Candida species are commonly found in the human normal flora, however they are a major cause of nosocomial infections that can be life threatening. This fungal species is an opportunistic pathogen and causes infection in individuals who are immunosuppressed. A key characteristic of Candida’svirulence is the ability to change its morphology from ovoid yeast to filamentous hyphae. Alcaligenes species are common bacteria found in the environment that rarely, if at all, cause infections in humans. It has been observed that when allowed to interact, Alcaligenes faecalis changes the morphology of Candida albicans from yeast cells to hyphal cells. When A. faecalis interacts with Candida glabrata or a mutated C. albicans, it causes no change in morphology and the cells are all in the yeast morphology. When allowed to interact with C. albicans and the mutated C. albicans, Alcaligenes viscolactis did not cause any changes in morphology to either type with all cells staying in the yeast form. Interestingly, however, both A. faecalis and A.s viscolactis both inhibited C. albicans and C. glabrata which was demonstrated on both agar plate interactions and liquid co-cultures. A. faecalis showed a greater inhibitory effect than A.viscolactis. The concentration of A. faecalis does not seem to be a contributing factor to the inhibitory effect it has on both C. albicans and C. glabrata.Taken together, these results demonstrate that A. faecalis and A. viscolactiscould potentially be used to control one of the key virulence traits of C. albicansand could potentially identify new areas of study in Prokaryotic-Eukaryotic interactions, as well as, potential targets for treatment of C. albicans infections.

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Late stage diagnosis, uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life, contributes to anxiety, stress, fear, and uncertainty throughout the cancer treatment experience. This qualitative study sought to explore the cancer treatment experience of adults with newly diagnosed HNSCC, including laryngeal, esophageal, and oral cancers. Study participants were recruited from the University of Kentucky Ear Nose and Throat Clinic in Lexington KY. Participants agreed to be interviewed after receipt of their cancer diagnosis and again after completion of their cancer treatment. Socio-emotional Selectivity Theory, and Leventhal’s Self-Regulation Model provided the theoretical foundation for exploring the ongoing emotional, psychological, and physical aspects of the cancer experience while also recognizing the role of age and time perception. Forty-one patients completed two in depth semi- structured interviews. Transcripts were coded for key themes. Findings indicated that HNSCC in older patients is often preceded by lifelong alcohol, tobacco, and substance use. Despite frequent interaction with health and substance abuse treatment professionals, very few patients had prior knowledge of HNSCC risk or had been screened for these cancers. Experience with addiction treatment programs and perceptions of time seem to influence cancer treatment experience. The following themes were identified: (1) dynamic time perspectives including taking time, making time, junk time and time out; (2) recovery vs. cure from disease; (3) the role of reconciliation, hope, self-inventory, reflection, and spirituality in navigating the cancer experience; (4) the role of healing vs. cure; and (5) patient's moving forward to a life after cancer. Findings from this investigation suggest that patients with a history of lifelong substance use could benefit from earlier detection and improved awareness and knowledge of HNSCC risk. Findings can be applied to improve access to cancer screening through addiction and cessation programs, reduce lags in diagnosis, improve prognosis and contribute to the development of clinical tools. Additionally, the intersection of advancing chronological age, comorbidity, and perception of time warrants further investigation.

The National Tsunami Hazard Mitigation Program partnered with the National Weather Service (NWS) in 2000 to create the TsunamiReadyTM (TR) Community program. TR is designed to help communities in coastal areas plan and prepare for tsunamis. To achieve TR recognition communities must meet certain criteria including specific emergency planning and management actions within the categories of mitigation, preparedness, response, and recovery. This study’s purpose was to evaluate the acceptability and usefulness of key components of a proposed revised set of TR Community program guidelines. Research was guided by the Elaboration Likelihood Model (ELM) using Community Based Participatory Research methods to gather input from expert panels composed of local expert community stakeholders from 5 states and 1 US territory. Two qualitative data collection methods were used: online prediscussion surveys administered via Survey Monkey© and focus group discussions. Fifty participants attended 1 of 6 focus group discussions, with 20 participants completing surveys. Data analysis focused on 8 discussion topics: subdivision of communities by vulnerability, proportion of the population to be protected, evacuation effectiveness, evacuation drills or exercises, vertical evacuation, educating businesses, educating residents, and acceptability of a revised guidelines format. Supporting and opposing themes were identified, providing rich information of community-level perceptions regarding the guidelines. Most notably, the fidelity of the 2 ELM pathways were confirmed as separate. The peripheral pathway demonstrated a significant need for clarification and definition of program terms and activities through the surveys, while focus groups facilitated the central pathway for participants to discuss and debate various program guidelines. This study provides several recommendations based on community input for updating and revising the TR Community program guidelines including: revisions to the overall format, a new focus on community tsunami hazard, and additional actions and activities to improve community tsunami mitigation and preparedness efforts. Finally, the data and recommendations provided will be used to compile a final draft of the TR Community program guidelines for the NWS.

