Medicine and Health Sciences Commons^™

Overcoming Treatment Resistance In Heterogeneous Tumors, Nikhil Hebbar

Theses and Dissertations--Toxicology and Cancer Biology

Most primary tumors are heterogeneous and are often composed of therapy-sensitive and emerging therapy-resistant cancer cells. Rather unexpectedly, treatment of therapy-sensitive tumor cells in heterogeneous tumor microenvironments resulted in apoptosis of the therapy-resistant cancer cells. We identified a novel Par-4 amino-terminal fragment (PAF, which includes amino acids 1-131 of Par-4) that is produced and released by therapy-sensitive cancer cells following therapy-induced caspase-dependent cleavage of the tumor suppressor Par-4. PAF caused paracrine apoptosis in therapy-resistant cancer cells. Unlike Par-4-inducible apoptosis, which is dependent on the cell surface GRP78 receptor, PAF produced cancer-selective apoptosis independent of cell surface GRP78 function. Par-4 contains …

Differential Gene Expression In Equine Cartilaginous Tissues And Induced Chondrocytes, Emma N. Adam

Theses and Dissertations--Veterinary Science

Degenerative joint disease, or osteoarthritis, is a major cause of lameness and morbidity in horses, humans, and dogs. There are no truly satisfactory cures for this widespread problem and current treatments all have limitations or unwanted side effects.

New cell-based strategies to repair joint surface lesions have generated a high level of interest, but have yet to achieve the full restoration of articular cartilage structure and function. Currently used therapy cells include autologous chondrocytes and adult mesenchymal cells such as bone marrow derived cells and adipose derived cells. Unfortunately, the resultant repair tissue is biomechanically inferior fibrocartilage. A critical gap …

Determinants Of An Individual's Suicide Intention In South Korea, Nam Keun Choi

MPA/MPP/MPFM Capstone Projects

This study has examined a variety of variables that influence an individual’ s suicide intention, and analyzed the impact of these variables. The data are from the 2014 wave of the Korea Welfare Panel Survey (KoWePS). I analyze data on 13,687 out of 17,134 survey participants.

The dependent variable of my study is suicide intention such as suicidal thoughts and behaviors. The independent variables are classified into three categories: socio-demographic, psychological and mental health. Socio-demographic variables are gender, age, education, marital status, and income. Psychological variables are self-esteem, satisfaction with life, and religion. Mental health variables are depression, alcohol use, …

Novel Role Of Cd47 In Obesity-Associated Metabolic Dysfunctions, Heather L. Norman-Burgdolf

Theses and Dissertations--Pharmacology and Nutritional Sciences

Obesity and its associated comorbidities are of global concern. These complications are largely driven by perturbations in energy homeostasis, inflammation, and oxidative stress within metabolic tissues. Although these underlying pathways have been established, molecular mechanisms augmenting metabolic dysfunction have not been fully defined. CD47, a ubiquitously expressed cell membrane receptor, has been previously implicated in the development of inflammation and oxidative stress in a number of disease conditions. Previous work from our lab and others has confirmed that the most potent ligand of CD47, TSP1, plays a critical role in facilitating inflammation and metabolic dysfunction in diet-induced obesity. Whether these …

An Examination Of Maternal Stress And Secondhand Smoke Exposure On Perinatal Smoking Status, Karen R. Damron

Theses and Dissertations--Nursing

The median prevalence of smoking among women of childbearing age in the United States is 22.4%. Of women who identify themselves as smokers in the three months prior to conception, 55% quit during pregnancy; however, 40% of those who quit relapse and return to smoking within six months after delivery. Smoking has been identified as an important means of stress management among smokers in general, and though limited to the perinatal period, pregnancy-specific stress adds to a woman’s typical day-to-day stress burden. Little data exists as to the effect of SHS exposure on smoking status during pregnancy and the impact …

Hearts In The Balance: The Impact Of Desired Versus Received Social Support Needs On Persons With Heart Failure, Melanie P. Schrader

Theses and Dissertations--Nursing

Social support is the collection of tangible and intangible experiences that surround people as they cope with daily stressors. High quality social support is important among patients with cardiovascular disease (CVD) because it has positive effects on social, psychological and physical well-being, and those with good social support cope better with the travails of CVD. Although there are many studies of social support in CVD, little work has been done on the topic of discrepancies between desired and received social support in the context of gender.

