Medicine and Health Sciences Commons^™

Changes In Bacterial Growth Rate Govern Expression Of The Borrelia Burgdorferi Ospc And Erp Infection-Associated Surface Proteins, Brandon L. Jutras, Alicia M. Chenail, Brian Stevenson

Microbiology, Immunology, and Molecular Genetics Faculty Publications

The Lyme disease spirochete controls production of its OspC and Erp outer surface proteins, repressing protein synthesis during colonization of vector ticks but increasing expression when those ticks feed on vertebrate hosts. Early studies found that the synthesis of OspC and Erps can be stimulated in culture by shifting the temperature from 23°C to 34°C, leading to a hypothesis that Borrelia burgdorferi senses environmental temperature to determine its location in the tick-mammal infectious cycle. However, borreliae cultured at 34°C divide several times faster than do those cultured at 23°C. We developed methods that disassociate bacterial growth rate and temperature, allowing …

Clobazam Therapeutic Drug Monitoring: A Comprehensive Review Of The Literature With Proposals To Improve Future Studies, Jose De Leon, Edoardo Spina, Francisco J. Diaz

Psychiatry Faculty Publications

Background: Clobazam was recently approved for Lennox–Gastaut syndrome in the United States. There is no published review article focused on clobazam therapeutic drug monitoring (TDM) in English.

Methods: More than 200 clobazam articles identified by a PubMed search were carefully reviewed for information on clobazam pharmacokinetics. Clobazam is mainly metabolized by a cytochrome P450 (CYP) isoenzyme, CYP3A4, to its active metabolite, N-desmethylclobazam. Then, N-desmethylclobazam is mainly metabolized by CYP2C19 unless the individual has no CYP2C19 activity [poor metabolizer (PM)].

Results: Using a mechanistic approach to reinterpret the published findings of steady-state TDM and single-dosing pharmacokinetic studies, 4 different serum clobazam …

Two Semis Collide - Fire Ensues; Both Drivers Perish, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

One summer’s night, a 49 year-old semi-truck driver (D1), pulling a flatbed loaded with salvage cars for recycling traveled north on a three-lane state highway. D1 topped a hill, drove through a right curve when the unit rolled onto the driver’s side, slide across the center line and entered a straight stretch approximately half way to the bottom of a hill. As D1’s unit was sliding down the hill in the south bound lanes, a 52 year-old semi-truck driver (D2) hauling bottled beverages was traveling south in the straight stretch up the hill. As D1 slide down the hill, D2 …

Imatinib Reverses Doxorubicin Resistance By Affecting Activation Of Stat3-Dependent Nf-Κb And Hsp27/P38/Akt Pathways And By Inhibiting Abcb1, Jonathan T. Sims, Sourik S. Ganguly, Holly Bennett, J. Woodrow Friend, Jessica Tepe, Rina Plattner

Pharmacology and Nutritional Sciences Faculty Publications

Despite advances in cancer detection and prevention, a diagnosis of metastatic disease remains a death sentence due to the fact that many cancers are either resistant to chemotherapy (conventional or targeted) or develop resistance during treatment, and residual chemoresistant cells are highly metastatic. Metastatic cancer cells resist the effects of chemotherapeutic agents by upregulating drug transporters, which efflux the drugs, and by activating proliferation and survival signaling pathways. Previously, we found that c-Abl and Arg non-receptor tyrosine kinases are activated in breast cancer, melanoma, and glioblastoma cells, and promote cancer progression. In this report, we demonstrate that the c-Abl/Arg inhibitor, …

Rv Dysfunction By Mri Is Associated With Elevated Transpulmonary Gradient And Poor Prognosis In Patients With Sickle Cell Associated Pulmonary Hypertension, Kim-Lien L. Nguyen, Shoaib Alam, Xin Tian, Steve W. Leung, Catherine Seamon, Caterina P. Minniti, James G. Taylor, Vandana Sachdev, Andrew E. Arai, Gregory J. Kato

