Medicine and Health Sciences Commons^™

Applicant Selection To A Regional Medical Training Program: A Structural Analysis Of Interviewer Assessments, Terry D. Stratton, Paula K. Arnett, Anthony D. Weaver, J. Bodie Stevens, Carol L. Elam

Behavioral Science Faculty Publications

Introduction: For regional campuses with specific program foci, assessing applicant fit necessarily extends beyond academic and professional factors. Based on assessments of applicants to a regional Rural Physician Leadership Program (RPLP), this study explores the relationship of academic and socio-demographic factors with interviewers’ ratings of: (1) likelihood of eventually practicing in a rural area of the state; and (2) overall acceptability to medical school.

Methods: The study population consisted of 163 first-time RPLP applicants interviewed independently from 2009-2016 by two faculty members at both main and regional medical campuses. Path analysis was used to calculate direct, indirect, and total effects …

Using Case-Level Context To Classify Cancer Pathology Reports, Shang Gao, Mohammed Alawad, Noah Schaefferkoetter, Lynne Penberthy, Xiao-Cheng Wu, Eric B. Durbin, Linda Coyle, Arvind Ramanathan, Georgia Tourassi

Kentucky Cancer Registry Faculty Publications

Individual electronic health records (EHRs) and clinical reports are often part of a larger sequence-for example, a single patient may generate multiple reports over the trajectory of a disease. In applications such as cancer pathology reports, it is necessary not only to extract information from individual reports, but also to capture aggregate information regarding the entire cancer case based off case-level context from all reports in the sequence. In this paper, we introduce a simple modular add-on for capturing case-level context that is designed to be compatible with most existing deep learning architectures for text classification on individual reports. We …

Evaluating The Feasibility And Acceptability Of Internet-Based Cognitive Behavioral Therapy For Insomnia In Rural Women, Mairead Eastin Moloney, Madeline Dunfee, Matthew Rutledge, Nancy Schoenberg

Sociology Faculty Publications

Background: Insomnia, one of the most common sleep disorders among women in midlife, is associated with multiple negative health outcomes. Rural Appalachian women are disproportionately affected by insufficient sleep, but their barriers to care (e.g., health care shortages, cultural norms) may prevent intervention. This study assessed the feasibility and acceptability of Sleep Healthy Using the Internet (SHUTi) an Internet-based version of cognitive behavioral therapy for insomnia in Appalachian women ages 45+ years.

Materials and Methods: We used mixed methods to assess feasibility (through summaries of recruitment and retention data) and acceptability (quantitatively through online survey scales and qualitatively …

Chagas Disease In The New York City Metropolitan Area, Crystal Zheng, Orlando Quintero, Elizabeth K. Revere, Michael B. Oey, Fabiola Espinoza, Yoram A. Puius, Diana Ramirez-Baron, Carlos R. Salama, Luis F. Hidalgo, Fabiana S Machado, Omar Saeed, Jooyoung Shin, Snehal R. Patel, Christina M. Coyle, Herbert B. Tanowitz

Internal Medicine Faculty Publications

Background

Chagas disease, caused by the parasite Trypanosoma cruzi, once considered a disease confined to Mexico, Central America, and South America, is now an emerging global public health problem. An estimated 300 000 immigrants in the United States are chronically infected with T. cruzi. However, awareness of Chagas disease among the medical community in the United States is poor.

Methods

We review our experience managing 60 patients with Chagas disease in hospitals throughout the New York City metropolitan area and describe screening, clinical manifestations, EKG findings, imaging, and treatment.

Results

The most common country of origin of our patients …

Ccne1 Amplification As A Predictive Biomarker Of Chemotherapy Resistance In Epithelial Ovarian Cancer, Justin W. Gorski, Frederick R. Ueland, Jill M. Kolesar

Obstetrics and Gynecology Faculty Publications

Ovarian cancer is the most-deadly gynecologic malignancy, with greater than 14,000 women expected to succumb to the disease this year in the United States alone. In the front-line setting, patients are treated with a platinum and taxane doublet. Although 40-60% of patients achieve complete clinical response to first-line chemotherapy, 25% are inherently platinum-resistant or refractory with a median overall survival of about one year. More than 80% of women afflicted with ovarian cancer will recur. Many attempts have been made to understand the mechanism of platinum and taxane based chemotherapy resistance. However, despite decades of research, few predictive markers of …

Gut Microbiome-Modified Polyphenolic Compounds Inhibit Α-Synuclein Seeding And Spreading In Α-Synucleinopathies, Tritia R. Yamasaki, Kenjiro Ono, Lap Ho, Giulio M. Pasinetti

