Medicine and Health Sciences Commons^™

Nurses' Knowledge Of Eating Disorders, Carly S. Price

Undergraduate Honors Theses

Eating Disorders are a range of disorders marked by abnormal eating habits. These habits can often have a detrimental effect on the body and have the potential to complicate acute medical problems if they are a pre-existing condition. Due to this, it is important that members of the healthcare team be aware of the nature of these disorders from both a physical and mental health perspective in order to provide the best, most holistic care. In this study, individuals with nursing experience in acute medical and acute psychiatric care were asked 11 questions concerning the assessment and knowledge of eating …

Cd4 T Cell-Derived Ifn-Γ Plays A Minimal Role In Control Of Pulmonary Mycobacterium Tuberculosis Infection And Must Be Actively Repressed By Pd-1 To Prevent Lethal Disease, Shunsuke Sakai, Keith D. Kauffman, Michelle A. Sallin, Arlene H. Sharpe, Howard A. Young, Vitaly V. Ganusov, Daniel L. Barber

United States Public Health Resources

IFN-γ–producing CD4 T cells are required for protection against Mycobacterium tuberculosis (Mtb) infection, but the extent to which IFN-γ contributes to overall CD4 T cell-mediated protection remains unclear. Furthermore, it is not known if increasing IFN-γ production by CD4 T cells is desirable in Mtb infection. Here we show that IFN-γ accounts for only ~30% of CD4 T cell-dependent cumulative bacterial control in the lungs over the first six weeks of infection, but >80% of control in the spleen. Moreover, increasing the IFN-γ–producing capacity of CD4 T cells by ~2 fold exacerbates lung infection and leads to the early death …

The Emergence Of Systematic Review In Toxicology, Martin L. Stephens, Kellyn Betts, Nancy Beck, Vincent Cogliano, Kay Dickersin, George Gray, +8 Additional Authors

Environmental and Occupational Health Faculty Publications

The Evidence-based Toxicology Collaboration hosted a workshop on “The Emergence of Systematic Review and Related Evidence-based Approaches in Toxicology,” on November 21, 2014 in Baltimore, Maryland. The workshop featured speakers from agencies and organizations applying systematic review approaches to questions in toxicology, speakers with experience in conducting systematic reviews in medicine and healthcare, and stakeholders in industry, government, academia, and non-governmental organizations. Based on the workshop presentations and discussion, here we address the state of systematic review methods in toxicology, historical antecedents in both medicine and toxicology, challenges to the translation of systematic review from medicine to toxicology, and thoughts …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc, Hildi J. Hagedorn, Randall Brown, Michael Dawes, Eric Diepernick, Donald Myrick, Elizabeth M. Oliva, Todd H. Wagner, Jennifer P. Wisdom, Alex Harris

Health Policy and Management Faculty Publications

Background: Only 7.8% of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation components. …

Interrupted Aortic Arch Complicated With Takotsubo Cardiomyopathy Mimicking Aortic Dissection, Farhala Mari Baloch, Javed Majid Tai, Aamir Hameed, Abdul Baqi

Section of Cardiology

A 50-year-old man presented to the emergency department with interscapular pain, diaphoresis and restlessness. Initial examination raised the possibility of aortic dissection; however, the CT scan did not concur with the diagnosis. An ECG showed ST segment elevation in leads V1-V6 and echocardiography showed severe left ventricular systolic dysfunction. Coronary angiography through the right femoral artery was attempted but the diagnostic catheter could not be advanced to the ascending aorta. Radiocontrast injection showed complete obstruction of the descending aorta. Coronary angiography through right radial approach showed mild left anterior descending disease. The aortogram showed complete interruption of the ascending aorta …

Studies On The Prevalence And Control Of Parasitic Helminths In "Natural" Laying Hens, Brittany R. Weir

Animal Science Undergraduate Honors Theses

One societal trend that has been gaining much traction and popularity since the 21^st century began is “organic” and/or “natural” food products. In 1999, the global market accounted for $15.2 billion dollars worth of organic food and drink, compared to the market in 2014 where we consumed $80 billion dollars worth (Willer et. al, 2016). With “natural” production of food animals however, “natural” parasite transmission may be a consequence. To that end, this experiment examines the prevalence of helminths in 110 “natural” laying hens from three regional farms and the efficacies of fenbendazole, piperazine, and levamisole on what should …

Aging American Prisons: Length Of Stay, Dying Behind Bars, And Implications For Public Health, Stephanie G. Barger

