Digital Commons Network^™

A Deimplementation Framework For Curricular Hoarding In Pharmacy Education, Mary E. Fredrickson, Ashleigh Barrickman, Krista L. Donohoe, Angela L. Goodhart, Caroline Lindsay Ko, Daniel R. Malcom, Frank Romanelli, Marissa C. Salvo

Pharmacy Practice and Science Faculty Publications

Objective: To propose a holistic approach to managing curricular transformation that addresses various curricular obligations, incorporates the emotional component of curricular overload, and utilizes deimplementation science to reframe curricular change decisions. Findings: Given the need to codify processes and interventions that continually seek to ensure curricula are modernized, contemporary, and free of outdated teaching materials, we have developed a systematic deimplementation approach to address curricular overload. Its intent is to free space for more impactful learning and practices within pharmacy curricula that can lead to measurable improvements in workload, satisfaction, and learning outcomes for both students and faculty. Summary: By …

Behavioral And Transcriptomic Markers Of Susceptibility To Escalate Fentanyl Intake, Jack V. Keady, Richard Charnigo, Jakob D. Shaykin, Emily Prantzalos, Mengfan Xia, Emily D. Denehy, Cody Bumgardner, Justin Miller, Pavel I. Ortinski, Michael Thomas Bardo, Jill R. Turner

Pharmacy Practice and Science Faculty Publications

The “loss of control” over drug consumption, known as escalation of intake in opioid use disorder (OUD), is well-established in preclinical rodent models. However, little is known about how antecedent behavioral characteristics, such as valuation of hedonic reinforcers prior to drug use, influence fentanyl intake trajectories. Moreover, it is unclear if distinct escalation phenotypes are driven by transcriptomic markers predictive of OUD susceptibility. Male and female Sprague-Dawley rats (n = 72) were trained in a sucrose reinforcement task using a progressive ratio schedule. Individual differences in responsivity to sucrose were hypothesized to predict escalation of fentanyl intake. Rats underwent daily …

Validity And Reliability Of Force Insoles To Measure Center Of Pressure During Return-To-Sport Testing, Delaney Mcneese, Charles Eisner, Rachel Todd, Brian W. Noehren, Meredith K. Owen

Biomedical Engineering Faculty Publications

Center of pressure is a valuable biomechanical variable, predicting joint loading contributions during movement and giving insight into compensatory patterns. The purpose of this study was to assess the validity and reliability of force insoles in calculating vertical ground reaction force and center of pressure during return-to-sport jump testing. Ten healthy individuals performed double- and single-leg vertical and horizontal jumps on an instrumented treadmill while wearing instrumented force insoles. Vertical ground reaction force and anterior–posterior and medial–lateral center of pressure were collected at peak vertical ground reaction force from both devices. Repeat testing occurred 7 ± 5 days following the …

Non-Contact Optical Spectroscopy For Metabolic And Vascular Characterizations Of Orthotopic Tongue Cancer Models In Vivo, Md Zahid Hasan, Jing Yan, Sumit Sarker, Pranto Soumik Saha, Caigang Zhu

Biomedical Engineering Faculty Publications

Most tissue optical spectroscopy platforms use a fiber probe for light delivery and collection, while the inconsistent probe-sample contact could induce significant distortions in the measured optical signals, which consequently bring analysis errors. Moreover, it will be practically difficult to use a fiber probe for measurements in some cases such as oral cancer investigations using small animal models. To address the critical challenge, we report a portable, lens-based, optical spectroscopy device capable of quantifying key vascular and metabolic parameters in vivo without probe-sample contact. We combined lenses based diffuse reflectance and fluorescence spectroscopy into one portable platform to enable multi-parametric …

Noninvasive Diffuse Optical Monitoring Of Cerebral Blood Flow And Oxygenation Responses To Intermittent Hypoxia In Neonatal Rats, Pegah Safavi, Mehrana Mohtasebi, Chowdhury Azimul Haque, Faezeh Akbari, Xuhui Liu, Yiqi Yuan, Li Chen, Lei Chen, Guoqiang Yu

Biomedical Engineering Faculty Publications

Significance: Intermittent hypoxia (IH) is common in preterm neonates and can cause hypoxic–ischemic brain injury. Simultaneous monitoring of cerebral blood flow (CBF) and oxygenation is essential to detect oxygen delivery-extraction mismatches and guide intervention.

Aim: We aimed to adapt and test an innovative diffuse speckle contrast flow oximetry (DSCFO) system for continuous monitoring of cerebral hemodynamics during IH in neonatal rats, a model approximating human neonates.

