Medicine and Health Sciences Commons^™

Novel Evidence That The Mannan-Binding Lectin Pathway Of Complement Activation Plays A Pivotal Role In Triggering Mobilization Of Hematopoietic Stem/Progenitor Cells By Activation Of Both The Complement And Coagulation Cascades, M. Adamiak, A. Abdelbaset-Ismail, M. Suszynska, Ahmed K. Abdel-Latif, J. Ratajczak, M. Z. Ratajczak

Internal Medicine Faculty Publications

No abstract provided.

Ligand Trap Of The Activin Receptor Type Iia Inhibits Osteoclast Stimulation Of Bone Remodeling In Diabetic Mice With Chronic Kidney Disease, Toshifumi Sugatani, Olga A. Agapova, Yifu Fang, Alycia G. Berman, Joseph M. Wallace, Hartmut H. Malluche, Marie-Claude Faugere, William Smith, Victoria Sung, Keith A. Hruska

Internal Medicine Faculty Publications

Dysregulation of skeletal remodeling is a component of renal osteodystrophy. Previously, we showed that activin receptor signaling is differentially affected in various tissues in chronic kidney disease (CKD). We tested whether a ligand trap for the activin receptor type 2A (RAP-011) is an effective treatment of the osteodystrophy of the CKD-mineral bone disorder. With a 70% reduction in the glomerular filtration rate, CKD was induced at 14 weeks of age in the ldlr−/− high fat-fed mouse model of atherosclerotic vascular calcification and diabetes. Twenty mice with CKD, hyperphosphatemia, hyperparathyroidism, and elevated activin A were treated with RAP-011, wherease 19 …

From Dose To Response: In Vivo Nanoparticle Processing And Potential Toxicity, Uschi M. Graham, Gary Jacobs, Robert A. Yokel, Burtron H. Davis, Alan K. Dozier, M. Eileen Birch, Michael T. Tseng, Günter Oberdörster, Alison Elder, Lisa Delouise

Pharmaceutical Sciences Faculty Publications

Adverse human health impacts due to occupational and environmental exposures to manufactured nanoparticles are of concern and pose a potential threat to the continued industrial use and integration of nanomaterials into commercial products. This chapter addresses the inter-relationship between dose and response and will elucidate on how the dynamic chemical and physical transformation and breakdown of the nanoparticles at the cellular and subcellular levels can lead to the in vivo formation of new reaction products. The dose-response relationship is complicated by the continuous physicochemical transformations in the nanoparticles induced by the dynamics of the biological system, where dose, bio-processing, and …

Mammogram And Tomosynthesis Classification Using Convolutional Neural Networks, Xiaofei Zhang

Theses and Dissertations--Computer Science

Mammography is the most widely used method of screening for breast cancer. Traditional mammography produces two-dimensional X-ray images, while advanced tomosynthesis mammography produces reconstructed three-dimensional images. Due to high variability in tumor size and shape, and the low signal-to-noise ratio inherent to mammography, manual classification yields a significant number of false positives, thereby contributing to an unnecessarily large number of biopsies performed to reduce the risk of misdiagnosis. Achieving high diagnostic accuracy requires expertise acquired over many years of experience as a radiologist.

The convolutional neural network (CNN) is a popular deep-learning construct used in image classification. The convolutional process …

Cardiac Chemical Exchange Saturation Transfer Mr Imaging Tracking Of Cell Survival Or Rejection In Mouse Models Of Cell Therapy, Ashley L. Pumphrey, Shaojing Ye, Zhengshi Yang, Jennifer Simkin, John C. Gensel, Ahmed Abdel-Latif, Moriel H. Vandsburger

Saha Cardiovascular Research Center Faculty Publications

Purpose:

To examine whether cardiac chemical exchange saturation transfer (CEST) imaging can be serially and noninvasively used to probe cell survival or rejection after intramyocardial implantation in mice.

