Medicine and Health Sciences Commons^™

The Female And Male Adolescent Breast, Donald E. Greydanus, Stephanie Stockburger, Hatim A. Omar, Colleen B. Dodich

Pediatrics Faculty Publications

The breast is an important organ system for the adolescent female and occasionally for the adolescent male as well. This chapter reviews basic principles of breast concerns and disorders including congenital anomalies, asymmetric breast development, underdeveloped breasts, virginal hypertrophy, breast masses, mastaglia, galactorrhea, gynecomastia in males, and others. Clinicians should be attuned to issues and concerns for this important structure in adolescents.

Sexually Transmitted Diseases In Adolescence, Donald E. Greydanus, Jane Seyler, Hatim A. Omar, Colleen B. Dodich

Pediatrics Faculty Publications

High rates of unprotected sexual behavior in adolescents result in millions of sexually transmitted diseases (STDs) in the world. This paper reviews factors inducing high STD rates, specific STDs, and their management based on 2010 US Centers for Disease and Prevention (CDC) STD guidelines. Clinicians should screen all their sexually active adolescent patients for STDs and provide preventive education as well as treatment measures.

Pregnancy In Adolescence, Donald E. Greydanus, Marlene B. Huff, Hatim A. Omar, Colleen B. Dodich

Pediatrics Faculty Publications

Over 14 million adolescents in the world annually give birth and nearly 800.000 adolescents in the United States become pregnant each year. This paper considers concepts of teen pregnancy including risks to the mother as well as offspring, the adolescent father, issues related to abortion, and concepts of prevention of unwanted pregnancy in youth. Adolescent pregnancy is a global phenomenon affecting all societies and cultures.

Adolescent Female Menstrual Disorders, Donald E. Greydanus, Shawn Sorrel, Hatim A. Omar, Colleen B. Dodich

Pediatrics Faculty Publications

This paper reviews basic concepts of menstrual disorders in adolescents beginning with an overview of menstrual physiology followed by consideration of various abnormal menstrual patterns: amenorrhea (primary and secondary), dysfunctional uterine bleeding, dysmenorrhea (primary and secondary), and premenstrual syndrome.

Late Removal Of Titanium Hardware From The Elbow Is Problematic, Abdo Bachoura, Ruriko Yoshida, Christian Lattermann, Srinath Kamineni

Orthopaedic Surgery and Sports Medicine Faculty Publications

A retrospective review of 21 patients that underwent bone screw removal from the elbow was studied in relation to the type of metal, duration of implantation, and the location of the screws about the elbow. Screw failure during extraction was the dependent variable. Five of 21 patients experienced hardware failure during extraction. Fourteen patients had titanium alloy implants. In four cases, titanium screws broke during extraction. Compared to stainless steel, titanium screw failure during removal was not statistically significant (P = 0.61). Screw removal 12 months after surgery was more likely to result in broken, retained screws in general …

Novel Mechanism Leading To Mismatch Repair Deficiency And Mutator Phenotype, Janice Ortega Rodríguez

Theses and Dissertations--Toxicology and Cancer Biology

DNA mismatch repair (MMR) is a critical genome-maintenance system. It ensures genome stability by correcting mismatches generated during DNA replication, suppressing homologous recombination, and inducing apoptosis in response to severe DNA damage. As a result, defects in MMR lead to genome-wide mutations and susceptibility to both hereditary and sporadic cancer syndromes. The hallmark of cancer cells defective in MMR is their ability to display frequent instability in simple repetitive DNA sequences, a phenomenon called microsatellite instability (MSI). However, only ~70% of the MSI-positive tumors have identifiable MMR gene mutations, indicating that additional factor(s) are responsible for the MSI phenotype in …

Physiological And Toxicological Roles Of Abc Transporters In Cellular Efflux Of Substrates, Donna J. Coy

Theses and Dissertations--Toxicology and Cancer Biology

ATP-binding cassette (ABC) transporters are transmembrane proteins that transport a wide variety of substrates across intra and extra-cellular membranes. A few examples of endo and xenobiotic substrates are metabolic products, lipids, sterols, and drugs. An important function of ABC transporters involved in export is to prevent intracellular the buildup of toxic products. Several ABC transporters have also been associated with drug resistance upon treatment with chemotherapeutic agents. P-glycoprotein (P-GP) and the multidrug resistant (MRP) transporters of the ABC C family are examples of transporters that confer chemo-resistance.