Internal Medicine Presentations

Patients with sickle cell disease (SCD) and pulmonary hypertension (PH) have increased mortality. SCD-PH is often complicated by high cardiac output (CO) related to anemia. The transpulmonary gradient (TPG) reflects a pressure differential across the pulmonary vascular bed without the confounding effect of CO (PVR=TPG/CO). Based on the cardiac transplant literature, a TPG ≥ 12 mmHg indicates significant pulmonary arterial hypertension (PAH). With PH, there is often morphologic adaptation by the right ventricle (RV). In idiopathic PAH, RV dilation and decreased function have been correlated with poor prognosis. We hypothesize that patients with SCD and a TPG ≥ 12 mmHg …

Genetic Diversity In The Modern Horse Illustrated From Genome-Wide Snp Data, Jessica L. Petersen, James R. Mickelson, E. Gus Cothran, Lisa S. Andersson, Jeanette Axelsson, Ernie Bailey, Danika Bannasch, Matthew M. Binns, Alexandre S. Borges, Pieter Brama, Artur Da Câmara Machado, Ottmar Distl, Michela Felicetti, Laura Fox-Clipsham, Kathryn T. Graves, Gérard Guérin, Bianca Haase, Telhisa Hasegawa, Karin Hemmann, Emmeline W. Hill, Tosso Leeb, Gabriella Lindgren, Hannes Lohi, Maria Susana Lopes, Beatrice A. Mcgivney, Sofia Mikko, Nicholas Orr, M. Cecilia T. Penedo, Richard J. Piercy, Marja Raekallio, Stefan Rieder, Knut H. Røed, Maurizio Silvestrelli, June Swinburne, Teruaki Tozaki, Mark Vaudin, Claire M. Wade, Molly E. Mccue

Veterinary Science Faculty Publications

Horses were domesticated from the Eurasian steppes 5,000-6,000 years ago. Since then, the use of horses for transportation, warfare, and agriculture, as well as selection for desired traits and fitness, has resulted in diverse populations distributed across the world, many of which have become or are in the process of becoming formally organized into closed, breeding populations (breeds). This report describes the use of a genome-wide set of autosomal SNPs and 814 horses from 36 breeds to provide the first detailed description of equine breed diversity. F(ST) calculations, parsimony, and distance analysis demonstrated relationships among the breeds that largely reflect …

Nanotubes As Mitochondrial Uncouplers, Patrick G. Sullivan

Neuroscience Faculty Patents

A method of uncoupling mitochondria in a subject including administering nanotubes to the subject in a therapeutically effective amount, wherein the nanotubes are self-rectifying is provided. A method of decreasing reactive oxygen species and decreasing detrimental loading of Ca²⁺ into mitochondria is provided, including administering a pharmaceutically effective amount of nanotubes into the subject. A method of reducing weight, treating cancer, reducing the effects of traumatic brain injury, or reducing the effects of ageing, in a subject including administering a pharmaceutically effective amount of nanotubes into the subject is also provided.

Food Venue Choice, Consumer Food Environment, But Not Food Venue Availability Within Daily Travel Patterns Are Associated With Dietary Intake Among Adults, Lexington Kentucky 2011, Alison A. Gustafson, Jay W. Christian, Sarah Lewis, Kate Moore, Stephanie Jilcott

Dietetics and Human Nutrition Faculty Publications

OBJECTIVE: The retail food environment may be one important determinant of dietary intake. However, limited research focuses on individuals' food shopping behavior and activity within the retail food environment. This study's aims were to determine the association between six various dietary indicators and 1) food venue availability; 2) food venue choice and frequency; and 3) availability of healthy food within food venue.

METHODS: In Fall, 2011, a cross-sectional survey was conducted among adults (n=121) age 18 years and over in Lexington, Kentucky. Participants wore a global position system (GPS) data logger for 3-days (2 weekdays and 1 weekend day) to …

Nanotubes As Mitochondrial Uncouplers, Patrick G. Sullivan

Neuroscience Faculty Patents

A method of uncoupling mitochondria in a subject including administering nanotubes to the subject in a therapeutically effective amount, wherein the nanotubes are self-rectifying is provided. A method of decreasing reactive oxygen species and decreasing detrimental loading of Ca²⁺ into mitochondria is provided, including administering a pharmaceutically effective amount of nanotubes into the subject. A method of reducing weight, treating cancer, reducing the effects of traumatic brain injury, or reducing the effects of ageing, in a subject including administering a pharmaceutically effective amount of nanotubes into the subject is also provided.