Materials and Methods:

Experiments were compliant with the National Institutes of Health Guidelines on the Use of Laboratory Animals and approved by the Institutional Animal Care and Use Committee. One million C2C12 cells labeled with either europium (Eu) 10-(2-hydroxypropyl)-1,4,7-tetraazacyclododecane-1,4,7-triacetic acid (HP-DO3A) or saline via the hypotonic swelling technique were implanted into the anterior-lateral left ventricular wall in C57BL/6J (allogeneic model, n = 17) and C3H (syngeneic model, n = 13) mice. Imaging …

The Effects Of Perinatal Oxycodone Exposure On The Stress Axis And Neurobehavior, Thitinart Sithisarn

Theses and Dissertations--Physiology

Opiate addiction is now a major public health problem. Pregnant women continue to use opiates during gestation; up to 5.4% of pregnant women report using illicit drugs during pregnancy. Previous studies have shown that perinatal insults and exposure to opiates such as morphine in utero can affect the development of the hypothalamic-pituitary-adrenal (HPA)-axis of the offspring and are associated with higher risk of developing neurobehavioral problems. Oxycodone, a semisynthetic putative kappa opioid receptor and partial mu opioid receptor agonist is now one of the most frequently abused pain killers during pregnancy, however limited data are available regarding whether and how …

The Mechanical Properties Of Non-Failing And Failing Human Myocardium, Cheavar A. Blair

Theses and Dissertations--Physiology

Heart failure is a clinical syndrome that manifests when there are structural and functional impairments to the heart that reduces the ability of the ventricles to fill or eject blood. The syndrome affects ~6 million Americans and is responsible for nearly 300,000 deaths annually. At the core of the syndrome are dysfunctional sarcomeres, the machinery that drives cardiac contraction and relaxation. By assessing the mechanical properties of human cardiac tissue, the information provided in this dissertation will provide data that demonstrates how sarcomeric dysfunction contributes to heart failure in the left and right ventricles. Additionally, these data will supply information …

Most Likely To Succeed: The Exploration Of Factors Affecting Successful Completion Of A Practical Nursing Program, Jennifer J. Shoemake

Theses and Dissertations--Educational Leadership Studies

In the realm of higher education, retention is a concept vital to the progression and security of all institutions. This remains true for all nursing programs as well because reports have shown an attrition rate as high as 50% in some nursing programs across the globe. Along with the nursing shortage projected in the next 20 years, retention in nursing programs poses a massive problem for not just higher education but healthcare as well. Therefore, it is important for nursing educators to understand the factors affecting student completion of a nursing program.

This two-phase, mixed-methods study sought to answer the …

The Impact Of Sglt2 Inhibitors, Compared With Insulin, On Diabetic Bone Disease In A Mouse Model Of Type 1 Diabetes, Kathryn M. Thrailkill, Jeffry S. Nyman, R. Clay Bunn, Sasidhar Uppuganti, Katherine L. Thompson, Charles K. Lumpkin, Evangelia Kalaitzoglou, John L. Fowlkes

Barnstable Brown Diabetes Center Faculty Publications

Skeletal co-morbidities in type 1 diabetes include an increased risk for fracture and delayed fracture healing, which are intertwined with disease duration and the presence of other diabetic complications. As such, chronic hyperglycemia is undoubtedly a major contributor to these outcomes, despite standard insulin-replacement therapy. Therefore, using the streptozotocin (STZ)-induced model of hypoinsulinemic hyperglycemia in DBA/2J male mice, we compared the effects of two glucose lowering therapies on the fracture resistance of bone and markers of bone turnover. Twelve week-old diabetic (DM) mice were treated for 9 weeks with: 1) oral canagliflozin (CANA, dose range ~10-16 mg/kg/day), an inhibitor of …

Singing Portuguese Nasal Vowels: Practical Strategies For Managing Nasality In Brazilian Art Songs, André Campelo

Theses and Dissertations--Music

The articulation of Portuguese nasalized vowels poses some articulatory problems accompanied by negative acoustic effects for the performance of Brazilian art songs. The main objective was to find strategies that permit the singer to conciliate an idiomatic pronunciation of these vowels with a well-balanced resonance, a desirable quality in classical singing. In order to devise these strategies, the author examined sources dealing with nasalized vowels from varied perspectives: acoustic properties of vowel nasalization, phonetic and phonological aspects ofBrazilian Portuguese (BP), historical views on nasality in singing, and recent vocal pedagogy research. In addition to the overall loss of sonority, the …

Comparative Storage And Utilization Analysis Of Insulin Across Inpatient Hospital Settings, Tristan A. Moorman

MPA/MPP/MPFM Capstone Projects

Insulin is the primary medication used by health systems across the nation to provide glucose control to those patients who need it. As this medication is generally available in a multi-dose vial, proper administration techniques should be used to minimize waste and optimize the cost effectiveness of the drug. Even though dosing guidelines for hospital use of insulin exist each institution has the opportunity to choose their administration technique. In this paper I will to identify administration characteristics utilized by four different hospitals in the central Kentucky area, compare and contrast those techniques through data collection, and analyze the findings …

Cross-Validation Of The Validity-10 Subscale Of The Neurobehavioral Symptom Inventory, Jordan P. Harp

Theses and Dissertations--Psychology

The present study is a cross-validation of the Validity-10 embedded symptom validity indicator from the Neurobehavioral Symptom Inventory (NSI) for the detection of questionable response validity during evaluation for mild traumatic brain injury (TBI).

