Medicine and Health Sciences Commons^™

Effectiveness Of Prophylactic Lingual Strengthening Exercises For Patients With Head And Neck Cancer A Systematic Review, Cassidy Pickens

Theses and Dissertations--Communication Sciences and Disorders

Radiation treatment for head and neck cancer has devastating effects on swallowing ability. Prophylactic swallowing exercises are often recommended. However, the evidence for these exercises is equivocal and information regarding critical components of an exercise program is lacking. The purpose of this systematic review was to examine the evidence regarding lingual strengthening exercises as a component of a prophylactic swallowing program.

Vocal Function Exercises For Normal Voice: The Effects Of Maximally Sustained Phonation, Mariah Elaine Morton

Theses and Dissertations--Communication Sciences and Disorders

Vocal Function Exercises (VFEs) is a well-known treatment program that consists of four exercises, in which the first and fourth tasks require maximally sustained phonation. However, the active ingredients responsible for treatment efficacy are still unknown. The primary purpose of this investigation was the explore the effects of maximally sustained phonation on the VFE outcome measure of maximum phonation time (MPT) in individuals between the ages of 18-40 with normal voice. Participants were randomized into three experimental groups that completed VFEs for six weeks. The baseline group sustained tasks one and four for as long as was achieved at the …

Effects Of Naltrexone On Alcohol And Nicotine Use In Female P Rats, Usman Z. Hamid, Sarah E. Maggio, Meredith A. Saunders, Kimberly Nixon, Mark A. Prendergast, Richard L. Bell, Michael T. Bardo

Posters-at-the-Capitol Presentations

The objective of the present study was to determine the effectiveness of the opioid antagonist naltrexone at reducing the consumption of EtOH and nicotine in female alcohol-preferring (P) rats. P rats have been selectively bred to have a genetic predisposition for alcohol abuse, which allows them to be used as an animal model of alcoholism. P rats readily self-administer i.v nicotine (Le et al., 2016), have EtOH consumption during adolescence that is similar to that seen in adulthood, and operantly respond for EtOH until they are impaired/intoxicated (Bell et al., 2006). Thus, P rats are a useful model for studying …

Screening For Alcohol Use, Misuse, Or Abuse In The Primary Care Setting Using The Audit-C Tool: An Extension Study, Courtney Amanda Minnis

DNP Projects

Abstract

PURPOSE: The purpose of this study was to improve alcohol screening rates in one primary care setting by educating and supporting providers and office staff on the use of the Audit-C alcohol screening tool.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected utilizing a retrospective chart review from the electronic medical records of adults over age 18 years by visit type: New Patient Visit, Annual Visit, or Employee Wellness Exam. Data included: demographic data of patient age, race, gender, the Audit-C score, and whether or not an intervention was performed.

RESULTS: Five providers …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Fraud Detection Protocol For Web-Based Research Among Men Who Have Sex With Men: Development And Descriptive Evaluation, April M. Ballard, Trey Cardwell, April M. Young

Epidemiology and Environmental Health Faculty Publications

Background: Internet is becoming an increasingly common tool for survey research, particularly among “hidden” or vulnerable populations, such as men who have sex with men (MSM). Web-based research has many advantages for participants and researchers, but fraud can present a significant threat to data integrity.

Objective: The purpose of this analysis was to evaluate fraud detection strategies in a Web-based survey of young MSM and describe new protocols to improve fraud detection in Web-based survey research.

Methods: This study involved a cross-sectional Web-based survey that examined individual- and network-level risk factors for HIV transmission and substance use among young MSM …

2018 Kentucky Dental Workforce Update, Sydney P. Thompson, Melissa Slone, Frances J. Feltner

Center of Excellence in Rural Health Workforce Reports

The perception that oral health is in some way less important than and separate from general health has been deeply ingrained in the American consciousness. Many Americans are unaware of ways to preserve oral health and may not recognize signs indicating they are in trouble. Poor oral health can contribute to various diseases including endocarditis, cardiovascular disease, diabetes, HIV/AIDS, osteoporosis, and Alzheimer’s disease.

Kentuckians often fair worse on a multitude of health measures, especially rural Kentuckians. According to the 2019 County Health Rankings data, when compared to US averages, Kentuckians are more likely to smoke (18% vs 23%), be obese …

Metabolism Reprogramming In Hexavalent Chromium-Induced Human Lung Carcinogenesis, James Tate Fortin Wise

Theses and Dissertations--Pharmacology and Nutritional Sciences

Hexavalent chromium, Cr(VI), is an established human carcinogen that is a worldwide environmental health concern. It is well understood that reactive oxygen species, genomic instability, and DNA damage repair deficiency are important contributors to Cr(VI)-induced carcinogenesis. After decades of research some cancer hallmarks remain understudied for the mechanism of Cr(VI) carcinogenesis. Dysregulated cellular energetics have been established as a hallmark of cancer. Energy pathways that become dysregulated in cancer include mitochondrial respiration, lipogenesis, pentose phosphate pathway, one carbon metabolism, and increased anaerobic glycolysis in the presence of oxygen or ‘Warburg effect’.

