Medicine and Health Sciences Commons^™

Implementing Centeringpregnancy, A Group Prenatal Care Model, In Hamilton County, Ohio, Morgan Avery

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

Target Population and Need

Hamilton County, Ohio exhibits high rates of poverty, unemployment, and negative health outcomes. Specifically, Hamilton County continues to perform poorly in maternal and child health outcomes such as infant mortality, low birth weight, gestational diabetes, and preterm birth rates. Many people in the community exbibit poor health behaviors such as inadequate prenatal care, drug use during pregnancy, and smoking during pregnancy.

Program Approach

The Hamilton County Health Department intends to implement an evidence based group prenatal care program, CenteringPregnancy, in three health centers around Hamilton County in an effort to reduce poor maternal and child health …

An Ecological Approach To Understanding Lethal Violence In The Us Using Stream Analogy, Jacqueline Seals

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

ABSTRACT OF CAPSTONE

Background: Lethal violence, homicides and suicides, is a growing issue in the US. Historically homicides and suicides have been studied separately, but with stream analogy of lethal violence homicides and suicides are both currents of lethal violence, just branching in opposite directions. The purpose of this study is to understand which county-level factors increase risk of lethal violence.

Methods: This ecological study combined open-source datasets to create one dataset of socioeconomic risk factors of lethal violence. Counties with 10 or more lethal violent deaths were included (n=2751). Negative Binomial models examined the relationship between risk factors and …

The Role Of Neural Precursor Cell Expressed Developmentally Down-Regulated Protein 9 In Enhanced Aggressiveness Of Hexavalent Chromium Transformed Bronchial Epithelial Cells, Peter Van Wie

Theses and Dissertations--Toxicology and Cancer Biology

Hexavalent chromium (Cr(VI)) is classified as a confirmed human carcinogen by the International Agency for Research and Cancer (IARC) and by the U.S. Environmental Protection Agency (EPA). Chronic exposure to (Cr(VI)) causes malignant cell transformation in human bronchial epithelial BEAS-2B cells. These Cr(VI)-transformed cells exhibit a highly aggressive phenotype including increased migration, invasion, and angiogenesis. The Cas family protein neuronal precursor developmentally down regulated protein 9 (NEDD9/Cas-L/HEF1) was dramatically overexpressed in Cr(VI)-transformed cells compared to normal BEAS-2B cells. Knockdown of NEDD9 by its shRNA reduced migration and invasion in vitro measured by migration and invasion assays. shNEDD9 reduced tumor formation …

Methodological Considerations For The Determination Of The Critical Resistance For The Deadlift, Alexander C. Moss

Theses and Dissertations--Kinesiology and Health Promotion

This study determined if plate movement during conventional deadlifting affects critical resistance (CR) estimates derived from the linear work limit (W_lim) versus repetitions relationship. Eleven subjects completed 1-repetition maximum (1RM) deadlift testing followed by 8 visits, to determine the number of repetitions to failure at 50%, 60%, 70%, and 80% 1RM for both reset (RS) and touch-and-go (TG) methods, respectively. The CR was calculated as slope of the line of total work completed (repetitions × load [in kilograms]) versus total repetitions for each of four intensities (50-80% 1RM). The number of repetitions to failure were determined at CR …

Identifying And Predicting Intention To Quit Using Juul Among Emerging Adults, Jakob W. Hester

Theses and Dissertations--Kinesiology and Health Promotion

Objectives: (1) Describe intention to quit, (2) identify relationships between sociodemographic factors or social influences and intention to quit, (3) explore if Theory of Planned Behavior-informed constructs can predict intention to quit as well as identify which construct best predicts, and (4) discover if descriptive norms strengthen a predictive model of intention to quit among emerging adults currently using Juul. Participants: Full-time, first-year students currently using Juul, an e-cigarette product, at a large university in the southeastern United States (N = 182). Methods: A November 2018 online survey assessed sociodemographic characteristics, social influences, patterns of use, quit intention, and attitudes, …

Knee Joint Loading Following Anterior Cruciate Ligament Reconstruction: Link To Patient Reported Outcomes And A Novel Method To Monitor With Wearable Sensors, Alex Spencer

Theses and Dissertations--Kinesiology and Health Promotion

Recovery from anterior cruciate ligament reconstruction (ACLR) commonly results in undesirable physical and patient-reported outcomes (PROs). Identification of modifiable factors such as knee contact force (KCF) early in rehabilitation that can improve these outcomes is important due to the rapid decrease in function, quality of life, and joint health in this population. Additionally, if noninvasive measurement of KCFs outside of a traditional laboratory were possible, clinicians could optimize patient treatment with personalized care. Therefore, there are two primary aims to this thesis: 1) quantify the link between KCF and PROs which measure pain, ability to perform activities of daily living, …