Sociology and Criminology Undergraduate Honors Theses

One notable consequence of mass incarceration is the growing population of elderly prison inmates in the U.S. This growth raises questions concerning the causes and implications of such a change, as housing older prisoners places a financial strain on state and federal correctional systems. Because this added cost is largely a result of medical needs, the growing elderly inmate population has raised questions about the impact of incarceration on health. This study investigates the causes of this “graying” of American prisons and its potential effects on correctional and community health. Using National Corrections Reporting Program data from 1990 to 2009, …

Current State Of Opioid Therapy And Abuse, Laxmaiah Manchikanti, Adam M. Kaye, Alan David Kaye

School of Pharmacy Faculty Articles

Currently, there is growing tension between the twin challenges of opioid therapy for chronic pain and adverse consequences of abuse, leading to multiple complications including respiratory failure and death. The recent data from Centers for Disease Control and Prevention (CDC) have shown continued escalation of prescription opioid use with opioid overdose deaths topping all previous estimations. Numerous policy initiatives, advisories, and guidelines have been advanced through the years to control the opioid epidemic. The strategies to prevent opioid abuse and to maintain opioid therapy when medically necessary fall into primary and secondary prevention categories. The primary prevention category is extremely …

Assessing Cultural Competence In A Mental Health Outpatient Facility., Alexis N. Keen Crook

Electronic Theses and Dissertations

Cultural competence is a concept that has been thoroughly investigated in healthcare, but there is a dearth of literature and research on this topic as it pertains to mental health services. In healthcare, research has shown that a lack of cultural competence is directly linked to high levels of misdiagnoses, mistrust of healthcare and professionals, and overall poor health in minority populations. Using the Campinha-Bacote model for cultural competence in health care, I explore how cultural competence is defined and operationalized in an outpatient mental health facility. I hypothesize that, similar to research addressing cultural competency in healthcare systems, cultural …

Impact Of Epigallocatechin-3-Gallate (Egcg), A Broad-Spectrum Anti-Inflammatory, In Controlling Intestinal Factors Contributing To Inflammatory Bowel Disease., Gerald Wayne Dryden, Jr.

Electronic Theses and Dissertations

This dissertation explores the role of epigallocatechin-3-gallate (EGCG), as a potential treatment for patients with inflammatory bowel disease (IBD). IBD is a common disorder that causes a great deal of suffering. Our understanding of the etiologies, pathogenic mechanisms, and treatment targets continues to evolve. Many new therapeutic targets are making their way through the pharmaceutical pipelines. However, not all patients benefit from these therapies. EGCG has long been studied as an anti-cancer agent. Most of our understanding of this compound comes from the oncologic literature. As the pathways of oncology and inflammation converge, new lessons can be taken from the …

Objective Evaluation Of Clinical Shade-Matching Outcomes., Erin Ballard

Electronic Theses and Dissertations

The purpose of this study was to objectively evaluate shade-matching outcomes within an academic institution. Using the Spectrophotometer, E was calculated between the reference shade: restoration shade () and restoration shade: prescription shade (). The t-test was used to determine if E maintained clinical acceptance at E: 3.7. Satisfaction with shade-match and need for objective measurement were surveyed using a Five Point Likert Scale. Correlational relationships were assessed via Pearson Correlation. Mean E values were above the acceptance value (pppp

Leveling The Playing Field Through Partnerships And Collaboration : Neighborhood Revitalizations And The Influence Of Social Determinants Of Health And Institutional Logics., J. M. Bohn

Electronic Theses and Dissertations

A qualitative study guided by grounded theory was on a Midwest US city (population > 50,000 people), three of its inner city neighborhoods, and community coalition and partnership efforts in neighborhood revitalizations. A two-phase semi-structured interview methodology assessed interviewees’ experiences in initiatives focused on improving social determinants of health in the neighborhoods. Phase I interviews (n= 11) identified the spectrum of partnerships and initiatives while Phase II interviews (n=28) captured detailed experiences of interviewees. Inter-institutional systems and institutional logics theory were applied in the post-data collection analysis. Interviewees were from public and private sectors including: built environment, economic development, residential/commercial property …

Cell-Based Therapies For Ischemic Cardiomyopathy : Investigations Of Intramyocardial Retention And Safety Of High Dose Intracoronary Delivery Of C-Kit Positive Cardiac Progenitor Cells, And Therapeutic Utility Of A Novel Population Of Cardiac Mesenchymal Stem Cells Expressing Stage-Specific Embryonic Antigen-3 (Ssea-3)., Matthew C. L. Keith

