Digital Commons Network^™

School-Centered Tobacco Retailer Exposure And Neighborhood Opportunity Across Urban And Rural Tennessee, Sima Namin Dr, Jacob Black, Jennifer Ferris, Robert E. Heidel Dr

Journal of Appalachian Health

Introduction: Tobacco retailer availability contributes to youth tobacco use, and retailers are concentrated in socioeconomically disadvantaged communities. However, few studies have examined how school-centered retailer exposure intersects with neighborhood opportunity in a predominantly rural Appalachian state.

Purpose: The purpose of this study is to assess the association between neighborhood opportunity and school-centered tobacco retailer exposure across Tennessee (TN), including differences by rurality and Appalachian status.

Methods: We constructed a tract-level, school-centered youth tobacco exposure index for TN using tobacco retailer locations and public and private K-12 school data. The index incorporated retailer proximity, density, and distance-decay accessibility measures. Child Opportunity …

Disparities In Access To Medicare-Approved Medical Specialists In Rural Kentucky, Logan Hurm, Jacob A. Welch, James Adkins

Journal of Appalachian Health

Introduction: Approximately 20% of the United States population resides in a rural community; however, only 10% of all healthcare resources and physicians are dedicated to these areas. Appalachia, and Kentucky (KY) in particular, have higher populations living in rural areas which leads to a greater number of individuals affected by medical access disparities. As of 2026, 21% of KY’s population is eligible for Medicare, making access to Medicare-accepting specialty physicians crucial for the state’s population.

Purpose: This research aims to quantify healthcare disparities among rural communities in KY through quantification of the potential distance required to travel to access specialty …

States Strip Local Governments Of Authority To Govern Causing Some Rural Communities To Suffer, Terence J. Centner

Kentucky Law Journal

No abstract provided.

The New Parens Patriae, Meredith Johnson Harbach

Kentucky Law Journal

No abstract provided.

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

High-Deductible Health Plans In Rural And Urban Populations: Outpatient Utilization And Out-Of-Pocket Costs, Aaron P. Smith, Jefferey Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings This policy brief explores rural-urban differences in High-Deductible Health Plan (HDHP) enrollment, subsequent healthcare utilization, and out-of-pocket (OOP) costs. ▪ HDHP enrollment was uncommon. Rural residents were slightly less likely to enroll than urban residents across all demographic groups. ▪ Switching plans influenced utilization. Compared to those who did not change healthcare plans, switching from a Traditional plan to a HDHP was associated with a larger reduction in 2022 outpatient visits for both rural and urban residents. Moving from a HDHP to a Traditional plan was associated with a smaller reduction in 2022 outpatient visits for …

Evaluation Of Kentucky’S Work Zone Speed Camera Pilot Program: Speed And Crash Analyses, Xu Zhang, William Staats, Eric Green

Kentucky Transportation Center Research Report

Kentucky introduced automated speed enforcement in work zones to mitigate hazards and improve the safety of motorists and workers. This study describes the impacts of automated speed enforcement at five pilot sites. Researchers analyzed speed data and crash data from pilot sites and paired control sites. The control sites and pilot sites had similar traffic volumes, lane configurations, and functional classifications. Analysis drew on over 15 million individual speed records captured using automated enforcement cameras as well as segment-level speed data from HERE.  Active enforcement at pilot sites was associated with lower mean, 85th-percentile, and 99th-percentile vehicle speeds. Average vehicle …

Production Country Origin Impact On Soybean Oil Quality, Huazhen Liu, Micah Pope, Todd Doehring, Pradeep Kachroo, David Hildebrand

Plant and Soil Sciences Faculty Publications

Previous studies have suggested variability in soybean oil quality depending on geographic origin of the soybeans. In this study, 1035 crude degummed soybean oil (raw oil unrefined except for degumming) samples collected from vessels and crushers over five harvest years (2020–2024) were analyzed for 11 key quality attributes. Soybean oil samples were sourced from soybeans that originated from the United States, Brazil, and Argentina. The results indicate that US-grown soybeans consistently produce the highest-quality oil, characterized by the lowest free fatty acid (FFA) levels and lowest neutral oil loss (NOL). Oils from US soybeans also exhibited the highest iodine values. …

Improving The Clinical Trial Landscape For Patients With Atypical Variants Of Alzheimer's Disease, Nick Corriveau-Lecavalier, Neus Falgàs, Deepti Putcha, Jonathan Graff-Radford, Keir X.X. Yong, Baayla D.C. Boon, Rosaleena Mohanty, Eric Westman, Colin Groot, David T. Jones, Lea T. Grinberg, Gil D. Rabinovici, Jennifer L. Whitwell, Liana G. Apostolova, Melissa E. Murray, Dustin B. Hammers, Suzanne E. Schindler, Inga Atonsdottir, Elizabeth K. Rhodus, Jonathan M. Schott, Ignacio Illán-Gala, Ogbuagu Chukwuanugo, Jorge J.Llibre Guerra, Ruth Peters, Erin L. Abner, Carla Abdelnour, Albert Lladó, Renaud La Joie

