Medicine and Health Sciences Commons^™

Technological Change And The Practice Of Healthcare Communication: Implications For Patient-Centered Care, From A Communication Ethics Perspective, Emmalee Torisk

Electronic Theses and Dissertations

Written in a historical moment marked in many ways by the COVID-19 pandemic and the changes it has wrought, including the increased availability and use of telehealth services, this project attempts to consider the implications of the continued integration of technology into health care, centering on the following essential question: How do technological changes affect the contemporary practice of healthcare communication, particularly that which occurs between the patient—the consumer of health care—and their provider? This dissertation thus considers the ways in which such linkages of technology and health care seem to fit into a larger shift within health care …

Trends In Hysterectomy In Hospital And Ambulatory Settings In Kentucky 2017-2020., Felicia A. Pugh

Electronic Theses and Dissertations

Hysterectomy is the most common treatment for benign uterine conditions in the United States. Data suggest that one in nine women will have the procedure in their lifetime (1). Previous studies indicate that abdominal hysterectomy rates for non-malignancies are declining as alternative methods are increasing for decades; however, those trends do not apply for all women in the country (2-5). In this cross-sectional study, hysterectomy procedures completed between 2017-2020 are described in Kentucky Cabinet for Health and Family Services data. Multivariable logistic regression is used to assess the odds of abdominal hysterectomy for benign indications in Kentucky. Conclusion: Rates of …

Development Of 3d-Bioprinted Scaffolds For Oral Probiotic Application., Jhanvi Patel

Electronic Theses and Dissertations

Background: Porphyromonas gingivalis adheres to and invades gingival epithelial cells, resulting in decreased cell viability. Previous studies have indicated that probiotics are effective against dental pathogens; however, few approaches provide sustained-delivery of active agents in the oral cavity. Hypothesis: Probiotics will limit P. gingivalis effects on Telomerase Immortalized Gingival Keratinocyte (TIGK) cells and 3D-printed scaffolds will prolong probiotic release. Methods: Lactobacillus acidophilus, Lactobacillus reuteri, and Bifidobacterium bifidum were assessed with adhesion and antibiotic protection assays to limit P. gingivalis effects on TIGKs. Scaffolds were printed with a select probiotic and evaluated for release kinetics. Results: Free L.a., …

The Use Of Medical Marijuana For The Relief Of Chronic Pain, Jacquelyn M. Paylor

Electronic Theses and Dissertations

Abstract For thousands of years, medical cannabis has been used for relief of chronic pain and personal ailments. It changes users’ mental capacities and perceptions while treating and providing relief from pain and muscle spasms. As a recreational and spiritual substance, this Schedule I drug requires special consideration and certification to administer. Increasing complaints of chronic pain have led doctors to prescribe opioids for pain relief. As prescriptions for opioids have increased, the number of opioid-related mortality and morbidity incidents have also risen. The high rates of opioid-related near deaths and overdoses have led policy makers, clinicians, pharmacists, and providers …

Peaking For Maximal Strength: Muscular Adaptations And Performance Outcomes, Spencer K. Travis

Electronic Theses and Dissertations

The purposes of this dissertation were to 1) determine what tapering and peaking practices appear to be most effective via systematic review, 2) to identify the tapering and peaking practices used by North American powerlifters, 3) to experimentally compare muscular adaptations and performance changes following two different training cessation periods, and 4) to experimentally compare the two most common taper models following a training program aimed at peaking maximal strength. Based on the scientific literature, a step and exponential taper appeared to be the most effective tapering models used when volume-load is reduced by half over 2±1 week. Interestingly, North …

Decreased Kidney Mitochondrial Content And Pgc-1Α Following Repeated Low-Dose Cisplatin-Induced Kidney Injury., Andrew Joseph Orwick

Electronic Theses and Dissertations

Cisplatin is highly effective and one of the most commonly used chemotherapeutic agents in the treatment of a number of different solid organ tumors. Unfortunately, the dose-limiting nephrotoxicity occurs in up to 30% of patients, which requires alterations to treatment regimens that are often less effective. The kidney’s function is to provide fluid homeostasis, and this is an energy-intensive process. Proper renal function is dependent on functional mitochondria. PGC-1α regulates mitochondrial number, respiratory capacity, and mitochondrial proteins in proximal tubule cells. We delivered low-dose cisplatin to mice via intraperitoneal injections once a week for 4 weeks. The mice were then …

