Medicine and Health Sciences Commons^™

Servsafe® Exam: Student's Memory Retention Two Years Later, Laura E. Tincher

Theses and Dissertations--Nutrition and Food Systems

This study analyzed the memory retention of University of Kentucky Dietetic and Hospitality students as it relates to food safety and sanitation knowledge originally presented on the ServSafe® certification exam. Dietetic and hospitality students take the ServSafe® certification course during the sophomore year of their degree program, but they are responsible for the sanitation and food safety information throughout their entire program of undergraduate study. The final sample consisted of 25 participants, with 84% (n=21) in the Dietetics program and 16% (n=4) in the Hospitality, Management and Tourism program. The mean difference in total score, domain one, domain two, domain …

Healthcare Industry Injuries By Patient Contact Status In Kentucky, 2012-2014, Kristen Ranzenberger

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

Objectives

The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to 1) characterize healthcare industry injuries by patient contact status; 2) identify the occupations associated with healthcare injuries by patient contact status; and 3) determine healthcare injury rates by occupation, to gain a better understanding of healthcare industry compensated injuries , and better target healthcare industry safety practices and programs.

Methods

Workers’ Compensation first reports of injuries (FROI) from the healthcare industry in Kentucky were categorized into injuries involving in direct patient contact vs. injuries without direct patient contact using narrative …

Are There Delays In Receipt Of Treatment Among Appalachian Kentucky Women With Breast Cancer, Huong Thi Thanh Luu

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

Background: Women living in rural and under-resourced Appalachian Kentucky may experience delays in receiving cancer treatment yet such delays have not been systematically evaluated. In this analysis, we hypothesize that women diagnosed with breast cancer who live in Appalachian Kentucky would be more likely to have a treatment delay compared to those living in other Kentucky regions and adjusting for individual measures of socioeconomic status.

Methods: In this cohort study, women included in the Kentucky Cancer Registry with a diagnosis of an incident, primary breast cancer in the prior 12 months were interviewed by phone (n=1,245; response rate 26.9%). Cox …

Examining Alcohol Consumption, Psychological Distress, And Current Smoking Status: Results From The Behavioral Risk Factor Surveillance System, 2013, Guangxing Zhan

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

Introduction: Approximately 443,000 people die from smoking or exposure to secondhand smoke, and another 8.6 million people have a serious smoking-related illness, which costs nearly $96 billion in health-care expenditures and $97 billion in productivity losses annually in the United States. This study examined the association between alcohol consumption and smoking status, and how psychological distress can affect this association. Methods: Data come from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). We used binary logistic regression models to compute adjusted odds ratios between alcohol consumption and smoking status, controlling for age, gender, race, education, and income. We used chi-square …

Associations Among Sexual Violence, Risky Sexual Behaviors, And Substance Abuse: Risk And Protective Factors Among Women From The National Survey Of Family Growth, Michelle Kroger

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

Introduction: Millions of women experience sexual violence which results in a plethora of adverse health consequences. Given the scope of the problem, more attention is needed to examine the complexities in which sexual violence occurs, and possible associations among sexual violence and related health behaviors. The present study analyzes whether a significant association between sexual violence and condom use and/or sexually transmitted diseases (STDs) exists, and whether consuming alcohol and/or drugs increases women’s risk of having unprotected sex and/or an STD.

Methods: Data from the National Survey of Family Growth 2006-2010 and 2011-2013 were analyzed using bivariate and multivariate chi-square …

Rural Healthcare Worker's Willingness To Report To Work During Catastrophic Events, Aaron M. Macdonald

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

In the events leading up to, during, and following a catastrophic event, healthcare workers play a critical role in the outcome of these events. Therefore it is of the utmost importance that healthcare workers are able and willing to report to work. Prior to September, 2001 there had been three willingness to report studies published in the literature. Post September, 2001 and up until 2011 there was a renewed interest in the topic which led to the publishing of twenty plus papers on the topic. The current literature has examined willingness to report thoroughly and definitively; however, there is a …

Exploration Of Factors Associated With Patient Adherence In Upper Extremity Rehabilitation: A Mixed-Methods Embedded Design, Enrique V. Smith-Forbes

Theses and Dissertations--Rehabilitation Sciences

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem.

