Medicine and Health Sciences Commons^™

Therapeutic Drug Monitoring Of Beta-Lactam Antibiotics In Critically Ill Patients With Sepsis, Melissa Thompson Bastin

Theses and Dissertations--Clinical and Translational Science

Sepsis is a devastating diagnosis affecting over 750,000 patients a year, accounting for approximately 10% of all hospital admissions, costs more than $50,000 per patient, and exceeds $17 billion annual spending. The mortality rate for sepsis remains unacceptably high: one out of every three patients diagnosed with sepsis dies. Sepsis physiology induces physiologic changes to drug pharmacokinetic (PK) parameters that alter the ability to achieve the goal pharmacodynamic (PD) target for beta-lactams of >4-fold unbound concentration above the minimum inhibitory concentration for 100% of the dosing interval (100% fT >4x MIC). Sepsis treatment such as volume resuscitation and vasopressor …

Remote Supported Communication For Adults With Chronic Aphasia: A Serendipitous Study, Allie Hopper

Theses and Dissertations--Communication Sciences and Disorders

Supported communication is defined as anything that improves access to or participation in communication events or activities (King, Simmons-Mackie, & Beukelman, 2012). This thesis describes the results of a study that took place when a training program to provide graduate students in Communication Sciences and Disorders (CSD) with “hands on” experience in providing supported communication to persons with chronic aphasia (PWA) was interrupted by the outbreak of Coronavirus-19 and switched to a remote delivery format to fulfil service and training obligations to the PWA and the CSD graduate students respectively. The study (1) describes the actions taken to covert a …

The Gestation Of Health: Environmental Insults, Behavioral Interventions, And Protective Mechanisms, Brittany Breon Rice

Theses and Dissertations--Pharmacology and Nutritional Sciences

Diabetes remains a leading cause of death nationwide despite pharmacological advances. Recent etiological investigations of the disease detail the role of perinatal exposure to environmental contaminants, such as polychlorinated biphenyls (PCBs), in enhancing disease susceptibility. Polychlorinated biphenyl 126, a coplanar PCB, elicits its toxic effects through the aryl-hydrocarbon receptor and the disruption of endocrine signaling. The goal of this dissertation was to focus on delineating the differences in the developmental windows of diabetes susceptibility respective to the timing of PCB126 exposure and to understand the influence of maternal exercise and nuclear-factor erythroid-2-related factor 2 (Nrf2) expression in combating the negative …

The Role Of Microtubule-Associated Protein Tau In Neuronal Excitability And Epileptogenesis, Ryan A. Cloyd

Theses and Dissertations--Physiology

Tauopathies, including Alzheimer’s disease (AD), are devastating diseases with an immense burden on society which is predicted to increase in coming decades. In addition to progressive loss of memory and cognitive function, patients with tauopathies have a 6-10 fold increase in lifetime risk for seizures, and many are diagnosed with epilepsy. The presence of epileptiform activity on electroencephalogram (EEG) recordings from patients with AD predicts faster cognitive decline compared to patients without abnormal EEG readings. Electrophysiological measurements in murine models of AD have identified neuronal hyperexcitability. Furthermore, reducing tau phosphorylation or expression confers seizure resistance in animal epilepsy models. Although …

Novel Mammalian Models For Understanding And Treating Spinal Cord Injury, Michael B. Orr

Theses and Dissertations--Physiology

Spinal cord injury (SCI) is devastating and often leaves the injured individual with persistent dysfunction. The injury persists because humans have poor wound repair and there are no pharmacologic treatments to induce wound repair after SCI. The continued efforts to discover therapeutic targets and develop treatments heavily relies on animal models. The purpose of this project is to develop and study novel mammalian models of SCI to provide insights for the development and effective implementation of SCI therapies.