Oligodendrocyte Responses After Spinal Cord Injury., George Zach Wei

Electronic Theses and Dissertations

Recent studies demonstrate that neuroprotection strategies targeting the proteostasis network and components of its effector signaling pathways improve cell survival and motor recovery outcomes in several models of neuronal injury and degeneration. However, the individual contributions of these signaling pathways to the pathogenesis of spinal cord injury (SCI), white matter damage, and motor recovery have not yet been determined. Here, I explored the role of the HIF prolyl hydroxylase domain proteins (PHD/EGLN), effectors that can modulate stress responses activated by the proteostasis network, on motor function recovery after SCI. Furthermore, I identified previously unknown candidate mechanisms in an unbiased manner …

Development And Validation Of Biosafety Climate Scale And Survey-Based Analyses Of Safety Perceptions In Biological Research And Teaching Laboratories At Public Universities In The Usa., Sivarchana Mareedu

Electronic Theses and Dissertations

Biosafety plays a key role in ensuring safety of researchers’ as well as the public from unintentional exposures to infectious agents. However, the occurrence of lab acquired infections, exposures, and safety lapses in biological laboratories underscores challenges in biosafety program management. The raise in emerging and reemerging infectious diseases and the ongoing COVID-19 pandemic reiterates the need for biosafety and research community to work together. Literature recommends the application of safety climate in measuring safety culture. The goal of this dissertation is to quantify biosafety climate and examine associated factors to understand the gaps between research and biosafety professionals in …

Concurrent Reporting Of Adverse Childhood Experiences Among Perspectives Of Adolescents And Caregivers., Katie J. Berghuis

Electronic Theses and Dissertations

The consequences of Adverse Childhood Experience (ACE) events in youth have predominantly been studied through retrospective studies that assess adults’ first 18 years of life or caregiver report of ACEs in youth. Reliance on only caregiver report to discern ACEs is a limitation amongst prior studies as research has found that caregivers tend to underestimate ACEs among their children, and there is even a greater discrepancy of reporting between caregivers and youth 12 years and older. Therefore, this study investigated concurrent reporting of self-report ACE scores in adolescents – defined in this study as 12 to 20 years old – …

Metabolic-Epigenetic Regulation Of Macrophage Polarization., Jordan T. Noe

Electronic Theses and Dissertations

Tumor-associated macrophages polarized to an M2 phenotype (M2-TAMs) promote neo-angiogenesis, tumor-stromal matrix remodeling, and immuno-evasion, which, collectively, contribute to immunotherapeutic resistance and reduced cancer patient survival. Highly glycolytic “Warburg” cancer cells produce lactate that independently drives naïve M0→immunosuppressive M2 (M0→M2) macrophage polarization, but the mechanisms have not been fully elucidated. The atypical cytokine macrophage migration inhibitory factor (MIF) is a fundamental underlying requirement for immunosuppressive M2 macrophage polarization. Still, it is unknown whether a molecular link exists between lactate-supported and MIF-dependent M2 macrophage polarization. Using a combination of gene expression assays, chromatin immunoprecipitation, and metabolomic analyses, we identified that M2 …

“And The Next Day, You Are In Charge”: Policy Recommendations Stemming From A Qualitative Investigation Into The Professional Development Of Early Career Peer Support Specialists In Kentucky., Diane Zero

Electronic Theses and Dissertations

Over the last twenty years, the peer support segment of the behavioral health workforce has grown rapidly. However, few researchers have studied the effects on individuals from transitioning into the role. Likewise, there is limited research examining the professional development process of early career peer support specialists. To begin to fill these gaps in the literature, I conducted a qualitative research study examining workforce development experiences of peer support specialists in Kentucky. This dissertation reports on its findings and includes a policy paper with recommendations for improving policy and practice. Chapter one offers an introduction to the peer support workforce …

