Digital Commons Network^™

Utilitzing A Nurse Triage Model To Decrease The Administrative Burden Of Emr Messaging, Pamela B. Schneider

DNP Projects

Abstract

Background: The volume of Electronic Medical Records (EMR) messages from patients to providers continues to rise, yet clinic workflows have not been adequately restructured to accommodate. Increased EMR, especially the inbasket, is associated with provider burnout and decreased job satisfaction, contributing to provider turnover.

Purpose: To improve the triage and distribution of the EMR messaging workload

Method: A Nurse Triage Flowchart was implemented in the Gastroenterology Clinic at the University of Kentucky to help RNs/MAs triage patient messages for improved workflow. Surveys were completed by RNs/MAs and providers before and three months post-implementation. Data from EPIC over six …

“What We Say Matters”: Reducing Drug Use Stigmatization By Healthcare Professionals Through A Narrative-Based Awareness Campaign, Adam M. Traugott

DNP Projects

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma …

Evaluating A Public Health Program Using The Cdc Framework: A Case Study Approach, Brooke A. Poe

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

In Bourbon County, Kentucky, where rural health challenges and chronic disease burdens persist, a coalition of public health partners set out to improve population-level physical activity through an innovative, community-centered initiative. The Bourbon County Physical Activity Program emerged through collaboration between the Bourbon County Health Department, the University of Kentucky College of Public Health, and UK HealthCare. Together, these partners designed a six-month intervention that combined discounted YMCA memberships, partnerships with employers, a physical activity tracking app with behavioral incentives, and community-wide events to promote accessible and sustained engagement.

Guided by the CDC’s framework for program evaluation in public health, …

Influence Of Perceived Health Provider Communication, Diabetes Duration And Age At Diagnosis With Confidence In Diabetes Self-Care, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, William B. Burrows, Brittany L. Smalls

Family and Community Medicine Faculty Publications

Introduction: Several factors influence individuals’ confidence to perform diabetes-related self-care activities, including perceived patient-provider communication, diabetes duration and age at diagnosis. It has been well-documented that patient-provider communication is essential when managing chronic diseases such as diabetes; however, the impact of this communication with diabetes duration and age at diabetes diagnosis on confidence in performing self-care behaviors is obscure.

Research design and methods: We utilized data from the 2021 Household Component of the Medical Expenditure Survey among participants 18 years or older who had completed the Diabetes Care Survey. Ordinal logistic regression models were utilized to assess the association between …

Patterns Of Inpatient Antibiotic Utilization By Race And Ethnicity At Us Children’S Hospitals, Bethany A. Wattles, Jeffrey I. Campbell, Theresa Kluthe, Yana B. Feygin, Kahir Jawad, Michelle D. Stevenson, Deborah Winders Davis, Jennifer Porter, V. Faye Jones, Matt Hall, Michael J. Smith

Biostatistics Faculty Publications

Background and Objectives: Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity. Methods: This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates. Results: There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT. Conclusions: Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.

A Demographic Description Of Children And Adolescents With Concomitant Autism And Anxiety Along With A Comparison Of Receipt Of Psychological Services, Elizabeth Salt, Amanda T. Wiggins, David N. Toupin, Emma Parks, Chizimuzo Okoli, Mary Kay Rayens

Biostatistics Faculty Publications

Objective:(1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism.Methods:Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann-Whitney U tests, χ² tests of association, and logistic regression.Results:Demographic differences …

Clinical Criteria For Limbic-Predominant Age-Related Tdp-43 Encephalopathy, David A. Wolk, Peter T. Nelson, Liana Apostolova, Konstantinos Arfanakis, Patricia A. Boyle, Cynthia M. Carlsson, Nick Corriveau-Lecavalier, Penny Dacks, Bradford C. Dickerson, Kimiko Domoto-Reilly, Brittany N. Dugger, Rebecca Edelmayer, David W. Fardo, Michel J. Grothe, Timothy J. Hohman, David J. Irwin, Gregory A. Jicha, David T. Jones, Claudia H. Kawas, Edward B. Lee, Karen Lincoln, Gladys E. Maestre, Elizabeth C. Mormino, Chiadi U. Onyike, Ronald C. Petersen, Gil D. Rabinovici, Rosa Rademakers, Rema Raman