Lab mice (Mus musculus) are a powerful tool for recapitulating the progression and persistent damage evident in human SCI, but …

Metabolic And Electrophysiological Effects Of Fibroblast Growth Factor 19 In The Dorsal Vagal Complex, Jordan Wean

Theses and Dissertations--Physiology

The dorsal vagal complex (DVC) is an important homeostatic regulatory center located in the hindbrain that alters vagal parasympathetic activity in response to central, viscerosensory, and humoral cues. Within the DVC, second-order sensory neurons in the nucleus tractus solitarius (NTS) integrate ascending vagal sensory input with descending regulatory inputs from higher brain areas and respond to circulating hormones and glucose. In turn, the NTS projects to the dorsal motor nucleus of the vagus (DMV) which is comprised of cholinergic motor neurons and regulates gastric motility, hepatic glucose production, and pancreatic hormone release functions, among others.

Fibroblast growth factor 19 (FGF19) …

Development Of A Robust Linac-Based Radiosurgery Program For Multiple Brain Metastases & Estimation The Radiobiological Response Of Indirect Cell Kill, Allison Palmiero

Theses and Dissertations--Radiation Medicine

Accurate and precise delivery of Stereotactic Radiosurgery (SRS) using Gamma Knife (GK) unit by Leksell is a gold standard for multiple intracranial lesions. SRS provides less brain toxicity compared to whole brain radiotherapy techniques historically used. However, these treatments are limited in availability and are accompanied by long treatment times with painful, intolerable headframe fixation. With advancements in linear accelerator (Linac) based SRS, multiple brain lesions can be treated separately with individual isocenters or, more recently, altogether with a single isocenter multi-target (SIMT) volumetric modulated arc therapy (VMAT) technique. SIMT methods reduce the challenges of treating patients with GK by …

Maturation Of Equine Proximal Sesamoid Bones In Thoroughbred Horses, Angela Maria Mangine

Theses and Dissertations--Veterinary Science

Proximal sesamoid bone (PSB) injuries account for approximately 50% of all fatal catastrophic musculoskeletal injuries in Thoroughbred racehorses. In addition, PSB fractures are not uncommon in Thoroughbred foals and yearlings as a result of energetic or intense free exercise. The ability to interpret some PSB pathology assessments, however, is more difficult given the limited information published on the normal development and maturation of these paired sesamoid bones. In addition, the level of normal variation in PSB morphological and structural parameters within the Thoroughbred population as a function of age, body size, gender, and inter-animal variation are not well documented, complicating …

Structural Adaptation Of Equine Proximal Sesamoid Bones To High-Speed Exercise, Kathryn Mary Babiarz

Theses and Dissertations--Veterinary Science

Proximal sesamoid bone (PSB) fractures are one of the most commonly reported catastrophic musculoskeletal injuries (CMI) in Thoroughbred racing. Despite the seriousness of these injuries, an understanding of the structural changes that occur normally within PSBs in response to the biomechanical forces of high-speed exercise and how they relate to pathological events leading to fracture remain limited. To address this critical knowledge gap, PSBs from Thoroughbred horses were analyzed with both computed tomography (CT) and microcomputed tomography (µCT) to assess their morphological and structural parameters. Comparisons were made using samples from the left and right forelimbs of Thoroughbreds of both …

An Assessment Of The Carrier State And A Novel Marker Of Leptospira And Abortion In Central Kentucky Horses, Gloria Louise Gellin

Theses and Dissertations--Veterinary Science

Leptospirosis is a reemerging zoonotic infection of worldwide importance and affects all mammals. The bacterium is transmitted to animals and humans by urine, fetal membranes and body fluids. Leptospira shedding in the urine contaminates both soil and water, exposing both humans and animals to the bacterium. Leptospirosis in horses can cause abortion and is one of the etiologies of equine recurrent uveitis which can lead to blindness. Equine leptospiral abortion in Central Kentucky is primarily caused by serovar Pomona, with occasional cases attributed to serovar Grippotyphosa. There are a few reports in the literature attributing abortion to serovar Bratislava in …

