Medicine and Health Sciences Commons^™

A Mixed-Methods Analysis Of Abortion Attitudes And Perceptions Among Women Living In Alabama And South Carolina, Anthony Peluso

Electronic Theses and Dissertations

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access …

Bdnf-Related Gene Expression Of Laser Capture Microdissected Glutamate Neurons From The Anterior Cingulate Cortex In Mouse Models Of Autism Spectrum Disorder, Misty Owens

Electronic Theses and Dissertations

Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting social behaviors. ASD affects 1 in 59 children with males affected more frequently. ASD is postulated to result from excitatory and inhibitory neurotransmission imbalances. Brain-derived neurotrophic factor (BDNF) signaling affects ASD by influencing synaptogenesis, plasticity, and survival. Studying early in-utero neuropathological changes within ASD requires the use of animal models. Expression of BDNF-associated genes were analyzed within laser capture microdissected pyramidal neurons from the anterior cingulate cortex of male and female BTBR and valproic acid mouse models. No expression differences were found in any gene comparing the three groups. Gender comparisons …

Cluster Analysis Of Opioid Accessibility In The Carolinas Using Data From The Arcos Database And An Enhanced Two-Step Floating Catchment Area Method, Michael T. Bunker

Electronic Theses and Dissertations

This study takes advantage of transaction level data from the U.S. Drug Enforcement Administration's (DEA) Automation of Reports and Consolidated Orders System (ARCOS) database made newly available under court order by The Washington Post in July 2019. This data details individual shipments of pharmaceutical opioid analgesics from wholesalers to retail distributors. Using the Enhanced 2-Step Floating Catchment Area (E2SFCA) method, this study calculated access to opioid morphine milligram equivalents (MME) per capita for census tracts in North Carolina and South Carolina during the year 2009. This study demonstrated that outlier volumes of opioid analgesics at individual pharmacies are not always …

The Effects Of Two Modes Of High-Intensity Intermittent Exercise On Postprandial Metabolism, David J. Buckley

Electronic Theses and Dissertations

The purpose of this study was to see if exercise in the form of Tabata or Sprinting would lower postprandial lipemia and glycemia. Tabata was composed of body-weight exercises. Both Tabata and Sprinting consisted of 5 rounds with each round lasting 4 minutes and included movements performed for 20 seconds followed by 10sec of rest. Following the completion of each round, participants received a 60 second break. Both exercise sessions were isocaloric and lasted 25min. Thirty minutes following exercise, participants were given a 75g-oral glucose solution and a high-fat meal two hours following exercise. The postprandial assessment lasted 6 hours. …

A School-Based Sexual Health Education Program, Tracy L. Kendall

Electronic Theses and Dissertations

A small rural community has high incidence rates of chlamydia (4,751 per 100,000) and gonorrhea (970 per 100,000) in females 15–24 years old. Data obtained from Texas Health and Human Services showed that incidence rates of chlamydia and gonorrhea in females 15–24 years old were higher in Navarro County, Texas, than the state of Texas. Texas schools do not mandate sex health education. There is a gap in school-based sexual health education available to 18- and 19-year-old females residing in this rural community in Texas. The purpose of this research study was to evaluate the impact of school-based sexual health …

Medical Noncompliance In A Pediatric Patient Living In A Single-Parent Household, Lucy Obianuju Norrell

Electronic Theses and Dissertations

Abstract Noncompliance is a patient’s inability to comply with the recommended treatment for their complete recovery from an ailment, while compliance is the extent to which a patient adheres to the provider’s directive, such as medication and orders given. The purpose of this study was to determine if motivational interviewing when applied to noncompliant pediatric patients from single-parent households, would improve global medical compliance in this population as compared to the standard of care at the end of three months. Thirty-two participants were recruited using the homogeneous purposeful sampling. The project employed a mixed-method approach. Fred Kleinsinger’s noncompliant behavior tool …

Cystic Fibrosis Transmembrane Conductance Regulator Modulator Therapies In Cystic Fibrosis: A Retrospective Evaluation Of A Nationwide Specialty Pharmacy Database, Zumi Mehta

Electronic Theses and Dissertations

Background: Cystic fibrosis (CF) is a progressive, genetic disorder caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Patients with CF experience excessive mucus build up and infections leading to complications in the pancreas, lungs, and other organs. There has been a paradigm shift in the treatment of CF with the introduction of CFTR modulator therapies and given their high acquisition cost, assessing their economic burden along with the adherence rate of patients is imperative. Objective: (i) To assess the utilization of CFTR modulator therapies in a specialty pharmacy CF patient population and (ii) to calculate …