Histone Deacetylases In Alcohol Associated Liver Disease., Srineil Bodduluri

Electronic Theses and Dissertations

Alcohol abuse is endemic worldwide and there is no FDA approved treatment for Alcohol-Associated Liver Disease (ALD). Many scholars have posited that targeting Histone Deacetylases (HDAC) may be therapeutic in ALD intervention. In this study, the changes in hepatic gene expression and immune phenotyping of mice undergoing chronic plus binge alcohol exposure was examined. The characterization of relative mRNA levels for all 18 HDAC were performed. Results showed decreased expression of the genes HDAC 1,7,9,10,11 and Sirtuin enzymes (SIRT) 3,4,5,7. Other pathways related to lipid metabolism as well as systemic inflammation and hepatic injury also exhibited significant changes. These altered …

Multilateration Index., Chip Lynch

Electronic Theses and Dissertations

We present an alternative method for pre-processing and storing point data, particularly for Geospatial points, by storing multilateration distances to fixed points rather than coordinates such as Latitude and Longitude. We explore the use of this data to improve query performance for some distance related queries such as nearest neighbor and query-within-radius (i.e. “find all points in a set P within distance d of query point q”). Further, we discuss the problem of “Network Adequacy” common to medical and communications businesses, to analyze questions such as “are at least 90% of patients living within 50 miles of a covered emergency …

Development And Evaluation Of A Body Weight Support Treadmill For Use With Locomotor Training On Pediatric Spinal Cord Injury Patients., Winston T Rauch

Electronic Theses and Dissertations

The consequences of spinal cord injury (SCI) are devastating regardless of the age of a patient. When the injury occurs in children five years old or younger, however, the impact is magnified due to the inevitable development of scoliosis (96%) and hip dysplasia (57%) (Schottler et al., 2012). To reduce occurrence of these complications and improve the quality of life for these patients, specialized activity-based therapies such as locomotor training (LT) are being increasingly used to improve overall trunk control and muscle activity in the lower extremities (Harkema et al., 2012; Howland et al., 2014). The aim of this therapy …

Exploring Opportunities For Prevention Of Child Sexual Abuse In A Diverse American Muslim Community., Rishtya Meena Kakar

Electronic Theses and Dissertations

Recognizing the significant mental, emotional, developmental and health consequences for victims of child sexual abuse (CSA) and sociopolitical consequences for families and communities in every cultural, ethnic, and religious group around the world, this study sought to determine key opportunities for prevention of CSA in a diverse American Muslim community using a public health socioecological lens, rooted in aspects of critical theory. While there is considerable research on situational and individual-level risk factors related to CSA cases, there is less research on the societal and community-level processes related to the primary prevention of CSA, especially among minoritized communities. Responding to …

Tobacco Cessation Counseling Practices Amongst Dental Hygienists In Central Texas, Lacy Murray

Electronic Theses and Dissertations

Although tobacco cessation is an uphill battle for almost everyone who attempts to quit, it is important that dental hygienists do not assume that patients are not interested. Dental hygienists are in an ideal position to offer cessation help to their tobacco using patients. The purpose of this study was to gain a better understanding of the tobacco cessation practices among central Texas dental hygienists. Specifically, dental hygienists were asked about beliefs, motivation, and confidence with regard to their tobacco cessation practice. A positive significant, moderate, relationship was found between beliefs and confidence (r=0.647), beliefs and practices ( …

Adverse Childhood Experiences (Aces): Assessing Their Impact On Mental Health Outcomes Among Us Children And The Mitigating Role Of Resilience, Glory Okwori

Electronic Theses and Dissertations

ACEs are traumatic life events occurring during childhood that can have negative effects. Common mental disorders that are diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety and depression. The associations between ACEs and such problems in children have not been significantly examined. There are protective factors that can help reduce the effects of exposure to ACEs that have not been fully explored.

The purpose of this research study was to examine: 1) the prevalence of mental health outcomes in children; 2) the associations between ACEs, resilience and mental health outcomes; and 3) the role of resiliency as a …

Examining Predictors Of Attitudes And Knowledge Of Registered Nurses And Nursing Students In Tennessee Toward Pregnant And Perinatal Women With A Substance Use Disorder, Jessica Patrylo

Electronic Theses and Dissertations

Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more …

Missed Nursing Care: Accounting For Education, Experience, And Job Satisfaction In Registered Nurses, Jessica Bechard

Electronic Theses and Dissertations

Aim. The aim of this study was to examine missed nursing care in the context of academic preparedness, years of experience, and job satisfaction and determine predictors of missed nursing care.