Muscle Mass And Immune Function In The Senior Horse, Alisa Christina Herbst

Theses and Dissertations--Veterinary Science

Senior horses (≥ 15 years) represent up to one-third of the global equine population, and the proportion of old horses (≥ 20 years) in the U.S. has been steadily increasing. Aging is associated with a loss of skeletal muscle mass in horses, and while age-related muscle loss is comparingly well characterized in humans, little is currently known concerning underlying mechanisms, adverse outcomes, or the prevalence of low muscle mass in senior horses. One factor proposed to play a role in the development of age-related muscle atrophy in humans is inflamm-aging, a low-grade inflammation that affects elderly people and that has …

The Lived Experience Of Hope In The Midst Of Recovery From A Substance Use Disorder: A Phenomenology, Mary Katherine Lance

Theses and Dissertations--Family Sciences

Substance use disorder (SUD) is difficult to treat, as evidenced by its high prevalence and relapse rates. Research shows, however, that hope may have the potential to create effective and efficient change in the way we prevent and treat SUD. In order to utilize hope in this way, we must have a good understanding of what hope is. This phenomenological study aims to explore and describe the essence of hope through the lived experience of individuals in recovery from a SUD. Through interviews with 20 informants to generate data and an iterative interpretative process to identify shared meanings, hope emerged …

Assessing Self-Perceived Nutrition-Related Lifestyle Behaviors And Knowledge Of University Music Students Following A Targeted Presentation, Gretchen Trumbo

Theses and Dissertations--Nutrition and Food Systems

Although proven that nutrition can impact physical health, limited research examines the relationship between nutrition-related lifestyle behaviors, nutrition knowledge, and the prevalence of injury in university music students. The objective of this study is to evaluate nutrition-related lifestyle behaviors and self-perceived nutrition knowledge of university music students before and after a targeted nutrition education session. A baseline Qualtrics survey was administered to undergraduate and graduate music students (18+ years) via the University of Kentucky School of Music Listserv to gather data related to demographics, anthropometrics, history of playing-related injury, nutrition knowledge, attitudes, beliefs, and behaviors. A nutrition education presentation, focused …

Sexual Expression And Self-Confidence In Long-Distance Relationships, Morgann Kidwell

Theses and Dissertations--Family Sciences

Little is known about the impact of distance on sexual expression and self-confidence in long-distance relationships, especially as mediated by technology. The purpose of the present study is to investigate how sexual expression and self-confidence vary in romantic relationships between those in long- versus short-distance relationships. Data from 327 participants—156 in long-distance relationships and 171 in short-distance relationships—were collected via Amazon MTurk. Results indicate that forms of technology-mediated sexual expression are widely used in long-distance relationships. Technology-mediated sexual expression is positively associated with sexual satisfaction in both long- and short-distance relationships; however, technology-mediated sexual expression was not statistically associated with …

Psychological Distress And Relationship Satisfaction Among Survivors Of Sexual Violence, Alyssa Campbell

Theses and Dissertations--Family Sciences

The World Health Organization (WHO; 2002) has indicated that sexual violence is a serious public health concern, and both the WHO and the United Nations (UN) have declared that violence against women, in particular, is a profound violation of human rights (UN General Assembly, 1993; WHO, 2017). Although the systemic and negative impact of trauma on family and intimate relationships have been well documented, the empirical literature regarding the effects of adult sexual trauma on relationship satisfaction is less robust. These studies are designed to address this gap and will do so with analyses centered on an understudied population: the …

A Functional Variant On 20q13.33 Related To Glioma Risk Alters Enhancer Activity And Modulates Expression Of Multiple Genes., Mourad Wagdy Ali, C Pawan K Patro, Jacqueline Jufen Zhu, Christopher H Dampier, Sarah J Plummer, Cem Kuscu, Mazhar Adli, Ching C Lau, Rose K Lai, Graham Casey

Faculty Research 2021

Genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNPs) associated with glioma risk on 20q13.33, but the biological mechanisms underlying this association are unknown. We tested the hypothesis that a functional SNP on 20q13.33 impacted the activity of an enhancer, leading to an altered expression of nearby genes. To identify candidate functional SNPs, we identified all SNPs in linkage disequilibrium with the risk-associated SNP rs2297440 that mapped to putative enhancers. Putative enhancers containing candidate functional SNPs were tested for allele-specific effects in luciferase enhancer activity assays against glioblastoma multiforme (GBM) cell lines. An enhancer containing SNP rs3761124 exhibited allele-specific effects …