Health Priorities, Current Lifestyle Behaviors, And Barriers To A Healthy Lifestyle Among Emergency Department Nurses, Shannon C. White

Theses and Dissertations--Kinesiology and Health Promotion

Background: Emergency nurses are tasked with managing the hectic, unpredictable, and constantly changing environment of an ED. In addition, emergency nurses have been shown to have high levels of stress, irregular meal schedules, rotating shift work, long hours, and a lack of physical activity. Furthermore, research has suggested that nurses are at an increased risk for non-communicable diseases, such as diabetes, hypertension, and coronary heart disease (Phiri, et al., 2014), in addition to a high prevalence of obesity (Kyle, et al., 2016).

Methodology: In this study, 23 emergency nurses completed a 43-item survey regarding current behaviors and constructs of …

Effects Of Relative Inertial Load On Performance Measures And Quadriceps Electromyography During Flywheel Resistance Training Squats, Jason Todd Brantley Jr.

Theses and Dissertations--Kinesiology and Health Promotion

Flywheel resistance training (FRT) has become an increasingly popular modality for exercising due to its unique application of providing external resistance. Little is known about how changes in relative inertial loads affects performance and electromyography (EMG) activity. The purpose of this study was to examine how performance metrics and quadriceps EMG activity are affected by relative inertial load during FRT-based squats. Fifteen resistance trained individuals completed five sets of five repetitions of squats with varying relative inertial loads in random order. Peak Eccentric Power (PEP), Peak Concentric Power (PCP), average force, total work, and repetition time were measured. Surface level …

Atv Dynamics And Pediatric Rider Safety, James T. Auxier Ii

Theses and Dissertations--Biomedical Engineering

It has been observed through numerous academic and governmental agency studies that pediatric all-terrain vehicle ridership carries significant risk of injury and death. While no doubt valuable to safety, the post-hoc approach employed in these studies does little to explain the why and how behind the risk factors. Furthermore, there has been no prolonged, widespread, organized, and concerted effort to reconstruct and catalog the details and causes of the large (20,000+) number of ATV-related injuries that occur each year as has been done for road-based motor vehicle accidents. This dissertation takes the opposite approach from a meta-analysis and instead examines …

Leading Well: Anesthesiology Program Directors As Servant Leaders And Their Development Of Resident Wellness Programs, Amy Noel Dilorenzo

Theses and Dissertations--Education Sciences

Anesthesiology residents are at significant risk of developing serious issues during training including burnout, depression, and substance abuse. Recent accreditation requirements mandate that these well-being issues be addressed by residency training programs. Program directors, as the leaders of residency programs, are charged with protecting the wellness of residents and leading wellness initiatives. The program director role can be well-described in a servant leadership construct because they are charged with caring for the individual needs of their residents.

This dissertation is a report of a mixed-methods study that explores anesthesiology program directors’ self-perceptions as servant leaders and their efforts to lead …

The Coulter Principle: For The Good Of Humankind, Marshall Graham

Theses and Dissertations--History

The atomic bombings of Hiroshima and Nagasaki in August 1945 made Wallace H. Coulter abruptly comprehend the critical need for rapid and accurate blood-cell counts in providing care for victims of radiation exposure. This thesis documents the unwritten story of his journey from that comprehension through his invention and implementation of the Coulter Principle, its commercialization in the first widely available automated blood-cell counter, and elaboration of that ground-breaking counter into increasingly sophisticated instrumentation for analysis not only of blood cells, but of particles involved in many other scientific disciplines. International cold-war politics and the burgeoning of increasingly powerful nuclear …

Measuring The Effects Of Lobinaline-N-Bioxide (419) On Alcohol Consumption, Nicotine Locomotor Sensitization, And Conditioned Place Preference In Mice And Rats, Cocanut M. Suhail

Theses and Dissertations--Medical Sciences

Objective: Novel drug 419 was examined to see the effect it has in vivo mice and rats on alcohol consumption, nicotine locomotor sensitization, and conditioned place preference (CPP) models regarding behavioral tests on dopamine transporter activity.

Methods: Mice and rats were used to see how they react to the drug 419 and control vehicle, in each of the models. The animals were assessed to pre- and post- drug administration of novel drug 419. We examined each model to see the association between how drug 419 will help with treating drug abuse.

