Medicine and Health Sciences Commons^™

Long-Term Changes In Bolus Parameters During Swallowing Post-Chemoradiation Treatment., Brittany Rebecca Smiley

Electronic Theses and Dissertations

Current treatment for oropharyngeal cancer involves chemoradiation, which can have profound effects on swallowing function. Submental muscle activity is critical for airway protection and bolus transit but is highly susceptible to radiation-related swallowing impairments. This study examined whether chemoradiation targeting the submental muscles leads to measurable changes in esophageal distension during swallowing in a rodent model. We hypothesized that rats receiving chemoradiation would exhibit aberrant esophageal distension compared to chemotherapy-only controls. Twenty male rats underwent four cycles of cisplatin concurrently with either radiation or sham radiation. High-speed videofluoroscopy swallow studies were conducted pre- and post-treatment with thin liquids to analyze …

Analyzing The Association Of Competitive Food Policy On Competitive Food Content In U.S. Schools., Mary E. Curnutte

Electronic Theses and Dissertations

OBJECTIVES: School food can have a profound effect on the population’s health. Thirty million children receive food at school and consume half their daily calorie intake at school. Competitive foods are foods sold outside of school breakfast and lunch, such as those sold in vending machines. A new ruling for Smart Snacks Standards, a set of competitive food guidelines, started in the school year 2014-2015. It is known that competitive foods undermine school lunch participation, and a decrease in school lunch consumption is associated with poorer student health. Additionally, an increase in competitive foods tends to be of nutrient-poor …

Investigating Mental Health Outcomes Of National Collegiate Athletic Association (Ncaa) Division I Student-Athletes At The University Of Louisville, 2019-2023., Paul Harvey

Electronic Theses and Dissertations

Mental health outcomes among collegiate student-athletes, has become a broader concern in the 21^st century. This study examines prevalence and incidence of anxiety and depression amongst student-athletes at the University of Louisville from 2019-2023 across different Sports Groups. The prevalence of anxiety was found to be 20.22% and risk of anxiety was 15.65%. The prevalence of depression was found to be 13.11% and risk of depression was 18.75%. Logistic regression was used to estimate the association between sports groups and anxiety/depression. There was a borderline association between sports groups and prevalence of anxiety after confounder adjustment (OR=1.86, 95% CI: …

Cns-Specific Hiv Reservoir Characterization In Humans: Advancing Our Understanding Through Novel Genomics Methods., Ghazal Sadri

Electronic Theses and Dissertations

The persistence of the human immunodeficiency virus (HIV) reservoir despite years of suppressive antiretroviral therapy (ART) represents the principal obstacle to achieving a functional cure. Because the intact, replication-competent portion of the reservoir drives viral rebound after treatment interruption, HIV cure strategies must specifically identify and target cells harboring these proviruses. Conventional reservoir‐characterization techniques typically require separate assays to capture integration sites, assess proviral integrity, and quantify clonal proliferation and they rely on short‐read sequencing. These limitations hinder our ability to understand how integration landscapes, the integrity of the HIV genome, and cell‐division dynamics intersect to maintain viral persistence in …

Healthcare Utilization Patterns, Associated Factors, And Readmission Rates Among Children With Sickle Cell Disease., Daniya Mohammed Sabrah

Electronic Theses and Dissertations

Sickle Cell Disease (SCD) is common in Saudi Arabia, with a prevalence rate of 2.3%. It is an expensive disease to manage due to the extensive utilization of healthcare resources, including hospital readmissions, extended hospital stays, and frequent emergency department visits, which cost approximately $395 million annually in U.S. dollars. The primary objective of this study was to conduct a systematic literature review of healthcare utilization and cost of patients with SCD, following the PICO framework and PRISMA guidelines. The second aim utilized count models, including the negative binomial and Poisson, to identify factors associated with emergency, inpatient, and outpatient …

Differences In Prostate Cancer (Pca) Stage At Primary Diagnosis And Pca-Specific Mortality Among Rural Versus Urban Populations In Kentucky., Chase Herrmann

Electronic Theses and Dissertations

Kentucky Cancer Registry (KCR) prostate cancer (PCa) cases between the years of 1994 and 2021 were analyzed to examine differences between rural and urban populations’ primary stage at diagnosis and PCa-specific mortality. After adjusting for covariates, rural populations did not experience significantly higher odds of stage 3 diagnosis when compared to urban populations (OR = 1.02, 95% CI = 0.95 – 1.06). Rural populations had 16% increased odds of stage 4 diagnosis when compared to urban populations (OR = 1.16, 95% CI = 1.10 – 1.23). Rural populations had a 17% increased rate of PCa-specific death when compared to urban …