Epidemiology and Environmental Health Faculty Publications

Patients with atypical variants of Alzheimer's disease (AD) often present at a younger age with predominantly non-amnestic impairments and a more aggressive disease course. Historically, individuals with atypical presentations have not been included in large-scale clinical trials, which typically focus on late-onset, sporadic amnestic-predominant AD. Consequently, treatment options and research efforts specific to atypical AD remain limited. The emergence of amyloid-targeting therapies that slow disease progression underscores these challenges, as evidence supporting their efficacy in early-onset amnestic and non-amnestic AD variants is scarce. This perspective article argues that atypical AD represents an excellent disease model for clinical trials and proposes …

The Polysubstance Assessment Tool, Amanda M. Bunting, Charles M. Cleland, S. Michaela Barratt, Brittany Griffin, Jaimee Williams, Carrie B. Oser, Joshua D. Lee, Jennifer Mcneely

Sociology Faculty Publications

Background and aims: There are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined the retest reliability, acceptability and feasibility of a new quantitative assessment to measure polysubstance use. Design: A tool for assessing simultaneous and same-day polysubstance behaviors, the polysubstance assessment tool (PAT) was developed in interviewer-administered and electronic self-administered formats. Participants were allocated 1:1 to receive either version of the PAT and returned one to three days later to repeat the assessment. Setting: New York City, …

From Lineage Discovery To Conservation Prioritisation, Zachary G. Macdonald, Joscha Beninde, Julian R. Dupuis, Thomas W. Gillespie, H. Bradley Shaffer, Gregory F. Grether

Entomology Faculty Publications

Accurate inferences of diversification and evolutionary processes depend on knowing how many independently evolving lineages exist within nominally widespread taxa. Uncertainty in lineage number and composition also limits our ability to meaningfully prioritise conservation efforts. Addressing these knowledge gaps requires frameworks that sequentially identify distinct lineages, assess mechanisms that contribute to their divergence, and quantify spatial and environmental determinants of their genomic diversity. With these goals in mind, we apply whole-genome, ecological, and morphological analyses to the American rubyspot damselfly (Hetaerina americana), a widespread and well-studied North American insect that has been long regarded as a single species of least …

Basic Types Of Pasture Vegetation In The Songnen Plain, Li Chonghao, Zheng Xuanfeng, Zhao Kuiyi, Ye Juxin

IGC Proceedings (1977-2023)

In this paper, the ecological conditions of pasture vegetation, the plant constituents of the Songnen plain, and their basic types and succession are discussed. An approach is also presented on ways to improve natural steppe artificially. In this region, there are 29 lignosa associations that are suitable for grazing and 450 plant species that are suitable forages. Among them are more than 30 species of perennial gramineous and leguminous plants.

Constructed Care: Stitching Patient Journeys Through Quilting And Healthcare Design, Ashley D. Moberly

Graduate Final Projects

This thesis investigates how healthcare environments can better support patient experience through improved wayfinding, spatial clarity, and human-centered design strategies. Contemporary healthcare systems are often complex and difficult to navigate, placing additional cognitive and emotional burdens on patients, particularly those traveling from rural and underserved regions. Drawing from both professional experience in healthcare facilities planning and a comprehensive review of literature on spatial perception, wayfinding, and patient-centered care, this research identifies key challenges in how patients' access, interpret, and move through healthcare environments.

In response, the study introduces the Quilt Logic System, a conceptual framework that translates principles derived from …

Engineering Stormwater Resilience In Steep Valley Ccr Landfill Construction, Kevin Resnik, Grant Phelps

World of Coal Ash Proceedings

Construction of a CCR landfill within steep geography presents unique challenges related to stormwater management, erosion control, and establishing placement and compaction practices over an extended construction timeline. This presentation builds upon prior work focused on temporary rain cover and wet-weather resiliency, expanding the discussion to practical strategies implemented during the prolonged startup and subsequent phases of waste placement. Key topics include: Stormwater management during active construction, with emphasis on intercepting, conveying, and controlling runoff in a topographically constrained setting. Breaking up drainage areas to reduce flow concentrations, prevent channelized erosion, and improve maintainability as grading evolves. Erosion control approaches …

Geopolymers For Construction And Mining: Material Characterization And Application Prospects, Radoslaw Pomykala, Gabriela Fuks

World of Coal Ash Proceedings

Geopolymers have long been presented as an alternative to conventional concretes and cement-based binders, yet their practical use remains limited for various reasons. This paper examines both the material properties of such mixtures and their potential for broader application.