Neurology Faculty Publications

Misfolding, aggregation and deposition of α-synuclein (α-syn) are major pathologic characteristics of Parkinson’s disease (PD) and the related synucleinopathy, multiple system atrophy (MSA). The spread of α-syn pathology across brain regions is thought to play a key role in the onset and progression of clinical phenotypes. Thus, there is increasing interest in developing strategies that target and attenuate α-syn aggregation and spread. Recent studies of brain-penetrating polyphenolic acids, namely, 3-hydroxybenzoic acid (3-HBA), 3,4-dihydroxybenzoic acid (3,4-diHBA), and 3-(3-hydroxyphenyl)propionic acid (3-HPPA) that are derived from gut microbiota metabolism of dietary polyphenols, show in vitro ability to effectively modulate α-syn misfolding, oligomerization, and …

Stroke As The Initial Presentation Of Takayasu's Arteritis: A Case Report, Paran Davari, Paige Sutton, Kimberly S. Jones

Neurology Faculty Publications

In this study, we report the case of a pediatric neurology stroke patient who was ultimately diagnosed with Takayasu's Arteritis. Our case describes a 14-year-old Hispanic female with no significant past medical history who presented to an outside hospital for acute onset of confusion and right sided weakness. She was given tissue plasminogen activator (TPA) at the outside hospital and transferred as a stroke alert. Initial The NIH stroke scale (NIHSS) was 12 with primarily right sided symptoms. Physical exam was also significant for asymmetric pulses and blood pressures. Imaging was significant for multifocal stenosis. She was ultimately diagnosed with …

The Β3-Adrenergic Receptor Agonist Mirabegron Improves Glucose Homeostasis In Obese Humans, Brian S. Finlin, Hasiyet Memetimin, Beibei Zhu, Amy L. Confides, Hemendra J. Vekaria, Riham H. El Khouli, Zachary R. Johnson, Philip M. Westgate, Jianzhong Chen, Andrew J. Morris, Patrick G. Sullivan, Esther E. Dupont-Versteegden, Philip A. Kern

Internal Medicine Faculty Publications

BACKGROUND. Beige adipose tissue is associated with improved glucose homeostasis in mice. Adipose tissue contains β3-adrenergic receptors (β3-ARs), and this study was intended to determine whether the treatment of obese, insulin-resistant humans with the β3-AR agonist mirabegron, which stimulates beige adipose formation in subcutaneous white adipose tissue (SC WAT), would induce other beneficial changes in fat and muscle and improve metabolic homeostasis.

METHODS. Before and after β3-AR agonist treatment, oral glucose tolerance tests and euglycemic clamps were performed, and histochemical analysis and gene expression profiling were performed on fat and muscle biopsies. PET-CT scans quantified brown adipose tissue volume and …

Myeloid-Specific Deficiency Of Pregnane X Receptor Decreases Atherosclerosis In Ldl Receptor-Deficient Mice, Yipeng Sui, Zhaojie Meng, Se-Hyung Park, Wei-Wei Lu, Christopher Livelo, Qi Chen, Tong Zhou, Changcheng Zhou

Pharmacology and Nutritional Sciences Faculty Publications

Abstract The pregnane X receptor (PXR) is a nuclear receptor that can be activated by numerous drugs and xenobiotic chemicals. PXR thereby functions as a xenobiotic sensor to coordinately regulate host responses to xenobiotics by transcriptionally regulating many genes involved in xenobiotic metabolism. We have previously reported that PXR has pro-atherogenic effects in animal models, but how PXR contributes to atherosclerosis development in different tissues or cell types remains elusive. In this study, we generated an LDL receptor-deficient mouse model with myeloid-specific PXR deficiency (PXR^ΔMyeLDLR^−/−) to elucidate the role of macrophage PXR signaling in atherogenesis. The …

Evaluating The Effectiveness Of Undergraduate Clinical Education Programs, John W. Ragsdale, Andrea Berry, Jennifer W. Gibson, Christiane R. Herber-Valdez, Lauren J. Germain, Deborah L. Engle

Medical Student Education Faculty Publications

Medical schools should use a variety of measures to evaluate the effectiveness of their clinical curricula. Both outcome measures and process measures should be included, and these can be organized according to the four-level training evaluation model developed by Donald Kirkpatrick. Managing evaluation data requires the institution to employ deliberate strategies to monitor signals in real-time and aggregate data so that informed decisions can be made. Future steps in program evaluation includes increased emphasis on patient outcomes and multi-source feedback, as well as better integration of existing data sources.

