Medicine and Health Sciences Commons^™

Stories Of Strength: Chicago Latin@S' Navigation Of Health, Well-Being, And Chronic Disease, Lilian L. Milanés

Theses and Dissertations--Anthropology

Health inequalities take many forms related to race, gender, socioeconomic status, ethnic, language and many other axes throughout communities around the world. Type two diabetes, high blood pressure, and high cholesterol are examples of conditions (among many others) that disproportionately affect Latino@s in the U.S.. The research of this dissertation is based on fieldwork conducted throughout several predominantly Latin@ neighborhoods in Chicago, IL. This dissertation examines how Latin@s in Chicago navigate health and well-being, and how they engage in agentive strategies in the face of chronic disease. I recorded individual life histories and semi-structured interviews, focus groups, and participant observation …

Music Training As A Neuro-Cognitive Protector For Brain Aging: Cognitive And Neuropsychological Profiles In Professional Musicians, Catherine E. Schneider

Theses and Dissertations--Gerontology

The proportion of older adults living with cognitive impairments is increasing rapidly. This shift will likely increase mortality rates, reduce perceived quality of life, and cause economic burden to patients and health care systems. Currently evidence of highly effective and noninvasive interventions that prevent or slow the onset of cognitive impairment are limited. This study aims to better understand what drives cognitive aging variability among musicians versus non-musicians. Music playing has been shown to improve brain and cognitive functions by engaging networks of brain areas, simultaneously involving cortical mechanisms associated with executive, high-level cognitive and motor functions, and multiple sensory …

Older Adult Men’S Emotional Bonds With Their Dogs, Ranell L. Mueller

Theses and Dissertations--Gerontology

Knowledge of the deeper meanings of attachment to companion animals is limited, particularly in terms of older adults. This study employed a modified grounded theory method, a phenomenological lens and a life course perspective to gather and analyze data garnered from individual interviews and panel discussions in order to investigate the multiple dimensions of older adult men’s relationships with their companion animal dogs. Individual audio-recorded in-depth interviews and repeated panel discussions with a sub-group of the participants, convened as a panel over a three-month period, explored behavioral and emotional manifestations of attachment and the emotional bond to their companion animal …

Mechanisms And Potential Therapy On Disrupted Blood Pressure Circadian Rhythm In Diabetes, Tianfei Hou

Theses and Dissertations--Pharmacology and Nutritional Sciences

Arterial blood pressure (BP) undergoes a 24-hour oscillation that peaks in the active day and reaches a nadir at night during sleep in humans. Reduced nocturnal BP fall (also known as non-dipper) is the most common disruption of BP circadian rhythm and is associated with increased risk of untoward cardiovascular events and target organ injury. Up to 75% of diabetic patients are non-dippers. However, the mechanisms underlying diabetes associated non-dipping BP are largely unknown. To address this important question, we generated a novel diabetic db/db-mPer2^Luc mouse model (db/db-mPer2^Luc) that allows quantitatively measuring of mPER2 protein oscillation …

Impact Of A Leadership Development Program On Perceptions Of Structural Empowerment, Leadership Self-Efficacy, And Staff Nurse Clinical Leadership, Matthew E. Proud

DNP Projects

BACKGROUND: In order to serve as full partners on the interdisciplinary health care team: nurses at all levels must develop essential leadership competencies Organizations need to identify the essential leadership competencies required for bedside nursing staff and develop programs to enhance these competencies. Leadership competencies in areas such as managing change can help bedside nursing staff improve care delivery and quality outcomes.

PURPOSE: The purpose of this project was to evaluate the impact of an established leadership development program on participants’ perceptions of structural empowerment, leadership self-efficacy, and staff nurse clinical leadership in one university health system.

METHODS: The pilot …

Antibiotic Prescribing For Treatment Of Acute Pediatric Illnesses By Advanced Practice Nurses, Deborah J. Whitehurst

DNP Projects

Antibiotic over-prescribing by physicians for the treatment of acute respiratory tract illnesses have been examined in a variety of settings. Different studies have examined nurse practitioner (NP) prescribing practices both in the United States and various international settings. There have been limited studies specifically examining antibiotic prescribing practices in the pediatric population. However, no studies were found which compared population specific NP groups. The purpose of this study was to understand differences in antibiotic prescribing practices among advanced practice pediatric providers.