Electronic Theses and Dissertations

Over the last decade attempts at reducing morbidity and mortality of patients with chronic heart failure have been made via the development and implementation of novel cell based therapies. Substantial advances in cell based therapies with indications of efficacy have been shown along with a robust safety profile. Despite these advances, there is a substantial unmet need for novel therapies, specifically addressing repair and regeneration of the damaged or lost myocardium and its vasculature. Accordingly, cardiac cell-based therapies have gained attention. Various cell-types have been utilized, including bone marrow-derived mononuclear cells, bone marrow-derived mesenchymal stem cells, mobilized CD34⁺ cells, …

Positive Deviance, Contraceptive Self-Efficacy And Social Desirability In Sexually Active Adolescent Females : A Mixed Methods Approach., Ashley D. Miller

Electronic Theses and Dissertations

Unintended pregnancy is an issue that impacts women of all ages, ethnicities, and socioeconomic statuses. It also impacts the child that results and the society in which they live. In the United States, adolescents experience unintended pregnancy more than adolescents in other countries. The purpose of this dissertation was to explore the factors that contribute to successful contraceptive use among adolescent females (ages 13-18) seeking reproductive health services at a local family planning clinic. The theoretical framework of contraceptive self-efficacy (CSE) was used to frame this understanding. The exploration was conducted in three ways: a critical review of the literature …

Role Of Phosphodiesterase-4 In Alcohol-Induced Organ Injury., Diana Veronica Avila

Electronic Theses and Dissertations

Alcoholic liver disease (ALD) remains a leading cause of death from liver disease in the U.S., and there is still no FDA-approved therapy. Alcohol metabolism leads to generation of free radicals and oxidative stress with a resultant formation of lipid peroxidation products, which, in turn, contribute to the development of ALD. Alcohol induced hepatic steatosis is the earliest and most frequent manifestation of ALD and a significant risk factor for progressive liver disease. Cyclic adenosine monophosphate (cAMP) signaling has been shown to significantly regulate lipid metabolism. Moreover, agents that increase cAMP have been shown to effectively mitigate oxidative stress both …

The Influence Of Mir-99a On Mtor Signaling Regulation In Colorectal Cancer Cell Lines., Jonathan Rice

Electronic Theses and Dissertations

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of death. These are staggering statistics for a disease that can essentially be cured if caught early and the pathology is favorable to therapeutic intervention. There is currently a drastic decrease in five year survival as the cancer stage increases from locally confined disease to metastatic disease. These statistics suggest that although some strides have been made with colon cancer screening and early intervention, there is still much room for improvement in both screening and treatment of CRC. One of the pathways that have …

Environmental Vegetation : A Possible Association With Cardiovascular Disease Risk., Ray Anthony Yeager Ii

Electronic Theses and Dissertations

The built environment affects numerous aspects of human health and wellbeing, including risk of cardiovascular disease (CVD), the leading cause of morbidity and mortality in both the U.S. and worldwide. The amount and quality of environmental vegetation, is an important aspect of the built environment that affects known CVD risk factors, including psychosocial stress, health behaviors, and exposure to air pollutants. Nevertheless, little evidence on the role of potential mechanisms and geographic scale in these relationships exists. Of previous studies that describe associations between vegetation and CVD outcomes, limited investigation has been performed to assess these observed relationships in differing …

The Influence Of Nutrition Education And Self-Efficacy On Fruit And Vegetable Consumption For Low-Income Women In Rural West Kentucky., Lewatis Darnell Mcneal

Electronic Theses and Dissertations

Objective: To examine how participation in nutrition education programs, self-efficacy to consume fruit and vegetables and predictor of behavior to eat health foods (POB) influences the consumption of fruit and vegetables for low-income women in west Kentucky eligible or participating in federal supplemental nutrition assistance programs. Methods: A comparative study was conducted between low-income women participating in Special Supplemental Nutrition Assistant Program for Women and Children (WIC) and those eligible for SNAP but were not participating. The study examined consumption in six categories of fruit and vegetables, self-efficacy to consume fruit and vegetables, predictor of behavior to eat healthy foods …

Modification Of T9ss Cargo Proteins Of Porphyromonas Gingivalis For Their Secretion In Soluble Form And Purification By Affinity Chromatography., Apoorv Goel