We have studied two unique roles of ABC transporters in the liver and …

Relationships Between Telomeric Sequences And Structures, Dna Replication, And The Function Of The Werner Syndrome Protein, Deanna Edwards

Theses and Dissertations--Toxicology and Cancer Biology

All human chromosomes end with protective structures called telomeres, which consist of thousands of double-stranded TTAGGG repeats and end in a 3’ guanine-rich overhang. These structures shorten normally during each round of replication, and extremely short telomeres along with telomere dysfunction are thought to contribute to the development of aging and cancer. Although many proteins have roles in telomere maintenance, WRN, which is a 3’ to 5’ helicase that is deficient in the premature aging disorder Werner’s syndrome, has been proposed to play multiple roles at telomeres. In this study, I focus on the effect of telomeric sequences and/or structures …

Factors Influencing Acceptance Of A Worksite Wellness Program In A Major Urban Healthcare System - A Cross-Sectional Analysis, Deborah A. Ballard

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

Abstract

Adults spend a significant portion of their lives at their workplace. Thus the workplace provides an important venue for public health interventions aimed at prevention and wellness. Best practices for workplace wellness programs are continually being refined. Ironically, health care workers are often less healthy than other professionals and face significant barriers to participating in workplace wellness programs. This paper analyzes the experience of a large urban health care system as it instituted a workplace wellness program and offers recommendations to increase participation in healthcare workplace wellness program and create an overall healthier work environment for healthcare workers.

Factors …

Influence Of Medical Marijuana Programs On Controlled Substance Utilization, James A. Farley Ii

MPA/MPP/MPFM Capstone Projects

Currently there are no studies examining the impact of medical cannabis programs on controlled substance prescribing. The intent of this study is to conduct a preliminary investigation into whether cannabis substitution for prescription drugs results in lower rates of controlled substance use. The hypothesis is that controlled substance use (in this project, defined by controlled substance supply) will decline in states after the introduction of medical cannabis programs.

State and year–specific per capita retail distributions of the seven most commonly prescribed opioid drugs (fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone) were obtained from the Automation of Reports and Consolidated …

Influence Of Prescription Drug Monitoring Programs On Acetaminophen-Related Liver Toxicity, Aaron Barcelo

MPA/MPP/MPFM Capstone Projects

No executive summary.

An Analysis Of Laboratory Inspections At The University Of Kentucky, Rachel Eldridge

MPA/MPP/MPFM Capstone Projects

Recent news stories about laboratory accidents in which students were severely injured and killed have brought much-needed attention to lab safety. Creating a positive safety climate on college and university campuses is very important in reducing accidents. At the University of Kentucky, all laboratories are inspected once every year, and the results are recorded in a lab inspection database. These data include the department, building, lab classification, type of violation, room number, and the name of the PI (Principal Investigator). I want to analyze inspections to find out whether department and the lab classification are significant in looking at violations. …

Explaining Benefit Utilization Variability In Fmnp In Kentucky: An Application Of Pierre Bourdieu’S Theory, Stephanie M. Holcomb-Kreiner

Theses and Dissertations--Sociology

Research has demonstrated the crucial role fresh fruit and vegetable consumption plays in maintaining good health. However, most Americans do not consume adequate amounts, and low-income Americans consume the lowest quantities of fresh fruits and vegetables. The Farmers’ Market Nutrition Program (FMNP) and Senior Farmers’ Market Nutrition Program (SFMNP) attempts to rectify this situation by providing vouchers to low-income women, children, and elders that can be used only at farmers’ markets for the purchase of locally grown, fresh fruits and vegetables. Unfortunately, FMNP and SFMNP exhibit variable and often low benefit utilization. This variable and often low benefit utilization is …

