Medicine and Health Sciences Commons^™

A Comparison Of Post-Concussion Neurocognitive Test Results Of Recently Concussed High School Athletes To Their Neurocognitive Baseline Test Results Prior To Returning To Play, Karen Powers

DNP Projects

PURPOSE: In 2017, an estimated 2.5 million U.S. high school students reported having suffered at least one concussion while participating in sports or physical activity during the previous year. The purpose of this study is to evaluate the incidence of concussion among high school athletes and compare the athletes’ post-injury neurocognitive function to their baseline test results prior to returning to play.

METHODS: A retrospective records review of neurocognitive test scores of high school athletes during the June 2017 – June 2018 sport season was conducted. The records of 696 high school athletes were reviewed, including 30 post-injury test scores. …

Evaluation Of The Effectiveness Of A System Based Nurse Manager Collaborative Council On Work Engagement, Psychological Empowerment, And Value, Stacy Colligan

DNP Projects

BACKGROUND: Nurse Managers often do not receive direct acknowledgment for their accomplishments or have input into the facility wide decisions which directly impact them. Currently there are no known shared governance programs tailored to the nurse manager level.

PURPOSE: To determine the impact of a system shared governance model on nurse manager’s work engagement, psychological empowerment, and inclusion.

METHOD: A pretest and posttest design was utilized to determine the impact of shared governance participation for nurse managers. Spreitzer’s psychological empowerment scale and the Ultrech “Work and Well-being” instrument, in addition to some Likert scale and open-ended descriptive questions, were included …

Evaluation Of Provider Use Of The 2017 American College Of Cardiology/American Heart Association Guidelines For Diagnosis And Management Of White Coat Hypertension, Lauren Marie Louden

DNP Projects

BACKGROUND: White coat hypertension (WCH) is described as an anxiety-provoked, elevated in-office blood pressure reading, combined with a normal blood pressure reading outside of the clinic setting. This condition is often misdiagnosed as hypertension and can result in unnecessary antihypertensive treatment. PURPOSE: The purpose of this project was to determine provider adherence to the 2017 American College of Cardiology/American Heart Association hypertension guidelines for appropriate diagnosis and treatment of patients with white coat hypertension. METHODS: A retrospective chart review was performed on 100 randomly selected medical records of patients from an urban primary care practice diagnosed with an elevated blood …

Spinal Kappa Opioid Receptor Activity Inhibits Adenylyl Cyclase-1 Dependent Mechanisms Of Chronic Postoperative Pain, Lilian Custodio

Theses and Dissertations--Physiology

Chronic postoperative pain impacts millions of individuals worldwide that undergo a variety of surgical procedures. Opioids remain the mainstay analgesics of acute and perioperative pain; however, prolonged opioid therapy may lead to life-threating adverse effects, tolerance, dependence, and addiction. Therefore, unraveling the cellular mechanisms that drive persistent pain states and opposing endogenous analgesia provided by opioid receptor signaling, may lead to novel analgesics. Evidence suggests that tissue injury leads to increased sensitization of the spinal cord nociceptive neurons which increases susceptibility to chronic pain via an N-methyl-D-aspartate (NMDA) receptor activation of calcium-sensitive adenylyl cyclase isoform 1 (AC1). This phenomenon, named …

Targeting Maladaptive Plasticity After Spinal Cord Injury To Prevent The Development Of Autonomic Dysreflexia, Khalid C. Eldahan

Theses and Dissertations--Physiology

Vital autonomic and cardiovascular functions are susceptible to dysfunction after spinal cord injury (SCI), with cardiovascular dysregulation contributing to morbidity and mortality in the SCI population. Autonomic dysreflexia (AD) is a condition that develops after injury to the sixth thoracic spinal segment or higher and is characterized by potentially dangerous and volatile surges in arterial pressure often accompanied with irregular heart rate, headache, sweating, flushing of the skin, and nasal congestion. These symptoms occur in response to abnormal outflow of sympathetic activity from the decentralized spinal cord typically triggered by noxious, yet unperceived nociceptive stimulation beneath the level of lesion. …

Preclinical Targeting Of Trem2 For The Treatment Of Alzheimer's Disease-Type Pathology In A Transgenic Mouse Model, Brittani Rae Price

Theses and Dissertations--Physiology

Alzheimer's disease (AD) is defined as a progressive neurodegenerative disorder and is characterized by a devastating mental decline. There are three pathological hallmarks of the disease necessary for its diagnosis, these are extracellular amyloid plaques comprised of the beta-amyloid (Aβ) protein, intracellular neurofibrillary tangles comprised of hyperphosphorylated tau protein, and marked neuronal loss. Active immunization against Aβ_1-42 or passive immunization with monoclonal anti-Aβ antibodies has been shown to reduce amyloid deposition and improve cognition in transgenic mouse models of AD, aged beagles, and nonhuman primates. Unfortunately, due to cerebrovascular adverse events, both active and passive immunization strategies targeting Aβ …

