Medicine and Health Sciences Commons^™

Developing Graphic Libraries To Accompany The Craniofacial Human Ontology, Melissa D. Clarkson

Institute for Biomedical Informatics Faculty Publications

I describe the development of two graphic libraries to accompany parts of the Craniofacial Human Ontology. One library depicts phenotypes of cleft lip. The other represents development of the human head between 4 and 8 weeks of gestation.

Identifying Foot And Ankle Patients At Risk To Fall Based On Patient Reported Outcomes Assessments, Judith Baumhauer, Jack Teitel, Allison Mciyntyre, David Mitten, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post- operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) …

Intra-Arterial Nitroglycerin As Directed Acute Treatment In Experimental Ischemic Stroke, Michael E. Maniskas, Jill M. Roberts, Rebecca Trueman, Annastazia E. Learoyd, Amanda A. Gorman, Justin F. Fraser, Gregory J. Bix

Neuroscience Faculty Publications

BACKGROUND: Nitroglycerin (also known as glyceryl trinitrate (GTN)), a vasodilator best known for treatment of ischemic heart disease, has also been investigated for its potential therapeutic benefit in ischemic stroke. The completed Efficacy of Nitric Oxide in Stroke trial suggested that GTN has therapeutic benefit with acute (within 6 hours) transdermal systemic sustained release therapy.

OBJECTIVE: To examine an alternative use of GTN as an acute therapy for ischemic stroke following successful recanalization.

METHODS: We administered GTN IA following transient middle cerebral artery occlusion in mice. Because no standard dose of GTN is available following emergent large vessel occlusion, we …

Genotype-Phenotype Study In Patients With Valosin-Containing Protein Mutations Associated With Multisystem Proteinopathy, Ebaa Al-Obeidi, Sejad Al-Tahan, Abhilasha Surampalli, Namita Goyal, Annabel K. Wang, Andreas Hermann, Molly Omizo, Charles D. Smith, Tahseen Mozaffar, Virginia Kimonis

Neurology Faculty Publications

Mutations in valosin‐containing protein (VCP), an ATPase involved in protein degradation and autophagy, cause VCP disease, a progressive autosomal dominant adult onset multisystem proteinopathy. The goal of this study is to examine if phenotypic differences in this disorder could be explained by the specific gene mutations. We therefore studied 231 individuals (118 males and 113 females) from 36 families carrying 15 different VCP mutations. We analyzed the correlation between the different mutations and prevalence, age of onset and severity of myopathy, Paget's disease of bone (PDB), and frontotemporal dementia (FTD), and other comorbidities. Myopathy, PDB and FTD was present in …

Serum Tumor Necrosis Factor-Alpha Associates With Myocardial Oxygen Demand And Exercise Tolerance In Postmenopausal Women, Stephen J. Carter, David R. Bryan, William H. Neumeier, Stephen P. Glasser, Gary R. Hunter

Internal Medicine Faculty Publications

The functional implications of serum tumor necrosis factor-alpha (TNF-α), a marker of oxidative stress, on hemodynamic parameters at rest and during physical exertion are unclear. The aims of this investigation were to examine the independent associations of TNF-α on myocardial oxygen demand at rest and during submaximal exercise, while also evaluating the association of TNF-α on exercise tolerance. Forty, postmenopausal women, provided blood samples and completed a modified-Balke protocol to measure maximal oxygen uptake (VO_2max). Large artery compliance was measured by pulse contour analyses while rate-pressure product (RPP), an index of myocardial oxygen demand, was measured at rest …

Longitudinal Patterns Of Potentially Inappropriate Medication Use Following Incident Dementia Diagnosis, Christine M. Ramsey, Danijela Gnjidic, George O. Agogo, Heather Allore, Daniela Moga

Pharmacy Practice and Science Faculty Publications

Introduction: Potentially inappropriate medication (PIM) use in older adults with dementia is an understudied area. We assessed longitudinal changes in PIM exposure by dementia type following dementia diagnosis.

Methods: We followed 2448 participants aged ≥ 65 years (52% women, 85.5% Caucasian, mean age 80.9 ± 7.5 years) diagnosed with dementia after enrollment in the National Alzheimer's Coordinating Center (2005-2014). We estimated the association between dementia type and PIM annually for 2 years after diagnosis, using Generalized Estimating Equations.