Proteasome Regulation Of Caspase-8: Significance In Cancer, Michael Vincent Fiandalo

Theses and Dissertations--Molecular and Cellular Biochemistry

Anti-tumor therapeutic strategies based on combinations of chemotherapeutic agents with a death inducing ligand such as TNF-α Related Apoptosis Inducing Ligand (TRAIL), are directed towards selective and effective cancer cell apoptosis and enhanced therapeutic response. We previously demonstrated that proteasome inhibition sensitizes TRAIL resistant prostate cancer cells to TRAIL-mediated apoptosis via stabilization of the active p18 subunit of initiator caspase-8. The present study investigated the functional link between caspase-8 and the proteasome, by analyzing the impact of caspase-8 ubiquitination and proteasomal degradation on the outcomes of the extrinsic apoptosis pathway in cancer cells. Caspase-8 ubiquitination status was assessed by polyubiquitin …

The Cellular Nucleic Acid Binding Protein Regulates The Alzheimer’S Disease Β-Secretase Protein Bace1, Christopher J. Holler

Theses and Dissertations--Molecular and Cellular Biochemistry

Alzheimer’s disease (AD) is the most common neurodegenerative disease affecting the elderly population and is believed to be caused by the overproduction and accumulation of the toxic amyloid beta (Aβ) peptide in the brain. Aβ is produced by two separate enzymatic cleavage events of the larger membrane bound amyloid precursor protein, APP. The first, and rate-limiting, cleavage event is made by beta-secretase, or BACE1, and is thus an attractive therapeutic target. Our lab, as well as many others, has shown that BACE1 protein and activity are increased in late-stage sporadic AD. We have extended these findings to show that BACE1 …

Attentional Bias And Alcohol Abuse, Jessica Jane Weafer

Theses and Dissertations--Psychology

Selective attention towards alcohol-related cues (i.e., “attentional bias”) is thought to reflect increased incentive motivational value of alcohol and alcohol cues acquired through a history of heavy alcohol use, and as such attentional bias is considered to be a clinically relevant factor contributing to alcohol use disorders. This dissertation consists of two studies that investigated specific mechanisms through which attentional bias might serve to promote alcohol abuse. Study 1 compared magnitude of attentional bias in heavy (n = 20) and light (n = 20) drinkers following placebo and two doses of alcohol (0.45 g/kg and 0.65 g/kg). Heavy drinkers displayed …

Effect Of Lower Body Positive Pressure On Cardiovascular Response At Various Degrees Of Head Up Tilt, Vladimir Ilyich Kostas

Theses and Dissertations--Kinesiology and Health Promotion

Various models of simulated weightlessness and resulting cardiovascular effects have been researched in the last 50 years of space exploration. Examples of such models are the Alter-G (Alt-G) treadmill used for body unweighting and head-up-tilt (HUT) model each providing similar cardiovascular effects, but differing in their stimulation of vestibular centers . Advantages of using the Alt-G include: use of lower body positive pressure (LBPP) to simulate hypogravity, it acts as a countermeasure to alleviate negative cardiovascular effects of standing and provides a constant vestibular stimulus. In addition, the Alt-G shorts themselves may be providing a certain degree of LBPP, acting …

Adult Bmi Change And Risk Of Colon Cancer In Postmenopausal Women, Lyla Blake-Gumbs, Zhengyi Chen, Cheryl L. Thompson, Nathan A. Berger, Thomas C. Tucker, Li Li

Markey Cancer Center Faculty Publications

Purpose. We recently reported an association of adult BMI change with colon cancer risk. Here, we sought to further explore this association with respect to postmenopausal HRT use in a larger study population. Methods. We included 1,457 postmenopausal women participating in an ongoing population-based case-control study of colon cancer. Results. We confirmed a previously reported association of adulthood weight gain and increased risk of colon cancer: compared to those with <5 kg/m² change of BMI, women who reported moderate (5–10 kg/m²) and large (>10 kg/m²) BMI changes since their 20s had OR estimates …

Tobacco Treatment In College Health, Joanne Brown

DNP Projects

ABSTRACT: Tobacco Treatment in College Health

The college years are a critical time in the development of smoking behavior and tobacco use. Smoking is linked to 30% of cancer deaths, 80% of deaths from chronic obstructive pulmonary disease and early cardiovascular disease and death. Effective treatment interventions at this time provide an opportunity to drastically reduce premature morbidity and mortality.