Variability In Plasma Concentrations Of Methylprednisolone 6 Days After Intrasynovial Injection Of Methylprednisolone Acetate In Racing Horses: A Field Study, Jacob Machin, W. Duer, G. Maylin, C. K. Fenger, D. Wilson, M. Ivey, B. Berthold, S. Allison, Thomas Tobin

Veterinary Science Faculty Publications

Background: Methylprednisolone (MP) acetate is a commonly used corticosteroid for suppression of inflammation in synovial structures in horses. Its use is often regulated in equine sports by plasma MP concentrations. Objectives: To describe variability in MP plasma concentrations after MP acetate injection in different synovial structures and with co-administration with hyaluronic acid (HA). Study design: Field study in actively racing horses in three disciplines (Thoroughbred, Standardbred and Quarter Horse). Methods: Seventy-six horses (15 Thoroughbreds, 20 Standardbreds and 41 Quarter Horses) were included in the study. Injection of any synovial structure with a total body dose of 100 mg MP acetate …

Evaluation Of A Palliative Care Initiative On The African Continent: Responsibly Improving Access To Pain Treatment, J. Spencer Hirschi

MPA/MPP/MPFM Capstone Projects

The African continent today faces a crisis of inadequate palliative care, in spite of the growing level of suffering of its citizens who are faced with debilitating diseases and injuries. Much of this problem stems from deeply ingrained attitudes towards opioids: while the American continent grapples with the effects of opioid overprescribing, physicians trained in Africa are taught that opioids are inappropriate for virtually all scenarios, and therefore they come to fear and avoid their use or simply remain untrained on them altogether. Patients fail to advocate for themselves out of submission to the doctor’s authority, governments remain apathetic to …

Evaluating The Impact Of Fine Particulate Matter Pollution Standards On Mortality Rates In The Southeastern United States, Lauren Wice

MPA/MPP/MPFM Capstone Projects

The Environmental Protection Agency (EPA) continuously monitors six criteria pollutants that are known to have impacts on public health and welfare. One of these pollutants, fine particulate matter, or PM_2.5 (which includes particles that are smaller than 2.5 micrometers in diameter), is easily inhalable and can enter the lining of the lungs and the bloodstream, posing a great risk to human health. Standards for allowable concentrations of PM_2.5 were amended in 1997, 2006, and again in 2012, becoming increasingly stringent each time. According to the EPA, health organizations, and other research studies, these particles can specifically contribute to …

Walking With A Robotic Exoskeleton Does Not Mimic Natural Gait: A Within-Subjects Study, Chad Swank, Sharon Wang-Price, Fan Gao, Sattam Almutairi

Kinesiology and Health Promotion Faculty Publications

Background: Robotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics.

Objective: The purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait.

Methods: The study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 …

Neuropsychological Correlates Of Striatal Dopaminergic Dysfunction In Parkinson’S Disease, Brittany D. Walls

Theses and Dissertations--Psychology

Parkinson’s disease (PD) is a common neurodegenerative disorder associated with dysfunction of the basal ganglia, which contributes to a range of motor, cognitive, and affective symptoms. Striatal dopaminergic deficits are one of the core pathological mechanisms thought to contribute to the extra-motor (i.e., cognitive and affective) symptoms in early PD. The present study investigated the relationship between striatal dopaminergic integrity and cognition in 21 patients with PD and 21 age and education matched controls. Each individual underwent dopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) (i.e., DaTscan) and standardized neuropsychological testing. Strong positive associations were found between …

A Singer’S Stress: Yoga And Meditation Techniques In The Collegiate Voice Studio, Zackery David Morris

Theses and Dissertations--Music

Often neglected in voice study is the understanding that a singer’s instrument lives in his/her body and therefore cannot be packed away like other musical objects. Yoga and mindfulness compliment the belief of a whole body instrument. Data gathered on college campuses report that stress and anxiety are on the rise, thus reinforcing the need for MBSR and yoga as beneficial and proven tools for stress relief. The current state of research in the realm of mental health in colleges merits the study of a cohesive layout of these exercises and their expected outcomes in singing as well as stress …

Impact Of Prescription Opioid Access Restrictions On Alcohol-Induced Mortality In Kentucky, Changwe Park

MPA/MPP/MPFM Capstone Projects

Prescription drug monitoring programs (PDMPs) are state policy tools to combat risky opioid prescribing. Since 2012, several states began to mandate PDMP use. As mandating use laws have settled down, evaluating potential adverse events becomes possible.

In this study, I focus on alcohol-induced mortality as a potential unintended consequence via substituting alcohol for prescription opioids, since alcohol and opioids are often concurrently misused as a part of pain self-management. Therefore, the aim of this study is to analyze the unintended consequences of prescription opioid access restrictions on alcohol-induced mortality.