British Eugenics Failure And Success, Angela Gallagher

Electronic Theses and Dissertations

The historical narrative of eugenics often focuses on those eugenic societies and movements that ‘succeeded’ in part or in full in achieving a eugenic society. Less studied are those societies that failed, whether due to social backlash or internal incoherence. The British Eugenic Educational Society as the foundational point of eugenics, has therefore been overlooked as a result of it’s perceived lack of contribution to eugenic thought and its failure to pass eugenic legislation. Founded by Francis Galton, the originator of the philosophy of eugenics, the British Eugenic Educational Society should have been successful given it’s reputation and the numerous …

Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne

Electronic Theses and Dissertations

Background: Approximately 70% of the adult population in the United States has overweight or obesity and increased risk for developing chronic diseases. Dietary self-monitoring adherence using a paper diary is associated with weight loss; however, few studies have examined this association with dietary self-monitoring apps. Objectives: 1) explore if an association exists between app-based dietary self-monitoring and weight change among adults with overweight or obesity and 2) explore the relationships between the frequency, consistency, and completeness of self-monitoring and weight change. Methods: Participants self-monitored dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned …

Coping Behaviors Of African Americans With Inflammatory Bowel Disease: A Focused Ethnography, Patricia Scott

Electronic Theses and Dissertations

Background: Increasing numbers of African Americans are being diagnosed with inflammatory bowel disease (IBD) in the United States (Dahlhamer, Zammitti, Ward, Wheaton, & Croft, 2016). Little is known about the influence of culture on coping with the disease. Method: Twelve African American adults with IBD were interviewed and observed using a focused ethnography. Results: Data analysis resulted in four major themes: (1) spending time living in the bathroom; (2) time and food restricted eating practices and cultural food avoidance; (3) dealing with a life full of stress; and (4) the practice of seclusion to promote health. Discussion: Participants described coping …

Caring For Victims Of Child Maltreatment: Pediatric Nurses’ Moral Distress And Burnout, Angela Karakachian

Electronic Theses and Dissertations

Background: Moral distress is a significant concern for nurses as it can lead to burnout and intentions to leaving the profession. Pediatric nurses encounter stressful and ethically challenging situations when they care for victims of suspected child maltreatment. Data on pediatric nurses’ moral distress in this situation are lacking, as most research in this field has been done in adult inpatient and intensive care units.

Aims: The purpose of this study was to describe pediatric nurses’ moral distress and determine the impact of caring for victims of suspected child maltreatment on nurses’ moral distress, burnout, and intention to leave.

Design …

Risk Factors Associated With Pressure Injury In Pediatric Congenital Heart Disease Patients, Ashlee Shields

Electronic Theses and Dissertations

Pediatric congenital heart disease (CHD) patients have unique risk factors associated with the pathophysiology of abnormal heart function. This vulnerable population is likely at an increased risk of acquiring a pressure injury during hospitalization. There are limited studies that include congenital heart disease patients and more specifically, factors unique to these patients. The purpose of this study was to identify risk factors associated with development of pressure injury in pediatric CHD patients. This retrospective study used a convenience sample from hospital-acquired data including subjects with congenital heart disease. The results demonstrated an association between pressure injury development and variables both …

Gene Delivery To The Blood-Brain Barrier For Ischemic Stroke Therapy, Wanzhu Zhao

Electronic Theses and Dissertations

Stroke is a major cause of death in the United States. We aim to develop safe and efficient approaches for the treatment of stroke. Regenerative therapies have been identified as the major need for curing stroke [1]. We explored two different carriers (poly (ethylene glycol)_5k-poly (L-aspartate-diethylenetriamine)₄₈ (PEG-DET) / Pluronic P84 (P84) and exosomes (EXOs) / microvesicles (MVs)) to deliver brain-derived neurotrophic factor (BDNF) plasmid DNA (pDNA), a functional gene encoding a neurotrophin. In the first project, our data showed that DNA nanoparticles (NPs) with 0.03% P84 was a promising formulation to deliver Luciferase pDNA into immortalized human …

Pilot Study Exploring The Effect Of Targeted Cox-2 Inhibition In Macrophages Responding To Neuronal Injury; Promoting Enhanced Axonal Regeneration, Alyssa Brauckmann