Background. Patient care that is omitted or delayed is known as missed nursing care. Failure to provide the necessary care interventions on time can lead to decreased patient outcomes. Academic preparation, the number of years of nursing experience, and job satisfaction can also play a pivotal role in patient outcomes. Limited studies have assessed academic preparedness and years of nursing experience on missed nursing care while also …

Economic Insecurity, Poverty, And Parental Alcohol Misuse, Joey Tucciarone

Electronic Theses and Dissertations

Because parental alcohol misuse is associated with numerous negative outcomes for drinkers and other family members, it is important to examine factors predictive of alcohol misuse patterns among parents living with at least one child under the age of 18. Two possible factors include economic insecurity and poverty. This study sought to address whether measures of economic insecurity (i.e., housing and/or food insecurity in the past 12 months) and a dichotomous measure of poverty predict parental binge drinking and parental heavy alcohol consumption in a large population-based sample. It was hypothesized that economic insecurity and poverty, analyzed separately, would predict …

Bilateral Ground Reaction Force Jumping Asymmetry And Performance, Keith Painter

Electronic Theses and Dissertations

The prevalence of asymmetry in performance research has increased in recent years with mixed results. Much of the performance research has focused on unilateral jumping activities attempting to show relationships to other performance variables. However, bilateral ground reaction forces (bGRF) from jumps are more frequently assessed in athlete monitoring programs and the asymmetry from those jumps could be a simple addition to data already being collected. Research into bGRF asymmetries is lacking and no studies have addressed longitudinal changes. Additionally, research into the relationship of asymmetries to performance have infrequently used athletes. For these reasons, this dissertation will focus on …

Prevalence Of Musculoskeletal Disorders In Third- And Fourth-Year Dental Students At The University Of Tennessee Health Science Center College Of Dentistry, Felisa Jackson

Electronic Theses and Dissertations

The effects of pain suffered from musculoskeletal disorders by dental professionals may lead to reduced work hours, loss of production, and early retirement. Although third- and fourth-year dental students are provided lectures about musculoskeletal disorders, proper positioning and ergonomics, they are at an increased risk of developing MSD. This study was conducted to evaluate the prevalence on musculoskeletal disorders in third- and fourth-year dental students and to determine if third-year dental students experience more MSD pain than fourth-year dental students at the University of Tennessee Health Science Center College of Dentistry. A total of 50 third- and fourth- year dental …

Shared Decision-Making For Contraceptive Counseling Among Women Seeking Services At Safety Net Clinics In South Carolina And Alabama, Dumisa M. Nyarambi

Electronic Theses and Dissertations

Shared decision-making (SDM) for contraceptive counseling and method initiation is a hallmark of patient-centered care; SDM is associated with patient satisfaction, method continuation, and the prevention of pregnancy and short inter-pregnancy intervals. To achieve a high-quality experience for women Person-centered approach to counseling is the preferred approach to achieve SDM. Demographic factors and women’s perceptions of their providers have been linked to decision-making. Literature is lacking on SDM practices in safety net clinics, particularly in local health departments. Exploring these constructs is important to inform practices and policies for family planning. This research aimed to examine: 1) the influence of …

Neuroinflammation, Peripheral Inflammation And Gut Microbiome Profiles In Male Mice From Two Proposed Mouse Models Of Social Behavior Deficits, Sarah Parkinson

Electronic Theses and Dissertations

Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by social deficits and repetitive actions. A communication pathway exists between the brain and gut called the gut-brain axis. It is thought that gut bacteria can secrete signaling molecules, triggering inflammation across the body. These studies attempt to determine if markers are expressed in two mouse models of ASD behaviors, BTBR and a valproic acid model. Immunohistochemistry of ionized calcium binding adaptor molecule 1 from male mouse brain tissue showed no microglial activation in any group. Cytokine analysis did exhibit an increase in interleukin 1 (IL-1) in male adult mice only. …

