Biopsychological Predictors Of Pain And Function In Patients With Rotator Cuff Conditions, Nicole Cascia

Theses and Dissertations--Rehabilitation Sciences

Predicting worse patient-reported outcomes in those with Rotator Cuff (RC) conditions is dependent on examining both biological and psychological impairments. In order to help determine which biopsychological factors are associated with pain and function in patients with RC related conditions and to determine who may be at an increased risk for worse outcomes after Reverse Shoulder Arthroplasty (RSA), biopsychological associations between patient demographics, scapular motion, humeral motion, RC tear size, pain associated psychological distress, and function were clinically evaluated to investigate prediction models for pain and function. The central hypothesis is that in a group of patients with symptomatic Cuff …

Vestibular Function And Sports-Related Concussion: An Exploratory Investigation Of The Consequences Of Sports Related Concussion On Vestibular Function And Outcomes, Carolina Quintana

Theses and Dissertations--Rehabilitation Sciences

Sports-related concussions (SRC), or mild traumatic brain injuries that occur as a result of sports or athletic participation, are said to affect approximately 300,000 young adults and 1.4 million youth athletes in the United States on an annual basis. SRC create a significant burden on the health care system by generating an estimated $60 billion dollars in direct and indirect costs in 2000. In addition to the financial burden these injuries create, they additionally impose both short- and long-term effects for those effected and their overall health. Among the many effects of concussions are physical signs as symptoms such as …

Physical And Occupational Therapy For Young Children With Delayed Motor Development: Exploring Current Practices, Challenges, And Families’ Implementation Of Home Activities In Early Intervention, Afnan Gmmash

Theses and Dissertations--Rehabilitation Sciences

The literature supports the use of family-centered early intervention(EI) for young children with or at risk for cerebral palsy (CP) to promote the children’s motor development. Young children with or at risk for delayed motor development in their first three years of life are entitled to EI under Part C of The Individuals with Disabilities Education Improvement Act. Identifying current EI provided for young children with delayed motor development is essential to detect possible gaps and factors that could prevent therapists from providing the best EI. Understanding the parent’s perspective on the implementation of activities outside therapy to maximize the …

Anterior Cruciate Ligament Injury-Induced Alterations In Inflammation And Muscle Physiology, Emily R. Hunt

Theses and Dissertations--Rehabilitation Sciences

Long term weakness and atrophy of the quadriceps muscle are a direct result of anterior cruciate ligament (ACL) injuries and persist for up to 10 years post injury. Muscle atrophy ensues regardless of ligamentous reconstruction surgery, indicating that muscle atrophy following injury is a function of the ligament rupture and not reconstruction surgery. Elucidating the mechanisms underlying quadriceps atrophy following ACL rupture is crucial for developing interventions to restore proper quadriceps size and mitigate weakness thereby allowing for improved patient function. In addition to understanding the specific mechanisms that contribute to quadriceps atrophy following ACL rupture, the timing of atrophic …

Determining The Role Of Satellite Cells During Skeletal Muscle Adaptation, Davis A. Englund

Theses and Dissertations--Rehabilitation Sciences

Physical inactivity, advancing age, limb immobilization, degenerative diseases and various systemic diseases (many cancers, sepsis, HIV, COPD, kidney disease) all lead to skeletal muscle wasting. The loss of muscle mass is of major clinical importance because it leads to an increased risk for morbidity, disability, and the loss of independence; collectively contributing to a substantive increase in healthcare utilization and cost. The prevalence of cachexia (disease-induced muscle wasting) can reach as high as 80% in certain patient populations and the average cost per hospital stay is $4,641 more than in non-cachectic patients. Direct healthcare costs attributable to sarcopenia were estimated …

Influences Of Functional And Psychological Factors On Biomechanics Following An Anterior Cruciate Ligament (Acl) Reconstruction, Chelsey Roe

Theses and Dissertations--Rehabilitation Sciences

Objective: The aims of this research were to identify gaps in the literature related to return to sport (RTS) test batteries following primary anterior cruciate ligament reconstruction (ACLR) (Aim 1) and define recovery in athletes from 4-9 months after ACLR across three domains: 1) psychological recovery and biomechanics (Aim 2), 2) rehabilitation quantity and biomechanics (Aim 3), and 3) functional performance and biomechanics (Aim 4). Ultimately, the results of this research would quantify recovery following ACLR in athletes with a desire to RTS and identify objective criteria throughout rehabilitation prior to RTS.