Results: We found that in alcohol consumption model the …

Elucidating The Complex Signaling Events Driving Intestinal Stem Cell Plasticity Following Injury, Evan Lynch

Theses and Dissertations--Microbiology, Immunology, and Molecular Genetics

Signaling events governing intestinal stem cell (ISC) homeostasis maintain the delicate balance of active self-renewal and passive differentiation to replenish intestinal epithelial cells (IEC) every 3-5 days. However, under certain contexts, ISC function is irreversibly compromised—requiring committed IEC lineages to dedifferentiate and regain “stemness”. In the current studies, we examine the signaling events driving epithelial cell responses to injury to expose pathologic failures in the healing response. Our specific goal is to tease out the cellular contexts that promote dedifferentiation to design effective therapeutics for disease conditions compromising ISC function.

First, we generated a novel transgenic animal using the epithelial-specific …

Residential Radon Exposure, Its Contribution To Lung Cancer, And Social Determinants Of Radon Testing, Stacy Stanifer

Theses and Dissertations--Nursing

Lung cancer is a highly preventable form of cancer. Cigarette smoking is the leading cause of lung cancer followed by radon gas exposure and exposure to secondhand smoke. Kentucky leads the nation in both incidence and mortality from lung cancer. Tobacco use in Kentucky continues to be a major public health concern as nearly one-quarter of adults report current tobacco use and just over one-third of Kentucky homes with children lack rules which prohibit smoking in the home. Radon, a colorless, odorless radioactive gas, occurs naturally from the decay of uranium found in rocks and soil and is harmful when …

Associations Between Psychosocial Stressors, Genes, And Cardiovascular Disease In At-Risk Adults, Kaitlin Voigts Key

Theses and Dissertations--Nursing

Psychosocial stressors have a significant adverse impact on cardiovascular health. While better medical treatments and increased emphasis on healthy lifestyle have improved cardiovascular health for many in the United States over the past 50 years, there are persistent inequities in cardiovascular disease (CVD) rates, with the highest rates among populations burdened by chronic exposure to psychosocial stressors such as discrimination and anxiety, among others. Genetic factors may interact with these stressors further influencing the rates of CVD in these populations. The purpose of this dissertation is to examine associations among psychosocial stressors and other CVD risk factors, and the influence …

Tobacco Use And Nicotine Withdrawal Among Patients With Mental Illness, Yazan Daher Al-Mrayat

Theses and Dissertations--Nursing

People with mental illness (MI) are disproportionately affected by tobacco use compared to the general population. In fact, it is estimated that people with MI consume approximately 44% of cigarettes smoked in the United States. Moreover, the MI population is at greater risk for the negative social, economic, and health consequences associated with tobacco use and are reported to have 25-year shorter life expectancies than the general population. The impact of tobacco use is further noticeable among patients with MI who require psychiatric hospitalization. Quitting smoking in this population has been linked to fewer discharges against medical advice, better quality …

Establishing Exclusive Breastfeeding And The Influence Of Hospital Support, Martha Monroe

Theses and Dissertations--Nursing

Maternal-child health authorities recommend that infants breastfeed exclusively for the first six months of life. Currently, 25% of infants in the United States do so. Breastfeeding specific care that mothers receive from their postpartum nurses and lactation specialists is integral to successfully initiating exclusive breastfeeding. Due to the time sensitive nature of establishing milk supply, interrupting the process of lactogenesis with supplementation puts infants at high risk for early termination of breastfeeding. The purpose of this dissertation is to examine the relationship of breastfeeding care received during the postpartum hospital stay, defined as the first 48-72 hours of life, and …

Responses To Symptoms Among Patients With Heart Failure, Chin-Yen Lin

Theses and Dissertations--Nursing

Patients with heart failure (HF) suffer from chronic and progressive symptoms. Failure to respond appropriately to escalating symptoms of HF causes a delay in seeking care, which results in worse symptom status, frequent rehospitalizations, and contributes to higher mortality. In order to enhance HF self-care, promote timely care-seeking, and improve outcomes, identification of factors that affect patients’ responses to symptoms and their decisions to seek care is essential. Thus, the purposes of this dissertation were to (1) identify factors associated with patients’ responses to worsening HF symptoms, and (2) determine the impact of responses to symptoms on outcomes in patients …

It Matters Who You Live With. The Relationship Of Living Arrangement And Medication Adherence In Patients With Heart Failure, Rana Lindsay-Rahman