The study evaluated geopolymers produced from different types of fly ash, including typical siliceous ashes and ash with elevated CaO content. The influence of mixture components, such as solids content, activator type, and sample preparation and curing methods, on technological properties was investigated. Research covered fresh mixtures—rheological behavior and setting time—as well as hardened samples using mechanical testing, XRD, and SEM. …

Transportation Logistics Panel, John Ward, Andrew Vollmer, Tracy Zea, Marci Jenks

World of Coal Ash Proceedings

As the industry shifts from freshly generated ash to harvested materials and advanced utilization, logistics is becoming one of the primary drivers of project success or failure. This moderated panel will explore how sourcing, transportation, and storage realities are changing — and what project teams most often underestimate when working with harvested coal ash. Panelists will discuss what breaks, what becomes more complex, and how logistics considerations are reshaping planning and development.

Demystifying Large Language Models: How Ai Is Transforming Data, Compliance, And Decision-Making In Coal Ash And Environmental Management, Scott Pfeiffer

World of Coal Ash Proceedings

The environmental and coal combustion residuals (CCR) industries generate vast amounts of information—from groundwater monitoring reports and RCRA documentation to closure plans and analytical data. Managing, interpreting, and communicating this information is a growing challenge for utilities, regulators, and consultants alike. Large Language Models (LLMs), such as OpenAI’s GPT architecture, represent a breakthrough in how organizations can interact with their technical data. These models use deep neural networks trained on billions of words to understand, summarize, and generate language with human-like accuracy. When securely adapted for enterprise use, LLMs can automate routine reporting, extract data from technical documents, generate regulatory …

Building Resilience When Disaster Strikes, Anna G. Kalema, Felipe González-Seguel, Louisa A. Summers, Esther E. Dupont-Versteegden, Ashley A. Montgomery-Yates, Kirby P. Mayer

Physiology Faculty Publications

No abstract provided.

Infective Endocarditis Hospitalizations In Kentucky, 2008-2018: Spatial And Temporal Trends, Meera Marji, Steve Browning, W. Jay Christian, Richard Charnigo, Steve W. Leung, Anna Kucharska-Newton

Journal of Appalachian Health

Introduction: Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid epidemic. In 2016, Kentucky (KY) ranked among the top ten states for opioid-related overdose deaths, but limited data exist on IE trends in KY.

Purpose: This study seeks to examine county-level spatial and temporal trends in IE hospitalization rates in KY.

Methods: Hospital inpatient discharge data from 2008–2018 for KY residents aged 18 and older were analyzed. IE admissions and drug use status were identified using ICD-9 & 10 diagnosis codes. U.S. Census data calculated yearly IE hospitalization rates per 100,000 residents. …

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

A Tale Of Two Landlords, Christopher J. Ryan Jr.

Kentucky Law Journal

No abstract provided.

Decolonizing The Law Of The U.S. Virgin Islands, Anthony M. Ciolli

Kentucky Law Journal

No abstract provided.

Sacbe 1 And Classic Maya Urban Culture, Traci Ardren, Scott R. Hutson, Travis W. Stanton, Patrick Rohrer, Justin P. Lowry

Anthropology Faculty Publications

One of the most significant engineering accomplishments of Maya civilization is Sacbe 1, a raised road connecting the ancient urban centers of Yaxuna and Coba. Using new lidar data in concert with excavation, epigraphic inscriptions, and landscape reconnaissance, we show that settlement and an urban experience emanated westward from Coba along the sacbe. The leaders of Coba - in particular, an ambitious seventh-century queen - used the sacbe to expand the political and cultural influence of their dynasty into the center of the peninsula while securing territory and resources. Gaps in the sacbe, precise delineation of its many curves, and …

Toward An Emerging Public Health Paradigm, Rod Wallace, Katherine Frels, Maria Itria Ibba, Conrad Lyford, Devin Rose, David Baltensperger, Jan A. Delcour, Steven Greenspan, Alison Lovegrove, Barbara Schneeman, Peter Shewry, Edward Souza, William W. Wilson, Gary W. Yohe, Jim Anderson, George Annor, Jayne Bock, Claudia Carter, Brett Carver, Jianli Chen, Edward C. Deehan, Noah Dewitt, Lisa Diewald, Jason Donovan, Corrine K. Hanson, David Holding, Amir Ibrahim, Mariah Jackson