Results:Participants with Lewy body dementia had more PIM use, and participants with frontotemporal dementia had less PIM use than participants with …

The Role Of The Public Health Nurse In Rural Areas Of Kerry And Cork, Hannah Healy

Theses

Aim of Research: To understand and gain insight into the role of the Public Health nurse in rural communities in Kerry and Cork.

Background: Public health nursing is the single largest group in community care, current figure employed by the HSE stands at 1,438. Demographic, changes such as the increase in population coupled with the shift in care from the acute sector to primary care has provided many challenges to the PHN service .

Objective: Whilst there have been substantial reviews on the role and workload of the PHN in Ireland, there is limited qualitative research available on what the …

Problematic Child Mealtime Behavior And Caregiver Mobile Phone Use, Libby Milkovich, Meredith Dreyer, Brooke Sweeney, Sarah Nyp, Ben Black

Posters

BACKGROUND

Problematic mealtime behaviors (PMB) (externalizing behavior at mealtime) have been seen anthropologically when adult caregivers are absorbed in their mobile phones. Parents with mobile phone problematic use (MPPU) are more likely to be absorbed in a mobile device. Neither the correlation of MPPU to PMB, nor the frequency of PMB to perceived impairment of problem behavior have been quantitatively studied.

OBJECTIVE

Evaluate correlation of caregiver MPPU and child PMB to improve understanding of the possible implications of caregiver MPPU

METHODS

Participants included caregivers of children ages 2-8 years being seen in a pediatric hospital clinic. Participants completed a survey …

Implementation Of Bedside Huddle To Improve Communication When Coordinating Care For Picu Patients With Newly Diagnosed Anterior Mediastinal Masses, Laura Mccarthy, Pam Nicklaus, Paul Sheeran, Tara Benton, Jenna Miller, Douglas C. Rivard, Melissa Gener, Susan Whitney, Keith August

Posters

No abstract provided.

Experimentally Investigating The Joint Effects Of Physical Activity And Sedentary Behavior On Depression: A Randomized Controlled Trial, Jeremiah Blough

Electronic Theses and Dissertations

Objective: To experimentally examine whether increasing sedentary behavior, among a young adult active population, for one week is still associated with increased depression symptomology even when allowing for a moderate engagement in physical activity (PA). Methods: Participants were confirmed as active via self-report and accelerometry during baseline and randomly assigned to one of three experimental groups. The Sedentary Intervention Group (n=19) reduced steps to less than 5000/day and were not alloto exercise for one-week; the Reduced MVPA (moderate-to-vigorous PA) Group (n=18) reduced steps to less than 5000/day but exercised for 50% of their previously reported vigorous PA for one-week; and …

Development And Characterization Of Fluocinolone Acetonide Loaded Nanosized Lipid Carriers For Ocular Delivery Via Subconjunctival Route: Synergistic Effect Of Vitamin A Palmitate, Bhavik Soneta

Electronic Theses and Dissertations

Though nanotechnology which exploits the use of nanoparticles for therapeutic application have embarked as an emerging tool for drug delivery applications, the delivery of therapeutic molecules into deep ocular compartments has always been a challenging task. In this regard, the main objective of our current investigation was to develop and evaluate the fluocinolone acetonide (FA) loaded nanostructure lipid carrier (FA-NLC) in situ gel for improved ocular bioavailability by subconjunctival injection. FA, a corticosteroid administered for inhibiting the ocular inflammation either as intravitreal injection or as intravitreal implants. The FA-NLCs were developed by using vitamin A palmitate as one of the …

Feasibility Of Aquasolvetm Hpmc-As Lg Via Hot-Melt Extrusion: Effect Of Pressurized Co2 On Physico-Mechanical Properties, Mashan Almutairi

