Medicine and Health Sciences Commons^™

A Novel Nonparametric Test For Heterogeneity Detection And Assessment Of Fluid Removal Among Crrt Patients In Icu, Shaowli Kabir

Theses and Dissertations--Epidemiology and Biostatistics

Over the past decade acute kidney injury (AKI) has been occurring among 20%-50% of patients admitted to the intensive care unit (ICU) in United States. Continuous renal replacement therapy (CRRT) has become a popular treatment method among these critically ill patients. But there are multiple complications in implementing this treatment, including discrepancies in practiced and prescribed fluid removal, possibly related to the heterogeneity among these patients. With mixture modeling there have been several techniques in detecting heterogeneity with their specific limitations. In this dissertation a novel nonparametric ‘d test’ will be used to detect heterogeneity among CRRT patients in ICU. …

Herstory: Women’S Professional Career Experiences In Sport Psychology, Rena M. G. Curvey

Theses and Dissertations--Educational, School, and Counseling Psychology

The purpose of this study was to explore women’s professional career experiences in sport psychology. Using qualitative methodology, seventeen female sport psychology practitioners participated in intensive semi-structured interviews from May 2021 to July 2021. This study resulted in two distinct manuscripts. First, guided by constructivist grounded theory methodology, embedded in a feminist standpoint framework, this study developed a grounded theory to help explain what sources attract and retain women in sport psychology. The developed theory includes the following main categories: sources of career attraction, training and professional development, and sources of career retention, and ten subcategories. This theory contributes to …

Art Education In Medical Education: Benefits And Challenges, Sara K. Brown

Theses and Dissertations--Art and Visual Studies

Humanity is synergistic with art and medicine. Likewise, art education can be impactful throughout medical education. Art as a tool to develop the next generation of healthcare differs from the clinical goals of creative art therapies. Over the prior decade, many medical schools now provide curricular offerings in the arts and humanities. Less is known about the application in postgraduate medical settings. The focus of this thesis is to review the pairing of artist-educators with postgraduate medical training programs.

One such program is ArtsCAFE (Arts Connect Around Food and Enrichment), an intercollegiate project fusing experienced arts educators with medical educators …

Identifying Bisphosphonate Protein Biomarkers In Equine Sera Using Mass Spectrometry Methods, Malinda Jayne Alison Porter

Theses and Dissertations--Veterinary Science

Bone resorptive diseases affect humans and horses, alike. Examples of these diseases include osteoporosis, Paget’s disease, and osteogenesis imperfecta in humans, and navicular disease in the horse (Mitchell et al., 2019; Suva et al., 2021). Bisphosphonates are used to treat these diseases, and may remain in the bone for several years after administration, demonstrating the need for newer drug testing methods.

The purpose of the discovery phase of this study was to use blood samples of in-training horses which had been given an initial administration of the bisphosphonate tiludronate and identify protein biomarkers that changed in response to this class …

Investigating The Uncertainties In Ct Non-Small Cell Lung Cancer Radiomics, Gary Ge

Theses and Dissertations--Radiation Medicine

Radiomics is a technique that extracts quantitative features, termed radiomic features, from medical images using data-characterization algorithms. These radiomic features can be used to identify tissue characteristics and radiologic phenotyping that are not observable by clinicians in a non-invasive, low-cost manner, potentially generating image biomarkers for clinical decision. To date, there are still many uncertainties involved in radiomics which limit its clinical implementation. Herein, we propose to explore the impact of each component in the radiomics pipeline on predicting clinical outcomes. In Chapter II, we conduct a thorough review of CT lung cancer radiomics studies to examine the typical feature …

Attentional Bias, Inhibitory Control, And Food Reinforcement As Mechanisms Promoting Eating Behavior After Exercise, Kylie F. L. Mcfee

Theses and Dissertations--Nutrition and Food Systems

Background: Excess weight and obesity are serious health conditions characterized by modifiable and nonmodifiable risk factors. Exercise is a common method for achieving weight loss; however, results are not always achieved due to post-exercise compensatory behaviors. Increased energy intake (EI) is thought to be the main compensatory behavior hindering weight loss among overweight and obese adults. It is important to determine and understand the mechanisms behind energy compensation following exercise, as this will allow for the discovery of future interventions that may provide individuals with ways to improve exercise as a weight loss treatment.