Implementation Of Houdini Guidelines Nurse-Driven Protocol To Lower Catheter-Associated Urinary Tract Infections And Foley Utilization Days, Tammie N. Collins

Electronic Theses and Dissertations

Catheter-associated urinary tract infections are a common issue in healthcare settings. These issues contribute to hospital-acquired infections and can lead to complications and increased healthcare costs. The quality project evaluated the impact of the HOUDINI guidelines nursedriven protocol to reduce infection rates and Foley utilization days. A structured guideline for Foley catheter safe removal was implemented using a quantitative method. Catheter-associated urinary tract infection rates and Foley utilization days pre- and postintervention were tracked. Data were collected using the electronic health records, infection control data sheets, and the HOUDINI checklists. A baseline assessment of catheter-associated urinary tract infections rates was …

The Lived Experience Of New Graduate Nurses Implementing Evidence-Based Practice In A Clinical Setting, Kimberly A. Mcfarland

Electronic Theses and Dissertations

The purpose of this qualitative interpretive phenomenological analysis study was to explore the perceptions and lived experiences of new graduate nurses (NGNs) as they implemented evidence-based practice (EBP) in clinical settings. This study addressed the problem that NGNs often lack the skills and confidence to effectively apply EBP, despite its critical role in improving patient outcomes. The research aimed to provide insight into the challenges, support systems, and strategies that influence EBP integration during the transition from student to practicing nurse. The study utilized the interpretive phenomenological analysis methodology to analyze data collected through semistructured interviews conducted via the Teams …

Investigating The Role Of The Hypocretin/Orexin System In A Novel Model Of Polysubstance Dependence, Tyler Zarin

Electronic Theses and Dissertations

Substance use disorders (SUD) in the United States are steadily increasing. Potent and dangerous substances such as methamphetamine (MA) and fentanyl (FEN) are often co-used as a polysubstance (POLY), either intentionally or unknowingly as FEN is a common adulterant. SUD is characterized by physiological and psychological dependence involving the negative reinforcement of anhedonia and withdrawal which drive hypermotivated drug-taking behaviors. Current theory suggests that recruitment of hypocretin/orexin (HCRT) neuropeptide in reward and stress associated brain regions contributes to drug dependence. Despite strong evidence for HCRT’s role in mono-drug dependence, a relevant model for POLY dependence has yet to be developed, …

Medical Professionals' Perceptions Of Healthcare Artificial Intelligence, Falon M. Costigan

Electronic Theses and Dissertations

This study examined whether medical professionals across different levels of expertise show differences in their perceptions of healthcare artificial intelligence (AI). Specifically, the researcher hypothesized that participants with more expertise and experience would have greater negative perceptions associated with AI in healthcare compared to participants with a lower expertise level. Participants completed a questionnaire evaluating their perceptions of healthcare AI across four components: long-term negative consequences of AI, need for AI safeguards, positive perceptions of AI, and AI control. Participants also completed demographic questions evaluating participants' age, sex, ethnicity, years working in a healthcare setting, medical …

Impact Of A Transplant Nurse Navigator In The Dialysis Setting, Judith D. Pozzerle

Electronic Theses and Dissertations

Patients with kidney disease have better patient outcomes and quality of life with a kidney transplant. However, the transplant process is complicated with inherent inequalities and biases and patients frequently fail to initiate a referral for transplant evaluation. The Centers for Medicare and Medicaid have now placed financial incentives to improve the number of patients transplanted. The only way to increase the number of patients transplanted is to start with a referral for evaluation. Studies have been done highlighting the barriers, but there is a lack of studies implementing strategies to improve these numbers. Utilizing Kotter’s change theory and describing …

Preeclampsia: Implementation Of The American College Of Obstetricians And Gynecologists Standardized Protocol, Sheila Harwell

Electronic Theses and Dissertations

Preeclampsia is a significant medical condition that affects the perinatal population, posing risks to both the mother and fetus. Complications associated with preeclampsia include stroke, seizure, placental abruption (premature separation of the placenta from the uterus), fetal growth restriction (impaired growth due to reduced blood flow through the placenta), premature birth, and low-birth-weight infants with associated developmental issues. Because there is no cure for preeclampsia, the current management involves the timely administration of intravenous antihypertensives to reduce the risk of stroke and seizure. The gap in practice identified was the obstetrical department’s lacking a standardized protocol, compared to adopting the …