Biostatistics Faculty Publications

Limbic predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is highly prevalent in late life and a common co-pathology with Alzheimer's disease neuropathologic change (ADNC). LATE-NC is a slowly progressive, amnestic clinical syndrome. Alternatively, when present with ADNC, LATE-NC is associated with a more rapid course. With the emergence of anti-amyloid therapeutics, discrimination of LATE-NC from ADNC is critical and will lead to greater clinical recognition of amnestic patients without ADNC. Furthermore, co-pathology with LATE-NC may influence outcomes of these therapeutics. Thus there is a need to identify patients during life with likely LATE-NC. We propose criteria for clinical diagnosis of …

Code Status Discussions, Hunter Bechtold, Reagan T. Smith, Peter Wallenhorst, Kaylee Gouge, Sarah Schaefer, Kelsey Karnik, Kristen Mcquerry, Kristen E. Fletcher

Biostatistics Faculty Publications

Introduction: Residents frequently conduct code status discussions (CSDs) with patients, but many report not receiving formal training in this skill. While institutions have attempted to address this, there remains a need for a curriculum that uses standardized patients (SPs), is generalizable to students interested in different medical specialties, and has been tested on a large sample of students. Methods: We trained 192 fourth-year medical students across four different campuses in how to conduct CSDs during one 2-hour workshop as part of their Transition to Residency course in April 2024. Students worked with SPs as part of this workshop. Students at …

A Myostatin Inhibitory Antibody Combined With Insulin, Partially Rescues The Musculoskeletal Phenotype Of Female Insulin-Deficient Diabetic Mice, R. Clay Bunn, Reuben Adatorwovor, Philip D. Ray, Alexander R. Keeble, Christopher S. Fry, Sasidhar Uppuganti, Jeffry S. Nyman, John L. Fowlkes, Evangelia Kalaitzoglou

Biostatistics Faculty Publications

Introduction: Type 1 diabetes is associated with deficits in both skeletal muscle and bone. Inhibition of myostatin, a negative regulator of muscle mass, was explored as a druggable target to improve the musculoskeletal phenotype associated with insulin-deficient diabetes in female mice. Methods: We investigated whether administration of an inhibitory myostatin antibody (MyoAb) in streptozotocin-induced diabetes in female mice is protective for skeletal muscle and bone. DBA/2J female mice were injected with low-dose streptozotocin or with citrate buffer (vehicle). Subsequently, mice were implanted with insulin-containing or vehicle pellets, with groups being randomized to myostatin or control antibody for 8 weeks. At …

Diagnosing Statistical Education Needs Of Health Science Learners, Amy S. Nowacki, Ann M. Brearley, Robert A. Oster, Emily Slade, Katrina L. Devick, Matthew J. Hayat, Sally W. Thurston

Biostatistics Faculty Publications

Many types of health science learners, including clinical and translational scientists, students, researchers, and clinicians, seek to increase their knowledge of biostatistics. These learners are heterogeneous in their field, career stage and career focus. Based on the collective experience of an expert panel with over 115 years teaching statistics to health science learners, we propose a framework for considering the needs of health science learners motivated by their career goals. This framework defines four types of health science learners seeking statistical training: (a) consumers, (b) “milestone makers”, (c) biomedical researchers with statistical support, and (d) biomedical researchers without statistical support. …

An Exploration Of Ibdp Coordinator Leadership In Southeastern U.S. Public High Schools, Raymond W. Scheetz Jr.

Theses and Dissertations--Educational Leadership Studies

Along with its brand, vision, and curricula, International Baccalaureate (IB) provides member schools with requirements and expectations, such as implementing a program coordinator. However, the need for flexibility that would allow for global implementation leaves the nature of IB’s required program coordinator positions subject to local discretion in many ways. However, while increasing in numbers globally, IB Diploma Programs are still not widely implemented in public high schools throughout the U.S. Southeast. As a result, the position of an IBDP coordinator is unusual in such schools in the region. Also, the IBDP coordinator position has not been substantially defined or …

How Elementary Schools Support Families In Mandatory Middle School Choice: A Comparative Case Study, Eleni Filippatos

Theses and Dissertations--Educational Leadership Studies

This dissertation examines the role of New York City elementary school leaders in shaping fifth graders' middle school choice processes in two public schools serving predominantly economically disadvantaged, Latino families. As school choice increasingly influences students' academic trajectories, understanding how leaders engage families in this decision-making process is essential for promoting educational equity. The study explored how public elementary school principals, counselors, and teachers support families during the universal middle school application process.