Electronic Theses and Dissertations

The objective of the current study was to investigate the processability of Aquasolve™ HPMC-AS LG via hot-melt extrusion, and to examine the effect of pressurized carbon dioxide (P-CO2) on the physico-mechanical properties of Efavirenz (EFA)-loaded extrudates (EXT). EFA is as a poorly water-soluble drug and HPMC-AS LG was chosen as a carrier for this study. To optimize the process parameters and formulations, various physical mixtures were prepared with the following composition: EFA (30-40-50% w/w) and HPMC-AS LG (70-60-50 % w/w) respectively. Physical mixtures were extruded through the co-rotating twin-screw extruder (16mm Prism Euro Lab, Thermo Fisher Scientific) utilizing a standard …

Synthesis And Characterization Of Redox-Sensitive Polymer And Prodrug For Targeted Drug Delivery, Chang-Hee Whang

Electronic Theses and Dissertations

Systemic administration of chemotherapeutics is associated with various side effects deriving from accumulation in off-target sites and acute toxicity of the drugs. In the past decade, engineering targeted drug delivery platforms arose as a novel paradigm to overcome such obstacles and ultimately achieve advanced forms of chemotherapy. This thesis reports successful syntheses of l-RSP, a redox-sensitive self-immolative polymer, and DNS-SN38, thiol-sensitive SN-38 prodrug, as potential candidates for targeted drug delivery platforms. By covalently conjugating a redox-trigger (p-nitrobenzyl alcohol) and self-immolative linker (p-hydroxybenzyl alcohol) to the cyclization spacer (n-2-(hydroxyethyl)ethylene diamine), a novel self-immolative monomer was obtained. Polymerization of the respective monomer …

Crystalline Salt Formation Of An Acidic Drug Indomethacin Using Hot Melt Extrusion Technology, Mustafa Bookwala

Electronic Theses and Dissertations

Although salt formation is the most ubiquitous and effective method of increasing the solubility and dissolution rates of acidic and basic drugs, it consumes large quantities of organic solvents and is a batch process. Herein, we show that the dissolution rate of indomethacin (a poorly water-soluble drug) can be increased by using hot melt extrusion of a 1:1 (mol/mol) indomethacin:tromethamine mixture to form a highly crystalline salt, the physicochemical properties of which are investigated in detail. Specifically, pH–solubility studies demonstrated that this salt exhibited a maximal solubility of 19.34 mg/mL (>1000 times that of pure indomethacin) at pH 8.19. …

A Novel Acetaminophen Soft-Chew Formulation Produced Via Hot Melt Extrusion With Inline Near-Infrared Monitoring As A Process Analytical Technology Tool, Pengchong Xu

Electronic Theses and Dissertations

People suffer dysphagia when swallowing hard tablets and capsules. Gelatin based soft chewable tablets was used as an alternative and novel drug delivery format to overcome dysphagia. But conventional method of producing gelatin based soft chewable tablets has many potential issues. The objective of this study is using glycerol and hot-melt extrusion technique to address potential issues and optimizing the formulation. Gelatin (15%), acetaminophen (30%), saccharin (1.5%), xylitol (6.5%), sodium chloride (2%) and six different ratios of water (45-0%) and glycerol (0-45%) were used in seven formulations. The extrusion process temperature of formulation 1-6 and formulation 7 were 90 ëšc …

Mapping Opioid Mortality Rates Across Treatment Capacity To Identify Need And Access, Garrett K. Wong, Justin R. Chang, Chase Greco, Yadunandan Pillai, Mohammad A. Shahrezaei, Melissa H. Burton, Rob Lawrence, Alan Dow

Graduate Research Posters

Background: The opioid and heroin overdose epidemic is a public health emergency in the state of Virginia, resulting in the death of more than 1,100 people in 2016. In order to overcome this epidemic, we need to match the places with the greatest need for services related to substance use disorders with the appropriate healthcare workforce.

Aims: As the data about the overdose outbreak and related socioeconomic factors grow in size and complexity, data scientists have attempted to utilize big data techniques to identify communities and risk factors contributing to addiction.

Methods: Using data obtained from the …

Visualizing The Opioid Overdose With A Dynamic Heat Map To Identify And Predict Vulnerable Communities, Justin R. Chang, Garrett K. Wong, Chase Greco, Yadunandan Pillai, Mohammad A. Shahrezaei, Melissa H. Burton, Rob Lawrence, Alan Dow

Graduate Research Posters

Background: Opioid and heroin overdose epidemic is a public health emergency in the state of Virginia. In order to prevent overdose deaths, we need the target expertise in substance use disorders to areas with high rates of overdose. In particular, an area with an acute spike in overdoses might represent an urgent need for intervention.