Commentary: Models Of Dissemination And Implementation In Public Health, Glen Mays

Frontiers in Public Health Services and Systems Research

As public health researchers and public health practitioners, we need to become much more skilled in applying dissemination and implementation models within our research designs and within our delivery systems if we want the accumulating scientific knowledge to result in improvements in population health. Many of our standard public health tools can be affective in facilitating D&I – regulation, education, measurement and reporting, peer pressure, social media, and economic incentives – but context really matters. The basic message behind this article is clear: choose your D&I model carefully and strategically to maximize the likelihood of success.

Models In Dissemination And Implementation Research: Useful Tools In Public Health Services And Systems Research, Rachel G. Tabak, Elaine C. Khoong, David Chambers, Ross C. Brownson

Frontiers in Public Health Services and Systems Research

Dissemination and implementation (D&I) science seeks to understand how to systematically facilitate utilization of evidence. Theories and frameworks (hereafter called models) augment D&I research by enhancing efforts to spread evidence-based interventions (EBIs). D&I models are relevant for public health services and systems research, which also explores the uses of evidence. This report: 1) develops an inventory of models; 2) synthesizes this information; and 3) provides guidance on how to select a model. The research team used snowball sampling to collect models. This article uses three author-defined variables: construct flexibility, focus on dissemination and/or implementation activities, and socio-ecological framework level to …

A Patient-Centered Approach For Evaluating Public Health Roles Within Systems Of Care For Children With Special Healthcare Needs, Danielle M. Varda, Ayelet Talmi

Frontiers in Public Health Services and Systems Research

Despite the apparent success that local and state health departments have had integrating a public health approach to provide programs and services for families with children who have complex health needs, there continues to be mixed results in terms of satisfaction and degree of support from this system. Current evaluations collect performance data from system stakeholders, rarely including the patient perspective. Examining the system holistically using Social Network Analysis, to include both the stakeholder and patient perspectives of how well the system is functioning affords greater understanding of how a public health approach to systems of care leads to more …

Commentary: Changing The Channel: Public Health Communication In The 21st Century, Anna Goodman Hoover

Frontiers in Public Health Services and Systems Research

This commentary asserts the need for research examining the use and efficacy of social media as a tool for meeting public health stakeholders’ information needs. The author points to several potential research questions for the field, situates studies addressing these questions within the PHSSR Research Agenda, and introduces the work of Harris et al. that is included in this issue of Frontiers. The commentary closes with a call for horizontal stakeholder communication that supports evidence-based decision-making.

Social Media Adoption In Health Departments Nationwide: The State Of The States, Jenine K. Harris, Doneisha Snider, Nancy Mueller

Frontiers in Public Health Services and Systems Research

Web-based social media sites are increasingly being used by the public to find and share health information. Public health organizations, including state health departments (SHDs), have begun adopting social media to disseminate health information to consumers. The purpose of this study was to examine adoption patterns and characteristics associated with social media adoption in SHDs across the U.S. In early 2012, we used web searches to identify which SHDs had adopted Facebook or Twitter and the adoption date. Adoption of social media has grown steadily since 2008, with 28 SHDs using Facebook and 41 using Twitter as of February 2012. …

Commentary: Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Laura L. Hitchcock

Frontiers in Public Health Services and Systems Research

In Hospital Tax-Exempt Policy: A Comparison of Schedule H and State Community Benefit Reporting Systems, Rosenbaum et aldescribe the numerous variations between current state law in 24 states and federal requirements regarding nonprofit hospitals’ community benefit activities. The potential for nonprofit hospitals to help shape community health is great, and how states choose to address requirements regarding community benefit, and potentially reinforce the new federal requirements to incentivize hospital participation in addressing root causes of poor health, should be of significant interest to the public, policy makers and public and population health experts, given the large percentage of …

Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Sara Rosenbaum, Maureen Byrnes, Amber M. Rieke