The goal of this project was to describe and compare antibiotic prescribing practices of pediatric nurse practitioners (PNP) and …

Human Trafficking Awareness Pilot Project In Nursing Faculty And Senior Nursing Students In Western Kentucky, Kristin Reid

DNP Projects

PURPOSE: Human trafficking is an ongoing public health issue on a global and local platform. The care of victims is unique and multifaceted, with various physical and mental health care needs recognized. Human trafficking victims are often difficult to identify, as there have been reports that up to 88% of human trafficking survivors described encounters with healthcare professionals while they were being trafficked yet none were identified as victims (Office of Trafficking in Persons, 2017). This information places the healthcare provider at the forefront for advocating human trafficking victim identification and post identification care. The purpose of this project was …

Utilization Of Web‐Based App To Target Obesogenic Factors In Rural Kentucky Counties With High Rates Of Obesity, Erin M. Casey

Theses and Dissertations--Nutrition and Food Systems

Due to socioeconomic disparities and geographic isolation, rural Kentucky residents bear a greater burden of poor health compared to national averages. Specifically, rural Kentucky residents are at greater risk of becoming obese and suffering from comorbidities of obesity such as type 2 diabetes, hypertension and cardiovascular disease. The purpose of the present study was two-fold. First, we the barriers to nutrition and physical activity unique to rural Kentucky counties which high proportions of obese adults (< 40%) were examined and extrapolated. Second, this information was used to develop a health and wellness app tailored to rural Kentucky counties. The objective was met via a formative assessment regarding causes for obesity in three rural Kentucky counties using focus groups. From these discussions, two major themes arose: barriers to good nutrition and physical activity, and desired web‐app features. From this assessment, FitFaceoff was developed and released into the same counties. Usage and user interaction were assessed using GoogleAnalytics™ software. Analysis revealed poor user liking and unsuccessful implementation of FitFaceoff, however further qualitative research is needed to evaluate poor user reception of FitFaceoff and possible future directions.

Assessing Malnutrition In Liver Disease Patients Being Evaluated For Transplant Using The Nutrition Focused Physical Exam, Madison Hilgendorf

Theses and Dissertations--Nutrition and Food Systems

Patients with liver disease have an increased risk for malnutrition because of side effects of the disease. The Nutrition Focused Physical Exam (NFPE) was developed for nutrition professionals to aid physicians in a nutrition-based diagnosis of malnutrition. The purpose of this study was to examine the NFPE for its validity in liver disease patients being evaluated for transplant. In addition, the NFPE was used to assess incidence and severity of malnutrition in end stage liver disease patients and compare these results to already developed malnutrition tools such as the Patient Generated-Subjective Global Assessment (PG-SGA), Triceps Skinfolds (TSF), Mid-Arm Circumference (MAC), …

Adrenergic Stimulation In Acute Hyperglycemia: Effects On Cellular And Tissue Level Murine Cardiac Electrophysiology, Sridevi Thyagarajan

Theses and Dissertations--Biomedical Engineering

Cardiovascular complications associated with elevated levels of glucose in the blood (Hyperglycemia, HG) is a growing health concern. HG is known to be associated with a variety of cardiovascular morbidities including higher incidence of electrical disturbances. Although effects of chronic HG have been widely investigated, electrophysiological effects of acute hyperglycemia are relatively less known. Further, hyperglycemic effects on adrenergic response is not widely investigated. We used excised ventricular tissues from mice to record trans-membrane potentials during a variety of pacing protocols to investigate cellular/tissue level electrophysiological effects of acute hyperglycemia and adrenergic stimulation (1µM Isoproterenol, a β-adrenergic agonist). A custom …

The Effect Of Early Life Photoperiod Manipulation On Cocaine-Induced Behavioral Sensitization In Male And Female Japanese Quail, Shannon Elizabeth Eaton

Theses and Dissertations--Psychology

Estrogens seem to play a role in the locomotor activating effects of cocaine. Japanese quail provide a good model for hormonal manipulation as alterations of their photoperiod controls hormone levels. The current study aims to examine the role of early life photoperiod manipulation in cocaine-induced behavioral sensitization in quail. It was expected that if quail were raised on a short photoperiod, they would have a reduction in gonadal hormones and this reduction in hormones would affect the acquisition of cocaine-induced behavioral sensitization. Quail were raised on an 8L:16D or a 16L:8D light cycle. Following 2 days of habituation, quail were …

Developing A Predictive Model For Prostate Cancer Screening Intent, Quentin E. Moore