Participants: Twenty-two post-ACLR athletes 17 females, 8 males, …

Using Transcranial Direct Current Stimulation To Improve Naming Ability In Post-Stroke Aphasia: Evaluating Evidence And Optimizing Outcomes, Mohammed Alharbi

Theses and Dissertations--Rehabilitation Sciences

Introduction. Aphasia is a devastating acquired language disorder that affects about one third of stroke survivors. Aphasia can severely affect quality of life and can be associated with economic burdens due to the need for long-term communication rehabilitation. Traditional aphasia therapies are known to be effective; however, progress is often slow and limited in severe cases – full restoration of communication abilities is rarely achieved. Thus, there is a critical need for therapeutic solutions that can reduce the associated burden of aphasia. Transcranial direct current stimulation (tDCS) is a non-invasive and inexpensive neuromodulation technique that has the potential to boost …

Rna Sequencing Of Human Peripheral Nerve In Response To Injury: Distinctive Analysis Of The Nerve Repair Pathways, Andrew S. Welleford, Jorge E. Quintero, Nader El Seblani, Eric M. Blalock, Sumedha Gunewardena, Steven M. Shapiro, Sean M. Riordan, Peter Huettl, Zain Guduru, John A. Stanford, Craig G. Van Horne, Greg A. Gerhardt

Neuroscience Faculty Publications

The development of regenerative therapies for central nervous system diseases can likely benefit from an understanding of the peripheral nervous system repair process, particularly in identifying potential gene pathways involved in human nerve repair. This study employed RNA sequencing (RNA-seq) technology to analyze the whole transcriptome profile of the human peripheral nerve in response to an injury. The distal sural nerve was exposed, completely transected, and a 1 to 2 cm section of nerve fascicles was collected for RNA-seq from six participants with Parkinson's disease, ranging in age between 53 and 70 yr. Two weeks after the initial injury, another …

Vancomycin Dosing Practices Among Critical Care Pharmacists: A Survey Of Society Of Critical Care Medicine Pharmacists, Alexander H. Flannery, Drayton A. Hammond, Douglas R. Oyler, Chenghui Li, Adrian Wong, Andrew P. Smith, Qiu Min Yeo, Whitney Chaney, Caitlin E. Pfaff, Angela M. Plewa-Rusiecki, Paul Juang

Pharmacy Practice and Science Faculty Publications

Introduction: Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population.

Objectives: To evaluate critical care pharmacists' self-reported vancomycin practices in comparison to the 2009 guideline recommendations and other best practices identified by the study investigators.

Methods: An online survey developed by the …

Utilizing Cdc Framework For Program Evaluation To Inform Assessment Of An Interprofessional Leadership And Teamwork Curriculum, Madeline Aulisio

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

Background
The ability to collaborate effectively and lead a team when the need arises has become an expectation of health professionals. Graduates of health professions programs are expected to possess skillsets that will allow them to both collaborate and lead effectively in addition to their profession-specific knowledge. Leadership Legacy, an interprofessional elective created at the University of Kentucky in 2009, was designed to address this need.

Methods
After nearly ten years of cohorts, an opportunity arose for program evaluation with a reliable method such as the Centers for Disease Control and Prevention Framework for Program Evaluation. The novel use of …

The Association Between The Medicare Bundled Payments Initiative And Cardiac Rehabilitation Enrollment, Jing Li

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

Cardiac rehabilitation (CR) represents a proven-effective intervention in secondary prevention that can stabilize, slow or reverse cardiovascular disease (CVD) progression, facilitate the ability of the patient to preserve or resume an active and functional contribution to the community, and reduce the risk of future cardiovascular events. Despite multiple guideline recommendations for CR and coverage by Medicare and most health plans, participation in CR remains low. Bundled payments are one of the suggested reforms designed to move health care providers toward to value-based care and is very applicable to the CR utilization in patients diagnosed with acute myocardial infarction (AMI) or …