Using a qualitative comparative case study design, I conducted semi-structured interviews, field observations, and document analysis to compare leadership practices at two demographically similar elementary schools with …

Empowering Future Educators: Exploring Preservice Elementary Teachers’ Self-Efficacy Within Integrated Stem Experiences In A Science Methods Course, Shane C. Campbell

Theses and Dissertations--Education Sciences

There is an ongoing need for preparing high-quality preservice elementary teachers who are confident and capable in the design and delivery of integrated STEM instruction. This qualitative study examines the experiences of a small cohort of preservice elementary teachers enrolled in a science teaching methods course and further examines how preservice teachers' perceptions of self-efficacy change as a result of their participation in integrated STEM experiences in science methods coursework. Data were collected using pre and post surveys to capture self-reported efficacy levels related to STEM teaching, along with semi-structured interviews conducted before and after the course to further contextualize …

Smart Qos-Aware Resource Management For Edge Intelligence Systems, Minoo Hosseinzadeh

Theses and Dissertations--Computer Science

There are several definitions for Smart Cities. One common key point of these definitions is that smart cities are technologically advanced cities which connect everything in a complex urban environment including infrastructure, information, and even people to cope with the crucial problems linked with the urban life such as traffic, pollution, city crowding, health, and poverty. Central to this vision are the Internet of Things (IoT) and Big Data, where interconnected devices with sensors collect vast amounts of data for informed decision-making. However, the rapid expansion of IoT devices challenges efficient data processing while meeting diverse Quality-of-Service (QoS) requirements; for …

Temporal Team Formation Games With Dynamic Preferences, Cameron Egbert

Theses and Dissertations--Computer Science

In the professional world, it is imperative for management entities to allocate their human resources to a work schedule, and such models of coalition formation games are well-studied. However, most existing literature only considers coalition formation in the context of a single moment in time, without accounting for changing preferences among individuals as they work together. The primary contribution of this thesis is a new team formation game that incorporates skill-based team formation and a dynamic variant of Additively Separable Hedonic Games. These Temporal Team Formation Games with Dynamic Preferences (TTFG-DPs) allow for two psychologically common preference dynamics: a preference …

Optimization, Machine Learning, And Networking Solutions For Cyber-Physical Systems, Xu Tao

Theses and Dissertations--Computer Science

Cyber-Physical Systems (CPS) represent a transformative paradigm that integrates sensing, computation, and actuation through networked systems to enable intelligent, context-aware applications across various domains. Despite their growing potential, CPS still face critical challenges, particularly in maintaining reliable, low-latency communication and efficient data processing in resource-constrained and dynamic environments. These challenges are further magnified in rural or remote deployments, where traditional network infrastructure is often unavailable or unreliable. This dissertation addresses these challenges through the development of optimization and inference algorithms that enhance network performance in Software-Defined Networks (SDN), using techniques such as reinforcement learning and network tomography for efficient routing. …

Information-Theoretic Methods For Efficient Training And Robust Evaluations In Self-Supervised Learning, Oscar Skean

Theses and Dissertations--Computer Science

Self-supervised learning (SSL) has become a cornerstone of modern machine learning, offering a scalable alternative to costly human annotation by constructing pretext tasks directly from raw data. While SSL has delivered strong results across vision, language, and multimodal domains, two major limitations persist: (1) SSL methods are often significantly slower to train than supervised counterparts, and (2) evaluation protocols remain narrow, with most studies relying on linear probing accuracy on the pretraining dataset. . These challenges are particularly acute for large language models (LLMs), where training costs and interpretability of intermediate representations are critical concerns.

In this work, we propose …

Covid-19 Impacts On Refugee-Serving Ngos In Clarkston And The Atlanta Metropolitan Area, Georgia, United States, Ghazal Khaksari

Theses and Dissertations--Anthropology

This study provides a unique anthropological perspective on how technology, language, NGO staff, and culture intersect during emergency times, which can affect NGOs’ abilities to reach and help communities. Findings of this study emphasize the importance of equality in digital access and of available and culturally competent interpreters in reducing the gap between NGOs and refugee communities. The digital divide has played a fundamental role during the pandemic, often leading to other problems for both NGOs and refugees. This issue has taken a variety of forms in terms of access to education, language classes, community cohesion, and communication with and …

Communities Of Stone Toolmakers Along The Lower Cumberland And Tennessee Rivers, Vanessa N. Hanvey