Interweaving Teaching Strategies In Interprofessional Education: A Pilot Study With Graduate Occupational Therapy And Physician Assistant Students, Eric C. Nemec, Lola Halperin, Jaimee Betts Hegge

Physician Associate Studies Faculty Publications

The importance of interprofessional education (IPE) has been emphasized by the World Health Organization and is currently required by both the occupational therapy (OT) and physician assistant (PA) education accreditation agencies in the United States. Moreover, a growing body of evidence suggests that IPE fosters learners’ understanding of the roles different disciplines play in healthcare delivery and prepares future health professionals for patient-centered care. Authors designed and implemented an IPE event aimed to foster the following core Interprofessional Education Collaborative (IPEC) competencies among graduate OT and PA students: Values/Ethics for Interprofessional Practice, Roles and Responsibilities, Interprofessional Communication, and Teams and …

Efficacy And Safety Of Once-Daily Vibegron For Treatment Of Overactive Bladder In Patients Aged ≥65 And ≥75 Years: Subpopulation Analysis From The Empowur Randomized, International, Phase Iii Study, Susann Varano, David Staskin, Jeffrey Frankel, Denise Shortino, Rachel Jankowich, Paul N. Mudd

Physician Associate Studies Faculty Publications

Background

Overactive bladder (OAB) is common among older adults. The efficacy and safety of vibegron for the treatment of OAB were demonstrated in the international, phase III EMPOWUR trial. This subpopulation analysis from EMPOWUR assessed the efficacy and safety of vibegron in patients aged ≥ 65 and ≥ 75 years.

Methods

In EMPOWUR, patients with OAB were randomly assigned 5:5:4 to receive once-daily vibegron 75 mg, placebo, or tolterodine 4 mg extended release, respectively, once daily for 12 weeks. Coprimary efficacy endpoints were change from baseline at week 12 in average daily number of micturitions and urge urinary incontinence (UUI) …

Finding Parity Through Preclusion: Novel Mental Health Parity Solutions At The State Level, Ryan D. Kingshill

Dickinson Law Review (2017-Present)

Recently, the federal government has taken numerous steps to promote the equal treatment (also known as parity) of mental and physical health issues. The two most impactful actions are the Mental Health Parity and Addiction Act of 2008 and the Affordable Care Act. These acts focus on the traditional avenue for parity change—insurance regulation. While these acts have improved parity, major gaps in coverage and treatment between mental health/substance use disorder treatment and medical/surgical treatment persist. ERISA Preemption, evasive insurer behavior, lack of enforcement, and lack of consumer education continue to plague patients and healthcare professionals. On its own, federal …

Achieving Better Care In Pennsylvania By Allowing Pharmacists To Practice Pharmacy, Travis Murray

Dickinson Law Review (2017-Present)

Traditionally, state legislatures implemented Prescription Drug Monitoring Programs (“PDMPs”) to assist prescribers, pharmacists, and law enforcement in identifying patients likely to misuse, abuse, or divert controlled substances. PDMP databases contain a catalog of a patient’s recent controlled substances that pharmacies have filled, including the date, location, the quantity of medication filled, and the prescribing health care provider. Prescribers in Pennsylvania have a duty to query the PDMP before prescribing controlled substances in most clinical settings. Pharmacists have a similar duty in Pennsylvania to dispense safe and effective medication therapy to patients and to screen patients for potential signs of misuse, …

Covid Round 2: Workplace Support And Compassion Fatigue In Emergency Workers, Carlene A. Robinson, Kelly L. Sullivan

Eagles Talking About the Public’s Health

No abstract provided.