Health literacy among the elderly Hispanics is a problem for 44% who read at the lowest level due to issues with recognition, cognition, or vision. The purpose of this study was to determine the extent that elderly Hispanics have problems with medication adherence due to health literacy. The social cognitive theory was the framework for this study. Inclusion criteria consisted of being 65-75 years of age, and speaking and/or reading English and/or Spanish. Questionnaires from 156 individuals were completed in Cobb County/Atlanta GA and analyzed using multiple regression to determine the relationship between health literacy and medication usage. Medication adherence was the dependent variable and independent variables were gender, age, Hispanic origin, education, income, income means, health insurance, health literacy, and medication usage. Statistical significance was noted in medication adherence, health literacy, and working full-time. Results were based on the correct answers from health literacy questions, which showed an association between medication adherence and health literacy and a reduction in medication adherence problems among elderly Hispanics who worked full-time. These findings showed a significant association between medication adherence and health literacy level among elderly Hispanics. No medication adherence problems were noted among participants who had good health literacy, unlike participants with poor health literacy. A larger ethnic group may show a variation of problems in future studies. Implications for social change could include recommendations for the use of Spanish language hotlines and reading materials to provide care, knowledge, and medication information assistance.

<p><strong>Background –</strong> Universal family drop-in centres (drop-ins) are open to all children between the ages of zero and six and their carers regardless of ethnoracial make up and socioeconomic status. Provincially-funded drop-in centres offered by Aboriginal organizations address the need for culturally sensitive services for urban Aboriginal children (UAC) meanwhile promoting early learning opportunities for all children. Knowledge of factors that influence Aboriginal carers’ use of a culturally sensitive drop-in centre will inform policy-makers about the structures and resources required to ensure equitable access to drop-in centres for UAC.</p> <p><strong>Objectives – </strong>A pilot study to: 1) assess the feasibility of identifying and recruiting UAC with children between the ages of zero and six for optimal identification of the population in need of services; 2) describe the factors that influence the use of an Aboriginal early learning drop-in centre by carers of UAC between the ages of zero and six as perceived by service providers, users of the service, and non-users.</p> <p><strong>Methods –</strong> A qualitative descriptive study was conducted. A purposeful sample of 12 participants was selected. All service providers were invited to participate. Snowball sampling was used for users; convenience sampling was used for non-users. Semi-structured interviews with all participants were used to collect data. Directed content analysis was used with the Availability-Affordability-Acceptability framework for access to services to analyze interview data. Interviews between groups were compared and contrasted to confirm findings. During the research process, field notes of observations and reflections were recorded to address feasibility issues.</p> <p><strong>Results –</strong> Of the 12 eligible carers approached, 10 carers consented. Of the ten, nine carers were interviewed (4 users; 5 non-users). Recommendations for large-scale study protocol were: use of three categories of carers (current users; previous users; non-users); include non-Aboriginal carers of UAC in the sample population; recruit carers who live in the same neighbourhood where the service is located; provide detailed instructions for recruitment to gatekeepers. Key findings of the factors influencing use of the service were proximity of service to carer’s home, the carer and child having unstructured time, the type of Aboriginal-based content offered at the service, the carer’s trust of service providers, presence of social support, and carer’s sense of safety.</p> <p><strong>Conclusions –</strong> This pilot study suggests that conducting a large-scale study to identify factors that influence the use of an Aboriginal-based universal family drop-in centre as perceived by carers of urban Aboriginal children and service providers of the service is feasible with some methodological modifications. Recommendations for change are outlined.</p> <p><strong><br /></strong></p> / Master of Science (MSc)