Theses and Dissertations--Anthropology

Concurrently occupied between circa 8,600-8,200 cal B.P., the Canton (15Tr1), Lawrence (15Tr33), Morrisroe (15Lv156), and Whalen (15Ly48) sites have similar stone tool assemblages. Though the sites are situated close to one another within the lower Tennessee and Cumberland River watersheds, the connection between the people who occupied each site remains unclear. Extensive lithic deposits representing all stages of tool manufacture were identified at both the Canton and Lawrence sites, and previous lithic analyses show that similar raw materials were being accessed by stone toolmakers at all four sites. To investigate the relationship between the people who occupied these sites, this …

Strategic Alignment Of Lexington Public Library And Art Community, Jonnisa Ferguson, Samantha Metzger-Elder

MPA/MPP/MPFM Capstone Projects

Amidst the evolving economic, political, religious, social, and technological landscape of the United States, one enduring element across communities has been the presence and importance of public libraries. Despite the decreasing number of genuinely public spaces in America, public libraries remain accessible and welcoming to all (Howard, 2019). Modern public libraries unite people and are "rewriting common assumptions of what people think a library does" (Carlson, 2024). Going far beyond books, libraries are serving as a "trusted public common for social innovation and civic engagement," partnering with community organizations to address daily living issues (i.e., food insecurities and professional development), …

A Comparative Study Of State-Level Fast Programs To Identify Best Practices For Kentucky, Alana Morgan

MPA/MPP/MPFM Capstone Projects

This capstone project examines best practices among state-level innovation programs participating in the U.S. Small Business Administration’s Federal and State Technology (FAST) Partnership Program, with a specific focus on the Kentucky Science and Engineering Foundation (KSEF). As a key player in Kentucky’s innovation ecosystem, KSEF supports small businesses and entrepreneurs in pursuing federal Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) funding. This study evaluates KSEF’s current program effectiveness and identifies strategies from similar states that could strengthen Kentucky’s outcomes in securing federal innovation funding.

Using a qualitative comparative research design, this study analyzes interviews with program …

The Impact Of Medicaid Postpartum Coverage Expansion On Insurance Coverage In California, Akuoma Nwannunu

MPA/MPP/MPFM Capstone Projects

This study examines the impact of California’s 12-month Medicaid postpartum expansion on insurance coverage outcomes among recent mothers using pooled data from the American Community Survey (ACS) microdata from 2018-2019 and 2022-2023. A quasi-experimental difference-in-differences design compared postpartum mothers with non-postpartum mothers to assess whether the policy altered Medicaid enrollment, private coverage, or uninsurance in the first two years after implementation. Findings show that Medicaid coverage increased slightly and uninsurance declined modestly among postpartum mothers, while private coverage remained stable. Across all three outcomes, however, the DID estimates were small and statistically insignificant, which indicates early but limited measurable effects. …

Sex-Specific Roles Of The Adipocyte Mineralocorticoid Receptor In Obesity And Early Life Stress, Meghan B. Turner

Theses and Dissertations--Pharmacology and Nutritional Sciences

Obesity is a burgeoning health epidemic caused by chronic overnutrition and exacerbated by genetic, environmental and developmental factors. The adipocyte mineralocorticoid receptor (MR), a transcriptionally active nuclear receptor, is speculated to contribute to metabolic dysfunction in the obese state. MR expression is increased in obese adipose tissue, and MR modulates the expression of fat-derived hormones such as leptin and adiponectin. In women, obesity can be exacerbated by early life stress, such as adverse childhood experiences (ACEs). Studies show that women display a positive association between cumulative ACE exposures and increased body mass index. Previously, we demonstrated that maternal separation and …

Nothing Short Of Superheroic: A Quantitative Study Of Lifetime Exposure To Superhero Comic Book Media As A Predictor Of Attitudes Towards Diversity, Equity, And Inclusion, Michael Nguyen

Theses and Dissertations--Educational Leadership Studies

This dissertation examined the relationship between lifetime exposure to superhero comic book media and attitudes toward diversity, equity, and inclusion (DEI). Drawing on theories of identity formation—transitional objects, parasocial relationships, and cultivation theory—it investigated whether engagement with superhero narratives predicted DEI attitudes. Using quantitative methods, data from 499 U.S. adults were collected via Qualtrics. Two instruments were used: the Lifetime Superhero Comic Book Media Exposure Scale (LSES) and the Intolerant Schema Measure (ISM), which assessed prejudice across race, gender, sexuality, class, age, and religion. Multiple linear regression revealed that superhero media exposure significantly predicted ISM scores (B = 0.118, …