Electronic Theses and Dissertations

Background: Porphyromonas gingivalis, a keystone-pathogen associated with periodontitis, utilizes the Type IX Secretion System (T9SS) to secrete proteins bearing the conserved C-terminal domain (CTD), many of which are essential virulence factors. These include, besides gingipains and PPAD, 29 other proteins. During or after the outer membrane translocation the CTD is cleaved off and a glycan moiety is covalently attached anchoring the secreted proteins at the bacterial cell surface. Objective: Most of the CTD bearing proteins have only hypothetical functions assigned. It is plausible that these CTD bearing proteins may also play a crucial role in P. gingivalis pathogenesis. Therefore, …

Tobacco-Gene Activity Profile In Porphyromonas Gingivalis, Filifactor Alocis And Treponema Denticola., Neelima Chowdary Cherukumalli

Electronic Theses and Dissertations

Smoking is an established risk factor for periodontitis. Prior studies have shown that cigarette smoke extract (CSE) can induce profound phenotypic changes in Porphyromonas gingivalis and alters the virulence of this important periodontal pathogen. We hypothesized that CSE might also alter gene expression in established periodontal pathogens, Porphyromonas gingivalis and Treponema denticola, as well as in the emerging pathogen, Filifactor alocis. Oral bacteria were grown in CSE-conditioned medium (1000 ng/ml nicotine equivalents) or in unconditioned control medium. Total RNA was extracted and CSE-regulated genes were identified by comparison of the mRNA profiles of CSE with control cultures using RNA-Seq …

The Impact Of Medicaid Expansion On Utilization Of Mental Health Services In West Louisville, Kentucky., Susan Theresa Buchino

Electronic Theses and Dissertations

Mental health is an essential component of overall health status, and mental illnesses are a leading cause of disability. In addition to expanding insurance coverage, the Affordable Care Act (ACA) reinforced parity for mental health services in insurance plans. This mixed-methods study assessed mental health service utilization by an urban and predominately African-American population following the successful implementation of the ACA and Medicaid expansion in Louisville, KY. Claims data from one Medicaid Managed Care Organization were analyzed to assess mental health care utilization patterns pre- and post- Medicaid expansion and determine differences in utilization rates between the Medicaid expansion population …

Identification Of Predictors And Moderators Of Weight-Related Behaviors In College Students., Heather Owens

Electronic Theses and Dissertations

College students are at increased risk for weight-gain and obesity compared to their non-student peers. Although many studies have confirmed these findings, few address the underlying causes of weight-related behaviors in college students. Associations between sleep behaviors (sleep duration and sleep quality), stress and weight-related behaviors (physical activity and food choices) have been identified, but studies have not adequately explored these associations among college students. Further, the influence of bioecological determinants of health cannot be overlooked when addressing health-related behaviors in diverse populations. The purpose of this dissertation was to explore factors impacting sleep behaviors and weight-related behaviors in college …

Examining The Motivations And Benefits Of Student-Athletes Performing Community Service., Matthew Ryan Huml

Electronic Theses and Dissertations

With over 460,000 active student-athletes (NCAA, n.d.), the student sub-population is large enough to investigate potential options for institutions to increase their academic achievement. Additionally, participating in academic-related activities is especially important because of concerns about student-athletes spending more than the 20 hours per week the NCAA allows for working on their sport (Wolverton, 2008). Studies frequently highlight a lack of effort by student-athletes to adjust to academic opportunities and expectations within higher education (Adler & Adler, 1991; Lally & Kerr, 2005; Levine, Etchison, & Oppenheimer, 2014; Miller & Kerr, 2003). To combat this adjustment to higher education, community service …

Porphyromonas Gingivalis Gingipains Induce A Pro-Inflammatory Extracellular Microenvironment : The Role Of Par-2 And Fibronectin., Jeffrey S. Marschall

Electronic Theses and Dissertations

Periodontitis is a chronic inflammatory disease that is characterized by severe tissue destruction of the gingiva and other tooth supporting structures; if left untreated, tooth loss and disintegration of the alveolar bone occurs. This chronic inflammatory state has been linked to other systemic diseases such as cardiovascular disease, diabetes, rheumatoid arthritis, and Alzheimer’s disease. Porphyromonas gingivalis is the major pathogenic microbe in periodontitis. The main virulence factors of P. gingivalis are the Arg-aa and Lys-aa gingipains, which are proteolytic enzymes implicated in a plethora of activities that allow P. gingivalis to subvert the human immune system in the oral cavity …

Abin1 In The Pathogenesis Of Glomerulonephritis And The Novel Polocyte-Neutrophil Proinflammatory Axis., Erik Anderson Korte