Theses and Dissertations--Nursing

Medication adherence is an ongoing challenge for patients with heart failure (HF) that can adversely affect mortality, morbidity, and quality of life. Living with a spouse has been associated with better adherence while living alone has been associated with poor adherence. Other factors demonstrated to affect adherence include medication complexity, perceived barriers to adherence, and depressive symptoms. Interestingly, the effect of these latter factors on adherence has not been examined in the context of the patient’s living arrangement. The purpose of this dissertation was to investigate the relationships among medication complexity, perceived barriers, and depressive symptoms with medication adherence across …

Meaningful Measurement Matters: Defining Potentially Inappropriate Medication Use To Target Cognitive Outcomes, Ashley I. Martinez

Theses and Dissertations--Pharmacy

Preventable and unintended consequences of medication use occur in more than 25% of ambulatory and hospitalized patients, and nearly half of long-term care patients. Unfortunately, many medications used to treat common health conditions in older adults (such as anxiety, behavioral disturbances, incontinence, insomnia, depression, and pain) have also been linked to cognitive impairment and decline. Recently, substantial efforts to investigate medications and medication classes that may be associated with cognitive impairment and decline in older adults have been undertaken. Unfortunately, studies have used a wide variety of different tools to define “potentially inappropriate medication” (PIM) use, and no published literature …

Relationship Between Initial Prescription Opioid Exposure Length And Future Opioid Use Disorder Diagnosis In Opioid Naive Adolescents, Eric Lindahl

Theses and Dissertations--Pharmacy

Objectives: The long-term risks associated with the use of short-term prescription opioids in opioid naïve adolescents in not well characterized. The purpose of this study was to explore the potential association between the days’ supply of the initial prescription opioid exposure and the rates of diagnosed OUD in the subsequent 3-year period. Methods: We conducted a retrospective cohort study using a nationwide database of commercially-insured adolescents aged 12-17 at the time of the index opioid fill. A multivariable Cox Proportional Hazard regression model was developed to analyze the association of interest while accounting for known risk factors for the development …

The Impact Of Bone Marrow Transplantion On Patients With Psychiatric Diagnoses: Medication Adherence Assessment, Brittany Galop

Theses and Dissertations--Pharmacy

Objectives: We investigated whether there is a measurable difference in medication utilization for psychiatric conditions before and after bone marrow transplantation (BMT). Previous studies have identified a potential association between psychiatric conditions and immune function. We hypothesized that medication utilization for psychiatric diagnoses would be impacted by BMT.

Methods: This study was a retrospective, quasi-experimental cohort design. De-identified data was compiled from the Truven database for patients ranging from January 2009 through December 2016. Two measurements of medication utilization, proportion of days covered (PDC) and medication possession ratio (MPR) were calculated for each included Medispan-defined class of medications before analyzing …

Antiresorptive Bone Therapy Use In Advanced Lung Cancer And Associated Outcomes, Noor Naffakh

Theses and Dissertations--Pharmacy

Background/Rationale: Studies have shown antiresorptive agents decrease skeletal related events in metastatic non-small cell lung cancer. However, two prevalence studies have found low utilization rates of antiresorptive therapy in advanced lung cancer. The first study reported a rate of 14.8% during the 1995-2009 time period, while the second study reported a 33% usage rate during the time frame of 2002-2011. We believe these low utilization rates are associated with the poor prognosis of these patients. The prognosis of advanced lung cancer has improved significantly since these trials were conducted, and the utilization of denosumab has not been evaluated. We hypothesize …

Population Pharmacokinetic Modeling And Genetic Association Analysis In Infants With Neonatal Abstinence Syndrome Receiving Morphine Or Clonidine, Fei Tang

Theses and Dissertations--Pharmacy

Neonatal abstinence syndrome, or NAS, is a postnatal opioid withdrawal syndrome occurring in 55% to 94% of neonates as a result of in utero exposure to opioids. It has emerged as a significant public health issue, as its incidence more than quadrupled in the past decade. There is significant variability in disease severity and treatment outcomes in neonates with NAS due to patient-specific factors and treatment- or site-specific factors. To understand what contributes to variability in length of hospital stay and other outcomes in neonates with NAS, we assessed population pharmacokinetics (PK) of clonidine and morphine, and we investigated potential …

Extensively Drug-Resistant Pseudomonas Aeruginosa In Vitro Susceptibility And Mechanisms Of Resistance, Chanah Gallagher