Theses and Dissertations--Nursing

African Americans bear a disproportionately high burden of cancer incidence and mortality in this country. The purpose of this dissertation was to investigate factors associated with African-American men, who are incarcerated, making informed health decisions about participation in prostate cancer screening, as well as exploring factors that reduce modifiable risk factors for cancer. The United States incarcerates more people per capita than any country in the world and African American men are overrepresented in the U.S. prison system

This dissertation is composed of three manuscripts. The first paper reviews the current literature about the factors that influence African-American males in …

A Novel Role For The Tumor-Suppressor Par-4 In Regulation Of Adipogenesis And Obesity, James Sledziona

Theses and Dissertations--Toxicology and Cancer Biology

Prostate Apoptosis Response-4 (Par-4) is a conserved and ubiquitous tumor-suppressor factor which can selectively induce apoptosis in tumor cells, while leaving normal cells unaffected. While Par-4 is well established as a tumor-suppressor, there have yet been no formal investigations as to whether it has a physiologic role in normal tissues.

Early observations of Par-4 knockout mouse lines yielded that the adult mice displayed significant weight gain and fat accumulation compared to their wild-type counterparts while on a conventional chow diet. Interestingly, obese mouse and human subjects were found to exhibit reduced expression of Par-4 in adipose tissue as well as …

Aggressive Diuresis And Severity-Adjusted Length Of Hospital Stay In Acute Congestive Heart Failure Patients, Muhammad U. Butt

Theses and Dissertations--Clinical Research Design

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. > 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in …

Using Foot Pressure Analysis To Predict Reoccurrence Of Deformity For Children With Unilateral Clubfoot, Juanita Jean Wallace

Theses and Dissertations--Kinesiology and Health Promotion

Reoccurrence of deformity can affect upwards of 64% of children with clubfoot. The ability to use foot function as a measure of reoccurrence has not been previously assessed. The purpose of this investigation was to utilize foot pressure analysis to predict the probability of reoccurrence in children with unilateral clubfoot. Retrospective foot pressure data revealed predictive algorithms detecting the probability of experiencing any type of reoccurrence (overall reoccurrence) and for experiencing a tibialis anterior tendon transfer (TATT). The equation for overall reoccurrence reported sensitivity and specificity of 0.82 and 0.81 and the equation for TATT reported values of 0.81 and …

Multivariate Analysis To Identify Potential Biomarkers For Prognosis And Treatment Resistance In Head And Neck Cancer Patients, Christina Ann Wicker

Theses and Dissertations--Toxicology and Cancer Biology

It is estimated that nearly 50,000 individuals in the United States will be diagnosed with head and neck cancer in 2017 (American Cancer Society www.cancer.org). Ninety percent of oral cancers are head and neck squamous cell carcinoma (HNSCC). Major obstacles in the treatment of HNSCC are recurrence and treatment resistance, which contributes to increased mortality. Therefore, there is increased need to determine genetic alterations in HNSCC that may be ideal novel drug targets, and biomarkers to improve diagnostic and prognostic testing.

Abnormal localization and overexpression of base excision repair protein and transcriptional regulator Apurinic/Apyrimidic endonuclease (APE1) has been associated with …

Vascular Cognitive Impairment And Dementia: The Importance Of Mixed Pathologies From Mouse Models To Humans, Alex Marian Helman

Theses and Dissertations--Molecular and Cellular Biochemistry

Age-related neurologic disease is a significant and growing burden on our society. Although the largest share of research effort has typically been devoted to the common neurodegenerative illnesses (such as Alzheimer’s disease, or AD), the reality is that nearly all cases of neurodegenerative disease possess elements of mixed pathology. Vascular contributions to cognitive impairment and dementia (VCID) is a complex form of dementia, combining aspects of vascular disease and other forms of dementia, such as Alzheimer’s disease. This pathology is heterogeneous and can include cerebral amyloid angiopathy (CAA), hemorrhages, white matter infarcts, and changes to the neurovascular unit. Given the …

Interactive Clinical Event Pattern Mining And Visualization Using Insurance Claims Data, Zhenhui Piao

Theses and Dissertations--Computer Science

With exponential growth on a daily basis, there is potentially valuable information hidden in complex electronic medical records (EMR) systems. In this thesis, several efficient data mining algorithms were explored to discover hidden knowledge in insurance claims data. The first aim was to cluster three levels of information overload(IO) groups among chronic rheumatic disease (CRD) patient groups based on their clinical events extracted from insurance claims data. The second aim was to discover hidden patterns using three renowned pattern mining algorithms: Apriori, frequent pattern growth(FP-Growth), and sequential pattern discovery using equivalence classes(SPADE). The SPADE algorithm was found to be the …