Association Of Aβ With Ceramide-Enriched Astrosomes Mediates Aβ Neurotoxicity, Ahmed Elsherbini, Alexander S. Kirov, Michael B. Dinkins, Guanghu Wang, Haiyan Qin, Zhihui Zhu, Priyanka Tripathi, Simone M. Crivelli, Erhard Bieberich

Physiology Faculty Publications

Amyloid-β (Aβ) associates with extracellular vesicles termed exosomes. It is not clear whether and how exosomes modulate Aβ neurotoxicity in Alzheimer's disease (AD). We show here that brain tissue and serum from the transgenic mouse model of familial AD (5xFAD) and serum from AD patients contains ceramide-enriched and astrocyte-derived exosomes (termed astrosomes) that are associated with Aβ. In Neuro-2a cells, primary cultured neurons, and human induced pluripotent stem cell-derived neurons, Aβ-associated astrosomes from 5xFAD mice and AD patient serum were specifically transported to mitochondria, induced mitochondrial clustering, and upregulated the fission protein Drp-1 at a concentration corresponding to 5 femtomoles …

Incentive Sensitization For Exercise Reinforcement To Increase Exercise Behaviors, Kyle D. Flack, Harry M. Hays, Jack Moreland

Dietetics and Human Nutrition Faculty Publications

Individuals can be sensitized to the reinforcing effects of exercise, although it is unknown if this process increases habitual exercise behavior. Sedentary men and women (body mass index: 25–35 kg/m², N = 52) participated in a 12-week aerobic exercise intervention. Exercise reinforcement was determined by how much work was performed for exercise relative to a sedentary alternative in a progressive ratio schedule task. Habitual physical activity was assessed via accelerometry. Post-intervention increases in exercise reinforcement predicted increases in physical activity bouts among those who expended over 2000 kcal per week in exercise and who compensated for less than …

Neuroligin-1 Is Altered In The Hippocampus Of Alzheimer's Disease Patients And Mouse Models, And Modulates The Toxicity Of Amyloid-Beta Oligomers, Julien Dufort-Gervais, Chloé Provost, Laurence Charbonneau, Christopher M. Norris, Frédéric Calon, Valérie Mongrain, Jonathan Brouillette

Pharmacology and Nutritional Sciences Faculty Publications

Synapse loss occurs early and correlates with cognitive decline in Alzheimer’s disease (AD). Synaptotoxicity is driven, at least in part, by amyloid-beta oligomers (Aβo), but the exact synaptic components targeted by Aβo remain to be identified. We here tested the hypotheses that the post-synaptic protein Neuroligin-1 (NLGN1) is affected early in the process of neurodegeneration in the hippocampus, and specifically by Aβo, and that it can modulate Aβo toxicity. We found that hippocampal NLGN1 was decreased in patients with AD in comparison to patients with mild cognitive impairment and control subjects. Female 3xTg-AD mice also showed a decreased NLGN1 level …

Seeking Care At Free Episodic Health Care Clinics In Appalachia, Malerie Lazar, Sandra Thomas, Lisa Davenport

Journal of Appalachian Health

Background: People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers.

Purpose: A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, …

Skin Cancer And Uv Exposure-Related Behaviors Among Appalachian And Non-Appalachian Adults, Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, Robin C. Vanderpool

Journal of Appalachian Health

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates.

Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample.

Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted …

Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton

Journal of Appalachian Health

Introduction: The Affordable Care Act (ACA) enacted on March 23, 2010 significantly impacted access to healthcare for people living with HIV (PLWH). Expansion of care was accomplished in three areas: eliminating exclusions for pre-existing conditions, elimination of lifetime caps on healthcare expenditures, and expansion of Medicaid eligibility.

Purpose: This study evaluated the impact of state implementation of the ACA Medicaid expansion on referral to HIV care at a Ryan White federally funded clinic in Kentucky (University of Kentucky Bluegrass Care Clinic [UK BCC]).

Methods: Retrospective chart review of all newly enrolled patients at the UK BCC between March 2010 and …

Food Insecurity Among College Students With And Without Medical Disorders At A University In Appalachia, Laura Mcarthur, Melissa D. Gutschall, Kimberly Fasczewski, Anna Jackson

Journal of Appalachian Health

Objective: This study compared severity of food insecurity, characteristics, and behaviors of college students with and without diagnosed medical disorders.

Design: Data were collected using a cross-sectional online questionnaire. Variables measured were food security status, disorders, coping strategies, and perceived barriers to food access. Descriptive and inferential statistics examined associations and compared groups. Statistical significance was p≤0.05.