Active Travel For Children And Youth: Lessons From Active Routes To Schools North Carolina, Leah Ferguson

Electronic Theses and Dissertations

This Integrated Learning Experience (ILE) investigates literature regarding the impact of national Safe Routes to School (SRTS) programs and takes a deeper dive into the lessons that can be learned from North Carolina’s Active Routes to School (NC ARTS) programs through an analysis of data collected from 2007 to 2019. This report is focused on understanding the relationship between and among variables included in the Six Es of SRTS framework: Education, Engineering, Encouragement, Enforcement, Equity, and Evaluation. This investigation provides insight that extends understanding of parental comfort and engagement with these programs. A unique theoretical model was developed as were …

Endothelial Heat Shock Protein A12b And Yes-Associated Protein Cooperatively Promote Angiogenesis Following Myocardial Infarction, Min Fan

Electronic Theses and Dissertations

Heart failure after myocardial infarction (MI) remains the leading cause of mortality among all cardiovascular diseases globally. Angiogenesis plays a critical role in cardiac functional recovery after MI. Heat shock protein A12B (HSPA12B) is predominately expressed in endothelial cells and required for angiogenesis. Yes-associated protein (YAP) has been reported to promote tumor angiogenesis.

In the present study, we investigated the cooperative role of HSPA12B and YAP in angiogenesis following myocardial ischemic injury. Endothelial specific deficiency of HSPA12B (eHspa12b^-/-) or YAP (eYap^-/-) impairs angiogenesis and exacerbates cardiac dysfunction after MI, when compared with wild type …

The Effect Of Training Status On Adaptations To 11 Weeks Of Block Periodization Resistance Training, Alexander Wetmore

Electronic Theses and Dissertations

The primary purpose of this dissertation was to investigate the effect of training status on adaptations to resistance training. A secondary purpose of this dissertation was to investigate the relationship between subjective and objective forms of monitoring resistance training (RT). The benefits of RT are well understood but training status may be a major influence on training outcomes. Fifteen males of various training status were recruited for this study. Subjects completed 11 weeks of block periodization (BP) training. Subjects were tested for absolute strength (ABS) and relative strength (REL) in the barbell back squat, 0kg and 20kg static jumps (SJ) …

Athlete Monitoring Program In Division I Collegiate Female Soccer, Ai Ishida

Electronic Theses and Dissertations

The objectives of this dissertation include 1) to review athlete monitoring strategies and the physical performance demands of female soccer match-play and to provide practical application of athlete monitoring programs, 2) to examine individual and group relationship between training load (TL) and subjective recovery and stress state and neuromuscular performance, and 3) to investigate acute effects of match-play on neuromuscular and subjective recovery and stress state in National Collegiate Association Athlete (NCAA) division I collegiate female soccer. TL was assessed using 10Hz Global Navigation Satellite System units. Subjective recovery and stress state was measured using the Short Recovery and Stress …

Accelerometry And Global Navigation Satellite Systems Derived Training Loads, Abdulmalek Bursais

Electronic Theses and Dissertations

The objectives of this dissertation include 1) to review accelerometry and Global Navigation Satellite System (GNSS) derived measures used to monitor training load, 2) to investigate the validity and reliability of accelerometers (ACCs) to identify stepping events and quantify training load, 3) to assess the relationship between accelerometry and Global Navigation Satellite Systems (GNSS) derived measures in quantifying training load. In Study I, acceleration data was collected via two tri-axial ACC (Device A and Device B) sampling at 100Hz mounted closely together at the xiphoid process level. Each participant (n=30) performed two trials of straight-line walking, running, and …

Performance Effects Of A Strength Training Program In Collegiate Runners, Alyssa Younker

Electronic Theses and Dissertations

Research has shown that lower limb asymmetries can negatively impact performance and risk of injury. However, there is little research on the effects of lower limb asymmetry on running performance, nor the effects of strength training on lower limb asymmetry in runners. The purpose of this study was to examine the relationship between jumping ability and asymmetry and long distance running performance, as well as to determine the performance effects a strength training program has on collegiate runners. Data from athlete monitoring of 10 collegiate distance runners and 6 sprinters were analyzed. Athletes (Distance Runners n = 10, Sprinters n …