Value-Based Healthcare Reimagined: A Mixed-Methods Study On Behavioral Health Clinicians' Perspectives, Amanda L. Strickland

Electronic Theses and Dissertations

This study explores how behavioral health clinicians perceive Value-Based Healthcare (VBHC), a model designed by Porter and Teisberg (2006) to improve outcomes relative to costs. While widely promoted in healthcare reform, VBHC poses unique challenges when applied to behavioral health settings. Using an explanatory mixed-methods design, this study first assessed clinicians’ awareness of VBHC through a survey of 23 licensed clinicians at a Community Mental Health Center (CMHC) in Colorado. Quantitative findings revealed that one-third of participants were aware of VBHC with awareness differing by role prompting further exploration in a qualitative phase. Semi-structured interviews with eight clinicians provided deeper …

Synthetic Protein Mimetic Based Therapies For Neurodegeneration, Nicholas H. Stillman

Electronic Theses and Dissertations

Protein-protein interactions (PPIs) are crucial for the regulation of a majority of, if not every fundamental cellular process. Despite their role in regular biological processes, dysregulated and/or aberrant protein-protein interactions (aPPIs) are often related to the onset of disease including cancer, viral infection, and amyloid diseases. aPPIs have historically been deemed ‘undruggable’ due to their large surface area and lack of a binding cavity; however, today, more than 40 disease-related aPPIs have been targeted with small molecules and several of those have reached clinical trials.

A class of synthetic protein mimetics called oligopyridylamides (OPs) has been shown to inhibit disease-related …

Management If Aggressive And Disruptive Behavior In The Emergency Department Using De-Escalation Techniques And Simulation: A Quality Improvement Project To Improve The Knowledge And Confidence Of Emergency Department Nurses And Clinical Staff, Ernestine Darby-Littlejohn

Electronic Theses and Dissertations

Abstract

Approximately 40% of all healthcare workers have reported episodes of violence by patients over the last 2 years. This Veteran’s Health Agency reported 824 disruptive events reported in the last 5 years, of which 56 occurred in the emergency department. Research shows that interventions are not always timely, resulting in the clinical staff requesting the Veteran’s Health Agency Police to intervene when a veteran’s level of stress is escalating. The gap in practice is shown to be related to a lack of knowledge in the clinical staff in managing high stress levels exhibited by some veterans, limited knowledge of …

Improving Outcomes Of Depression Through Implementation Of Depression Screenings At A College Health Center, Shelby Hanigan

Electronic Theses and Dissertations

Depression is a common phenomenon. Depression and suicidality are a problem on university campuses. This quality improvement Doctor of Nursing project aimed to establish the importance of routine depression screenings within a college health clinic. The purpose of this project was to determine if implementing routine depression screenings at a university health clinic will or will not increase the number of counseling referrals when compared to the absence of depression screenings in place within an identified timeframe. This protocol screened for depression in college-aged students and suggested care to those students who screened positive. It also led an interprofessional team …

Impacts Of Early/Mid-Gestation Shearing On Umbilical Blood Flow And Lamb Birth Weight, Mara Johnson

Electronic Theses and Dissertations

Studies outside the USA have reported that shearing pregnant ewes during mid to late gestation increases lamb birth weight. Our hypothesis was that shearing pregnant ewes on day 50 of gestation would increase umbilical blood flow (UBF), fetal size, lambing and placental weights. Twenty-eight Polypay ewes were randomly assigned to two treatments: shorn (S) and sham-shorn (Control, CON) and divided in singleton (S: n=4; CON: n=4), twins (S: n=5; CON: n=5) and triplets (S: n=5; CON: n=5). Umbilical BF and fetal and placental measurements were obtained via ultrasonography every 10 days from day 50 to 110 of gestation. Lamb birth …

Transcriptional Regulation Of Mouse Line-1 Subfamilies, Karabi Saha

Electronic Theses and Dissertations

No abstract provided.