Frontiers in Public Health Services and Systems Research

The Patient Protection and Affordable Care Act (ACA) revises federal tax exemption standards for nonprofit hospitals by clarifying and augmenting their community benefit obligations. The ACA amendments followed the 2009 launch of Schedule H – the form on which hospital community benefit, financial, and institutional activities are reported and which must be appended to each facility’s annual Form 990 nonprofit institution information return. Schedule H effectively creates a nationwide, standardized, facility-specific, transparent, and fully publicly accessible reporting system covering the nation’s more than 2,900 nonprofit hospitals. Schedule H delineates financial assistance and bad debt, and requires identification of community health …

Carrots, Sticks And False Carrots: How High Should Weight Control Wellness Incentives Be? Findings From A Population-Level Experiment, Harald Schmidt

Frontiers in Public Health Services and Systems Research

Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear.

While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty …

Learning By Doing For Public Health Improvement, Glen P. Mays

Frontiers in Public Health Services and Systems Research

All too often, the knowledge gained through learning-by-doing in public health fails to be fully harvested and disseminated because of missed opportunities to carefully study the experiences and innovations occurring in practice. The field of public health services and systems research (PHSSR) has emerged to capitalize on these opportunities before they are missed.

Activation Of Thromboxane A2 Receptor (Tp) Increases The Expression Of Monocyte Chemoattractant Protein -1 (Mcp-1)/Chemokine (C-C Motif) Ligand 2 (Ccl2) And Recruits Macrophages To Promote Invasion Of Lung Cancer Cells, Xiuling Li, Hsin-Hsiung Tai

Pharmaceutical Sciences Faculty Publications

Thromboxane synthase (TXAS) and thromboxane A₂ receptor (TP), two critical components for thromboxane A₂ (TXA₂) signaling, have been suggested to be involved in cancer invasion and metastasis. However, the mechanisms by which TXA₂ promotes these processes are still unclear. Here we show that TXA₂ mimetic, I-BOP, induced monocyte chemoattractant protein -1(MCP-1)/chemokine (C-C motif) ligand 2 (CCL2) expression at both mRNA and protein levels in human lung adenocarcinoma A549 cells stably over-expressing TP receptor α isoform (A549-TPα). The induction of MCP-1 was also found in other lung cancer cells H157 and H460 that express relatively …

Genome-Wide Analysis Reveals Selection For Important Traits In Domestic Horse Breeds, Jessica L. Petersen, James R. Mickelson, Aaron K. Rendahl, Stephanie J. Valberg, Lisa S. Andersson, Jeanette Axelsson, Ernie Bailey, Danika Bannasch, Matthew M. Binns, Alexandre S. Borges, Pieter Brama, Artur Da Câmara Machado, Stefano Capomaccio, Katia Cappelli, E. Gus Cothran, Ottmar Distl, Laura Fox-Clipsham, Kathryn T. Graves, Gérard Guérin, Bianca Haase, Telhisa Hasegawa, Karin Hemmann, Emmeline W. Hill, Tosso Leeb, Gabriella Lindgren, Hannes Lohi, Maria Susana Lopes, Beatrice A. Mcgivney, Sofia Mikko, Nicholas Orr, M. Cecilia T. Penedo, Richard J. Piercy, Marja Raekallio, Stefan Rieder, Knut H Røed, June Swinburne, Teruaki Tozaki, Mark Vaudin, Claire M. Wade, Molly E. Mccue

Veterinary Science Faculty Publications

Intense selective pressures applied over short evolutionary time have resulted in homogeneity within, but substantial variation among, horse breeds. Utilizing this population structure, 744 individuals from 33 breeds, and a 54,000 SNP genotyping array, breed-specific targets of selection were identified using an F(ST)-based statistic calculated in 500-kb windows across the genome. A 5.5-Mb region of ECA18, in which the myostatin (MSTN) gene was centered, contained the highest signature of selection in both the Paint and Quarter Horse. Gene sequencing and histological analysis of gluteal muscle biopsies showed a promoter variant and intronic SNP of MSTN were each significantly associated with …

Semi-Truck Driver Dies After Being Struck By Flatbed Driver In Crossover Collision, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