Dementia is increasingly recognized as a major and growing threat to public health worldwide, and there is a critical need for prevention and treatment strategies. However, it is necessary that appropriate methodologies are used in the identification of risk factors. The purpose of this dissertation research was to develop further the body of literature featuring Markov chains as an analytic tool for data derived from longitudinal studies of aging and dementia. Data drawn from 649 participants in the University of Kentucky’s Alzheimer’s Disease Center’s (UK ADC) Biologically Resilient Adults in Neurological Studies (BRAiNS) cohort, which was established in 1989 and follows adults age 60 years and older who are cognitively normal at baseline to death, were used to conduct three studies. The first study, “Mild cognitive impairment: Statistical models of transition using longitudinal clinical data,” shows that mild cognitive impairment is a stable clinical entity when a rigorous definition is applied. The second study, “Self-reported head injury and risk of cognitive impairment and Alzheimer’s-type pathology in a longitudinal study of aging and dementia,” shows that when the competing risk of death is properly accounted for, self-reported head injury is a clear risk factor for late-life dementia and is associated with increased beta-amyloid deposition in the brain. The third study, “Incorporating prior-state dependence among random effects and beta coefficients improves multistate Markov chain model fit,” shows that the effect of risk factors, like age, may not be constant over time and may be altered based on the subject’s cognitive state and that model fit is significantly improved when this is taken into account.

Introduction: E-cigarettes have been marketed as smoking cessation aids and harm reduction strategies. Prior regional surveys found that physicians are recommending them to patients despite the lack of evidence supporting these industry claims. Yet, little is known about physicians’ beliefs regarding e-cigarettes and whether these beliefs are associated with them recommending e-cigarette use in clinical practice. Methods: This three-manuscript dissertation used a mixed-methods approach including both qualitative and quantitative research methods. The aims were to: (1) Uncover the factors associated with primary care physicians’ (PCPs) decisions to recommend e-cigarettes to their patients for tobacco use cessation; (2) Estimate the prevalence of PCPs who recommend e-cigarettes to their patients as a tobacco use cessation aid; (3) Estimate the influence of factors identified in Aim 1 on PCPs’ decisions to recommend e-cigarettes to their patients for tobacco use cessation; (4) Evaluate the conceptual model which demonstrates the factors contributing to PCPs’ decisions to recommend e-cigarettes to their patients for tobacco use cessation. Results: Study 1 found that PCPs expressed a lack of information about e-cigarette safety and efficacy along with skepticism about the role of e-cigarettes in tobacco control in general and in smoking cessation in particular. However, once a patient initiates a discussion with them, PCPs seem to be endorsing patients’ interests in using e-cigarettes, as well as recommending e-cigarettes to particular types of patients who smoke for both smoking cessation and as a harm reduction strategy. Study 2 found that over three-quarters (82.7%, n=220) of PCPs reported previously discussing e-cigarettes with their patients. Overall, 57.8% (n=155) reported previously recommending e-cigarettes to an adult patient who smoked. Among those recommending e-cigarettes, the majority reported recommending them for smoking cessation and harm reduction (71.6%, n=111), 18.8% for smoking cessation only, and 9.6% for harm reduction only. The likelihood of recommending e-cigarettes to patients was associated with considering their patients’ interest in using e-cigarettes, PCP’s belief that e-cigarettes can help in quitting smoking, and PCP’s belief that e-cigarettes limit secondhand smoke exposure for others. Study 3 found that PCPs intend to recommend e-cigarettes for smokers with prior unsuccessful quit attempts (mean=3.63, ±2.1), followed by heavy smokers wanting to quit (3.57, ±2.2), and heavy smokers refusing to quit (mean=3.50, ±2.2). The mean for PCPs’ recommendation intentions was 3.04 (±2.0) for light smokers wanting to quit, and 3.01 (±1.9) for light smokers refusing to quit. Nevertheless, these recommendation intentions were driven by PCPs’ beliefs and perceptions of e-cigarette benefit and harm; however, these intentions varied by patients’ tobacco use profile. Discussion: Findings across the three studies highlight the significance of PCPs’ beliefs in driving their recommendations of e-cigarettes versus evidence based knowledge, as well as, the importance of patients’ factors and interest in using e-cigarettes for PCPs’ recommendations for e-cigarette use.