This document follows the progression from the discussion of the problem to evaluation of an intervention. The first manuscript is a review of existing literature on Internet interventions with young adults, including methodology, theoretical frameworks and outcome measures for tobacco …

Enantioselective Demethylation: The Key To The Nornicotine Enantiomeric Composition In Tobacco Leaf, Bin Cai

Theses and Dissertations--Plant and Soil Sciences

Nicotine and nornicotine are the two main alkaloids that accumulate in Nicotiana tabacum L. (tobacco), and nornicotine is the N-demethylation metabolite of nicotine. Nicotine is synthesized in the root, and probably primarily in the root tip. Both nicotine and nornicotine exist as two isomers that differ from each other by the orientation of H atom at the C-2' position on the pyrrolidine ring. (S)-nicotine is the dominant form in tobacco leaf and the enantiomer fraction of nicotine (EF_nic), the fraction of (R)-enantiomer over the total nicotine, is approximately 0.002. Despite considerable efforts to elucidate nicotine and nornicotine …

Region 11 Meld Na Exception Prospective Study, Robert A. Fisher, Douglas M. Heuman, Ann M. Harper, Martha K. Behnke, Alastair D. Smith, Mark W. Russo, Steven Zacks, John W. Mcgillicuddy, James Eason, Michael K. Porayko, Patrick Northup, Michael R. Marvin, Johnathan Hundley, Satheesh Nair

Surgery Faculty Publications

Introduction. Hyponatremia complicates cirrhosis and predicts short term mortality, including adverse outcomes before and after liver transplantation.

Material and methods. From April 1, 2008, through April 2, 2010, all adult candidates for primary liver transplantation with cirrhosis, listed in Region 11 with hyponatremia, were eligible for sodium (Na) exception.

Results. Patients with serum sodium (SNa) less than 130 mg/dL, measured two weeks apart and within 30 days of Model for End Stage Liver Disease (MELD) exception request, were given preapproved Na exception. MELD Na was calculated [MELD + 1.59 (135-SNa/30 days)]. MELD Na was capped at 22, and subject to …

Primary Closure Without Diversion In Management Of Operative Blunt Duodenal Trauma In Children, Katherine Smiley, Tiffany Wright, Sean Skinner, Joseph A. Iocono, John M. Draus

Surgery Faculty Publications

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003-2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages < 14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. …

Using The Scrambled Sentences Test To Examine Relationships Between Cognitive Bias, Thought Suppression And Borderline Personality Features, Paul Jefferson Geiger

Theses and Dissertations--Psychology

Cognitive bias and thought suppression are two maladaptive patterns of thinking that have been associated with borderline personality disorder (BPD). Negative cognitive biases related to BPD include thoughts that they are bad, powerless, or vulnerable and that the world is dangerous. Thought suppression is a maladaptive emotion regulation strategy where unwanted thoughts are intentionally pushed out of one’s consciousness. However, previous research has connected thought suppression and cognitive biases to BPD only via self-report measures. The present study examined whether a laboratory task meant to measure cognitive bias and thought suppression (Scrambled Sentences Test) would predict BPD features over and …

Effects Of Response Elaboration Training On Sentence Production Of Persons With Chronic Agrammatic Aphasia, Ryan S. Husak

Theses and Dissertations--Rehabilitation Sciences

Purpose: Response Elaboration Training (RET) is a treatment program for increasing the amount of information contained in the speech of individuals with aphasia. This study employed a sentence production task (SPT) to examine whether RET will (1) generalize to a task not worked on in treatment and (2) affect syntactic performance.