The sample and data derived from a three-site Veterans Affairs (VA) parent study to validate the TBI Clinical Reminder, a routine set of questions asked of all recently returned veterans at VA facilities to screen for history of TBI. In the parent study, veterans recently returned from Iraq and Afghanistan underwent an evaluation for TBI with a physician and completed an assessment battery including neuropsychological tests …

Analyzing Songs Used For Lyric Analysis With Mental Health Consumers Using Linguistic Inquiry And Word Count (Liwc) Software, Ashley M. Miller

Theses and Dissertations--Music

Lyric analysis is one of the most commonly used music therapy interventions with the mental health population, yet there is a gap in the research literature regarding song selection. The primary purpose of this study was to determine distinguishing linguistic characteristics of song lyrics most commonly used for lyric analysis with mental health consumers, as measured by LIWC2015 software. A secondary purpose was to provide an updated song list resource for music therapists and music therapy students working with the mental health population. The researcher emailed a survey to 6,757 board-certified music therapists, 316 of whom completed the survey. Respondents …

Utilizing The Social Ecological Model To Address Drinking Behaviors Among College Students Participating In Ncaa Division I Non-Revenue Generating Sports, Andrew M. Smith

Theses and Dissertations--Educational Policy Studies and Evaluation

College students between the ages of 18 and 24 are considered high-risk for alcohol-related negative consequences due to drinking at high-risk levels (Barry, Howell & Salaga, 2015). Within that population, varsity student athletes are considered at even greater risk for those issues (Druckman, 2015; Wechsler, 2002).

With football and men’s basketball being considered the only revenue-generating NCAA Division I sports, non-revenue-generating sports consist of the majority of student athletes (NCAA, 2016). This study is designed to examine high-risk drinking as well as alcohol-related consequences among non-revenue-generating student athletes attending a National Collegiate Athletic Association (NCAA) Division I school.

The sample …

The Dynamic Nature Of Chromatin, Caitlyn M. Riedmann

Theses and Dissertations--Molecular and Cellular Biochemistry

Eukaryotic organisms contain their entire genome in the nucleus of their cells. In order to fit within the nucleus, genomic DNA wraps into nucleosomes, the basic, repeating unit of chromatin. Nucleosomes wrap around each other to form higher order chromatin structures. Here we study many factors that affect, or are effected by, chromatin structure including: (1) how low-dose inorganic arsenic (iAs) changes chromatin structures and their relation to global transcription and splicing patterns, and (2) how chromatin architectural proteins (CAPs) bind to and change nucleosome dynamics and DNA target site accessibility.

Despite iAs’s non-mutagenic nature, chronic exposure to low doses …

Discovering A Novel Antifungal Target In Downstream Sterol Biosynthesis Using A Squalene Synthase Functional Motif, Kristin Brooke Linscott

Theses and Dissertations--Molecular and Cellular Biochemistry

The sterol biosynthetic pathway is essential for growth of all eukaryotic cells and the main target of antifungal agents. The emergence of resistance to these antifungals in an already ill patient population indicates a need to develop drugs that have a broad spectrum of activity among pathogenic fungi and have minimal patient toxicity. Squalene synthase is the first committed step in the sterol pathway and has been studied intensively for development of antifungal agents. While the overall architecture of this enzyme is identical throughout eukaryotes, it was shown that plant and animal genes cannot complement a squalene synthase knockout mutation …

Properties And Optimization Of Respiratory Navigator Gating For Spiral Cine Dense Cardiac Mri, Sean Michael Hamlet

Theses and Dissertations--Electrical and Computer Engineering

Cardiac magnetic resonance (MR) imaging can non-invasively assess heart function. Displacement encoding with stimulated echoes (DENSE) is an advanced cardiac MR imaging technique that measures tissue displacement and can be used to quantify cardiac mechanics (e.g. strain and torsion). When combined with clinical risk factors, cardiac mechanics have been shown to be better predictors of mortality than traditional measures of heart function.