Since the passage of the Clean Water Act, concern about surface water quality has increased. Reducing exposure to pathogens and adverse impacts on human health because of contact with surface waters has become the focus of many regulatory agencies. Fecal pollution is often a cause of surface water impairment. Fecal indicators, such as fecal coliforms and Escherichia coli, are used as surrogates to evaluate the presence or absence of fecal pollution. However, a growing body of research has shown that these species lack key characteristics necessary to be adequate indicators. As such, explorations into the efficacy of indicator species in predicting fecal pollution in water are necessary. Sinking Creek is a tributary of the Watauga River Watershed, located in Northeast Tennessee. Approximately ten miles of Sinking Creek have been placed on the national 303(d) list for fecal pollution, denoting the presence of fecal contamination exceeding the regulatory limit. Salmonella and Aeromonas are two enteric pathogens that would be expected to be detected in fecally contaminated waters. The primary objective of this study was to detect the presence of Salmonella and Aeromonas in Sinking Creek. The secondary objective was to evaluate their relationship with fecal coliforms, E. coli, and water quality parameters. Six study sites along Sinking Creek were sampled and standard methods were used to enumerate Salmonella and Aeromonas. Samples for Salmonella were collected for 8 months, while samples for Aeromonas were collected for seven. Salmonella and Aeromonas were present in Sinking Creek. Salmonella had the highest concentration at site 2 (the most downstream site), and was detected during all months of the study except for November. Salmonella concentrations varied by site. Aeromonas was present only during colder months, and had the highest concentration at site 2. Both Salmonella and Aeromonas show qualitative relationships with water quality parameters, such as dissolved oxygen and conductivity. However, statistically significant correlations of Salmonella and Aeromonas with water quality parameters were not observed. The lack of statistical significance is partially due to large variability and a small data set. Neither Salmonella or Aeromonas exhibited a relationship with fecal coliforms or E. coli. Therefore, fecal coliforms and E. coli may not be adequate indicator species for the presence of Salmonella, Aeromonas and possibly other waterborne pathogens. Traditional indicator species may inflate risk of pathogen exposure. Thus, many water bodies may be unnecessarily deemed as impaired. The results from this study can be used to guide further research regarding covariates influencing pathogen densities at fecally contaminated sites, as well as to guide decisions regarding impaired surface waters and management techniques.

The debate surrounding marijuana legalization has increased its popularity in recent years, as the state of California seriously considers the complete legalization of the substance for those ages 21 and over. This would make California the first government in recorded history to regulate the cultivation and sale of marijuana on a commercial level. Advocates back the economic positives concerning high tax revenues, but those opposed argue that the dangers associated with public health greatly outweigh any monetary gain. The present study attempts to reveal the possible public health concerns, even potential benefits, caused by marijuana use and its distribution. Specifically, measures of California’s Medical Marijuana Program will be assessed on the total number of drug treatment admissions in each county, taking into account treatment type and which type of drug is primarily responsible for said admissions. Findings reveal influences by both gateway and substitution effects, creating both positive and negative correlations throughout the field of public health. The influences of intangible variables, like that of the black market, make the results difficult to generalize. However, significant correlations can be found among specific health factors, like Heroin use, Crack/Cocaine use, and Residential Treatment.

Obesity has becoming one of the nation’s largest health concerns. An individual’s physical activity, diet, sedentary behaviors, and alcohol consumption patterns all play a role in fluctuation of BMI. While it is known that all of these can affect obesity, it is less commonly known how these behaviors cluster together in emerging adulthood. Uncertainty shrouds how these characteristics cluster together in young-adults. The purpose of this study is to utilize the 2015-2016 NHANES data to explore relationships of alcohol consumption, physical activity and sedentary behaviors to ascertain how strongly these measures of health cluster, and in what demographics do they most strongly cluster. A two-step cluster analysis resulted in 4 clusters being created with physical activity being the predominate indicator for grouping. Continuing analyses regarding the association of race, sex, and BMI are being conducted.