The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence.

The first purpose of this dissertation was to explore the MAM …

"Bent But Not Broken": A Mixed Methods Study Of Mothering During Chemotherapy For Breast Cancer, Julie A. Baltisberger

Theses and Dissertations--Rehabilitation Sciences

Breast cancer is the most common cancer diagnosis of women, with an estimated 232,670 new cases in 2014. With 89.2% of breast cancer patients surviving five years or longer, studies are needed to investigate the long-term impact of breast cancer on women and families (National Cancer Institute, 2014).

The purpose of this study was to examine, using a mixed methods approach, the impact of chemotherapy on mothering occupations for patients diagnosed with breast cancer. Thirty-one women (mean age=39.6, SD=5.79), with breast cancer of any stage, who were currently undergoing chemotherapy and had at least one child under the age of …

Perception And Use Of Communication Care Plans By Certified Nursing Assistants In Nursing Homes: The Role Of Professional Support, Christen G. Page

Theses and Dissertations--Rehabilitation Sciences

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs.

The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care …

Problem Solving Of Typically Developing Children On An Adaptation Of The Twenty Questions Task, Janice Carter Smith

Theses and Dissertations--Rehabilitation Sciences

This cross sectional study examined problem solving by typically developing children on the Rapid Assessment of Problem Solving test (RAPS). The RAPS, a modification of Mosher and Hornsby’s 20Q task, requires the examinee to solve three problems. Each problem involves asking yes/no questions to identify a target picture from a 32-picture array with as few questions as possible. Participants were 73 young (ages 7-9), 79 early adolescent (ages 10-13) and 77 adolescent (ages 14-17) children residing in Kentucky. Children were seen in the summer months and administered the RAPS on a single occasion, with 22 of the children being testing …

Effects Of An Online Training In The Ziggurat Model On The Autism Knowledge Of School-Based Speech-Language Pathologists (Slps), Wendy L. Wilkerson

Theses and Dissertations--Rehabilitation Sciences

Autism Spectrum Disorder (ASD) is a low-incidence disorder with high impacts on individuals, families, and society. School-based speech-language pathologists (SLPs) have tremendous responsibilities toward individuals with ASD, but pre-service SLPs are not adequately trained to fulfill these expectations. In order to reduce the widespread financial and social impact of ASD, school-based SLPs need to complete effective training to prepare them for the selection of established social-communication practices. One framework for the selection of individualized intervention is the Ziggurat Model (Aspy & Grossman, 2008). The following study used mixed methods to investigate the research question: “Does the ASD knowledge base of …

Farm To School Programs And Children's Dietary Behaviors, Kathleen Evers

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

There is an increasing promotion of the importance of fruit and vegetable consumption through prevention efforts, specifically in school systems, to control and prevent childhood obesity. Farm to School (FTS) programs offer interactive hands on experiences involving fruits and vegetables. This study examines a specific FTS program including a farmer interaction, and a broccoli taste testing experience for kindergarten and fourth grade students in a rural Kentucky county. By using a digital still photography method of plate waste, the decisions of approximately 115 students to take/not take broccoli and percentage of students’ consumption of broccoli was analyzed. Using chi-square and …

Association Between Stressful Life Events And Change Of Maternal Smoking During Pregnancy Using Prams 2011-2012, Shidie Tang

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

Objective: To examine the association between stressful life events during pregnancy and change of maternal smoking behaviors.

Methods: We used data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to conduct the research. Our data included 24 states from 2011-2012. We considered 13 stressful life events and grouped them into four categories: emotional, partner-related, financial and traumatic stressors. Change of Maternal Smoking during pregnancy was defined by smoking at the last trimester of pregnancy versus smoking at 3 months prior to smoking. Confounders included maternal age, race/ethnicity, education, marital status, Medicaid coverage upon delivery and income prior …

A Qualitative Analysis Of Four Appalachian Cervical Cancer Patient Navigators Interviews, Steven Hiestand