The purpose of this dissertation was to determine if there are gender differences in …

The Relationship Of Social Support In Self-Care, Depressive Symptoms, And Quality Of Life Outcomes In Patients With Heart Failure, Shannon C. Shumaker

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate outcomes associated with social support in patients with heart failure and their caregivers. Specific aims were to: 1) examine the association of depressive symptoms with self-care in patients with HF; 2) evaluate the psychometrics properties of the Multidimensional Scale of Perceived Social Support (MSPSS) instrument as a measure of perceived social support in patients with heart failure; and 3) determine whether patient and caregiver perception of relationship quality measured at baseline upon enrollment predicted quality of life at baseline in both patient and caregiver using a multilevel dyadic analysis in patient and …

Comparison Of Quick Methods For Determining Body Composition In Female Collegiate Athletes And Obese Females, Mandee E. Martin

Theses and Dissertations--Nutrition and Food Systems

The Body Mass Index (BMI) is a tool used broadly by public health agencies to assess weight in populations. However, when differentiating between fat mass and fat free mass the formula (BMI = weight in kilograms/height in meters2) is not applicable. Research suggests that evaluating body fat percentage and adipose tissue deposition may provide a nuanced indication of overall health, making it more accurate on an individual basis. This study evaluated four methods (Body Mass Index, waist circumference, A Body Shape Index, and Waist to Stature Index) that assess body composition and their ability to predict body fat percentage in …

Promoting Healthy Eating And Physical Activity: A Qualitative Examination Of Community-Based Obesity Interventions In Rural Kentucky, Brooke F. Butterworth

Theses and Dissertations--Nutrition and Food Systems

Rural Americans are medically underserved groups and are at greater risk of becoming obese than urban Americans. The purpose of this qualitative study was to determine the perceived causes of obesity in six counties of rural Kentucky and to determine how to customize strategies to reduce obesity in these areas. University of Kentucky Cooperative Extension Service Agents formed coalitions in each of the six counties to assess their communities’ needs and assets to inform plans for implementing evidence-based obesity interventions. Between February and August of 2015, the coalitions were convened for a total of 11 meetings. Each of the coalition …

Biventricular Finite Element Modeling And Quantification Of 3d Langragian Strains And Torsion Using Dense Mri, Zhanqiu Liu

Theses and Dissertations--Mechanical Engineering

Statistical data suggests that increased use of evidence-based medical therapies has largely contributed to the decrease in American death rate caused by heart disease. And my studies are about two applications of magnetic resonance imaging (MRI) as a non-invasive approach in evidence-based health care research. In my first study, the achievement of a pulmonary valve replacement surgery was assessed on a patient with tetralogy of Fallot (TOF). In order to evaluate the remodeling of right ventricle, two biventricular finite element models were built up for pre-surgical images and post-surgical images. In my second study, 3D Lagrangian strains and torsion in …

Novel Targets For Mitochondrial Dysfunction Following Traumatic Brain Injury, Heather M. Yonutas

Theses and Dissertations--Neuroscience

Mitochondrial dysfunction is a phenomenon observed in models of Traumatic Brain Injury (TBI). Loss of mitochondrial bioenergetics can result in diminished cellular homeostasis leading to cellular dysfunction and possible cellular death. Consequently, the resultant tissue damage can manifest as functional deficits and/or disease states. Therapeutic strategies to target this mitochondrial dysfunction have been investigated for models TBI and have shown promising effects.

For this project, we tested the hypothesis that mitoNEET, a novel mitochondrial membrane protein, is a target for pioglitazone mediated neuroprotection. To test this, we used a severe Controlled Cortical Impact (CCI) injury model in mitoNEET null and …

Is There A Trade-Off? Infant Health Outcomes And Managed Care Competition, Shana L. Moore

Theses and Dissertations--Public Policy and Administration

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to …

Making Health A Priority: Constrained Choices At The Grocery Store, Christy F. Brady