Formulation And Immunogenicity Of L1 Orf1 Mrna Vaccine In Mice, Raj Nandani

Electronic Theses and Dissertations

This dissertation presents the design, formulation, and immunogenicity evaluation of a novel mRNA vaccine targeting the L1 ORF1p protein, a tumor-associated antigen. The vaccine was synthesized using in vitro transcription and encapsulated in lipid nanoparticles (LNPs), with both unmodified uridine and N1-methylpseudouridine variants tested. Physicochemical characterization confirmed optimal particle size (160–220 nm), acceptable zeta potential, and encapsulation efficiency ranging from 74% to 92%, with preserved RNA integrity post-formulation. These results validate the robustness of the formulation workflow and its suitability for antigen delivery. Immunogenicity studies in C57BL/6 mice revealed modest but promising immune responses. While early activation markers (CD69) and …

“But The Trauma Did Not Fade Away” Childhood Sexual Abuse, Adolescent Pregnancy, And Rurality, Cynthia H. Mcniss

Electronic Theses and Dissertations

Childhood sexual abuse (CSA) and adolescent pregnancy are critical public health issues that intersect in complex ways, particularly in rural areas. Adolescents who have experienced CSA are at a significantly higher risk of becoming pregnant before the age of 19 compared to their peers without such a history (Madigan et al., 2014). Rurality is also associated with elevated rates of adolescent pregnancy due to various socio-economic and healthcare access challenges ("Rural Health Information Hub," 2024). This study employed a grounded theory approach to develop a comprehensive understanding of the social and psychosocial processes influencing the choices, actions, and decisions of …

Understanding Widowhood Cultural Practices, Values, And Beliefs, Of Nigerian American Women: An Ethnonursing Study, Prisca Anuforo

Electronic Theses and Dissertations

Introduction: Many widowhood cultural practices are detrimental to the health and well-being of widows in Nigeria. Little is known about the experiences of widowhood for Nigerian American women, their cultural practices, and how it affects their health.

Purpose: Understand widowhood cultural practices among Nigerian Americans and how these experiences may affect health and wellbeing.

Methods: The qualitative ethnonursing method was used to collect data from 25 Nigerian American widows. Data were analyzed using NVivo qualitative data manager software guided by Leininger’s four phases of qualitative analysis.

Results: Widowhood cultural practices are modified and undertaken to preserve health and honor the …

Challenges To Reproductive Justice: An Ethical Analysis Of Reproductive Technologies And Disparities, Courtney Brenner

Electronic Theses and Dissertations

This dissertation analyzes the Reproductive Justice Framework to describe possible solutions to the ethical challenges related to reproductive healthcare disparities. Various frameworks to support reproductive equity fail to address the challenges marginalized individuals face in accessing reproductive health services. The four ethical principles of autonomy, beneficence, nonmaleficence, and justice serve as foundational tools to support reducing these disparities. This dissertation uses the Reproductive Justice Framework to analyze the unequal distribution of harms among marginalized women. It highlights how access to care, such as Assisted Reproductive Technologies (ART), is disproportionately inaccessible to marginalized women. Then, it discusses the relationship between marginalized …

How Scientists Can Investigate Perception: Phenomenological Foundations For Qualitative Research, Kimberly Tucker

Electronic Theses and Dissertations

While medicine makes visible symptoms of disease, phenomenology provides a different tool for making illness experience visible. Phenomenology offers a tool for a new kind of description and a different kind of knowledge of disease. It holds a unique epistemic power through the descriptions it generates through the application of the transcendental phenomenological method. Husserl’s method, outlined in Ideas I, provides the steps for its implementation in clinical research. This dissertation explores the application of the transcendental phenomenological method as a foundation for research on perception, with the goal of characterizing phenomenological validity as a proper goal of medical epistemology. …

Advancing Continuous Manufacturing: The Role Of Process Analytical Technology In Process Development, Samuel R. Henson

Electronic Theses and Dissertations

The pharmaceutical industry is actively pursuing technologies which improve manufacturing processes with the goal of producing high-quality pharmaceutical products for patients, manifesting in an industry-wide investment in continuous manufacturing (CM). Process analytical technology (PAT) has been recognized for its successful monitoring of critical quality attributes during routine production and is often cited alongside CM due to its ability to make timely, in-line measurements of intermediate materials. Various PAT tools are valuable in process development, particularly as continuous wet granulation processes are developed for use within pharmaceutical manufacturing. This work applied PAT and chemometric modeling during CM process development to enhance …

Method Development Of [3 + 2] Cycloadditions Using Tertiary Amine N-Oxides And Efforts Towards The First Total Synthesis Of Chrysosporazine D, Alexander Cocolas