In the winter of 2011, a 46-year-old semi-truck driver (D1) hauling a flatbed trailer was traveling north in the right lane on a four lane interstate. Several minutes ahead of the semi was a pickup truck hauling an extension ladder that fell out onto the northbound travel lanes. A car behind the pickup swerved to avoid the falling ladder. Other cars swerved to avoid the ladder. The semi came upon the ladder and swerving cars. To avoid striking the cars and ladder, the semi driver swerved to the right, over-corrected to the left, drove across the northbound lanes, over a …

Design, Physicochemical Characterization, And Optimization Of Organic Solution Advanced Spray-Dried Inhalable Dipalmitoylphosphatidylcholine (Dppc) And Dipalmitoylphosphatidylethanolamine Poly(Ethylene Glycol) (Dppe-Peg) Microparticles And Nanoparticles For Targeted Respiratory Nanomedicine Delivery As Dry Powder Inhalation Aerosols, Samantha Ann Meenach, Frederick G. Vogt, Kimberly W. Anderson, J. Zach Hilt, Ronald C. Mcgarry, Heidi M. Mansour

Pharmaceutical Sciences Faculty Publications

Novel advanced spray-dried and co-spray-dried inhalable lung surfactant-mimic phospholipid and poly(ethylene glycol) (PEG)ylated lipopolymers as microparticulate/nanoparticulate dry powders of biodegradable biocompatible lipopolymers were rationally formulated via an organic solution advanced spray-drying process in closed mode using various phospholipid formulations and rationally chosen spray-drying pump rates. Ratios of dipalmitoylphosphatidylcholine (DPPC) and dipalmitoylphosphatidylethanolamine PEG (DPPE-PEG) with varying PEG lengths were mixed in a dilute methanol solution. Scanning electron microscopy images showed the smooth, spherical particle morphology of the inhalable particles. The size of the particles was statistically analyzed using the scanning electron micrographs and SigmaScan® software and were determined to be 600 …

Soluble Human Epidermal Growth Factor Receptor 2 (Sher2) As A Potential Risk Assessment, Screening, And Diagnostic Biomarker Of Lung Adenocarcinoma, Abby L. Cosentino-Boehm, Jacqueline M. Lafky, Tammy M. Greenwood, Kimberly D. Kimbler, Marites C. Buenafe, Yuxia Wang, Adam J. Branscum, Ping Yang, Nita J. Maihle, Andre T. Baron

Obstetrics and Gynecology Faculty Publications

Lung cancer is the leading cause of cancer-related death in the United States. Here, we evaluated the potential clinical utility of soluble human epidermal growth factor receptor 2 (sHER2) for the risk assessment, screening, and diagnosis of non-small cell lung cancer (NSCLC) using an unmatched case-control study design. Serum sHER2 concentrations were measured by immunoassay in 244 primary NSCLC cases and 218 healthy controls. Wilcoxon rank-sum tests, logistic regression models, and receiver operating characteristic plots were used to assess whether sHER2 is associated with lung cancer. Median serum sHER2 concentrations are higher in patients with adenocarcinoma than squamous cell carcinoma …

Public Health Expenditures, Public Health Delivery Systems, And Population Health, Glen P. Mays

Health Management and Policy Presentations

This seminar examines a series of approaches for estimating the health and economic effects attributable to public health expenditures in the U.S., along with a novel method for estimating economies of scale and scope in the delivery of public health services. The use of instrumental-variables techniques and network analytic methods are described in these research approaches.

Lifelong Bilingualism Maintains Neural Efficiency For Cognitive Control In Aging, Brian T. Gold, Chobok Kim, Nathan F. Johnson, Richard J. Kryscio, Charles D. Smith

Neuroscience Faculty Publications

Recent behavioral data have shown that lifelong bilingualism can maintain youthful cognitive control abilities in aging. Here, we provide the first direct evidence of a neural basis for the bilingual cognitive control boost in aging. Two experiments were conducted, using a perceptual task-switching paradigm, including a total of 110 participants. In Experiment 1, older adult bilinguals showed better perceptual switching performance than their monolingual peers. In Experiment 2, younger and older adult monolinguals and bilinguals completed the same perceptual task-switching experiment while functional magnetic resonance imaging (fMRI) was performed. Typical age-related performance reductions and fMRI activation increases were observed. However, …