Electronic Theses and Dissertations

Celecoxib nanoemulsion (CXB-NE) has been developed as a macrophage targeted analgesics by Dr. Janjic and her team at Duquesne University, (Janjic et al, 2018; Liu et al, 2020; Saleem et al, 2019b; Vasudeva et al, 2014). The CXB-NE nanoemulsion carrying a Nonsteroidal Anti-inflammatory (NSAID) inhibitor of COX-2 activity result in a reduction in PGE2 expression in macrophages. Using CXB-NE in rats that have peripheral nerve injury constricting the sciatic nerve relieves hypersensitivity, a pain-like behavior. The treatment also decreases inflammation associated with this chronic constriction injury (Janjic et al, 2018; Saleem et al, 2019b; Stevens et al, 2019). In this …

Quality In All Levels: A Model Defining And Measuring Quality In Bioethics Education, Ercan Avci

Electronic Theses and Dissertations

Due to the lack of academic studies in the quality assessment of bioethics education, this dissertation aimed to propose a normative model, Quality in All Levels (QAL), to define and measure quality in bioethics education. The QAL model described quality in bioethics education as conformance to the goals and determined these goals as (1) increasing ethical knowledge, (2) improving ethical skills to strengthen ethical sensitivity, awareness, and judgment, (3) developing ethicalbehavior, and (4) promoting cultural competence. The dissertation utilized Avedis Donabedian’s three approaches: structure, process, and outcome to formulate quality standards and indicators in bioethics education. In respect of …

Autism Spectrum Disorder: Investigating Predictive Adaptive Behavior Skill Deficits In Young Children., Emma L. Feige

Electronic Theses and Dissertations

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder that consists of difficulties with social communication and language, as well as the presence of restricted and repetitive behaviors. These deficits tend to present in early childhood and usually lead to impairments in functioning across various settings. Moreover, these deficits have been shown to negatively impact adaptive behavior and functioning. Thus, early diagnosis and intervention is vital for future success within this population. The purpose of this study was to further examine the subscales that comprise the adaptive behavior section of the Bayley-III to determine which of the ten subscales are …

Functionalizing Nanoparticles With Cafa Protein To Target Bar Peptide For Oral Delivery Applications., Hetal Desai

Electronic Theses and Dissertations

Background: Porphyromonas gingivalis adherence to Streptococcus gordonii may be important for P. gingivalis colonization in the oral cavity. Nanoparticles encapsulating synthetic peptide BAR (BAR-NPs) inhibit P. gingivalis adherence more potently than free BAR. However, BAR-NPs would exhibit low retention in an open flow environment. Hypothesis: Targeting BAR-NPs to the streptococcal surface using CafA protein will enhance their efficacy. Methods: CafA-modified NPs encapsulating BAR were synthesized using double emulsion approach. Surface binding and retention, and release kinetics of BAR from CafA-modified NPs was assessed. Functional inhibition assays were performed using dual a species biofilm. Results: CafA-modified NPs demonstrated specificity of adhesion, …

Hearing Loss: Investigating The Comfort, Confidence, Knowledge, And Preparedness Of Kentucky School-Based Speech-Language Pathologists., Amanda Matsumoto

Electronic Theses and Dissertations

Due to advances in technology, the number of users with hearing devices have increased. These users are often mainstreamed into classrooms with typical hearing peers. However, even with these devices, speech and language impairments may still persist. This study was conducted to analyze school-based speech-language pathologists’ (SLP) comfort, confidence, knowledge, and preparedness in treating students with hearing loss in Kentucky schools. 48 SLPs practicing in all levels of school including elementary, middle, and high, completed an anonymous online survey through the Qualtrics^® platform. Responses were received from SLPs representing 11 out of the 15 regions throughout Kentucky. Spearman’s rank …

Tobacco Enhances Bacterial-Induced Periodontal Bone Loss In Mice., Mina Iskander

Electronic Theses and Dissertations

Background: Tobacco smoking is the leading environmental risk factor for periodontal diseases. Delineation of the mechanisms underlying tobacco-induced or exacerbated periodontitis is hampered by the lack of an appropriate and reliable animal model. Hypothesis: We hypothesized that Porphyromonas-gingivalis-infected, cigarette smoke-exposed mice would represent reproducible models of acute (ligature model) and chronic (oral gavage model) tobacco-enhanced periodontitis that reflect multiple aspects of the disease noted in human smokers. Methods: In a chronic oral gavage disease model, Balb/c mice (6-8 weeks, 4 groups of n = 6 per group) were exposed to smoke produced by a Teague-10 smoking machine from 1R6F research …