Aims: The CDC urges the use of near real-time surveillance to effectively identify overdose incidence, and to coordinate community responses in the states affected by the epidemic, including Virginia. However, current opioid overdose datasets for Virginia lack adequate consistency, granularity, and temporality for …

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 …

Evaluation Of Barriers For Small-Scale Fruit And Vegetable Growers In Kentucky, Amanda Schroeder Hege

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The food system in the United States has witnessed significant challenges resulting in food security and safety concerns, environmental damage, economic distress, and a decline in our population’s health. While the last fifty years showed a drop in land and workforce dedicated to farming, industrialized farms are producing an overabundance of cheap corn that directly supplies inexpensive, unhealthy foods leading to American’s diets falling short of recommendations for good health, thus contributing to the obesity epidemic. This study utilizes an upstream approach to learn from farmers’ ability to grow good food that promotes healthy people, environments, and communities. Specifically, the …

The Relationship Between Access To Healthcare And Heart Disease Mortality In Kentucky, 2012-2014, Nima Farsi

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Cardiovascular disease is the cause for a large portion of the mortalities in the United States. Furthermore, Kentucky has one of the highest heart disease mortality rates out of all 50 U.S. States. This study hypothesized that heart disease mortality in Kentucky counties has a positive relationship with lack of accessibility to healthcare. Furthermore, this ecological study hypothesized that because there is no available usual source of a healthcare providers and ultimately a lack of accessibility to receive diagnostic/preventative services for this population, the high rate of cardiovascular disease mortality in Kentucky is dependent on access to healthcare services.

This …

Consultation Experience In Public Health, Hannah Bellamy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The following portfolio is an overview of my consulting experience in public health. My experiences include making frequency tables, producing summary statistics, conducting Chi- Square and T-Test, and reproducing a demographics table. Working with investigators, I have conducted a power analysis for a pilot study, assisted with a study design consultation, used the Kappa coefficient to test for inter-rater reliability, presented survey results with answer distributions, and produced summary statistics for an investigator’s research poster.

Working in the Applied Statistics Laboratory and with investigators has taught me the process of consulting. It begins by meeting with an investigator and determining …

A Policy Analysis Of The Kupuna Caregivers Act: Addressing The Needs Of Working Caregivers In Hawaii, Emily S. Mccarthy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The primary purpose of this paper was to provide a policy analysis of the Kupuna Caregivers Act that was passed at the end of 2017 in Hawaii. This legislation provides a $70 daily voucher that working caregivers can use to hire long-term care services for their elderly loved ones. This type of assistance allows caregivers to stay in the workplace, alleviates the stress of caregiving, and assists them in securing their own financial futures. The number of people over the age of 65 will double in size over the next forty years, presenting a variety of long-term care challenges in …

Gabapentin Prescribing Practices Among Physicians: Clinical Indications And Reasoning, Lili Buzsaki

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Gabapentin is an anticonvulsant and nerve pain medication with a variety of offlabel indications. There is at least some evidence that physicians have prescribed gabapentin to successfully treat several off-label conditions including alcohol dependence and withdrawal, brachioradial pruritus, chronic, refractory cough, diabetic neuropathy, fibromyalgia, hiccups (singultus), hot flashes, insomnia, neuropathic pain, adjunct therapy for postoperative pain, restless legs syndrome (RLS), anxiety disorders, and uremic pruritus.

An observational cross-sectional study was used to determine the various reallife off-label uses of gabapentin and physicians’ perspectives with regard to particular advantages over other drugs and interventions, via an online survey. In addition, a …

Identifying Veterans With Opioid Use Disorder That Could Benefit From Referral For Evidence-Based Medication-Assisted Treatment, Emily Hampton

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Current treatment guideline recommendations published by the American Society of Addiction Medicine for Opioid Use Disorder (OUD) include both psychotherapy and Medication- Assisted Treatment for optimal management of this chronic medical illness. Military veterans are at an increased risk for fatal outcomes related to opioid overdoses due to a higher prevalence of depression/Post-Traumatic Stress Disorder (PTSD) and self-medicated substance use compared to their civilian counterparts. Additionally, many have been diagnosed with OUD but are not being treated in accordance with current treatment recommendations.