The Function Of Erbin, A Scaffold Protein, As A Tumor Suppressor In Colon Cancer, Payton D. Stevens

Theses and Dissertations--Molecular and Cellular Biochemistry

Erbin belongs to the LAP (leucine-rich repeat and PDZ domain) family of scaffolding proteins that play important roles in orchestrating cell signaling. Here, we show that Erbin functions as a tumor suppressor in colon cancer. Analysis of Erbin expression in patient specimens reveals that Erbin is downregulated at both mRNA and protein levels in tumor tissues. Functionally, knockdown of Erbin disrupts epithelial cell polarity and increases cell proliferation in 3D culture. In addition, silencing Erbin results in an increase in the amplitude and duration of signaling through Akt and RAS/RAF pathways. Moreover, Erbin-loss induces epithelial-mesenchymal transition (EMT), which coincides with …

Controlling Platelet Secretion To Modulate Hemostasis And Thrombosis, Smita Joshi

Theses and Dissertations--Molecular and Cellular Biochemistry

Upon vascular injury, activated blood platelets fuse their granules to the plasma membrane and release cargo to regulate the vascular microenvironment, a dynamic process central to platelet function in many critical processes including hemostasis, thrombosis, immunity, wound healing, angiogenesis etc. This granule- plasma membrane fusion is mediated by a family of membrane proteins- Soluble N-ethyl maleimide Attachment Receptor Proteins(SNAREs). SNAREs that reside on vesicle (v-SNAREs) /Vesicle-Associated Membrane Proteins(VAMPs) interact with target/t-SNAREs forming a trans-bilayer complex that facilitates granule fusion. Though many components of exocytic machinery are identified, it is still not clear how it could be manipulated to prevent …

Functional Characterization Of Scaffold Protein Shoc2, Hyein Jang

Theses and Dissertations--Molecular and Cellular Biochemistry

Signaling scaffolds are critical for the correct spatial organization of enzymes within the ERK1/2 signaling pathway and proper transmission of intracellular information. However, mechanisms that control molecular dynamics within scaffolding complexes, as well as biological activities regulated by the specific assemblies, remain unclear.

The scaffold protein Shoc2 is critical for transmission of the ERK1/2 pathway signals. Shoc2 accelerates ERK1/2 signaling by integrating Ras and RAF-1 enzymes into a multi-protein complex. Germ-line mutations in shoc2 cause Noonan-like RASopathy, a disorder with a wide spectrum of developmental deficiencies. However, the physiological role of Shoc2, the nature of ERK1/2 signals transduced through this …

Multimodal Noncontact Diffuse Optical Reflectance Imaging Of Blood Flow And Fluorescence Contrasts, Daniel Irwin

Theses and Dissertations--Biomedical Engineering

In this study we design a succession of three increasingly adept diffuse optical devices towards the simultaneous 3D imaging of blood flow and fluorescence contrasts in relatively deep tissues. These metrics together can provide future insights into the relationship between blood flow distributions and fluorescent or fluorescently tagged agents. A noncontact diffuse correlation tomography (ncDCT) device was firstly developed to recover flow by mechanically scanning a lens-based apparatus across the sample. The novel flow reconstruction technique and measuring boundary curvature were advanced in tandem. The establishment of CCD camera detection with a high sampling density and flow recovery by speckle …

Intermittent Hypoxemia In Preterm Infants, Elie G. Abu Jawdeh

Theses and Dissertations--Clinical and Translational Science

Intermittent hypoxemia (IH) is defined as episodic drops in oxygen saturation (SpO₂). Virtually all preterm infants have IH events. Extremely preterm infants have hundreds of IH events per day. The extent of IH is not apparent clinically as accurately documenting cardiorespiratory events for day-to-day patient care management is challenging. High resolution pulse oximeters with 2 second averaging time are currently the ideal methods to measure IH. We have developed novel methods and processes to accurately and efficiently calculate an IH profile that reflects to spectrum of the problem.