Theses and Dissertations--Sociology

Mounting evidence of the deleterious health effects of poor diet, obesity, and correlated conditions underscore the need to understand how social factors influence food choices. A variety of factors contribute to the diets that Americans consume including limited time, limited income, lack of cooking skills, food deserts, and cheap, convenient foods in abundant portions in grocery stores and restaurants. These contextual factors serve as constraints that impact an individual’s ability to prioritize health when shopping for food. Using the three paper dissertation format, this project will utilize a Constrained Choice Theory (CCT) framework to investigate sociodemographic trends in priorities in …

Effects Of Obesity On United States Farmers: A Pilot Study, Sharon C. Hunsucker

Theses and Dissertations--Nursing

Previous research described the value farmers place on their ability to work. The impact of obesity on workers is an increasing concern in occupational health research; yet, knowledge regarding the impact of obesity on the performance of farm work is limited. Identifying the impact of obesity on farmer’s work ability can guide healthcare workers in promoting and motivating farmers to implement lifestyle changes to improve health and sustain longevity in their ability to work.

The purpose of this dissertation was to examine the impact of obesity on the work ability of U.S. farmers. Specific aims were to 1) examine the …

Identification Of Early Markers Of Occult Tissue Hypoperfusion In Patients With Multiple Trauma Injuries, Kathryn M. Moore

Theses and Dissertations--Nursing

Injury is a global health problem and in the United States is the leading cause of death for persons aged 1 – 44 years. The primary causes of trauma related death are head injury and hemorrhage; hemorrhagic shock is difficult to recognize in the first hours after trauma. Identification of specific and optimal criteria upon which to base effective triage decisions for trauma patients has been an elusive goal for decades.

The purpose of this dissertation was to identify measures available in the prehospital phase of care and in the Emergency Department that should be included for a more comprehensive …

An Evaluation Of The Screening And Management Of Patients With Type 2 Diabetes, Laura A. Cahoe

DNP Projects

Purpose: This purpose of this project was to evaluate preventive screening practices and adherence to guidelines for patients with type 2 diabetes (T2DM) as recommended by the American Diabetes Association (ADA) and United States Preventive Services Task Force (USPSTF) in the primary care setting. The specific aims were to: 1) determine the percentage of patients who received recommended screenings from the ADA, 2) determine the percentage of patients who received recommended screenings from the USPSTF, and 3) determine if the proportion of patients to receive the recommended screenings met established benchmarks set by Healthy People 2020 (HP2020).

Methods: A retrospective …

Surface-Initiated Polymerizations For The Rapid Sorting Of Rare Cancer Cells, Jacob L. Lilly

Theses and Dissertations--Chemical and Materials Engineering

Cancer metastasis directly accounts for an estimated 90% of all cancer related deaths and is correlated with the presence of malignant cells in systemic circulation. This observed relationship has prompted efforts to develop a fluid biopsy, with the goal of detecting these rare cells in patient peripheral blood as surrogate markers for metastatic disease as a partial replacement or supplement to tissue biopsies. Numerous platforms have been designed, yet these have generally failed to support a reliable fluid biopsy due to poor performance parameters such as low throughput, low purity of enriched antigen positive cells, and insufficiently low detection thresholds …

Perceived Stress, Caffeine Consumption, And Gpa Of Undergraduate Students At A Large Public University, Emma Simpson

Theses and Dissertations--Nutrition and Food Systems

Evidence suggests that college students may increase caffeine consumption to cope with the stress and demands of college. The relationships between perceived stress, caffeine consumption, and GPA were examined in students at a large public university. Students were surveyed to determine perceived stress (Cohen’s Perceived Stress Questionnaire), beliefs about caffeine, caffeine consumption, workload in and outside of the classroom, and GPA. Surveys were administered at the beginning of the semester and again at midterm. Based on Cohen’s 40-point scale, average stress scores increased from 15.95 ± 6.34 at the beginning of the semester to 18.89 ± 6.94 at midterms. Additionally, …

Across The States: Do Long Term Services & Supports Policies Affect The Number Of Nursing Home Residents With Low-Care Needs?, Mary Otis

MPA/MPP/MPFM Capstone Projects

Long term care for the elderly has been steadily gaining salience in the public policy realm for many years. The federal government has been vigorously studying and exploring solutions, including the Centers for Medicare and Medicaid Services’ (CMS) efforts to expand access to home and community-based services (HCBS) in order to reduce dependence on institutional care. These federal efforts include various incentive programs and policies recently offered under the Affordable Care Act. However, data on the strength of each state’s long term services and supports system has not been easily accessible until recently. The report “Raising Expectations: A State Scorecard …

Central And Peripheral Weight Gain Affect Trunk Kinematics And Lower-Extremity Muscle Activation Differently During Sit-To-Stand, Michelle Christine Walaszek

Theses and Dissertations--Kinesiology and Health Promotion

Background: Obesity-induced alterations in biomechanics and muscle recruitment during activities of daily living, such as sit-to-stand (STS) are often attributed to increases in adipose tissue (AT) mass. Central or peripheral distribution of AT may differently affect biomechanics and muscle recruitment.