Methods and Procedures: Three adults with chronic non-fluent Broca’s aphasia received RET in this prospective, repeated case study. The dependent variable was a SPT requiring the participant to put a verb in a sentence. Changes in the syntactic performance of the participant’s sentence productions were classified across …

A Shared Gene Expression Signature In Mouse Models Of Ebv-Associated And Non-Ebv-Associated Burkitt Lymphoma, Kathryn T. Bieging, Kamonwan Fish, Subbarao Bondada, Richard Longnecker

Microbiology, Immunology, and Molecular Genetics Faculty Publications

The link between EBV infection and Burkitt lymphoma (BL) is strong, but the mechanism underlying that link has been elusive. We have developed a mouse model for EBV-associated BL in which LMP2A, an EBV latency protein, and MYC are expressed in B cells. Our model has demonstrated the ability of LMP2A to accelerate tumor onset, increase spleen size, and bypass p53 inactivation. Here we describe the results of total gene expression analysis of tumor and pretumor B cells from our transgenic mouse model. Although we see many phenotypic differences and changes in gene expression in pretumor B cells, the transcriptional …

Microglial P38Α Mapk Is Critical For Lps-Induced Neuron Degeneration, Through A Mechanism Involving Tnfα, Bin Xing, Adam D. Bachstetter, Linda J. Van Eldik

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: The p38α MAPK isoform is a well-established therapeutic target in peripheral inflammatory diseases, but the importance of this kinase in pathological microglial activation and detrimental inflammation in CNS disorders is less well understood. To test the role of the p38α MAPK isoform in microglia-dependent neuron damage, we used primary microglia from wild-type (WT) or p38α MAPK conditional knockout (KO) mice in co-culture with WT cortical neurons, and measured neuron damage after LPS insult.

RESULTS: We found that neurons in co-culture with p38α-deficient microglia were protected against LPS-induced synaptic loss, neurite degeneration, and neuronal death. The involvement of the proinflammatory …

Driving Qi With Research: Findings From Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

Project P.A.T.H.S. In Hong Kong: New Curriculum In Response To Adolescent Developmental Issues, Hing Keung Ma, Daniel T. L. Shek, Joav Merrick

Pediatrics Faculty Publications

No abstract.

Effect Of Duration And Amplitude Of Direct Current When Lidocaine Is Delivered By Iontophoresis, Susan A. Saliba, Courtney L. Teeter-Heyl, Patrick O. Mckeon, Christopher D. Ingeroll, Ethan N. Saliba

Physical Therapy Faculty Publications

Dosage for the galvanic stimulation for iontophoresis varies. Clinicians manipulate the duration or the amplitude of the current, but it is not known which is more effective. We compared the anesthetic effect of lidocaine HCL (2%) by manipulating the current parameters on 21 healthy volunteers (age: 21.2 ± 4.2, height 170.7 ± 10.2 cm, mass 82.1 ± 19.2 kg). Three conditions were administered in a random order using a Phoresor II^® with 2 mL, 2% lidocaine HCL in an iontophoresis electrode. (1) HASD (40 mA_*min): High amplitude (4 mA), short duration (10 min); (2) LALD (40 mA.min): …

Adipose Tissue Extracellular Matrix And Vascular Abnormalities In Obesity And Insulin Resistance, Michael Spencer, Resat Unal, Beibei Zhu, Neda Rasouli, Robert E. Mcgehee Jr., Charlotte A. Peterson, Philip A. Kern

Clinical and Translational Science Faculty Publications

Context: Insulin resistance is associated with inflammation, fibrosis, and hypoxia in adipose tissue.

Objective: This study was intended to better characterize the extracellular matrix (ECM) and vascularity of insulin-resistant adipose tissue. Design: Adipose expression of collagens, elastin, and angiogenic factors was assessed using realtime RT-PCR and immunohistochemistry (IHC) in abdominal sc adipose tissue. Adipocyte-macrophage coculture experiments examined the effects of polarized macrophages on adipose ECM gene expression, and the effects of collagens were measured in an angiogenesis assay.

Participants and Setting: A total of 74 nondiabetic subjects participated at a University Clinical Research Center. Interventions: Interventions included baseline adipose biopsy …