Objective: To determine if a single …

Maximal Strength Training Increases Metabolic Energy Expenditure In Sedentary Adults Classified As Obese, Robert E. Anderson Iii

Theses and Dissertations--Nutrition and Food Systems

Background: Metabolic adaptations reduce resting and non-resting energy expenditure to account for approximately 120 kcal/day. Weight loss promotes greater skeletal muscle efficiency, reducing the energy cost of physical activity and is correlated with declines in skeletal muscle glucose oxidation. Maximal Strength Training (MST) has the potential to upregulate glucose utilization and may offset these metabolic adaptations. Objective: To determine if MST offsets markers of metabolic adaptation by increasing resting and non-resting energy expenditure in sedentary individuals classified as obese. Methods: Five (5) participants (2 females, 3 males), ages 18-35 years, with obesity (BMI 30–45 kg/m2) were enrolled in an 8-week …

Nutritional Status In Critical Care Of Covid-19 Patients, Dolph Lewis Davis Iii

Theses and Dissertations--Nutrition and Food Systems

Critical care nutrition is a poorly researched, and such a sudden pandemic event requiring manipulation of nutritional status via propofol-induced sedation for mechanical ventilation is potentially impactful on patient outcomes. This paper seeks to provide context to the impact of critical care protocols on the nutritional status of obese patients suffering from COVID-19.

An Examination Of Three Transitional Events In The Substance Misuse Trajectories Of Women With Criminal Legal System Involvement, Martha Tillson

Theses and Dissertations--Sociology

Research has consistently demonstrated that criminal legal system (CLS)-involved women are distinct from men in initiation and course of drug use, with important differences on biological, environmental, and sociocultural levels. Thus, the unique pathways and transitions into and out of drug use for women with CLS involvement are critical to consider from a research perspective, but also from a need to develop and support evidence-based, women-centered services in correctional contexts. This dissertation project uses a three-paper format to investigate three aims: (1) to understand CLS-involved women’s initiations to injection drug use and their experiences providing injection initiation assistance (IIA) to …

An Investigation Of Hhv6'S Impact On The Cognitive Progression And Microglial Changes In An Alzheimer's Disease Cohort, Charles E. Seaks

Theses and Dissertations--Physiology

The role of herpesviruses and, more specifically, HHV6 in the development of Alzheimer’s disease (AD) and associated cognitive decline is still being investigated. High ubiquity and prevalence in the population have led to a high degree of skepticism about HHV6 as a potential contributor to cognitive decline and dementias. However, recent evidence related to another herpesvirus, herpes simplex virus 1, suggests that reactivation, not carriage, of the virus may be the key factor to explain the dissonance between the virus’ ubiquity and contributions to dementias. With that in mind, we set out to assess cases from the Sanders-Brown Center on …

The Effects Of Cannabidiol On Senior Equine Health, Shelley Turner

Theses and Dissertations--Veterinary Science

Cannabis sativa L., has been revealed to produce hundreds of phytocannabinoids, of which cannabidiol (CBD) is one of the most desired. It has been revealed that CBD can potentially treat inflammation and act as an analgesic in humans without psychoactive effects of delta-9-tetrahydrocannabinol (THC). Recently, there has been interest in understanding the potential health benefits of CBD for horses. With an increasing senior horse population (< 15 years old), alternatives to the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone, firocoxib, and flunixin meglumine, are desired as these common anti-inflammatory treatments have negative side effects. Because senior horses may have chronic low-grade inflammation, termed inflamm-aging, they are a natural model to investigate the efficacy of CBD on inflammatory responses as well as other health parameters. Given this interest, and due to the lack of research conducted on CBD in the horse, the overall objective of this dissertation work was to conduct both basic and applied research investigating the effects of CBD on equine immune function and health. The first objective was to determine the in vitro effects of CBD as an anti-inflammatory. Peripheral blood mononuclear cells (PBMCs) from senior horses were cultured in vitro with increasing concentrations of pure CBD dissolved in dimethyl sulfoxide (DMSO). These cells were …

Defining Patient Cohorts For Guiding Clinical Trials And Treatment In Lafora Disease: A Model For The Rare Disease Community, Katherine Janae Donohue

Theses and Dissertations--Molecular and Cellular Biochemistry

In the US, approximately 8000 rare diseases have been identified. Combined, rare diseases impact more than 30 million people in the U.S. alone, with 75% of those being children. However, research, funding, and therapeutic development for the rare disease community remains challenging because of the incredible diversity – not only between diseases, but often even within a single disease.