Gleevec, An Abl Family Inhibitor, Produces A Profound Change In Cell Shape And Migration, Zaozao Chen, Elizabeth Lessey, Matthew E. Berginski, Li Cao, Jonathan Li, Xavier Trepat, Michelle Itano, Shawn M. Gomez, Maryna Kapustina, Cai Huang, Keith Burridge, George Truskey, Ken Jacobson

Markey Cancer Center Faculty Publications

The issue of how contractility and adhesion are related to cell shape and migration pattern remains largely unresolved. In this paper we report that Gleevec (Imatinib), an Abl family kinase inhibitor, produces a profound change in the shape and migration of rat bladder tumor cells (NBTII) plated on collagen-coated substrates. Cells treated with Gleevec adopt a highly spread D-shape and migrate more rapidly with greater persistence. Accompanying this more spread state is an increase in integrin-mediated adhesion coupled with increases in the size and number of discrete adhesions. In addition, both total internal reflection fluorescence microscopy (TIRFM) and interference reflection …

Low-Income Adults Food Management Practices And Nutrition Behaviors And The Association With Diet, Sarah Elizabeth Lewis

Theses and Dissertations--Nutrition and Food Systems

Food insecurity and diet quality are concerns in low-income populations, contributing to high rates of obesity. Food management skills may enable low-income populations to obtain a healthy food supply rather than relying on less expensive and less nutritious foods to fill their diets. The purpose of this study was to assess the relationship between food management practices and diet quality in SNAP-ED/EFNEP participants. This study examines the association between food management behaviors and dietary outcomes (Healthy Eating Index totals, total calories, carbohydrates, protein, fat, and fiber, and servings of fruits, vegetables, milk, and meats/beans) as measured by the Behavior Checklist …

Latexin’S Role In Regulating Hematopoietic Stem And Progenitor Cells, Yi Liu

Theses and Dissertations--Physiology

Previous studies in our lab identified a novel gene, latexin (Lxn), that regulates murine hematopoietic stem cells through balancing apoptosis, self-renewal and proliferation. In these dissertation studies, I performed a series of experiments to examine the function of Lxn using a Lxn conventional knockout mouse, and characterize Lxn’s role in the presence of hematopoietic stresses such as ionizing radiation, cytokines induced-mobilization, and hematopoietic malignancy.

The first series of experiments was designed to determine the role of Lxn in hematopoiesis under homeostatic conditions. I found that Lxn-/- mice exhibited hyperproliferative hematopoiesis, a repopulation advantage and elevated self-renewal capacity …

Preclinical Development Of Phytocannabinoid- And Endocannabinoid- Based Pharmacotherapies For The Treatment Of Ethanol-Induced Neurodegeneration, Daniel J. Liput

Theses and Dissertations--Pharmacy

Excessive ethanol consumption, characteristic of alcohol use disorders (AUDs), is associated with widespread neurodegeneration and cognitive and behavioral impairments that may contribute to the chronic and relapsing nature of alcoholism. Therefore, identifying novel targets that can afford neuroprotection will undoubtedly aid current treatment strategies for AUDs. The cannabinoids have been shown to provide neuroprotection in a variety of preclinical models of neurodegeneration; however minimal data is available regarding the use of cannabinoid-based pharmacotherapies for treating ethanol-induced neurodegeneration. Therefore, the current dissertation examined the overarching hypothesis: the cannabinoids are a therapeutic strategy to afford neuroprotection in the context of ethanol-induced neurodegeneration. …

Getting To The Other Side: An Exploration Of The Head And Neck Cancer Treatment Experience, Heather M. Wallace

Theses and Dissertations--Gerontology

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Late stage diagnosis, uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life, contributes to anxiety, stress, fear, and uncertainty throughout the cancer treatment experience. This qualitative study sought to explore the cancer treatment experience of adults with newly diagnosed HNSCC, including laryngeal, esophageal, and oral cancers. Study participants were recruited from the University of Kentucky Ear Nose and Throat Clinic in Lexington KY. Participants agreed to be interviewed after receipt of their cancer diagnosis …