In an effort to increase access to treatment and combat the opioid epidemic, the Lexington VA Medical …

An Ecologic Study Of Access To Acute Stroke Care, Mortality And Its Correlates In The Stroke Belt, Jeffrey E. Levy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Importance: Stroke is leading cause of death in the United States, but quick access to treatment has been shown to result in better outcomes and improved mortality. Among the many barriers to access, geographic proximity to hospitals certified in stroke care may also play a role.

Objectives: To calculate county-level measures of accessibility to certified stroke hospitals using GIS, and to examine its relationship with county stroke mortality while controlling for other county-level potential confounders.

Methods: Ecologic study using county mortality rates and census data to recreate stroke death counts for use in traditional, and a geographically …

Impact Of Health Insurance And Sociodemographic Characteristics On Survival For Women Diagnosed With Breast Cancer In Kentucky, Pramila Rai

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction Objective of the study was to explore the impact of health insurance and socio-demographic factors on survival for breast cancer patients in Kentucky. Breast cancer is the most prevalent cancer among women in the US. Breast cancer survival is affected by various factors including health insurance, residence, age, race, geographical distance, income.

Methods The data were obtained from Kentucky Cancer Registry and included 47,128 women diagnosed with primary breast cancer between 2000 to 2014. The relationship of health insurance and other socio-demographic factors was analyzed using Cox regression.

ResultsThe overall five-year survival proportion was 0.97, 0.76 and 0.71 …

Characteristics Of Synchronous And Multiple Primary Ovarian Cancer Cases In Seer And Kentucky, Lauren Shelton

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

OBJECTIVES: The primary aim of this study was to investigate whether ovarian cancer patients in Kentucky are more likely to have multiple primary and synchronized primary cancers compared to Non-Kentucky SEER registry cancer patients. A secondary aim of the study was to determine if there are other factors that may be associated with an increased risk of having multiple primary and synchronized cancer as well as determining if having multiple primary and synchronous cancer diagnoses changes survival rates in ovarian cancer patients. Additionally, another objective was to identify the most frequently observed subsequent and synchronous cancers sites that are diagnosed …

Implementing The National Diabetes Prevention Program In Mason County, Kentucky, Cassandra Yelton

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The National Diabetes Prevention Program (DPP) is sponsored by the Centers for Disease Control and Prevention (CDC). The program’s goal is to reduce the incidence of diabetes through dietary modification and physical activity. On one hand, the DPP is currently offered by various organizations through the country. On the other hand, the DPP is mostly unavailable in rural areas, especially the Diabetes Belt. The Diabetes Belt is in the eastern Appalachian region of the United States. People who live in this area of the country are more likely to develop diabetes than those who do not. Mason County, Kentucky has …

Wayne County Board Of Education Adaptation Of Love Notes Curriculum For Adolescent Pregnancy Prevention, Allison Shea Merritt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

West Virginia has the 8^th highest rate of adolescent pregnancy in the United States and the rate in Wayne County is significantly higher. Adolescent pregnancies cause negative health outcomes for both the baby and the mother. Adolescent mothers are at an increased risk of anemia, preeclampsia, and preterm labor and babies born to adolescent mothers are more likely to have a low birth weight and to have cognitive impairment. To address this burden, the school board has decided to use the ADAPT-ITT framework on the evidence-based Love Notes adolescent pregnancy prevention curriculum to adapt it to be more culturally …

Community Of Hope: A Comprehensive Suicide Prevention Intervention At Mit, Kyra Patel

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Suicide is the second leading cause of death for most age groups in the United States. The current rate of suicide among college students is 7.5 per 100,000 with the rate remaining fairly steady over the past 30 years. While the rate is lower on college campuses, compared to the general population ages 18-24, the issue is still much larger on a college campus due to suicide bereavement or the number of people affected and to what degree they were impacted. As of 2015, MIT (Massachusetts Institute of Technology) had the highest suicide of all reporting colleges. The primary objective …