LD is an ultra-rare childhood dementia and epilepsy caused by mutations in one of two driver genes: EPM2A, which encodes for the glycogen phosphatase laforin, and EPM2B/NHLRC1, which encodes the E3 ubiquitin ligase malin. Children with LD …

Bolstering The Effectiveness Of Exposure-Response Prevention In The Treatment Of Obsessive-Compulsive Disorder: Using Self-Compassion As An Adjunctive Intervention, Whitney E. Dyer

DSW Capstone Projects

Individuals suffering with Obsessive-Compulsive Disorder (OCD) face many challenges receiving proper diagnostics and evidence-based treatment. Furthermore, Exposure-Response Prevention (ERP), the empirically supported gold standard approach for targeting OCD, presents its own challenges. Examining the influences of ERP treatment reluctance is paramount to bolstering the effectiveness of outcomes and safeguarding participant adherence and ultimate success. This Capstone highlights the overlooking of addressing shame within traditional ERP protocol and posits a practice application model that supports the adjunctive use of self-compassion, a potent antidote for shame, within the use of ERP. As treatment hesitation is an inhibitor to relief for OCD sufferers, …

The Role Of Organizational Leaders In Employee Self-Care: A Change Management Approach, Olivia Dawn Honaker

DSW Capstone Projects

Although literature demonstrates that helping professionals have had high levels of stress and burnout for decades, the COVID-19 pandemic has only exacerbated the issue. The already burdened healthcare workers, now facing increased workloads, long hours, and high-level exposure to trauma, have created an urgency to address this significant risk to helping professionals. The current capstone will bring awareness to organizational leaders regarding the importance of employee self-care and the benefits of implementing employee self-care programs. First, a systematic literature review will examine self-care in helping professions and explore how organizational leaders operationalize employee self-care programs. In addition, the capstone aims …

A Pathway For Inclusive Innovation In Pediatric Mental Health: Prevention And Intervention Using Technology, Kate Corinne Bennett

DSW Capstone Projects

It is no secret that access to quality healthcare is difficult for citizens to achieve in the United States. Racism, discrimination, and oppression further exist at the root of compounding social problems, including limits in minority access to mental health services. The COVID-19 pandemic has also exacerbated mental health problems for young children, especially those who are already underserved and at risk. For these reasons, it is imperative that the social work profession emphasizes innovative approaches to equitable treatment access, including a focus on early intervention and the use of technology. Product one of this capstone engages a systematic review …

Policy Change To Reduce Active Duty Suicide Rates, Michelle Rae Loper

DSW Capstone Projects

There continues to be a dramatic increase in the rates of suicide within the Active-Duty military population. There have been a number of efforts to curb the rates without any prolonged success. Several actions and studies have been conducted on risk factors, prevention efforts, and treatment interventions in an attempt to reduce the rates. This capstone comprises a sequence of academic papers: a systematic literature review, a conceptualization paper, and a practical application paper. This project aims to identify the essential policy components necessary moving forward within the Department of Defense to address this critical issue. The research question leading …

Self-Care And Cultural Humility: Expanding The Practice Of Social Work Leaders, Donia Addison

DSW Capstone Projects

Social workers experience vicarious trauma, secondary traumatic stress, and compassion fatigue regularly. Well documented in the literature, self-care has the ability to assuage these negative consequences, as well as, positively impact retention rates, decrease burnout and increase the quality of services provided to clients. Despite a burgeoning of research on self-care and burnout over the last few decades, continued empirical research is necessary. This capstone project sought to add to the knowledge base on self-care and provide pragmatic recommendations for future research and social work practice.

This capstone project was comprised of three scholarly products and focused on fostering cultural …

The Underlying Issue: Acknowledging The Impact The Race-Based Bias Of Some White Teachers Poses For Black Adolescents, Cerenity Leavell-Barker

DSW Capstone Projects

Current literature fails to assess the race-based bias of some white teachers and its impact on the school-to-prison pipeline. The actions of some white teachers due to unconscious or conscious race-based bias can increase race-based stress experienced by Blacks students and lead to racial trauma. Racial trauma is a traumatic experience that can alter this stage of development and have significant impact on the academic achievement of Black adolescents and influence behaviors perceived as negative. The purpose of this capstone is to enhance awareness and knowledge on the traumatic impact the race-based bias of some white teachers poses for Black …

Decreasing Anxiety, Depression, And Suicidal Ideation Through The Implementation Of Education And Screening At Chandler Medical Center, Ashley Gillstrap

DNP Projects

PURPOSE: To provide education on high suicide rates within the healthcare community, screen providers for suicide risk factors, and disseminate mental health resources at the University of Kentucky Chandler Medical Center (UKCMC). The goal of this intervention is to increase awareness and provide resources to providers to essentially decrease these suicide rates.