End-expiratory breath-holds are typically used to minimize respiratory motion artifacts. Unfortunately, requiring subjects to breath-hold introduces limitations with the duration of image acquisition and quality of data acquired, especially in patients with limited ability to hold their breath. …

Evaluation Of Depression Screening Practices In Comorbid Patients In The Primary Care Setting, Kristyn L. Clark

DNP Projects

SPECIFIC AIMS: To evaluate the current rates of depression screening using the PHQ-2/9 in patients with comorbid conditions at a single, urban primary care office; to explore barriers to depression screening among providers.

METHODS: A retrospective chart review was completed on a sample of 188 patients seen between January and June 2017. Patients were equally divided among four comorbid diagnoses- COPD, obesity, hypertension, and type 2 diabetes. A provider interview was conducted to identify depression screening barriers and typical treatments regimens.

RESULTS: A total of 70.2% of patients had a documented depression screening. Of 67 patients diagnosed with depression, 11.9% …

Evaluation Of Screening Practices For Alcohol Use In Primary Care, Tiffany Centers

DNP Projects

Purpose: The purpose of this practice inquiry project was to examine current screening practices for alcohol misuse within a primary care clinic. The United States Preventive Services Task Force (USPSTF) guidelines state that alcohol misuse screening should be performed on adults aged 18 years or older using one of three standardized screening tools: Alcohol Use Disorders Identification Test (AUDIT), the abbreviated AUDIT-Consumption (AUDIT-C), or a single-question screening. If indicated, providers should provide a brief intervention and/or referral to treatment through the process known as SBIRT (screening, brief intervention, referral to treatment).

Methods: A retrospective chart review was conducted …

The Effect Of Trauma-Informed Care Training On The Knowledge And Awareness Of Medical Professionals At Kentucky Children’S Hospital, Laura Broughton

DNP Projects

Background: Many children who present to the hospital require treatments and procedures in their medical care that can be potentially emotionally traumatic for themselves and their families. Medical professionals caring for these children may also experience emotional trauma symptoms related to their work. A trauma-informed care approach to medical care may help to lessen these negative consequences in both patients and medical professionals. Purpose: The objective of this study was to assess the effectiveness of a one-hour training on trauma-informed care to nurses at Kentucky Children’s Hospital. Methods: Nurses participated in a one-hour interactive seminar and completed pre- and post-measures …

A Process Improvement Project To Increase Diabetic Retinopathy Screening Rates As Evidenced By Formal Documentation, Michelle Renae Campbell

DNP Projects

Purpose: To evaluate the effects of a referral process on diabetic retinopathy screening rates among patients with Type 2 diabetes and formal documentation completion rates of these screenings within a primary care setting.

Methods: A referral process for patient referral to an ophthalmologist for annual diabetic retinopathy screening was instituted for a 4-week period within a Norton Community Medical Associates (NCMA) primary care location for Type 2 diabetes patients. Charts of 30 patients pre-intervention were compared with the charts of 30 patients seen during the intervention phase of the study to evaluate the effects of the referral intervention. Demographic data, …

Introduction Of A Comprehensive Modified Early Warning Scoring System In A Large Rural Hospital, Beth A. Meade

DNP Projects

PURPOSE: To develop and test a comprehensive modified early warning scoring (MEWS) system for use on two medical-surgical-telemetry units in a large rural hospital in northeastern Kentucky; to educate and train nursing staff in utilization of a new MEWS system and early identification and management of clinical deterioration; and to determine nursing satisfaction regarding education, training, and use of a new MEWS system.

BACKGROUND: Adult medical-surgical patients are at risk for clinical deterioration. Rapid response systems and MEWS systems are strategies that have been employed to assist nursing staff in early identification and management of clinical deterioration. Testing of a …

The Effect Of Transition Readiness Interventions On Adolescents With Diabetes When Transitioning From Pediatric To Adult Clinic, Kimberly Walker

DNP Projects

PURPOSE: The purpose of this study was to initiate a transition readiness program which uses motivational interviewing at the Pediatric Endocrinology Clinic located within the UK HealthCare Kentucky Clinic. An evaluation of this program was conducted by assessing participant outcomes related to readiness for transitioning.

METHODS: This study was a quasi-experimental one group pretest posttest design to assess the effectiveness of transition readiness interventions on adolescent readiness and confidence in transition of care at the Pediatric Endocrinology Clinic located at the Kentucky Clinic. The sample consisted of 14 patients.