Methods: Fifteen healthy, normal weight (BMI 22.4 ± 1.9 kg/m², 24.1 ± 4.2 years) subjects volunteered. External loads equivalent to a 5 kg/m² BMI increase were applied in three conditions: unloaded (UN), centrally loaded (CL), and peripherally loaded (PL). Subjects completed three successful STS movements in a backless chair under each load condition in random order. Motion …

The Effects Of A Hip Flexor Stretching Program On Running Kinematics In Individuals With Limited Passive Hip Extension, Jeff H. Mettler

Theses and Dissertations--Kinesiology and Health Promotion

INTRODUCTION: Tightness of the hip flexor muscle group may contribute to altered sagittal plane kinematics of the lumbo-pelvic-hip (LPH) complex during dynamic movements. Therefore, the purpose of this study is to analyze the effects of a three-week home-based stretching program on passive hip extension (PHE), as well as on active hip extension (AHE), anterior pelvic tilt (APT), and lumbar spine extension (LSE) when running. METHODS: Twenty healthy subjects with limited PHE underwent a 3D gait analysis both prior (PRE) and following (POST) a three-week static hip flexor stretching program. RESULTS: Following the stretching program, peak PHE increased significantly (P < 0.001), while no significant improvements were reported in AHE, APT, or LSE. In addition, no relationship was found between the change in PHE with either the change in AHE, APT, or LSE. Finally, a high relationship was observed between AHE and APT during running (r = 0.83, p < 0.001), and low relationships were observed between APT and LSE (r = -0.41, p = 0.08) and AHE and LSE (r = -0.34, p = 0.15). CONCLUSION: A three-week static stretching program of the hip flexor musculature resulted in an increase in PHE, but the sagittal plane kinematics of the LPH complex during running remained unchanged. The correlations observed between AHE, APT, and LSE suggest there is a kinematic relationship between the hip, pelvis, and spine.

Women In White: A Retrospective Look At Medical Education At One School Before Title Ix, Karen Clancy

Theses and Dissertations--Educational Policy Studies and Evaluation

The Women in White generation of women physicians who graduated from American medical schools between World War II and the enactment of Title IX were trailblazers. They successfully pursued and achieved physician careers during a time when doctoring was still considered “man’s work.” They helped to clear a path to a modern medical student culture where women and men had more choices.

In a 2008 oral history interview, Dr. Jacqueline Noonan, world-renowned pediatric cardiologist, discoverer of the congenital heart condition known as “Noonan Syndrome,” and the first woman appointed to a chairman role at the University of Kentucky College of …

Assessment Of Blood Pressure Control In Patients Diagnosed With Hypertension In A Primary Care Setting, Lauren Prince

DNP Projects

Purpose: To evaluate provider adherence to the current hypertension management guideline, JNC 8, by assessing blood pressure control in individuals diagnosed with hypertension in an internal medicine clinic.

Methods: A retrospective chart review was conducted to assess the percentage of patients diagnosed with essential hypertension meeting the blood pressure goals set forth in JNC 8. In the absence of blood pressure control, provider intervention was assessed. Data collected included blood pressure, use of home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three office visits. In addition, current …

Prediction Screening To Identify Heart Failure Patients At High Risk For Readmission, Kelly L. Taylor

DNP Projects

Background: There is an increased need to identify factors associated with higher risk for excessive HF re-hospitalizations due to hospitals receiving financial penalties related to these re-hospitalizations and poorer patient outcomes. Identifying HF patients at highest risk for re-hospitalization with a screening instrument upon admission to the hospital would allow for early implementation of interventions tailored around reducing risk factors for re-hospitalization.