Setting: Data were collected at Appalachian State University in North Carolina.

Participants: The sample was 247 food insecure students, of whom 60% were females, 50% 3rd- and 4th-year students, and 75% whites.

Results: Medical disorders were reported by 67.2% of food insecure students, …

A Nutritional And Environmental Analysis Of Local Food Pantries Accessible To College Students In Rural North Carolina, Emily E. Frymark, Jonathon Stickford, Alisha Farris

Journal of Appalachian Health

Introduction: Food insecurity is a growing concern among college students and is especially prevalent in rural areas. Food pantries often serve as a resource to food insecure individuals yet, their policies, standards, and nutritional quality vary due to the unpredictability of food donations.

Purpose: To examine the nutritional quality of food items and adherence of best practices at local food pantries accessible to college students near a university in rural Appalachia.

Methods: Three food pantries in North Carolina were selected due to their proximity to a local, rural university. Food items were analyzed for nutrient and food …

Use And Perceptions Of A Campus Food Pantry Among Food Insecure College Students: An Exploratory Study From Appalachia, Laura Mcarthur, Kimberly S. Fasczewski, Alisha Farris, Miranda R. Petrone

Journal of Appalachian Health

Introduction: Food insecurity has emerged as a public health problem among college students in Appalachia, jeopardizing their physical, mental, and emotional health and academic success. Campus food pantries have been established in this region, but no data are available concerning student use or perception of services.

Purpose: This study measured use and perceptions of a campus food pantry by students at a mid-sized university in rural North Carolina.

Methods: An online questionnaire collected behavioral and perceptual data, and follow-up interviews explored these variables. Descriptive statistics with significance at p<0.05 and thematic analytical procedures were used.

Results: Questionnaires were submitted by 896 of 6000 recruited students (14.9%), …

The Need For Evidence-Based Interventions To Reduce Food Insecurity Among College Students, Sarah Brothers, Stephanie Jilcott-Pitts Phd

Journal of Appalachian Health

Food insecurity is defined as insufficient resources to meet food needs. This is a global problem but is not confined to those countries identified as poor. One group of Americans who are particularly affected, and for whom the effects are particularly severe, is college students.

Current Status Of Magnetic Resonance On Saliva For Oral And Dental Health Early Diagnosis, Anastasia Katsavochristou, Dimitrios Koumoulis

Oral Health Practice Faculty Publications

Magnetic resonance spectroscopy of biomolecules has recently gained attention for clinical diagnosis. Its combination with saliva collection and analysis can promote early disease detection and monitoring, by identifying biomarkers of specific underlying pathology or disease as detected in saliva. With this novel, non-invasive technique, certain salivary biomarkers have been linked to dental and periodontal tissues pathology, as well as to specific head and neck cancer malignancies. At present, diagnostic biomarkers are still in need for further identification (e.g., diagnosis and monitoring of Sjögren’s syndrome), and nuclear magnetic resonance spectroscopy has been found to be a promising technique to compliment the …

Medication-Related Osteonecrosis Of The Mandible, Galal Omami

Oral Health Practice Faculty Publications

No abstract provided.

Research Data Management From The Stem Perspective: Reproducibility, Data Reuse, Data Integration, Melissa D. Clarkson

Institute for Biomedical Informatics Presentations

This presentation highlights three big ideas in STEM data management:

• Reproducibility requires scripted pipelines
• Data reuse requires metadata and documentation
• Data integration requires use of standards

It also provides an overview of the FAIR principles for research data management.

Association Of A Simplified Finnegan Neonatal Abstinence Scoring Tool With The Need For Pharmacologic Treatment For Neonatal Abstinence Syndrome, Lori A. Devlin, Janis L. Breeze, Norma Terrin, Enrique Gomez Pomar, Henrietta S. Bada, Loretta P. Finnegan, Kevin E. O'Grady, Hendrée E. Jones, Barry Lester, Jonathan M. Davis

Pediatrics Faculty Publications

Importance: Observer-rated scales, such as the Finnegan Neonatal Abstinence Scoring Tool (FNAST), are used to quantify the severity of neonatal abstinence syndrome (NAS) and guide pharmacologic therapy. The FNAST, a comprehensive 21-item assessment tool, was developed for research and subsequently integrated into clinical practice; a simpler tool, designed to account for clinically meaningful outcomes, is urgently needed to standardize assessment.

Objectives: To identify FNAST items independently associated with the decision to use pharmacologic therapy and to simplify the FNAST while minimizing loss of information for the treatment decision.