Briding The Gap: Treatment Engagement Profiles And Outcomes Utilizing Novel Models, Allison Koetter

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

Background. The opioid epidemic is a public health emergency that requires collaboration between both private and public sectors to increase access to and capacity for efforts directed at treatment, prevention, and recovery. The Commonwealth of Kentucky via funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) created their State Targeted Response to the Opioid Crisis (Opioid STR) in order to help address these needs. The University of Kentucky, as an awardee of these funds, decided on an approach to highlight the Emergency Department (ED) bridge model, which links patients discharged from EDs and the hospital (inpatient addiction consult …

Prevalence Of Restricted Spirometry Within Two Eastern Kentucky Counties A Cross Sectional Study, Quincy Bascombe

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

Objective: This study examines the prevalence of restrictive spirometry in Eastern Kentucky and its association among men and women with various demographic and exposure (occupational and environmental) factors.

Methods: A cross sectional, cluster sample (N = 685) of participants from Letcher and Harlan Counties, aged 21 and over, answered a questionnaire focused on risk factors for respiratory health outcomes including questions on demographic, health, occupational, and environmental exposures variables. Pulmonary function tests were administered to all participants with no significant cardiovascular or cerebrovascular events within the past 30 days. Log-binomial regression was used to calculate prevalence ratios (PRs) …

Analysis Of High Potency Anticholinergic Prescribing In Scottish Nursing Home Patients, Alexandra Nugent

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

Purpose: The aim of this study was to compare the use of two or more high-potency anticholinergic (HPA) medications between patients 65 years and older in nursing homes and in the greater community using prescribing data. Methods: This secondary data analysis of the NHS Scotland PIS databased used prescription data from a nationally representative patient-level database. Patients were included were ≥65 years old, received ≥2HPA prescriptions from 2011Q2-2012Q1(11/12), 2016Q1-2017Q2(16/17), 2018Q2-2017Q1(18/19). The principle endpoint of this study was to assess for a change in patient’s relative risk of receiving ≥2HPA prescriptions. Results: 29,301 patients were identified. From 11/12 to 16/17 all …

Policy Analysis Of California Senate Bill 1138: Mandating Plant-Based Meal Options In Hospitals And Prisons, David Morton

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

Obesity, chronic disease, and poor nutrition are prevalent in the United States while healthcare costs rise. Nutritional research advancements have suggested the healthfulness of plant-based diets. In 2018, the California state senate passed Senate Bill 1138, requiring plant-based meal options in hospitals and prisons. This paper sought to examine the context surrounding the bill, determine the appropriateness of the bill, and recommend next steps for nutritional policies in the United States. In a review of the literature, malnutrition in hospitals and prisons is highly prevalent, and state governments have already made efforts to improve their citizens’ nutrition. In this analysis, …

Utilization Of A Community Pharmacy-Based Service For The Treatment Of Uncomplicated Urinary Tract Infections In Scotland, Robert Borchardt

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

Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim …

Assessing The Impact Of Raising The National Minimum Purchase Age Of Tobacco To 21 On Tobacco Use In Youth, Nicholas D. Guerra

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

Introduction: Tobacco use is the number one cause of preventable death in the United States with roughly 500,000 premature deaths a year and 3,200 youth smoking their first cigarette daily. On December 20, 2019, President Trump signed legislation to raise the federal minimum age of sale of tobacco products from 18 to 21 years, effective immediately. Prior to this recent regulation, over half of the US population was enforcing this age restriction. The objective of this research is to investigate the impact of tobacco 21 laws on tobacco use and project the national tobacco impact by using the state experiences …

Community Collaborations For Health Improvement In Laurel County, Kentucky: A Case Study, Kendall Ferrell

