Risk Information Seeking In The Context Of Covid-19: Testing The Comprehensive Model Of Information Seeking And Risk Information Seeking And Processing Model As Competing Explanatory Models, Xianlin Jin

Theses and Dissertations--Communication

Facing a pandemic caused by a novel coronavirus (COVID-19), the public feels uncertainty and fear. To cope with the pandemic and reduce uncertainty, the public needs accurate and prompt information. By theoretically and empirically comparing the Comprehensive Model of Information Seeking (CMIS) and the Risk Information Seeking and Processing Model (RISP), this dissertation aims to unpack the core mechanism of health and risk information seeking. Built on the two models, the author proposed an Integrated Model and explored which variables are the significant predictors of health and risk information seeking.

The author recruited 729 adult participants and analyzed 394 completed …