METHODS: A randomized controlled trial was used with a non-equivalent group pretest-posttest survey design to examine the effect of an education module about suicide risk factors. Along with a rating of how COVID-19 affected mental health, a Patient Health Questionnaire 9 (PHQ-9) was implemented, and mental health resources …

Estrogen Regulation Of Daily Metabolic Rhythms In Female Mice, Oluwabukola Omotola

Theses and Dissertations--Biology

Circadian rhythms are approximately 24-hour cycles of behavior, physiology, and gene expression. In mammals, these circadian rhythms are generated by clocks located in nearly every tissue in the body. The function of circadian clocks is to synchronize physiology and behavior with environmental cycles such as the light-dark cycle. After menopause, when circulating levels of estrogens are very low, women are more susceptible to obesity comorbidities such as metabolic syndrome and cardiovascular disease, suggesting that estrogens regulate these processes. Estrogens could protect females from metabolic dysfunction by regulating circadian rhythms. Consumption of diets that are high in fat contribute to obesity. …

Novel Mechanism Of Endogenous Pancreatic Cancer Cell Expression Of Immune Checkpoint Programmed Cell-Death 1 Protein (Pd-1) Inducing Epithelial-To-Mesenchymal Transition (Emt) Through The Met Pathway And Promoting Cancer Progression In An Immune-Independent Process, Megan M. Harper

Theses and Dissertations--Clinical and Translational Science

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers with few treatment options, necessitating an urgent need for novel therapeutics. Immuno-oncologic (IO) therapies have revolutionized anti-cancer regimens in the past decade but typically involve reactivation of adaptive immune responses. In particular, immune checkpoint PD-1 is traditionally expressed only on immune cells while PD-L1 (PD-1 ligand) is overexpressed on cancer cells. When tumor-endogenous PD-L1 binds the PD-1 receptor on T-cells, the immune cells undergo anergy resulting in self-tolerance and cancer cell immune evasion. However, contrary to standard dogma, we previously demonstrated tumor-endogenous PD-1 expression in PDAC. Our data indicated that …

Evaluation Of Middle School Teachers Knowledge, Attitudes, And Barriers Pertaining To Adapted Youth Mental Health First Aid For Middle School Students, Lauren Hurley

DNP Projects

Background: An estimated 17.1 million youth have experienced a mental health disorder, more than the number of children with cancer, diabetes, and AIDS combined (National Council for Behavioral Health, 2016). Unfortunately, of those children with a diagnosable condition, only a third receive mental health treatment (National Council for Behavioral Health, 2016). If a child or adolescent’s mental health disorder is left untreated, then unresolved issues may continue to affect them as adults, creating physical and mental health impairments, that could potentially have a negative impact on their futures. Youth Mental Health First Aid (YMHFA) is an evidenced-based training program that …

Exploring Palliative Care Education Needs And Desires Of Advanced Practice Providers In The Critical Care Setting, Jill Marie Clemmons

DNP Projects

Background: Critical care providers in the ICU setting are discovering that their patients are living longer with more comorbid conditions. They are confronted with palliative care situations almost daily. Recently palliative care has been thrust into the forefront of critical care and is a resource critical care nurse practitioners and physicians’ assistants need to be able to utilize. A gap in the literature has been found in the overall education of critical care providers regarding palliative care.

Purpose: The purpose of this study was to determine what palliative care training trauma/cardiac/neurological, and pulmonary critical care providers had previously received …

Classification And Effect Of Correctors On Sitosterolemia-Associated Mutants In Abcg8, Brittney Poole

Theses and Dissertations--Medical Sciences

Objective: To classify mutants of ABCG8 identified in subjects with clinically confirmed Sitosterolemia, a rare form of Familial Hypercholesterolemia distinguished by the accumulation of phytosterols in plasma and tissues and determine the effects of correctors and/or regulators of proteostasis on maturation of the ABCG5/ABCG8 sterol transporter.