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

Despite widespread incorporation of patient navigation into cancer care programs, there remains little consensus on the definition or core competencies which distinguish the patient navigator role within health care. In order to determine the definition and core competencies, the experiences and insights of patient navigators must be understood. Four patient navigators participating in a 2010 Appalachian Cervical Cancer intervention were interviewed. I qualitatively analyzed these interviews for important themes relating to the definition of patient navigation as well as important skills and competencies. The patient navigators identified patient navigation as being patient-centric and focused on overcoming barriers to cancer care. …

Evaluation Of The Move Program On Weight Loss Among Veterans, William Justin Allen

DNP Projects

The most current estimations from the CDC classify more than one third of the American population as obese (2011). This epidemic continues to contribute to a number of chronic diseases across the country including diabetes and heart disease, both associated with high morbidity and mortality (NHLBI, 1998). Billions of dollars are spent annually on obesity and obesity related conditions.

Perhaps this is what led the U.S. Department of Health and Human Services (HHS) to select Nutrition, Physical Activity, and Obesity as a Leading Health Indicator in Healthy People 2020. The updated NHLBI guidelines, based on clinical evidence, offer a blueprint …

Evaluation Of Primary Care Providers' Utilization Of Angiotensin-Converting Enzyme Inhibitor Therapy In Heart Failure Patients, Trisna P. Gozali

DNP Projects

Background: ACEI has been shown to help decrease mortality, morbidity, rate of re-hospitalization, and to improve symptoms of heart failure (HF). However, the rate of ACEI use for HF patients remain low despite the recommendations made by the ACCF/AHA Task Force in the current 2013 HF guideline. It is important to increase the use of ACEI because of its positive effect on the outcome of HF. In addition, improper charting could skew the number of patients who are actually taking ACEI, making it less than it actually it. Thus, providers should be on the forefront of encouraging ACEI use, especially …

Evaluation Of A Rheumatology Patient Prioritization Triage System, Katharine R. Layton

DNP Projects

The United States health care system is currently experiencing an increase in demand for services due to an aging population. Rheumatology, an Internal Medicine sub-specialty, treats those patients with arthritic conditions as well as other autoimmune and inflammatory conditions. A shortage of rheumatologists is projected by 2025, adding additional stress to an already burdened clinical area.This means patients can face substantial wait times when requesting consultation with a rheumatology provider.This capstone project will present three manuscripts that explore the referral process from primary to specialty care and strategies to reduce wait times. The first manuscript is a literature review that …

Examining Provider Perspectives On Implementation Of An Integrated Primary And Behavioral Health Care Model In The Outpatient Setting: A Qualitative Study, Holly Gray

DNP Projects

AIM The purpose of this qualitative descriptive research study was to identify and describe primary and mental health provider perspectives, including attitudes and knowledge related to integration of primary and behavioral health care in the outpatient setting. One objective of this project was to gather information from providers in both primary and behavioral health settings to ascertain how they perceive the idea of integrated care. Another objective of this project was to gather information about provider perception of current practice protocols for treatment of patients with comorbid physical and mental health issues, perceived facilitators and barriers to integrated care, and …

An Assessment Of Knowledge And Attitude Towards Stock Epinephrine Among Kentucky School Nurses, Brandi M. Duran

DNP Projects

This cross-sectional, pre-post intervention study was designed to gather information on Kentucky School Nurses attitude and knowledge toward non-prescribed epinephrine auto injectors in Kentucky Schools. All 500 members of the Kentucky Schools Nurses Association received a link to the pretest, educational intervention and posttest via email. Of those, 75 nurses responded and 72 were eligible to participate in the study. The data was analyzed through a paired t-test using SPSS. The results showed an increase in level of comfort with epinephrine, although it was not statistically significant. There was a statistical significance between the pretest and posttest when school nurses …

Diffuse Optical Measurements Of Head And Neck Tumor Hemodynamics For Early Prediction Of Chemo-Radiation Therapy Outcomes, Lixin Dong