The natural progression of IH is dynamic. There is low …

Evaluation Of A Peer Mentor Program On Adult Heroin Overdose Patients In The Emergency Department, Christina Schipper

DNP Projects

Abstract

PURPOSE: According to the Centers for Disease Control and Prevention (CDC), the rate of heroin use and heroin overdoses has greatly increased in the last decade, regardless of sex, age, race or income. The emergency department (ED) is a common place heroin users present, often as an overdose or due to a complication from their drug use. To address the current opioid epidemic, the CDC calls for increased access to substance abuse treatment services. Peer Mentors placed in the ED serve as a link for the patient to recovery services. The purpose of this study is to evaluate the …

The Effect Of An Educational Intervention On The Blood Culture Contamination Rate In Acutely Ill Adults, Kandace Vanhoozer

DNP Projects

PURPOSE: The purpose of this project was to assess the knowledge of nurses that collect blood culture specimens at University of Louisville Hospital and to implement an educational intervention among those nurses. It was expected that the educational intervention implemented for this project would increase nurses’ knowledge regarding the proper technique for blood culture specimen collection and decrease in the rate of contaminated blood cultures.

METHODS: This study included a prospective pre- and post-test of nursing knowledge followed by an educational intervention as well as a retrospective comparison of the pre- and post-education blood culture contamination rates.

RESULTS: Of the …

The Evaluation Of Advanced Practice Providers Practice Patterns And Delivery Of Care Models In The Specialty Practice Environment, Katherine W. Rogers

DNP Projects

Background: Advanced Practice Providers (APPs), specifically Nurse Practitioners (NP) and Physician Assistants (PA), have been utilized in healthcare for decades to improve access to care for patients. Norton Healthcare’s largest population of APPs is in specialty practices. The expansion of APPs into the medical group has been rapid and without evaluation of value and role identification.

Purpose: The purpose of this study is to evaluate Advanced Practice Provider (APP) practice patterns and care delivery models within specialty practices in a large medical group. The outcome of the study will help to identify trends in practice and areas where …

Does A Nonstandardized Lactulose Administration Practice Affect Hepatic Encephalopathy In Patients With Liver Disease In The Acute Care Setting?, Mary Broadbent

DNP Projects

PURPOSE: The purpose of this study is to examine whether inpatients with liver disease at University of Kentucky Hospital receiving lactulose are meeting the protocol of 2-4 bowel movements per day. Research shows that lactulose is the medication of choice used to treat and prevent hepatic encephalopathy (HE). Additional lactulose interventions, a patient’s MELD score, and GCS score will be examined in this study as well. This information would be beneficial to providers and nurses because it would provide data on patients who might require more lactulose interventions than others.

METHODS: Retrospective chart reviews of 70 inpatients with liver disease …

An Assessment To Determine The Need For A Palliative Care Team To Improve Patient Satisfaction And Decrease Healthcare Costs, Nathalie Weis

DNP Projects

Abstract

Objective: The purpose of this project was to determine if there is a need for a palliative care team (PCT) to which primary care medical professionals can refer patients. The specific objectives of this project were: 1. To assess the knowledge of primary care providers regarding palliative care. 2. To assess the value and need for palliative care from the PCPs’ perspective. 3. To evaluate the current ED utilization data for adults with serious chronic illness.

Methods: This was a descriptive study that involved an analysis of ED visit data for chronic illness, and a survey all …

Methods To Improve Interprofessional Collaboration In Administrative Dyads, Julie Lee Hudson

DNP Projects

Abstract

PURPOSE: The primary objective of this project was to determine if specific interventions, to include education, rounding, and regular meetings, improved collaboration and communication for nurse/physician dyads working in acute care hospital administrative roles.

METHODS: The study employed a prospective pre-test and post-test comparison of participants’ scores on a validated survey tool. This tool (JeffSATIC) measured perception of collaboration between nurses and physicians. The objective was to evaluate the differences in these scores in participants before and after an intervention.

RESULTS: This study sought to discover if specific interventions impacted scores on a tool measuring collaboration among dyad pairs. …

The Development Of Microfluidic Devices For The Production Of Safe And Effective Non-Viral Gene Delivery Vectors, Jason Matthew Absher

Theses and Dissertations--Chemical and Materials Engineering

Including inherited genetic diseases, like lipoprotein lipase deficiency, and acquired diseases, such as cancer and HIV, gene therapy has the potential to treat or cure afflicted people by driving an affected cell to produce a therapeutic protein. Using primarily viral vectors, gene therapies are involved in a number of ongoing clinical trials and have already been approved by multiple international regulatory drug administrations for several diseases. However, viral vectors suffer from serious disadvantages including poor transduction of many cell types, immunogenicity, direct tissue toxicity and lack of targetability. Non-viral polymeric gene delivery vectors (polyplexes) provide an alternative solution but are …