I compare the alcohol-induced mortality among adults during pre- and post-revision …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Impact Of Area-Under-The-Curve Monitoring For Vancomycin On Incidence Of Acute Kidney Injury In Orthopedic Patients, Kelli R. Keats

MPA/MPP/MPFM Capstone Projects

Vancomycin is an antibiotic used regularly in hospitals across the world. The most concerning adverse effect of vancomycin is its documented effect on kidney function. This study examines the impact of two dosing strategies of vancomycin on patients’ kidney function at the University of Kentucky Albert B. Chandler Medical Center. It specifically focuses on patients on the orthopedic service because these patients traditionally receive higher doses of vancomycin for longer periods of time due to the severity of their infections, which puts them at an increased risk of vancomycin-induced nephrotoxicity compared to other patients.

This study will serve as a …

Effects Of Multisensory Stop Signals On Sensitivity To Alcohol-Induced Disinhibition In Drinkers With Adhd, Alexandra R. D'Agostino

Theses and Dissertations--Psychology

Multisensory environments facilitate behavioral functioning in humans. The redundant signal effect (RSE) refers to the observation that individuals respond more quickly to stimuli when information is presented as multisensory, redundant stimuli rather than as a single stimulus presented to either modality alone. Our studies show that the disinhibiting effects of alcohol are attenuated when stop signals are multisensory versus unisensory. The present study expanded on this research to test the degree to which multisensory stop signals could also attenuate the disinhibiting effects of alcohol in those with attention-deficit hyperactivity disorder (ADHD), a clinical population characterized by poor impulse control. The …

Polysubstance Opioid Use In A Justice-Involved Population: An Analysis Of Patterns And Reentry Outcomes, Amanda Marie Bunting

Theses and Dissertations--Sociology

The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by …

Semisynthetic Aurones: A Family Of Newly Discovered Tubulin Inhibitors As Antineoplastic Agents, Yanqi Xie

Theses and Dissertations--Molecular and Cellular Biochemistry

Aurones belong to an uncommon class of plant flavonoids that provide the bright yellow coloration of some ornamental flowers and that possess a range of biological activities. Structure-activity relationships (SAR) in the aurone pharmacophore identified heterocyclic variants of the (Z)-2-benzylidene-6-hydroxybenzofuran-3(2H)-one scaffold that possessed low nanomolar in vitro potency in cell proliferation assays using various cancer cell lines, in vivo potency in prostate cancer PC-3 xenograft and zebrafish models, selectivity for the colchicine-binding site on tubulin, and absence of appreciable toxicity. Among the biologically active analogs developed in the course of this dissertation work were (Z …

Multigenerational Genomic And Epigenetic Effects Of Manufactured Silver Nanomaterials In Caenorhabditis Elegans, Anye Wamucho

Theses and Dissertations--Toxicology and Cancer Biology

There has been an increase in the incorporation of silver nanomaterials into consumer products due to their antimicrobial properties. Therefore there is potential for silver nanoparticles (Ag-NPs) to leach out into the environment during different life-cycle stages of these nanomaterial-containing products. Concern about the toxicity of Ag-NPs has led to investigations into their toxic effects on a variety of organisms mainly using acute and sub-chronic, single-generation exposures. The focus of this project was to understand the effects of long-term continuous multigenerational exposure to AgNO₃ and Ag-NPs in both pristine and environmentally transformed forms, on the model organism, Caenorhabditis elegans …

P4ha1 Is A New Regulator Of The Hif-1 Pathway In Breast Cancer, Ren Xu

Markey Cancer Center Faculty Publications

Hypoxia-Inducible Factor (HIF)-1 is a transcription factor that plays the key role in response to low oxygen concentrations, or hypoxia. Activation of the HIF-1 pathway is not only crucial for normal tissue development and function, but also involved in disease progression, such as cancer. Cancer cells proliferate rapidly in solid tumors, and thus, solid tumors consume much more oxygen and nutrients than normal tissue and generate oxygen tension. It is well established that oxygen tension in solid tumor tissue induces the aberrant activation of the HIF-1 pathway, and subsequently promotes angiogenesis and tumor progression. Breast cancer is a heterogeneous disease …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

The Effect Of Narrative Medicine Combined With Medication Assisted Treatment On Decreasing The Desire To Use Intravenous Substances In Hospitalized Patients With Infective Endocarditis, Paula Works

DNP Projects

Substance abuse is a significant problem that spans the nation. Of particular concern is the growing population of patients at UK HealthCare who have endocarditis as a complication from IV substance abuse.