Electronic Theses and Dissertations

Nitrogen-containing heterocycles are ubiquitous in bioactive molecules, pharmaceutical drugs, and natural products. For this reason, finding new and efficient ways to make such compounds remains a high priority for the organic and medicinal community. Our current endeavors build upon previously established work by our group, where we generated 1,2-diamines by coupling commercially available aldehydes with trimethylamine N-oxide (TMAO) in two steps. This route proved to be effective in generating 20+ novel 1,2-diamines and imidazolidines with a demonstrated ability to undergo transformations. Using this chemistry, we have developed a diastereoselective synthesis of 50+ novel 7-azanorbornanes using tertiary amine N-oxides …

Ethical Considerations In The Diagnosis And Treatment Of Autism Spectrum Disorder, Ferdinand Okafor

Electronic Theses and Dissertations

This dissertation is an ethical response to the ethical issues in the assessment, diagnosis, and treatment of autism. The problems that underlie the discussion are misconception about autism and Autistics. The misconception about autism and Autistics lead to misinterpretation of the neurological functioning, cognition, and the behaviors of Autistics. Consequently, it influences the approach and model of care in the assessment, diagnosis, and treatment of autism. Currently, the analytic approach and biomedical model of disease are applied in the assessment, diagnosis, and treatment of autism. The motive of the analytic approach and biomedical care is to cure autism. The consequence …

Efficient Development Of Density-Insensitive Near-Infrared Methods For In-Line Drug Content Monitoring In Continuous Powder Streams, Natasha L. Velez-Silva

Electronic Theses and Dissertations

A well-defined action plan to respond effectively to sudden changes in product demand is critical for preventing drug shortages within the pharmaceutical industry. An effective way to increase the output of a continuous manufacturing (CM) process is through flow rate adjustments. However, robust analytical methods must be in place to ensure consistent analytical performance across varying flow rates. Existing approaches for mitigating the physical effects of flow rate on Near-Infrared (NIR) measurements are often burdensome. Thus, efficient robust modeling strategies that reduce the current calibration burden and ensure model insensitivity to the physical variations in CM systems are needed. In …

Muslim Spirituality As A Foundation In Bioethics For Patient Encounters In Health Care, Sara Rahman

Electronic Theses and Dissertations

Spirituality plays a major role in decision making for individuals with faith-based values. There is often hesitation to discuss the role of faith in healthcare as a core value and coping mechanism. The growing cultural diversity amongst patients and physicians has increased the need to understand eastern religious principles and incorporate them into bioethical guidance. Even as the 2nd largest religion in the world, Islam has not been sufficiently integrated into religious bioethics in western medicine. Muslim populations of patients and physicians are growing, increasing the need for better understanding of how Islamic principles impact healthcare delivery. Although Islamic law …

Design, Synthesis, And Characterization Of Multi-Targeting Pyrrolopyrimidine Antifolates As Potential Single Agent Chemotherapeutic Entities, Tejashree Magdum

Electronic Theses and Dissertations

In cancer chemotherapy, the currently marketed antifolates have two major disadvantages: dose-limiting toxicities to normal tissues and susceptibility to drug resistance. These are due to their major transport by the ubiquitously expressed transporter and mutagenesis in enzymes present in cancer cells. This thesis describes an introduction, background, and research progress in antimetabolites-antifolates designed to multi-target (a) one-carbon metabolism and de novo nucleotide synthesis pathway and (b) target overexpressed transporter in cancer cells for selective tumor-targeting.

Cancer cells transport folate through three transporters: ubiquitously expressed reduced folate carrier (RFC), limitedly expressed proton-coupled folate transporter (PCFT), and folate receptors (FRs). The research …

The Ethical Contributions Of Nudges To Healthcare, Ian Doherty

Electronic Theses and Dissertations

“The Ethical Contributions of Nudges to Healthcare” examines the ethical use, implications, and rationale for using nudges in healthcare. The use of nudges in healthcare are being empirically examined. This leaves much to be examined from the ethical perspective. To examine the ethical perspective, the dissertation lays out how nudges interact with and enhance the biomedical principles of autonomy and beneficence. The dissertation then turns to clinical ethics. Nudges, more specifically the framing effect, are paired with trust in the patient-physician relationship to discern how best to aid a patient in his or her medical decision-making. The dissertation then investigates …