Methods: Disease-causing missense mutants within the cytosolic domain of ABCG8 were generated through site-directed mutagenesis. Normal and mutant proteins were expressed in human hepatocytes. Cellular proteins were prepared, and maturation was assessed by SDS-PAGE and immunoblotting. Formation of the higher molecular weight, mature form of glycoproteins was used as a bioassay for trafficking the …

Establishment And Verification Of A Sars Cov2 Antibody Detection Assay Comparing Venous And Mitra Samples, Stephen C. Mayer

Theses and Dissertations--Medical Sciences

During the COVID-19 pandemic in 2020, the need for highly-specific, wide-spread, and rapid serological testing surged. In this study, we showed very strong positive correlation between venous blood collection and Mitra home sampling kits for the detection of anti- spike IgGs using an in-house ELISA protocol (based on a protocol from Mt. Sinai). This study demonstrates the utility of using at-home, patient-centric testing to enhance the sero-surveillance methods currently in place for viral tracking and monitoring.

Investigating The Effects Of In-Vivo Therapeutics Hypoxia Treatment Paradigms In Neurite Outgrowth Patterns, Jae Hyun Yoo

Theses and Dissertations--Medical Sciences

Spinal cord injury, specifically in the cervical C3-C4 region of the cervical spine, contributes to impaired breathing and a diminished quality of life. Therefore it is important to find effective and safe therapeutics to restore breathing function. Indeed, there are a myriad of research being performed in addition to valuable collaboration amongst different institutions. As such, inspired by a previous experiment, we decided to test our hypothesis that an enriching environment consisting of different hypoxic environments - sustained and intermittent hypoxia alongside normoxia - would result in neurite outgrowth. Moreover, we hypothesized that sustained hypoxia would result in the greatest …

Mammalian Target Of Rapamycin Cell Signaling Pathway In Phosphatase And Tensin Homolog Induced Kinase 1 Knockout Rat Model Of Familial Parkinson's Disease, Martha Helena Mortell

Theses and Dissertations--Medical Sciences

More than 10 million people are living with Parkinson’s disease (PD), one million of which are people in the United States. PD is the second most common age-related neurodegenerative disorder, after Alzheimer’s disease, and is characterized by the accumulation of a-synuclein aggregates and the degeneration of dopaminergic neurons. The loss of endogenous dopamine in PD brain accounts for the motor decline presented clinically in PD patients. Etiological factors of PD include oxidative damage and inflammation, although the detailed mechanisms remain unknown. Risk factors for PD include gender, age, environmental factors, and gene mutations.

The current thesis research employed phosphatase and …

Learner Outcomes From An Echo In Augmentative And Alternative Communication, Lillie Reinhart

Theses and Dissertations--Communication Sciences and Disorders

Background: Students with complex communication needs (CCN) rely on the use of augmentative and alternative communication (AAC) to support their communication; however, many students are leaving high school without an effective form of communication. To build capacity and increase school professionals’ knowledge and self-efficacy in AAC, this thesis used an adaptation of Project ECHO (Extension for Community Healthcare Outcomes) for use with AAC.

Methods: Using a post then pre-retrospective survey, participants self-reported changes in knowledge, confidence, and overall satisfaction with ECHO sessions. Paired sample t-tests assessed participant-reported change in knowledge. Frequency counts were used to analyze responses about confidence and …

Apoe Genotype And Sex Modulate Ketogenic Diet Enhancements To Metabolism And Gut Microbiome In Young Mice, Andrew T. Yackzan

Theses and Dissertations--Medical Sciences

The apolipoprotein ε (APOE) allele in humans has been associated with risk for development of Alzheimer’s disease (AD). There are predominately three variations of the allele – ε2 (E2), ε3 (E3), and ε4 (E4) – with E4 contributing the greatest risk of AD development. Recent research has unveiled evidence of neurometabolic and neurovascular deficits in E4 carriers present decades before the onset of dementia; it is believed these chronic defects play a major role in the development of AD, thus making them a potential target for preventative intervention. The purpose of this study was to examine the effect of a …

Trem2: Gene Expression And Role In Alzheimer’S Disease, Henry Snider

Theses and Dissertations--Medical Sciences

Genetic mutations in the TREM2 gene are highly correlated with risk of Alzheimer’s disease, but alternative splicing patterns of TREM2 transcripts have not been fully described. Characterization of TREM2 alternative splicing will be of significant use to the scientific community as the field of Alzheimer’s disease research progresses. The goal of this study was to fully describe splicing patterns in TREM2, as different splicing isoforms of genes can alter express and/or function of the final protein. Human blood and anterior cingulate cortex brain tissue from 61 individual donors was processed and used for PCR and quantitative PCR as well as …