To investigate metabolism changes in Cr(VI) carcinogenesis, we exposed …

Preventing Interpersonal Violence At The University Of Kentucky: A Community-Level Expansion Of The Green Dot Program, Chelsey Reid

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

College students in the United States are at risk for being impacted by interpersonal violence (IPV), a spectrum of violence that includes sexual assault, dating violence, domestic violence, and stalking, with 1 in 5 women and 1 in 16 men being impacted by victimization during their collegiate careers. Through enhanced approaches to primary prevention, including through active bystander training, research has identified evidence-based strategies for reducing IPV prevalence. In Kentucky, 10.1% of all women impacted by IPV are first victimized prior to 18-years-old and 12.4% of all completed rapes are either alcohol or drug-facilitated. In light of these cumulative data, …

Brief Intervention And Buprenorphine Initiation For Opioid Use Disorder In Northern Kentucky Emergency Departments, Cady Cornell

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

The opioid epidemic has had sweeping, devastating effects on the United States. Kentucky has the fifth highest overdose mortality rate in the nation and the Northern Kentucky counties, specifically Kenton and Campbell, have been especially affected. Their opioid overdose mortality rates are the third and fourth highest in the state, respectively. In order to contribute to ongoing Northern Kentucky community efforts to combat the opioid epidemic, St. Elizabeth Healthcare is proposing to implement The Brief Negotiation Interview (BNI) in our emergency departments in order to provide more comprehensive care. The BNI is a motivational interviewing strategy that has been combined …

Methods For Multiple Imputation By Chained Equations Accounting For Missingness: A Simulation Study, Nathaniel Wilson

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

Improper treatment of missing data can lead to biased or invalid results. If the data are missing at random (MAR), multiple imputation by chained equations (MICE) is one method utilized to reduce bias. When implementing MICE, the imputation model must be compatible with the final analysis model. We aim to show how to include interaction terms in the imputation model to ensure valid results are obtained. Data were simulated for one continuous outcome originating from two binary predictor variables and their interaction. Missingness was imposed via a MAR mechanism. To handle the missing data, four methods were performed: complete records …

Thyroid Function Screening & Dysfunction In Patients With Heart Failure: An Examination Of Practice At The University Of Kentucky Albert B. Chandler Hospital From 2007-2017, Alexandra Paige Hall

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

Introduction: Heart failure constitutes a global pandemic affecting at least 26 million globally (an estimated 5.7 million of which are Americans), and its burden on our healthcare system is projected to increase.[1] As a result, it is imperative that diagnostics and treatment among that population be evidence based in order to contain costs and optimize patient outcomes. Over the last 20 years, thyroid function screening has been recommended for patients upon initial diagnosis of heart failure by the American College of Cardiology and other professional organizations. However, it remains unclear whether this recommendation is followed by practitioners and how much …

A Comparison Of Pediatric Prevention Policies To Pediatric Health Supervision Codes, Rania Burke

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

The number of policy statements from the AAP presents pediatricians with an increasing amount of advice related to prevention, yet the definition of prevention and well-child visits has not changed for outpatient office visits. Outpatient office visits are the primary means by which preventive care is administered. The objective of this study is to quantify and characterize the prevention policy recommendations that pediatricians are expected to provide patients/guardians beyond the well-child visit. Secondarily, an analysis was completed to demonstrate which prevention policies make recommendations that can be coded for reimbursement as part of a well-child prevention visit.

METHODS The author …

Preparation And Characterization Of Multimodal Hybrid Organic And Inorganic Nanocrystals Of Camptothecin And Gold, Christin P. Hollis, Alan K. Dozier, Barbara L. Knutson, Tonglei Li

Pharmaceutical Sciences Faculty Publications

We demonstrate a novel inorganic-organic crystalline nanoconstruct, where gold atoms were imbedded in the crystal lattices as defects of camptothecin nanocrystals, suggesting its potential use as simultaneous agents for cancer therapy and bioimaging. The incorporation of gold, a potential computed tomography (CT) contrast agent, in the nanocrystals of camptothecin was detected by transmission electron microscope (TEM) and further quantified by energy dispersive X-ray spectrometry (EDS) and inductively coupled plasma-optical emission spectrometers (ICP-OES). Due to gold's high attenuation coefficient, only a relatively small amount needs to be present in order to create a good noise-to-contrast ratio in CT imaging. The imbedded …

Methods To Quantify Nanomaterial Association With, And Distribution Across, The Blood-Brain Barrier In Vivo, Robert A. Yokel