Exploring The Collective Efficacy Of Elementary Special Education Teachers And Its Relationship To Distributed Leadership, Emma L. Jones

Theses and Dissertations--Educational Leadership Studies

This study examined the relationship between collective teacher efficacy (CTE) and distributed leadership practices among elementary special education teachers. CTE reflects teachers’ shared belief in their collective ability to improve student outcomes, while distributed leadership emphasizes shared decision-making, collaboration, and shared responsibility across school personnel.

Using a sequential explanatory mixed-methods design, the study combined survey data from the Collective Teacher Belief Scale with follow-up interviews. Survey results from 31 special education teachers indicated moderate to high levels of CTE, with slightly greater confidence in managing student behavior than in delivering instruction. Interviews with teachers across varying CTE levels provided deeper …

Using The Mand-Model Intervention Strategy To Increase Verbal Or Augmentative And Alternative (Aac) Two-Word Utterances For Requesting Items In A Naturalistic Setting, Morgan A. Williams

Theses and Dissertations--Education Sciences

This project examined the effectiveness of the mand-model milieu teaching strategy for increasing two-word verbal or augmentative and alternative communication (AAC) requests in a classroom. Three students participated. All students demonstrated increased mean length of utterance in words (MLUw) when requesting preferred items. For all students, correct two-word requests improved following a model prompt. Two students showed limited independent requesting following only a mand, while one student met criterion for consistent independent requesting. Other observed outcomes included improved communicative confidence, reduced frustration behaviors, and increased AAC acceptance and generalization across settings for one participant. Findings suggest that the mand-model strategy …

Teacher Perceptions Of A Mindful-Based Social Emotional Group Drumming Curriculum: A Collective Case Study, Kristin Lewis

Theses and Dissertations--Music

Educational researchers have discovered a connection between educator and student well-being. Educators need to cultivate these skills to effectively model social emotional learning (SEL). However, there is a shortage of resources for elementary general music educators that intentionally embed social emotional competencies in tandem with adhering to the National Core Arts Standards.

Therefore, the purpose of this study was to examine elementary music educators’ perceptions of a Mindfulness-Based Social Emotional Learning (MBSEL) group drumming curriculum and its impact on their own and their students’ social emotional competencies (SECs). The research questions were: (1) What are elementary music educators’ perceptions of …

Miguel Zenón's Solo On Olas Y Arenas And His Approach To Improvisation, David Alonso-Otero

Theses and Dissertations--Music

This paper is about Miguel Zenón’s approach to improvisation using one of his solos on his album Alma Adentro: The Puerto Rican Songbook. This includes the biography of Miguel Zenón along with the composer, Sylvia Rexach. Jazz Improvisation has a large spectrum of pedagogy, different ways to approach it along with various points of view. The purpose of this paper is to show one of the many ways to see jazz improvisation through the eyes of Miguel Zenón and his unique thinking process to jazz. The transcription will be in the appendices, as well as the interview done in …

A Pedagogical Survey Of Solo Multiple Percussion Literature, Austin Shoupe

Theses and Dissertations--Music

In the study of western classical percussion, there are three or four core instruments through which the necessary skills of the discipline are taught. The three universally accepted core instruments are snare drum, keyboard percussion, and timpani. Multiple Percussion is often considered as a fourth core instrument, given its significant presence in symphonic literature, musical theatre, chamber music, and solo repertoire. However, despite its importance to percussion performance, there are very few published pedagogical materials for multiple percussion. While there are etude books available, there are no comprehensive method books aimed at multiple percussion pedagogy.

To fill this gap in …

A Comparison Of Informal Choral Singing Experiences, Christopher Powell

Theses and Dissertations--Music

A traditional choir relies on the interest and participation of the population in communal singing. However, drawing willing participants into a traditional choir program can often prove challenging to music educators, community choir directors, and leaders of religious music programs. One of the most prevalent informal singing groups in the USA is Sacred Harp. Sacred Harp “singings” have been around since the early years of The Sacred Harp itself. These singings occur regularly in multiple locations across the country and around the world. These events have an open atmosphere and, despite the mostly Christian material, have no expectation of a …