Objectives: The specific aims of this study were to 1) identify characteristics that were predictive of HF re-hospitalization; and 2) use those characteristics to create a screening instrument.

Methods: A total of 158 patients (age=63±13; 50.6% female; 73.4% …

Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, Margaret A. Plymale

DNP Projects

Surgeons generally agree that morbid obesity is a contraindication to ventral hernia repair surgery due to risk of adverse outcomes. The purpose of this study was to describe the experience of patients with ventral hernia complicated by morbid obesity by reviewing a population of patients that were seen by a surgical service to determine the characteristics of those patients that had favorable and unfavorable outcomes. A retrospective medical record review was conducted of new patients with ventral hernias and morbid obesity (body mass index (BMI ) ≥ 40 kg/m²) seen by one surgical service over a two and …

Compliance With The 2015 American Diabetes Association Screening Guidelines For Diabetes Mellitus Type 2 In Primary Care, Krista L. Johnson

DNP Projects

Purpose: The purpose of this project was to evaluate provider use of hemoglobin (HgA1c) measurement as a method of screening for Type Two Diabetes Mellitus (T2DM) per the 2015 American Diabetes Association screening guidelines in a multidisciplinary primary care clinic in Kentucky.

Methods: A retrospective electronic medical record review was conducted in a large ambulatory care clinic. A master list was compiled of all patients aged 45-89 years who were seen for any reason the first week of November 2015. A total of 127 records that met inclusion criteria were randomly selected. The proportion of patients who were appropriately screened …

Text Messaging Appointment Reminders To Reduce No-Shows: A Pilot Study, Cameron M. Stephenson

DNP Projects

Background: Hospital and outpatient clinic no-show, did not cancel or did not attend rates are a serious problem to organizations across the United States health care system. No-show appointments reduce clinic productivity, wastes clinician time and clinic resources and can be detrimental financially. Bluegrass Pediatrics and Internal Medicine (BPIM) located in Georgetown, KY experiences these problems on a daily basis.

Purpose/Methodology. This quality improvement project consisted of evaluating the effects of text messaging on appointment attendance during 3 clinic weeks of February 2016. The sample was derived from all patients enrolled at BPIM with a scheduled well, established or routine …

The Effect Of Nurse Dose On Breastfeeding Exclusivity - A Patient Level Analysis, Gwen Moreland

DNP Projects

Background: Breastfeeding is strongly associated with health benefits for children and their mothers. Despite this knowledge, breastfeeding rates in the United States have increased only slightly. Current research examines the relationship between nurse characteristics and patient outcomes in adult intensive care and acute care settings. To date there is very limited research examining nurse variables and outcomes in women and children, and very little knowledge regarding the characteristics of the nurse in relation to patient’s breastfeeding success.

Purpose: The purpose of this practice inquiry project was to evaluate the relationship between the attributes of nurse dose and the immediacy and …

Improving The Identification, Delivery Of Care, And Outcomes Of Hospital-Acquired Sepsis, Nicholas James Welker

DNP Projects

Sepsis syndromes that develop among a hospital inpatient population can be difficult to differentiate from other disease processes that share systemic inflammatory response syndromes. A bedside nurse-driven screening process was developed at Baptist Health Lexington to aid with early sepsis identification and foster prompt goal-directed therapy. This retrospective study of 26 patients identified over a 6 month period measures intensive care length of stay, mortality, and sepsis severity. Exclusion criteria were pregnancy and Do Not Resuscitate orders.

Screening compliance was poor at 23.1 percent (n=6). Complete compliance with goal directed therapy was 7.7 percent, though some components of therapy such …

Management Of Hypertension In Student Patients In A University Student Clinic, Kathleen E. Solter

DNP Projects

Purpose: To evaluate provider adherence to a clinical guideline for management of hypertension, and to assess improvement in quality of management of student patients with hypertension in a university student clinic.

Methods: A retrospective chart review was conducted to identify student patients with hypertension. Data collected included the demographics of the sample patients, blood pressures, LDL results, weights, and evidence of provider compliance with guidelines.

Results: Of the 13 patient charts audited, providers recommended exercise to 46.15% of patients, weight loss or maintenance to 53.85% of patients, no-added salt diets to 53.85% of patients, low fat to 23.08% of patients, …