School-Based Speech-Language Pathologist's Perceptions Of Sensory Food Aversions In Children, Ellen Monroe

Electronic Theses and Dissertations

Sensory Food Aversions occur frequently in children who are likely to appear on Speech-Language Pathologist’s (SLP’s) caseloads. The lack of research regarding intervention for Sensory Food Aversions in schools and the assertion of a gap in school-based services for children with feeding disorders was a significant indicator for the need of the study. A quantitative, descriptive, exploratory research design was selected using a self-developed questionnaire in order to exploreschool-based SLP’s perceptions of their knowledge and skills related to Sensory Food Aversions, as well as determine resources available for working with this population. Findings from the study suggest a need for …

Volatile Organic Compound Exposure And Cardiometabolic Syndrome Risk In A Nationally Representative Cohort., Stacey Lane Konkle

Electronic Theses and Dissertations

BACKGROUND: The relative importance of environmental exposures such as volatile organic compounds (VOCs) is one of the paramount public health priorities of our time, yet is presently unstudied. VOCs are ubiquitous in the environment and have been associated with numerous adverse health effects, including a number of cardiovascular and metabolic effects that are components of Cardiometabolic Syndrome (CMS). OBJECTIVES: To examine the relationship between CMS and individual-level exposures to VOCs, measured as urinary metabolites of VOCs (UM-VOCs), in a nationally representative sample. METHODS: Associations between urinary biomarkers of exposure to 19 parent VOCs and CMS were assessed using the National …

Oral Health-Related Quality Of Life In Us Adults With Type 2 Diabetes., Giang Truong Vu

Electronic Theses and Dissertations

This dissertation focused on the relationship between type 2 diabetes (T2DM) and oral health-related quality of life (OHRQoL) and the factors associated with this relationship in the US. The objectives of the dissertation research were a three-part process: (1) to understand the relationships of T2DM with poor OHRQoL, clarify risk and preventive factors that affect this association, and identify research gaps in the literature, (2) to analyze risk factors associated with poor OHRQoL in US adults with T2DM using a nationally representative random probability cluster sample, and (3) to apply structural equation modeling (SEM) to a simplified Andersen’s Behavioral Model …

Transient Display Of Chimeric Proteins On Biological Surfaces As An Effective Strategy For Modulations Of Innate And Adaptive Immune Responses., Pradeep Shrestha

Electronic Theses and Dissertations

The major premise of this dissertation was to transiently display novel immunological ligands on biological membranes as a localized means of modulating innate and adaptive immune responses with applications to bone marrow and pancreatic islet transplantation. In Chapter two, we engineered donor allogeneic bone marrow cells to transiently display a novel form of FasL, SA-FasL, to efficiently purge out alloreactive donor T cells to prevent acute GVHD. In Chapter three, we engineered pancreatic islets with a novel form of CD47, SA-CD47, to modulate instant blood mediated inflammatory reaction (IBMIR) to prevent immediate islet graft loss following intraportal transplantation. GVHD is …

Sulforaphane Protects Against Ethanol-Induced Apoptosis And Teratogenesis Through Epigenetic Modulation Of Anti-Apoptotic Genes., Yihong Li

Electronic Theses and Dissertations

Background. Ethanol-induced excessive apoptosis in neural crest cells (NCCs), a multipotent progenitor cell population, is one of the major mechanisms underlying the pathogenesis of Fetal Alcohol Spectrum Disorders (FASD). However, the molecular mechanisms underlying FASD that results from maternal alcohol exposure during pregnancy are poorly understood. The overall goals of this study are to examine the mechanisms by which ethanol induces apoptosis and malformations in vitro and in vivo, and to develop a nutritional-based approach by using SFN and SFN-rich BSE to prevent FASD through epigenetic modulation. Results. This study demonstrates that ethanol exposure resulted in a significant increase …

Preventable Hospitalization Among Type 2 Diabetes Patients In Kentucky Before And After Medicaid Expansion 2010-2017., Turky Jamil Arbaein