Examining Differences In Rural, Micropolitan, And Metropolitan School Psychologists Roles And Delivery Of Mental Health Services, Ashley A. Williamson

All Graduate Theses, Dissertations, and Other Capstone Projects

Mental health service delivery in rural settings has become increasingly limited while rates of mental health concerns among youth have increased. Schools form a common hub in rural areas and they present an opportunity for the assessment of developing disorders as well as a means for delivering mental health services in an affordable and acceptable fashion. School psychologists supporting rural school districts are presented with a unique opportunity to provide various aspects of rural mental health service delivery. Over the last 40 years, little research has been published on rural school psychologist’s roles and responsibilities and their relationship to mental …

Peoples’ Experiences With Birth Doulas, Emily A. Gunderson

All Graduate Theses, Dissertations, and Other Capstone Projects

Birth doulas, as a non-medical resource for people going through the birthing process, have seen overall positive reception by providing a service otherwise missing from the recently medicalized birth environment (Gruber et al. 2013, Steel et al. 2015); this coincides with a time when fathers are being asked to play a more active role in their child’s birth (Coltrane 1996, Odent 2009). However, while we know a little about how mothers experience the services of a birth doula and how fathers experience birth generally, we have yet to find out how birthing people, both partnered and un-partnered, make sense of …

Communicating About Covid-19: Strategies For Promoting Risk-Reducing Behaviors On Facebook, Liz Scharnetzki, Nikki Jarvais, Elizabeth Rintz, Leo Waterston, David Pied, Paul Han

Costas T. Lambrew Research Retreat 2021

Introduction- Controlling the COVID-19 pandemic requires effective public health communication strategies that can promote risk-reducing behaviors despite scientific uncertainties about their effectiveness. The current project developed and tested different theory-based communication strategies for generating public interest in COVID-19 risk-reducing behaviors. • Assessed the efficacy of two novel message frames – destigmatizing and uncertainty normalizing - relative to existing strategies

Notch Signaling Regulates Perivascular Adipose Tissue (Pvat) Function During Diet-Induced Obesity, C Yang, A Harrington, L Ryzhova, L Liaw

Costas T. Lambrew Research Retreat 2021

Objectives:

-To test the hypothesis that canonical Notch signaling influence vascular function by regulating PVAT-derived vascular relaxation factors.

-To determine how overexpression of Notch signaling or loss of the key Notch signaling component influence PVAT function.

Impact Of A Primary Care Clinical Pharmacist On The Management Of Hepatitis C Viral Infection, Sierra Ferreiira, Adam Normandin, Linh Gagnon, Corinn Martineau

Costas T. Lambrew Research Retreat 2021

Interprofessional care including a pharmacist demonstrates a positive trend towards increasing access to care and improving adherence to Hepatitis C management in a primary care setting.

A New Project Echo Focused On Clinical Research In Development By The Nne-Ctr, Ivette Emery, Kerri Barton, Meredith Oestreicher, Neil Korsen, Irwin Brodsky

Costas T. Lambrew Research Retreat 2021

I diagram presented for the project by the NNE-CTR

Anterior-Based Muscle Sparing Approach For Total Hip Arthroplasty, Callahan M. Sturgeon, George M. Babikian, Brian J. Mcgrory, Adam J. Rana

Costas T. Lambrew Research Retreat 2021

A high value, high quality and low cost surgery: a 7.5 year single-center, retrospective case series

A Simulation-Based Outreach Program Improves Delivery Room Team Confidence In Neonatal Resuscitation At Rural Community Hospitals, Allison Zanno, Misty Melendi, Micheline Chipman, Jeffrey Holmes, Alexa Craig, Samantha Piro, Anna Gilbert, Sarah Gabrielson, Leah Mallory, Anya Culter, Mary Ottolini

Costas T. Lambrew Research Retreat 2021

Objective- Our goal is to pilot the use of an onsite Neonatal Community Outreach Education Program to improve provider confidence with procedural skills and neonatal resuscitation in the delivery room.

Determinants Of Private Well Water Testing In Maine, Jenny Carwile, Shravanthi M. Seshasayee, Kritika Anand, Abby F. Fleisch

Costas T. Lambrew Research Retreat 2021

Objectives: Describe sociodemographic characteristics associated with ever testing well water using data from the 2014-2017 Maine Behavioral Risk Factor Surveillance System (BRFSS) (n= 12,152).