Pharmaceutical Sciences Faculty Publications

The role and functional anatomy of the blood-brain barrier (BBB) is summarized to enable the investigator to appropriately address evaluation of nanomaterial interaction with, and distribution across, it into brain tissue (parenchyma). Transport mechanisms across the BBB are presented, in relation to nanomaterial physicochemical properties. Measures and test substances to assess BBB integrity/disruption/permeation are introduced, along with how they are used to interpret the results obtained with the presented methods. Experimental pitfalls and misinterpretation of results of studies of brain nanomaterial uptake are briefly summarized, that can be avoided with the methods presented in this chapter. Two methods are presented. …

Differential Abundance And Clustering Analysis With Empirical Bayes Shrinkage Estimation Of Variance (Dasev) For Proteomics And Metabolomics Data, Zhengyan Huang

Theses and Dissertations--Epidemiology and Biostatistics

Mass spectrometry (MS) is widely used for proteomic and metabolomic profiling of biological samples. Data obtained by MS are often zero-inflated. Those zero values are called point mass values (PMVs). Zero values can be further grouped into biological PMVs and technical PMVs. The former type is caused by the absence of components and the latter type is caused by detection limit. There is no simple solution to separate those two types of PMVs. Mixture models were developed to separate the two types of zeros apart and to perform the differential abundance analysis. However, we notice that the mixture model can …

Mechanisms Of Trinucleotide Repeat Instability During Dna Synthesis, Kara Y. Chan

Theses and Dissertations--Toxicology and Cancer Biology

Genomic instability, in the form of gene mutations, insertions/deletions, and gene amplifications, is one of the hallmarks in many types of cancers and other inheritable genetic disorders. Trinucleotide repeat (TNR) disorders, such as Huntington’s disease (HD) and Myotonic dystrophy (DM) can be inherited and repeats may be extended through subsequent generations. However, it is not clear how the CAG repeats expand through generations in HD. Two possible repeat expansion mechanisms include: 1) polymerase mediated repeat extension; 2) persistent TNR hairpin structure formation persisting in the genome resulting in expansion after subsequent cell division. Recent in vitro studies suggested that a …

Evaluating The Impacts Of Antidepressant Use On The Risk Of Dementia, Ran Duan

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is a clinical syndrome caused by neurodegeneration or cerebrovascular injury. Patients with dementia suffer from deterioration in memory, thinking, behavior and the ability to perform everyday activities. Since there are no cures or disease-modifying therapies for dementia, there is much interest in identifying modifiable risk factors that may help prevent or slow the progression of cognitive decline. Medications are a common focus of this type of research.

Importantly, according to a report from the Centers for Disease Control and Prevention (CDC), 19.1% of the population aged 60 and over report taking antidepressants during 2011-2014, and this number tends to …

Cost-Effectiveness Of A Weight Loss Intervention: An Adaptation Of The Look Ahead Lifestyle Intervention In The Us Military, Karina Manz

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

Objective: To assess whether a counselor-initiated adaptation (CI) of the Look AHEAD Intensive Lifestyle Intervention (ILI) in a military setting was cost-effective relative to a self- paced adaptation (SP).

Methods: We performed cost-effectiveness analysis from a payer perspective alongside a 2014- 2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force Base in Texas. We calculated incremental cost-effectiveness ratios (ICERs) for weight loss, reductions in waist circumference, and quality-adjusted life years (QALYs).

Results: After 12 months, the CI adaptation cost more per participant compared to the SP adaptation ($1,081 vs. $120), but achieved …

School-Based Hpv9 Vaccination Clinic In The Cumberland Valley Area Development District Of Kentucky, Eryne Wirthorn

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

Human Papillomavirus (HPV) is a group of more than 150 virus that can cause genital warts and cancers of the oropharynx, cervix, vagina, vulva, penis, and anus. A preventive vaccine currently exists that protects against seven oncogenic HPV strands and two strands that cause genital warts. Current guidelines for HPV9 vaccination consist of a 2-dose series delivered at 0 and 6 months for males and females ages 9-14, and a 3-dose series delivered at 0, 2, and 6 months for those ages 15-26.

While up-to-date (UTD) vaccination rates have increased across the Unites States, in 2017, only about 52.4% of …

A Comprehensive Assessment Of Crisis In Individuals With Intellectual Disabilities And Its Implications For Physical Therapy, Kathleen Sutton

Theses and Dissertations--Rehabilitation Sciences

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can …

Evidence-Based Music Therapy Treatment To Elevate Mood During Acute Stroke Care, Jessica L. Rushing

Theses and Dissertations--Rehabilitation Sciences

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The …

Prevalence Of Sports-Related Stress Urinary Incontinence In The Female Collegiate Athlete, Stacey Pagorek

Theses and Dissertations--Rehabilitation Sciences

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider.

Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in …

Connecting The Pieces: How Low Back Pain Alters Lower Extremity Biomechanics And Shock Attenuation In Active Individuals, Alexa Johnson

Theses and Dissertations--Rehabilitation Sciences

Low back pain in collegiate athletes has been reported at a rate of 37% from a wide array of sports including soccer, volleyball, football, swimming, and baseball. Whereas, in a military population the prevalence of low back pain is 70% higher than the general population. Compensatory movement strategies are often used as an attempt to reduce pain. Though compensatory movement strategies may effectively reduce pain, they are often associated with altered lower extremity loading patterns. Those who suffer from chronic low back pain tend to walk and run slower and with less trunk and pelvis coordination and variability. Individuals with …

Injury-Related Fear In Patients After Anterior Cruciate Ligament Reconstruction, Shelby Elyse Baez

Theses and Dissertations--Rehabilitation Sciences

Approximately 200,000 anterior cruciate ligament (ACL) injuries occur each year with about 100,000 of these injuries undergoing reconstruction (ACLR). The impetus of ACLR is to allow previously high functioning, physically active individuals to return to desired levels of sports participation and to engage in recommended levels of physical activity. However, 1 out of 3 patients after ACLR fail to return to competitive levels of sport and meet recommended levels of physical activity. Injury-related fear has been cited as the primary barrier for failure to return to sport. However, the research has been primarily qualitative in nature and limited research has …

Growing Old As A Rock Star: A Four-Part Study Of The Aging Voice, Joanna Sloggy

Theses and Dissertations--Rehabilitation Sciences

This dissertation focuses on the aging voice - specifically the aging elite vocal athlete. It is comprised of four components; a series of research studies and a viewpoint piece designed to explore the awareness, struggles, and vocal compensations of aging singers dealing with age related vocal and performance problems. The overarching goal of these studies is to inform the development of a voice care protocol for the aging rock star to guide customized intervention for these elite vocal athletes that is focused on optimizing both vocal output and performance.

First, the dissertation introduces and identifies characteristics of the exceptional voice. …

Effects Of The Dual Orexin Receptor Antagonist Dora-22 On Sleep In 5xfad Mice, Marilyn J. Duncan, Hannah Farlow, Chairtra Tirumalaraju, Do-Hyun Yun, Chanung Wang, James A. Howard, Madison N. Sanden, Bruce F. O'Hara, Kristen J. Mcquerry, Adam D. Bachstetter

Neuroscience Faculty Publications

Introduction: Sleep disruption is a characteristic of Alzheimer's disease (AD) that may exacerbate disease progression. This study tested whether a dual orexin receptor antagonist (DORA) would enhance sleep and attenuate neuropathology, neuroinflammation, and cognitive deficits in an AD-relevant mouse model, 5XFAD.

Methods: Wild-type (C57Bl6/SJL) and 5XFAD mice received chronic treatment with vehicle or DORA-22. Piezoelectric recordings monitored sleep and spatial memory was assessed via spontaneous Y-maze alternations. Aβ plaques, Aβ levels, and neuroinflammatory markers were measured by immunohistochemistry, enzyme-linked immunosorbent assay, and real-time polymerase chain reaction, respectively.

Results: In 5XFAD mice, DORA-22 significantly increased light-phase sleep without reducing Aβ levels, …

Oral Contraceptive Pills Are Not A Risk Factor For Deep Vein Thrombosis Or Pulmonary Embolism After Arthroscopic Shoulder Surgery, Austin V. Stone, Avinesh Agarwalla, Anirudh K. Gowd, Cale A. Jacobs, Jeffrey A Macalena, Bryson P. Lesniak, Nikhil N. Verma, Anthony A. Romeo, Brian Forsythe

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis.

Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery.

Study Design: Cohort study; Level of evidence, 3.

Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking …

Lung Cancer Screening In A Community Setting: Characteristics, Motivations, And Attitudes Of Individuals Being Screened, Margaret M. Byrne, Sarah E. Lillie, Jamie L. Studts

Behavioral Science Faculty Publications

We describe the characteristics of individuals being screened in community settings including factors influencing screening decisions and the level of information sought prior to screening. Individuals from two community-based radiology clinics (N = 27) were surveyed after screening. Screening efficacy and salience were the most important factors in screening decisions, whereas healthcare provider recommendations were rated not important. Half of participants reported no or little conversation about screening with their primary care provider, and 61.5 percent had not sought any information on screening. Individuals being screened in a community setting are unlikely to have sufficient information for an informed …

Attending To The Not-So-Little "Little Things": Practicing Trauma-Informed Pediatric Health Care, Aimee K. Hildenbrand, Scottie B. Day, Meghan L. Marsac

Pediatrics Faculty Publications

No abstract provided.