RESULTS: No statistical significance was found in the TRAQ tool and …

Implementing A Patient Hand-Hygiene Protocol To Decrease Clostridium Difficile Infections In The Acute Care Setting, Lydia S. Mendez

DNP Projects

PURPOSE: The purpose of this study was to develop and implement a patient hand hygiene protocol (PHHP) to improve patient outcomes, specifically to decrease the rates of clostridium difficile infections (CDI) at Norton Hospital (NH) and Norton Audubon Hospital (NAH) in Louisville, Kentucky.

METHODS: This was a multi-center, quasi-experimental study that implemented a PHHP on three units at two hospitals in the Norton Healthcare system. The sample consisted of 159 patients in the pre-intervention period and 18 patients in the intervention period. A retrospective records review was performed to analyze specific demographic variables.

RESULTS: No differences in age and gender …

Screening For Sleep Apnea In Patients With Hypertension Using The Stop-Bang Tool In A Primary Care Setting, Natalie R. Jennette

DNP Projects

Obstructive sleep apnea (OSA) is a common cause of high blood pressure but often undetected in patients with hypertension. Screening tools for OSA exist but are underutilized. This project aimed to identify current practices and perceptions related to screening for OSA in patients with hypertension and improve primary care provider knowledge of OSA and screening rates using the STOP-BANG screening tool. The providers acknowledged the importance of screening patients with hypertension but there was no increase in screening after education was provided. Effective screening tools exist but effective strategies to bring this evidence to practice need to be explored further.

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

An Evaluation Of An Innovative Weight Management Program In A Primary Care Setting, Susan Peak

DNP Projects

Background- Kentucky ranks third in the nation for childhood overweight and obesity. . Consumption of high dietary fat, excessive use of electronics, low levels of physical activity and consumption of sugar filled drinks are modifiable behaviors believed to be the biggest culprits behind these statistics.

Purpose- The purpose of this evaluation was to assess the implementation of the 5-2-1-0 plan in the management of childhood overweight or obesity within an urban primary care clinic.

Methods- After initiation of the program by the clinic focused interviews with the primary care providers were conducted to evaluate barriers and benefits to …

The Impact Of Nursing Staff Adherence With Chlorhexidine Gluconate Bathing On Intensive Care Unit Patient Outcomes, Tara M. Jones

DNP Projects

Purpose: The purpose of this study is to evaluate nursing staff adherence to a chlorhexidine gluconate (CHG) bathing protocol in the intensive care unit at Norton Brownsboro Hospital.

Methods: This study utilized a single-site, quasi-experimental, retrospective electronic medical record review format. The sample consisted of 200 patient records post CHG bathing protocol initiation from the Norton Brownsboro Hospital Intensive Care Unit during the period of March, 2015 to May, 2017.

Results: The sample was divided into adherent and non-adherent groups. No significant differences in age, sex, race, ICU length of stay (LOS), BMI, or mortality scores, presence of indwelling medical …

Effect Of A Parent Empowerment Program On Length Of Stay And Parental Stress In The Neonatal Intensive Care Unit, Holly L. Nieves

DNP Projects

PURPOSE: Research surrounding topics in the Neonatal Intensive Care Unit have long been focused on mortality and morbidity of this population. However, consideration of the parent-infant relationship and subsequently adverse outcomes that could be formed during the intensive care stay should be examined. Parent empowerment programs in the NICU have been shown to decrease length of stay, parental stress, and depression. The purpose of this study was to evaluate the impact of the COPE for HOPE parent empowerment program on length of stay, parental stress, maternal depression, and parent satisfaction in the Neonatal Intensive Care Unit with parents of infants …

Perceptions About Cognitive Enhancement Therapy Among Regional Mental Health Providers: A Mixed Methods Analysis, Adam A. Loose

DNP Projects

Cognitive Enhancement Therapy (CET) is a program, developed at the University of Pittsburgh, to improve cognitive deficits experienced by people diagnosed with schizophrenia. Since its implementation in various settings, CET has demonstrated positive outcomes for patients in many cognitive domains. This study took a mixed methods approach to assess the interest and knowledge of mental health providers at a regional level and a local mental health facility in particular, about beginning a CET program. The quantitative study obtained data from evaluations administered during two CET training events at a local mental health facility. Digitally recorded qualitative interviews were conducted with …