PURPOSE: The aims of this study were

1. To assess the effect of narrative medicine combined with MAT, compared to MAT alone, on desire to use in hospitalized patients with a history of IV substance use
2. To examine the changes in quality of life before and after the introduction of narrative medicine in hospitalized patients with a history of IV substance abuse using The Quality of Life Scale (QOLS). …

The Effect Of An Educational Workshop On Relational Aggression In An Acute Care Nursing Unit, Jennifer M. Dorsey

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effect of an educational intervention on relational aggression in an acute care unit using a pre and post questionnaire. The questionnaire was used to examine changes in Relational Aggression (RA) self-awareness before and after an educational video and to determine the effectiveness of an educational video compared to no educational materials on self-awareness of RA behaviors.

METHODS: This study was single site, quasi-experimental non-equivalent pretest posttest study at the University of Kentucky. Sample size for the pre-survey was 15 acute care nurses on the control and experimental units, completed between …

Evaluating Pre-Procedural Anxiety In Adults Undergoing Interventional Radiology Procedures, Rebecca Doll

DNP Projects

PURPOSE: The purpose of this study is to evaluate pre-procedural anxiety with the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the adult population of the Interventional Radiology department at University of Kentucky Medical Center. The objective is to provide meaningful data to providers in this clinical area that could potentially facilitate better departmental workflow and also promote quality patient outcomes.

METHODS: A retrospective chart review, using a pre/post design, was used to evaluate the departmental implementation of APAIS. Case logs for the department were observed from January 2018 to June 2018 and then again, following APAIS implementation, from July …

Gun Violence Screening In The Adolescent Setting, Amy Burnett

DNP Projects

Objective: The purpose of this project was to implement a routine gun violence screening tool into practice in order to assess the need for this type of screening in the Adolescent Medicine Clinic at the University of Kentucky.

Methods: This study used a quasi-experimental one group posttest design to examine the impact of the implementation of a gun violence screening tool on the proportion of patients screened and the proportion of patients referred for intervention that screen positive.

Results: There were 44 adolescent patients that participated in this study (n=44). Twelve out of 44 participants screened positive, which means they …

The Effect Of A Provider-Based Educational Program On Knowledge, Attitudes, Self-Efficacy, And Order Rates Of Cologuard® In A Primary Care Clinic, Cassilly B. Besten

DNP Projects

BACKGROUND: Colorectal cancer is one of the most common and deadly cancers, particularly in persons greater than 50 years of age. Most colorectal malignancies are slow-growing, making regular screening increasingly important to decrease morbidity, mortality, and cost of treatment. Cologuard® serves as an effective and non-invasive colorectal cancer screening modality for average-risk adults.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy, and ordering rates of Cologuard® among primary care providers.

METHODS: This study was a single-center, pre/post implementation study of the effectiveness of a provider-based educational intervention …

Barriers To Screening For Intimate Partner Violence Among Aprns In Kentucky, Kathryn L. Strait

DNP Projects

Abstract

Purpose:Intimate partner violence (IPV) occurs in at least one in every four females and one in nine men across the United States (Smith et al., 2017). While the prevalence of IPV is considerably high, the screening rates for IPV in primary care specifically average less than 12% (United States Preventative Services Task Force, 2013). Methods: In order to identify how to overcome the barriers to screening including time, knowledge of IPV, access to community resources, gender identity/sexual orientation, accuracy and availability of screening tools, and reimbursement for advanced practice nurses in Kentucky, a survey was sent to …

The Effect Of A Child's Guardian's Health Literacy On Asthma Knowledge In Pediatric Patients, Sylvan Ryder

DNP Projects

PURPOSE: The purpose of this project is to determine if there is a correlation between a guardian’s health literacy and their knowledge of their child’s asthma management.

METHODS: This is a cross-sectional study conducted in the University of Kentucky Pediatric Pulmonology Clinic in Lexington, Kentucky. The analysis focused on how a parent’s health literacy level effected their asthma knowledge. The Rapid Estimation of Adult Literacy in Medicine-Short Form was used to measure health literacy. An asthma knowledge questionnaire with a Likert-scale design was used to measure asthma knowledge. The sample included eight parents of children with an asthma diagnosis collected …

The Effect Of A Focused Education Session On Continuous Renal Replacement Therapy (Crrt) Troubleshooting To Increase Knowledge And Self-Confidence In Icu Nurses., Lauren Nance

DNP Projects

PURPOSE: The purpose of this study was to determine if education focusing on continuous renal replacement therapy (CRRT) troubleshooting was effective at improving ICU nurses’ knowledge and self-confidence levels. It was hopeful that, following the educational intervention, ICU nurses would have an increase in knowledge and report higher self-confidence levels regarding troubleshooting CRRT.

METHODS: This study involved the use of a pre-post-test and questionnaire to evaluate the efficacy of an educational intervention on ICU nurses’ knowledge and self-confidence levels at Saint Joseph Hospital. The pre-post-test was used to evaluate knowledge levels, while the pre-post questionnaire was used to evaluate self-reported …