Design, Setting, and Participants: This multisite cohort study included 424 neonates …

First-In-Human Studies Of Mw01-6-189wh, A Brain-Penetrant, Antineuroinflammatory Small-Molecule Drug Candidate: Phase 1 Safety, Tolerability, Pharmacokinetic, And Pharmacodynamic Studies In Healthy Adult Volunteers, Linda J. Van Eldik, Lumy Sawaki, Karen Bowen, Daniel T. Laskowitz, Robert J. Noveck, Byron Hauser, Lynn Jordan, Tracy G. Spears, Huali Wu, Kevin Watt, Shruti Raja, Saktimayee M. Roy, D. Martin Watterson, Jeffrey T. Guptill

Sanders-Brown Center on Aging Faculty Publications

MW01-6-189WH (MW189) is a novel central nervous system-penetrant small-molecule drug candidate that selectively attenuates stressor-induced proinflammatory cytokine overproduction and is efficacious in intracerebral hemorrhage and traumatic brain injury animal models. We report first-in-human, randomized, double-blind, placebo-controlled phase 1 studies to evaluate the safety, tolerability, and pharmacokinetics (PK) of single and multiple ascending intravenous doses of MW189 in healthy adult volunteers. MW189 was safe and well tolerated in single and multiple doses up to 0.25 mg/kg, with no clinically significant concerns. The most common drug-related treatment-emergent adverse event was infusion-site reactions, likely related to drug solution acidity. No clinically concerning changes …

Rural Caregivers: Identification Of Informational Needs Through Telemedicine Questions, Shoshana H. Bardach, Allison Gibson, Kelly Parsons, April Stauffer, Gregory A. Jicha

Sanders-Brown Center on Aging Faculty Publications

OBJECTIVES: The prevalence of Alzheimer's disease and associated disorders is increasing. Rural residents in the United States have less access to memory care specialists and educational and community resources than in other areas of the country. Over a decade ago, we initiated an interdisciplinary rural caregiving telemedicine program to reach Kentucky residents in areas of the state where resources for supporting individuals with dementia are limited. Telemedicine programs involve a short informational presentation followed by a question and answer session; programs are offered 4 times a year. The purpose of this study was to explore questions asked over 1 year …

Strategies For Mitigating Sexual Desire Discrepancy In Relationships, Laura M. Vowels, Kristen P. Mark

Kinesiology and Health Promotion Faculty Publications

Sexual desire discrepancy, when one member of a couple experiences more or less sexual desire relative to their partner, is among the main reasons for couples to seek therapy. A great deal of prior research has examined the complexity of sexual desire and the role of sexual desire discrepancy in long-term relationships, but little research has specifically examined strategies used to mitigate sexual desire discrepancy when it arises. Thus, the purpose of the present mixed methods study was to identify the strategies that individuals in long-term relationships use during times of desire discrepancy and to address whether the use of …

Did Social-Distancing Measures In Kentucky Help To Flatten The Covid-19 Curve?, Charles J. Courtemanche, Joseph Garuccio, Anh Le, Joshua C. Pinkston, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

In the absence of a vaccine or more effective treatment options, containing the spread of novel coronavirus disease 2019 (COVID-19) must rely on non-pharmaceutical interventions. All U.S. states adopted social-distancing measures in March and April of 2020, though they varied in both timing and scope. Kentucky began by closing public schools and restaurant dining rooms on March 16th before progressing to closing other non-essential businesses and eventually issuing a “Healthy at Home” order with restrictions similar to the shelter-in-place (SIPO) orders adopted by other states. We aim to quantify the impact of these measures on COVID-19 case growth in the …

Optimizing The Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures In A Rotator Cuff Model, Austin V. Stone, T. David Luo, Aman Sharma, Kerry A. Danelson, Michael De Gregorio, Michael T. Freehill

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory.

Hypothesis: Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force. …

Perinatal Drug Abuse And Neonatal Drug Withdrawal, Samarth Shukla, Lisa B. Zirkin, Enrique Gomez Pomar

Pediatrics Faculty Publications

Drug abuse and addiction have significantly increased over the last few decades; specifically, opioid abuse and dependence have increased to epidemic proportions. This increased use of drugs includes women of childbearing age and those who are pregnant. Drug abuse during pregnancy is a serious health risk for both mother and newborn infant. Infants exposed to maternal drugs in fetal life develop signs of drug withdrawal during early neonatal life. This group of withdrawal signs is known as neonatal abstinence syndrome (NAS). Although NAS is not a fatal condition, it results in significant illness and prolonged hospitalization.