Theses and Dissertations--Pharmacy

Pseudomonas aeruginosa causes severe healthcare-associated infections. Forty-eight extensively drug-resistant (XDR)-P. aeruginosa isolates were selected from 287 isolates collected for evaluation based on clinical susceptibility data. In vitro activity of commonly utilized antimicrobials (i.e. antipseudomonal beta-lactams, aminoglycosides, fluoroquinolones, and polymyxins) plus ceftolozane-tazobactam, ceftazidime-avibactam, and aztreonam-avibactam against XDR-P. aeruginosa were determined. The mechanism of resistance profile was determined through phenotypic expression analysis. Overall, polymyxin B and colistin were 100% susceptible. Apart from the polymyxins, ceftolozane-tazobactam had the highest susceptibility (94%) followed by ceftazidime-avibactam (90%) and amikacin (83%). Ceftolozane-tazobactam activity was not significantly different from ceftazidime-avibactam (p=0.6831). Only 40% of isolates …

Combination Of Investigational Cell-Based Therapy And Deep Brain Stimulation To Alter The Progression Of Parkinson’S Disease, Nader El Seblani

Theses and Dissertations--Pharmacy

Parkinson’s disease (PD) is the second most common neurodegenerative disorder and the motor symptoms are caused by progressive loss of midbrain dopamine neurons. There is no current treatment that can slow or reverse PD. Our current “DBS-Plus” clinical trial (NCT02369003) features the implantation in vivo of autologous Schwann cells (SCs) derived from a patient’s sural nerve into the substantia nigra pars compacta (SNpc) in combination with Deep Brain Stimulation (DBS) therapy for treating patients with advanced PD.

The central hypothesis of our research is that transdifferentiated SCs within conditioned nerve tissue will deliver pro-regenerative factors to enhance the survival of …

Correlating The Physicochemical Properties Of Magnesium Stearate With Tablet Dissolution And Lubrication, Julie L. Calahan

Theses and Dissertations--Pharmacy

Magnesium stearate (MgSt) is the most commonly used pharmaceutical excipient and is present in over half the tablet formulations on the market. In spite of its popularity as an effective lubricant, it has been repeatedly recognized that there is significant variability between MgSt samples, which can cause inconsistent lubrication between batches of MgSt. The hypothesis of this research is that the batch-to-batch variability in tablet lubrication and dissolution observed in tablet formulations containing different MgSt samples can be correlated with differences in MgSt physicochemical properties (fatty acid salt composition, crystal hydrate form, particle size and surface area). Developing correlations between …

Elucidating Molecular Function Of Mithramycin And Analogues For The Treatment Of Ews-Ets Expressing Cancers, Reiya Hayden

Theses and Dissertations--Pharmacy

Introduction: Chromosomal translocations are common in cancer. In many cancers such as prostate cancer, leukemia and Ewing sarcoma, chromosomal translocations are the main driver of malignancy. Ewing sarcoma is a cancer diagnosed mostly in children and adolescents that has very grim outcomes for patients with metastasis and recurrent disease. Malignancy in Ewing sarcoma is due to EWS-FLI1, an aberrant transcription factor that is the result of a chromosomal translocation. EWS-FLI1 is the main driver of oncogenesis in Ewing sarcoma and has been the target of many drugs developed to treat the disease. Mithramycin (MTM) was identified as a potent inhibitor …

Novel Small Molecule Antifungals For Invasive Fungal Infections, Emily Dennis

Theses and Dissertations--Pharmacy

Human fungal pathogens cause a range of diseases from benign skin conditions (i.e., ringworm) to thrush, mucosal membrane infections, and life-threatening systemic infections including bloodstream infections (i.e., aspergillosis and candidiasis) and Cryptococcal meningitis. These systemic infections occur most often in immunocompromised individuals and have high mortality rates. Current antifungal agents used in the clinic belong to three main classes: the polyenes (e.g., amphotericin B (AmB)), the echinocandins (e.g., caspofungin (CFG)), and the azoles (e.g., fluconazole (FLC)). In addition, the antimetabolite pyrimidine analogue flucytosine is used in combination with AmB. The …

Characterization And Engineering Of Interrupted Adenylation Domains, Taylor A. Lundy

Theses and Dissertations--Pharmacy

Nature has historically served as a prolific source of biologically active molecules produced by plants, fungi, and bacteria termed natural products (NPs). These NPs often serve as therapeutic leads due to their structural diversity and unique mechanisms of action. However, many need modifications to make them more effective or safer for human use. This can be a daunting and complicated task to do via traditional organic chemistry because of their complexity, copious stereocenters, and a multitude of reactive functional groups. For this reason, enzymatic modification of these NP during their biosynthesis is an appealing option. One major class of NPs …