Animal and Food Sciences Faculty Publications

An emerging paradigm in public health focuses on enhancing nutrition in existing food staples to reduce chronic disease at the population scale, rather than relying on individuals to change their behavior. This paradigm leverages plant and animal breeding, production practices, and processing to enhance nutrition, whereby foods consumed by millions can be improved at low incremental cost. This article supports and operationalizes this paradigm, illustrating the potential to improve diets through a case study that increases the arabinoxylan fiber content of commodity wheat through classical plant breeding (a non-GMO technology). The approach described in this article proposes to link agricultural …

Driving Employee Engagement Across Sectors: Current Evidence And An Agenda For Future Research, Taha Hameduddin, Kerstin Alfes, Adrian Ritz

Public Policy and Administration Faculty Publications

Employee engagement has emerged as a critical employee attitude linked to employee motivation and organisational performance and has successfully embedded itself in governments around the world. Apart from a few exceptions, however, much of what we know about engagement does not attend to the institutional context of public institutions and whether private-sector theories and approaches to driving employee engagement work well in public sector organisations. To address this gap, we systematically review the evidence on antecedents of employee engagement, and determine whether and how sectoral differences may matter. We then discuss the findings and contextualise the debate surrounding the employee …

Three Essays On Extreme Weather, Agricultural Productivity, And Water Resources, Munib Inam

Theses and Dissertations--Agricultural Economics

As extreme weather events become more frequent and more intense, understanding their effects becomes increasingly important. This dissertation examines those effects and related policy questions across three essays.

The first essay demonstrates that methodological choices in weather data construction can meaningfully affect estimated agricultural impacts of extreme weather. Using corn yields across the U.S. Corn Belt, it shows that constructing nonlinear weather measures after spatial interpolation reduces measured exposure to extreme heat and changes both estimated yield impacts and their downstream economic implications.

The second essay examines how weather exposure affects drinking water quality. It shows that microbial contamination responds …

Building The Ryan White Hiv/Aids Program Bench In Kentucky, Lauren Bifulco, Kathleen Harding, Jana Collins, Anna Rogers, Lenon Farkash, Marwan Haddad, Alice Thornton

Epidemiology and Environmental Health Faculty Publications

The Ryan White HIV/AIDS program (RWHAP) is governed by legislative and programmatic guidelines that ensure comprehensive services are provided to persons with HIV (PWH) across the United States. Comprehensive training and skill building opportunities for programmatic staff are rare. RWHAP funding recipient organizations may struggle to acquire and retain essential program-specific knowledge, with downstream impact on patient care and treatment. We designed a comprehensive 11-session videoconference learning series to improve program staff’s confidence and competence with RWHAP fundamentals. Quantitative pre-vs-post session data were analyzed using Wilcoxon Signed-Rank tests, and qualitative data using thematic analysis. We enrolled 136 staff from 23 …

Addressing Obesity And Diabetes In Appalachian Kentucky, Hannah E. Orens

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

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in …

Building Public Health Data Dashboards: Tutorial Playbook, Elwin Wu, Raymond Balise, Benjamin Katz, Daniel R. Harris, Matthew Bullard, Naleef Fareed, Marc Larochelle, Jennifer Villani

Institute for Biomedical Informatics Faculty Publications

Public health data dashboards have substantial potential to improve transparency, understanding, and decision-making at multiple levels, from individuals to public health practitioners and policymakers. However, creating effective dashboards presents many challenges. In this case-based tutorial on public health dashboard development, we share lessons learned from our experience developing data dashboards for the HEALing Communities Study (HCS), a National Institutes of Health (NIH)–funded, community-engaged intervention to deploy evidence-based practices to reduce opioid overdose deaths in 67 communities across 4 states. We present key decision points dashboard teams must address, along with the major considerations and trade-offs that shaped our approach. First, …

“Oh, You’Ve Come To Visit The Yard?”: Phenotypic Capital, Intragroup Marginalization, And The Gated Sanctuary In Black Lgbtq+ Communities, Keith J. Watts, Shawndaya S. Thrasher, Nicole Campbell, Laneshia Conner, Julian K. Glover, Janet K. Otachi, Dekeitra Griffin

Social Work Faculty Publications

Identity-based communities that share common characteristics, beliefs, and experiences (e.g., Black LGBTQ+ communities) have historically been conceptualized as protective bubbles that buffer Black LGBTQ+ individuals against the deleterious effects of systemic racism and cisheterosexism. However, this monolithic narrative often masks the internal power dynamics that divide belonging. This study explores the exclusionary dynamics embedded within these safe spaces, examining how internal hierarchies of skin tone, socioeconomic status, and gender performance function as proximal stressors. Guided by a critical constructivist paradigm, this study utilized Reflexive Thematic Analysis to analyze open-ended survey responses from 74 Black LGBTQ+ adults. Data were drawn from …