Electronic Theses and Dissertations

Objectives: 1) Analyze county level variation in T2DM-PH rates in Kentucky before ACA (2010-2013) and after the ACA (2014-2017). 2) Analyze the relationship between county level socioeconomic factors (income per capita, percentage of uninsured people, percent of urban population, primary care and general preventive offices, population aged 65 and above, median age, household income, percentage in poverty, and unemployment rate ) and county level T2DM-PH rates before (2010-2013) and after (2014-2017) ACA implementation in Kentucky. Method: This research was conducted in two phases: Phase one of this study estimated the county-level PH variation among T2DM patients across eight years (2010-2017), …

Tobacco-Derived Aldehydes: Platelet Activation, Thrombosis, And The Role Of Trpa1., Andre Dwayne Richardson

Electronic Theses and Dissertations

Cigarette smoking is the single largest risk factor for cardiovascular disease (CVD) pathophysiology. Numerous researchers have shown potential associations between aldehydes in tobacco-derived aerosols from mainstream cigarette smoke (MCS) or electronic cigarettes (e-cigs) and their cardiotoxicity by damaging blood vessel endothelium. The severity of exposure to these toxicants can furthermore lead to adverse cardiovascular outcomes such as myocardial infarctions, stroke, coronary and peripheral artery disease, or atherosclerosis due to blood clots, a pro-thrombotic event. However, the mechanisms by which levels of harmful and potentially harmful constituents (HPHCs) such as aldehydes induce thrombosis are not well-known. Of specific interest, evidence has …

The Role Of Slc7a11 In Controlling Extracellular And Intracellular Redox Environments Of Lung Fibroblasts - Potential Targets For Intervention In Aging And Idiopathic Pulmonary Fibrosis., Yuxuan Zheng

Electronic Theses and Dissertations

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by extracellular matrix deposition by fibroblasts. Aging and oxidative stress increase the susceptibility to IPF. Redox couples, cysteine/cystine (Cys/CySS) and glutathione/glutathione disulfide (GSH/GSSG), and their redox potentials (E_h) quantify oxidative stress. Fibroblasts from old mice maintain more oxidized extracellular E_h(Cys/CySS) than young mice. Microarray shows down-regulation of Slc7a11 potentially mediates this age-related oxidation. Slc7a11 is the key component of system X_c^-, an antiporter that imports CySS and exports glutamate. The first aim of this dissertation is to investigate the mechanistic link between Slc7a11 …

Evaluation Of Tracing Techniques In The Rat Spinal Cord Using A Custom Matlab Application., Rachel M. Zalla

Electronic Theses and Dissertations

The objective of this research project is to evaluate the efficiency of traditional chemical tracing compared to dual-viral tracing for labeling long ascending propriospinal neurons (LAPNs) in the uninjured rat spinal cord, and to develop a MATLAB program which will accurately quantify this labeling.

To evaluate chemical tracing, Fluoro-Ruby (FR) was injected at the level of the axon terminals, and the number of ipsilateral labeled cell bodies at lumbar level was quantified. Similarly, two dual-viral systems were evaluated, by either injecting retro-AAV-Cre or HiRet-Lenti-Cre unilaterally in combination with a Cre-dependent adeno-associated virus. The HiRet-Lenti and FR groups labeled significantly greater …

The Relationship Of Self-Efficacy And Clinical Reasoning Of Undergraduate Nursing Students, Amy G. Holder

Electronic Theses and Dissertations

Aim. This investigation aimed to discover if a there is a correlation between a student’s clinical reasoning self-efficacy and a student’s actual clinical reasoning ability. Also, this research sought to discover the connection between an undergraduate nurse’s self-efficacy of clinical reasoning and the locus of control of that student. Finally, this investigation sought to discover if perceived self-efficacy of clinical reasoning changed over time.

Background. The ability to successfully navigate the process of clinical reasoning is critical to providing safe, effective care for patients. For nurses, this process begins to develop in nursing school. Unfortunately, evidence suggests that newly graduated …

Neonatal Abstinence Syndrome And The Relationship Between Respiration And Feeding, Paul Rice

Electronic Theses and Dissertations

Objective: The primary purpose of this study was to determine the relationship between respiratory status and feeding difficulties in infants with NAS in comparison to full-term infants with no exposure to opioids.

Methods: A group of infants with NAS (262) were compared to a group of full-term infants with no exposure to opioids (279). These groups were further divided into feeding and respiratory groups based on severity. These groups were analyzed for differences in behavior and outcomes.

Results: Infants with NAS are 34.23 times more likely to develop respiratory distress and 111.03 times more likely to develop severe feeding difficulty. …