Theses and Dissertations--Biomedical Engineering

Chemo-radiation therapy is a principal modality for the treatment of head and neck cancers, and its efficacy depends on the interaction of tumor oxygen with free radicals. In this study, we adopted a novel hybrid diffuse optical instrument combining a commercial frequency-domain tissue oximeter (Imagent) and a custom-made diffuse correlation spectroscopy (DCS) flowmeter, which allowed for simultaneous measurements of tumor blood flow and blood oxygenation. Using this hybrid instrument we continually measured tumor hemodynamic responses to chemo-radiation therapy over the treatment period of 7 weeks. We also explored monitoring dynamic tumor hemodynamic changes during radiation delivery. Blood flow data analysis …

Muscular And Neural Contributions To Postactivation Potentiation, Brian Joseph Wallace

Theses and Dissertations--Kinesiology and Health Promotion

Muscle performance is partially a consequence of its recent contractile history. Postactivation potentiation (PAP) can occur after muscle contractions and leads to enhanced neuromuscular performance. The purpose of this dissertation was to explain the relationship between muscle factors (twitch potentiation, TP) and neural factors (reflex potentiation, RP) contributing to overall PAP following a non-fatiguing volitional muscle contraction. The tibial nerves of fifteen resistance trained volunteers (eleven men, four women) were stimulated intermittently at supramaximal (Mmax) and submaximal (Hmax) intensities for 20 minutes on separate days under three conditions: rest (Control); after a after a 10 second maximum voluntary isometric contraction …

The Effect Of Fluid Periodization On Athletic Performance Outcomes In American Football Players, Christopher W. Morris

Theses and Dissertations--Kinesiology and Health Promotion

For decades strength and conditioning professionals have been seeking optimal training volumes and intensities to yield maximum performance outcomes without the onset of injury. Unfortunately, current studies apply experimental training techniques without considering the individuals’ response to the imposed training load. Due to the vast genetic variability and extraneous environmental factors that affect one’s ability to recover, results from such studies are controversial and inconclusive. Athlete monitoring systems offer an objective assessment that is purported to evaluate an individual’s physiological readiness to adapt to an overload stimulus and thus allow for daily manipulations in training loads (i.e., fluid periodization). However, …

Biomechanical Analysis Of Race Walking Compared To Normal Walking And Running Gait, Jaclyn D. Norberg

Theses and Dissertations--Kinesiology and Health Promotion

Human locomotion is phenomenon that is extraordinarily complex. It is evident that a complete description of locomotion involves consideration of kinematics, kinetics, and muscle activity of the extremities in all of their various movements. Race walking (RW) is a form of upright locomotion that differs from normal walking and running by its form dictated by the International Amateur Athletics Federation (IAAF). Despite the similarities to both normal walking (NW) and running (RU), RW has not been the subject of equally intensive investigations.

This study explores the comprehensive biomechanics of race walking and how it compares to NW and RU. A …

The Effect Of Β-Hydroxy-Β-Methylbutyrate (Hmb) Supplementation On Neuromuscular Performance Following Fatiguing Exercise In Healthy Subjects, Jordon W. Macht

Theses and Dissertations--Kinesiology and Health Promotion

Supporters of a nutritional supplement, β-Hydroxy-β-Methylbutyrate (HMB) supplementation, claim that it will increase the muscular strength gains and lean muscle mass gains seen during a resistance training program. It has been suggested that HMB supplementation does this by preventing muscle damage or by regenerating damaged muscle cell membranes. However, no research has evaluated the effect of HMB supplementation on low frequency fatigue. Therefore, the purpose of this study was to determine if three weeks of HMB supplementation could attenuate the effects of low frequency fatigue caused by eccentric muscle contractions of the tibialis anterior muscle. A total of 33 healthy …

Cardiovascular Disease Risk Factors In Structural Firefighters, Nicholas W. Trubee

Theses and Dissertations--Kinesiology and Health Promotion

This dissertation is composed of two manuscripts assessing cardiovascular disease (CVD) risk in structural firefighters. Study 1 compared traditional CVD risk factors and health-related behaviors between professional and volunteer firefighters. Online questionnaires were sent to approximately 4000 firefighters in the state of Kentucky. The results indicated that 90% of volunteer and 58% of professional firefighters were classified as moderate-to-high CVD risk. Volunteer firefighters were significantly (p < 0.001) older and more likely (p = 0.026) to be current cigarette smokers. The mean body mass index among all firefighters in the sample was 30.8 kg·m^-2. Nearly 60% of volunteer firefighters were obese. Obese firefighters were more likely (p < 0.05) to have been diagnosed as diabetic or pre-diabetes compared to overweight and normal weight firefighters. These results indicate that volunteer firefighters may be at a greater CVD risk compared to professional firefighters.