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

Kentucky is currently ranked fifth in the United States for opioid-involved overdose deaths. This study assesses how the results of a community health needs assessment have developed collaborative community effort to create and expand services and programs to address opioid and substance use disorder in Laurel County, Kentucky. This particular community continues to rank opioid and substance abuse as a major health concern causing efforts to be put in place to create an opioid response program. A consortium was formed that developed the community health needs assessment survey. The results from the survey were then incorporated in to a strategic …

Asthma In Scotland: Prescribing Trends Since The National Review Of Asthma Deaths (Nrad), Quentin Kenner

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

Asthma in Scotland: prescribing trends since the National Review of Asthma Deaths (NRAD)

Purpose: Asthma remains prevalent worldwide with implications for morbidity and mortality. In Scotland, 1 in 14 people are currently being treated for asthma. Asthma burden prompted the creation of the National Review of Asthma Deaths (NRAD), which identified contributing factors. Since the NRAD, guidelines have changed and therapeutic indicators have been developed with an increased emphasis on controller medications. Few publications describe how the NRAD study affected prescribing and if inequalities among the asthmatic population exist. This study aimed to determine whether patients were receiving appropriate treatment …

Dalbavancin In The Community Emergency Department, Wesley Johnson

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

Introduction

Dalbavancin is an antibiotic within the class of medications known as lipoglycopeptides. This medication is given to patients presenting to the hospital with acute skin and skin-structure infections (ABSSSI). This is a unique medication because it is given as a one-time dose in the outpatient setting and it could prevent patients from requiring admission to the hospital.

Methods

The emergency department (ED) at Good Samaritan community hospital performed a trial period with dalbavancin and data was collected from November 2018 to March 2020. Retrospective chart review was performed to obtain patient data and outcomes. Patients would be contacted by …

Describing Interventional Approaches To The E-Cigarette/Juuling/Vaping Epidemic In Eastern Kentucky High Schools: A Case Study, Taylor Miller

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

Problem: Over the past few years there has been significant increase in vaping/juuling/e-cigarette use among the adolescent population. Since this is a new health issue, there are very few intervention programs for teens to receive education about these devices and support for quitting/treatment. The aim of this study was to provide insight on interventions that have already been implemented to provide direction for those seeking to design their own vape/juul/e-cigarette intervention. This was assessed by comparing approaches and lessons learned during the intervention implementation process.

Methods: The study was conducted using a case study approach. The researcher conducted interviews with …

Improving Colorectal Cancer Screening Rates In Perry County, Vashisht Madabhushi

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

Appalachian Kentucky has one of the highest incidence and mortality rates from colorectal cancer (CRC) in the country. CRC is curable if identified early through screening. However, Perry County has suboptimal screening levels. A multimodal program of patient reminders and mailed screenings will be used to increase CRC screening rates in Perry County. The primary outcome will be evaluated using a T-test for this prospective cohort study. Short term outcomes include increased CRC screening rates in delinquent patients. Long term outcomes include increased CRC detection rates and decreased CRC mortality in Perry County.

Implementing The Be Proud! Be Responsible! Program In Wolfe County Public Schools, Casey Gill

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

Kentucky’s teen pregnancy rate is higher than the national average, and Wolfe County has one of the highest rates of teen pregnancy in the state. Teen pregnancy causes adverse health effects for both mother and baby. Teen mothers have a higher likelihood of dropping out of high school, increased health problems related to pregnancy such as preterm labor and preeclampsia, increased risk of being a single parent, and lower income and SES status. The baby is also affected, with an increased risk of living in a single parent household, and living in poverty. The Kentucky River District Health Department plans …

An Analysis Of The Association Between Adverse Childhood Experiences And Food Insecurity Within The United States, Margaret Brooks

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

Adverse childhood experiences and food insecurity are significant public health issues within the United States. Previous studies have established the overall relationship between ACEs and food insecurity. This research investigates the statistical relationship between individual ACE indicators and food insecurity as well as the relationship between having two or more ACEs and food insecurity.

Diabetes Locus Of Control And Depression In Older Adults With Type 1 And Type 2 Diabetes: The Study Of Longevity In Diabetes, Jahvona Pretty

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

Abstract:

Objective: To determine if diabetes locus of control (dLOC) is associated with depression in older adults with type 1 and type 2 diabetes and whether this association differs by diabetes type.