Electronic Theses and Dissertations

Glomerulonephritis (GN) is the most common cause of end-stage renal disease worldwide and is characterized by deposition of immune complex, inflammation, proteinuria and podocyte damage. Immunosuppressive therapy is effective in less than 50% of patients, indicating that immunological activity is not the only relevant cause of kidney injury. While methods have been described for neutrophil-mediated immune activation, specific glomerular mechanisms for recruitment of neutrophils and development of GN have not been determined. Here I present a pathogenic mechanism for the development of GN involving a novel podocyte-neutrophil axis and reveal the importance of glomerular NF-κB inhibition by the ubiquitin binding …

Acrolein Is A Critical Mediator Of Alcohol-Induced Liver And Intestinal Injury In Alcoholic Liver Disease., Wei-Yang (Jeremy) Chen

Electronic Theses and Dissertations

Alcohol consumption can cause alcoholic liver disease (ALD), which remains a major cause of morbidity and mortality in the United States. Chronic alcohol consumption causes a pro-oxidant environment in the liver and increases hepatic lipid peroxidation. Acrolein is the most reactive and toxic aldehyde generated through lipid peroxidation. Acrolein forms protein adducts and triggers endoplasmic reticulum (ER) stress and hepatocyte apoptosis, which are recognized etiologic factors in ALD. Several studies have established the critical role of the gut-liver axis in ALD pathogenesis, wherein alcohol-induced gut barrier dysfunction contributes to liver injury. This study investigates, in vitro and in vivo, the …

Spatial Irregularities Of Compound Action Potential Origination In Individual Cochleae, Kaitlyn M. Kennedy

Graduate Theses/Dissertations

The present study aims to evaluate the origin of compound action potential (CAP) responses in the guinea pig ear using the following method. Pipettes were sealed into the cochlear apex of 26 guinea pigs to inject ototoxic pharmaceuticals that inhibit nerve responses without affecting cochlear function. The rate of the injection was adjusted once each minute to account for variations in the diameter of the cochlea and to maintain a steady flow of pharmaceuticals. CAP measurements collected at around 90-second intervals using tone burst stimuli during the injections allowed evaluation of the neural responses over time. Responses to higher stimulation …

Characterization Of The Skeletal Phenotype In Idua-W392x Knock-In Mice: Bone Metabolism Biomarkers, Christina J. Owensby

Graduate Theses/Dissertations

Mucopolysaccharidosis Type I (MPS I, Hurlers Syndrome) is a lysosomal storage disease caused by a deficiency of alpha-L-iduronidase (IDUA). IDUA catalyzes the degradation of the two glycosaminoglycans (GAGs); heparin sulfate (HS) and demantan sulfate (DS). The accumulation of HS and DS makes MPS I progressive with inevitable degeneration of multiple organ systems. Accumulated excess of GAGs on the skeletal system causes dysostosis multiplex, atlantoaxial instability, thoracolumbar kyphosis, genu valgum, acetabular dysplasia, and short stature. Skeletal biomarkers of bone formation and bone resorption were compared in wild-type, heterozygous, and IDUAW392X mice. To investigate osteoblast activity, levels of the bone formation marker …

Strategies To Improve Rn Communication Hcahps, Karen Montoro, Bsn, Rn, Ne-Bc

Department of Nursing papers and presentations

BACKGROUND

The impact of value based purchasing on reimbursement based on HCAHPS is a reality that Heath Care Organizations need to address. This Quality Improvement Project was designed by the CNO, Vice president of Nursing and the Nurse Manager to oversee the project. The decision was made to utilize an existing group of frontline staff who were engaged in efforts to improve patient satisfaction. This RN Communication Team met monthly beginning in March 2015.

Pharmacologic And Clinical Evaluation Of Posaconazole., Jason N. Moore, Jason R. Healy, Walter K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Posaconazole, a broad-spectrum triazole antifungal agent, is approved for the prevention of invasive aspergillosis and candidiasis in addition to the treatment of oropharyngeal candidiasis. There is evidence of efficacy in the treatment and prevention of rarer, more difficult-to-treat fungal infections. Posaconazole oral suspension solution has shown limitations with respect to fasting state absorption, elevated gastrointestinal pH and increased motility. The newly approved delayed-release oral tablet and intravenous solution formulations provide an attractive treatment option by reducing interpatient variability and providing flexibility in critically ill patients. On the basis of clinical experience and further clinical studies, posaconazole was found to be …