Study 2 investigated the association of cardiorespiratory fitness (CRF) and body fat with arterial stiffness in professional firefighters. Forty-six …

The Effects Of Spinal Manipulative Therapy On Isokinetic Strength And Postactivation Potentiation, Grant D. Sanders

Theses and Dissertations--Kinesiology and Health Promotion

Spinal manipulative therapy (SMT) is a therapeutic procedure employed by various healthcare practitioners for alleviating acute and chronic musculoskeletal complaints. This form of treatment is also delivered to enhance the performance and augment the rehabilitation of athletes. However, despite research findings alleging the strength-modulating effects of SMT alongside numerous professional athletes’ positive anecdotal claims concerning its results, the physiological processes to explain its effects remain largely unexplained. Therefore, the purpose of this work was to investigate the effects of SMT in a college-aged sample population with two experiments.

The first study examined the effect of SMT targeting the lumbosacral region …

A Public Duty: Medicine And Commerce In Nineteenth-Century American Literature And Culture, Heather E. Chacon

Theses and Dissertations--English

Using recent criticism on speculation and disability in addition to archival materials, “A Public Duty: Medicine and Commerce in Nineteenth-Century American Literature and Culture” demonstrates that reform-minded nineteenth-century authors drew upon the representational power of public health to express excitement and anxiety about the United States’ emerging economic and political prominence. Breaking with a critical tradition holding that the professionalization of medicine and authorship served primarily to support and define an ascending middle class, I argue that the authors such as Robert Montgomery Bird, Fanny Fern, George Washington Cable, and Pauline Hopkins fuse the rhetoric of economic policy and public …

Dietary Selenium Supplementation: Effects On Neurodegeneration Following Traumatic Brain And Spinal Cord Injury, Carolyn A. Crowdus Meyer

Theses and Dissertations--Neuroscience

Traumatic brain and spinal cord injury continue to be substantial clinical problems with few available treatment strategies. Individuals who are at a greater risk for sustaining a central nervous system (CNS) injury, such as professional athletes and military personnel, may benefit from a prophylactic supplement that would intervene in the neurodegenerative pathways immediately following injury. The high demand for selenium within the central nervous system, as well as the synthesis of selenoproteins by neurons and astrocytes suggests a critical role of selenium within the brain and spinal cord. Studies were designed to test the efficacy of enriched dietary selenium status …

Mitochondrial And Neuroprotective Effects Of Phenelzine Related To Scavenging Of Neurotoxic Lipid Peroxidation Products, John Cebak

Theses and Dissertations--Neuroscience

Lipid peroxidation is a key contributor to the pathophysiology of traumatic brain injury (TBI). Traditional antioxidant therapies are intended to scavenge the free radicals responsible for either the initiation or propagation of lipid peroxidation (LP). However, targeting free radicals after TBI is difficult as they rapidly react with other cellular macromolecules, and thus has a limited post-injury time window in which they may be intercepted by a radical scavenging agent. In contrast, our laboratory has begun testing an antioxidant approach that scavenges the final stages of LP i.e. formation of carbonyl-containing breakdown products. By scavenging breakdown products such as the …

Target-Directed Biosynthetic Evolution: Redirecting Plant Evolution To Genomically Optimize A Plant’S Pharmacological Profile, Dustin Paul Brown

Theses and Dissertations--Neuroscience

The dissertation describes a novel method for plant drug discovery based on mutation and selection of plant cells. Despite the industry focus on chemical synthesis, plants remain a source of potent and complex bioactive metabolites. Many of these have evolved as defensive compounds targeted on key proteins in the CNS of herbivorous insects, for example the insect dopamine transporter (DAT). Because of homology with the human DAT protein some of these metabolites have high abuse potential, but others may be valuable in treating drug dependence. This dissertation redirects the evolution of a native Lobelia species toward metabolites with greater activity …