Methods: Data for the current study were obtained from The Study of Longevity in Diabetes (SOLID), a prospective cohort study of aging, and diabetes. SOLID participants aged 60 and older with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes were recruited from members of Kaiser Permanente Northern California (KPNC). For the current study, we excluded all of the participants without diabetes since the primary exposure, …

Maternal Demographic And Psychosocial Factors Associated With Low Attendance Of A Centeringpregnancy Prenatal Care Program Among A Group Of High-Risk Women From Kentucky., Javeria Zafar

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

Abstract

Aim: To identify maternal demographic and psychosocial risk factors associated with poor attendance of CenteringPregnancy group prenatal care, and whether past or current experience of intimate partner violence is related to poor attendance.

Methods: Data from the EMPOWR (Efforts to Maximize Perinatal Outcomes in Women at risk) were used in a cross-sectional study design. Self-reported data from 607 high-risk pregnant women from Kentucky was used. Poor-attendance or non-compliance was defined as attending less than 6 out of the 10 group prenatal care session. Multivariable logistic regression was performed to assess the association between risk factors and compliance with the …

Analysis Of Health Survey Data To Address Topics In Environmental And Public Health, Nimish Valvi

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

Introduction: Manganese is an essential trace element that can cause adverse health effects with deficiency and in excess amounts. The purpose of this study is to determine the asscociation of blood manganese levels and the prevalence of myocardial infarction, stroke, and renal dysfunction in a general US population.

Methods: Data were used from the National Health and Nutritional Examination Survey (NHANES) of non-institutionalized US adults 20 years and older using the 2011-2012, 2013-2014, and 2015-2016 survey cycles (n=16629). Weighted multivariable logistic regression models adjusted for age, race/ethnicity, sex, and poverty income ratio (PIR), were used to determine the association of …

Health-Related Quality Of Life And Ptsd-Symptoms In Survivors Of Extracorporeal Membrane Oxygenation (Ecmo) Support, Jennifer Bauman

DNP Projects

Background: Extracorporeal membrane oxygenation (ECMO) survivors have shown to have poor physical and mental health outcomes post decannulation and hospitalization; thus leading to an overall decreased quality of life. Identifying and managing the psychological components of care in this patient population can improve their physical, emotional, and mental well-being.

Purpose: To assess the incidence of impaired health related quality of life (HRQOL) and posttraumatic stress disorder (PTSD) like symptoms in survivors of ECMO; identify which constellation of patients (respiratory vs. cardiac) have poorer HRQOL outcomes post ECMO; and compare the tools used to measure post procedural outcomes in this patient …

An Empirical Pilot Study Examining The Relationship Between Intention To Participate In Food Security Efforts And Childhood Socioeconomic Status Among Conference Attendees, Liana Dixon

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

Hunger is a global public health issue and finding a solution is a priority for the United Nations. The United Nations Sustainable Development Goal 2.2 calls for ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture for all people by 2030. The Universities Fighting World Hunger (UFWH) Summit, originating with the United Nation’s originated World Food Programme (WFP) and Auburn University, convenes attendees annually to share their own knowledge and ideas about how to “fight hunger,” as well as benefit from others knowledge and ideas. An important factor in tackling hunger and achieving health is addressing poverty and …

Monitoring Opioid Use In Cancer Survivors: Implementation Of Screening, Brief Intervention, And Referral To Treatment (Sbirt) In A Clinical Setting, Jennifer M. Dolly Prothro

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

Kentucky is a disparate state, ranking as one of the top states in incidence, prevalence, and mortality for both opioid use disorders (OUD) and cancer. Due to the high volume of both diseases in the state, there is a rising concern about the overlap of these two populations. Cancer and its’ treatment are known to cause chronic pain, defined as daily pain lasting 3 months or longer. Generally, chronic pain patients of any type are known to experience higher rates of opioid misuse (21-28%) and opioid dependence (8-12%) than the general population (4.1%, 0.9% respectively). The risk of OUD must …