Approach: Two compact laser diodes and a miniature CMOS camera were integrated into a fiber-free probe for continuous monitoring of changes in relative CBF (rCBF) and oxy- and deoxy-hemoglobin concentrations (Δ[HbO₂] and …

Comparative Evaluation Of R134a And Hfo‐1234ze Cryogen Spray Cooling Using A Mouse Model With Controllable Epidermal Pigmentation, Wangcun Jia, Yurie Jeong, Crystal Huynh, Oswald Lai, Emily Nguyen, Grant Swajian, Jade Niu, Ayana Kashikar, Joshua Khaw, Hong Pu, Bernard Choi, John August D'Orazio, J. Stuart Nelson, Bahman Anvari

Pediatrics Faculty Publications

Objectives: Cryogen spray cooling (CSC) is critical for protecting the epidermis during laser dermatologic procedures. The widely used cryogen, R134a, has a high global warming potential (GWP), motivating interest in environmentally favorable alternatives such as HFO-1234ze. This study evaluated whether HFO-1234ze provides epidermal protection comparable to R134a during laser exposure and investigated the mechanistic basis underlying any differences in cooling performance.

Methods: Laser-induced epidermal injury in conjunction with two cryogens was assessed in K14-SCF Mc1r^e/e mice with pharmacologically controllable interfollicular epidermal pigmentation. Laser treatment sites were assigned fluences relative to baseline skin lightness (L*) to span subthreshold …

From Barriers To Breakthroughs: Academic Advising And Resilience Among Online Social Work Students In Appalachia, Jessica Williamson

DSW Capstone Projects

This Doctor of Social Work (DSW) capstone project examines how academic advising can be leveraged as a resilience-informed intervention to support persistence among online social work students in the Appalachian region. Although online education has expanded access to higher education, Appalachian students continue to face significant structural, technological, and cultural barriers, including limited broadband access, financial instability, geographic isolation, and norms that emphasize self-reliance. These challenges contribute to lower retention and degree-completion rates, highlighting the need for intentional, context-responsive support strategies. This project integrates three scholarly products: a systematic literature review (SLR), a conceptual paper, and a practice application paper. …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

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

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

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

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

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

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

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

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

Improving Prenatal And Postpartum Care Gaps In Breathitt County, Megan Deaton

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

Maternal and infant health remain a major public health issue across the United States, particularly in rural communities. Barriers such as shortages of obstetric providers, transportation challenges, and limited access to prenatal and postpartum care contribute to delayed care, low follow-up rates, and an increased risk of poor outcomes, including preterm birth and low birth weight. In response, the proposed Maternal and Infant Health Program aims to address gaps in care access through a home visiting model that provides in-home support, maternal health education, care coordination, and referrals to healthcare services, with a direct focus on Breathitt County. Expected outcomes …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

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

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Strengthening Rural Mental Health Crisis Response: Integrating Broadband Telehealth Care Across Counties Served By Kentucky River District Health Department, Mary K. Mcnabb

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

Rural communities in Eastern Kentucky face persistent barriers to timely and effective mental health crisis care, including provider shortages, transportation challenges, and limited broadband infrastructure. Counties served by the Kentucky River Health Department Wolfe, Lee, Owsley, Perry, Knott, Leslie, and Letcher experience disproportionately high behavioral health needs while relying on shared regional resources. The Broadband-Enabled Rural Crisis Stabilization Initiative (BERCSI) is a proposed public health program designed to strengthen rural mental health crisis response through integrated, technology-enabled care. Grounded in evidence-based practices, including tele-mental health and crisis stabilization models, BERCSI leverages broadband expansion to facilitate rapid assessment, coordinated care, and …

Zero Tolerance Or Strong Cultural Diversity: The Hard Case Of Female Genital Surgery, James M. Donovan, Christiane Canant

Law Faculty Scholarly Articles

This article applies a thesis favoring strong cultural diversity to defend a subject-centered policy regarding female genital surgeries (FGS). That idea posits that cultural variation holds an intrinsic value that should be presumptively respected when setting policy and creating law. Correlatively, cultural homogenization, especially by force, should be resisted. 

Taking as a starting point the recent celebration of the United Nation’s Day of Zero-Tolerance for Female Genital Mutilation, the paper reviews the context of FGS practices in various societies and critiques the inconsistencies of U.N. arguments to advance its goal of total elimination by 2030. Especially problematic for the U.N. …

Characteristics Of Pulmonary Vs. Extrapulmonary Tuberculosis Cases In Kentucky From 2020 To 2024, Mariam M. Alkhairat

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

Objective: Tuberculosis (TB) remains an important public health concern in the United States, especially among people experiencing social and clinical vulnerabilities. Extrapulmonary TB, which occurs outside of the lungs, can be harder to detect and diagnose than pulmonary TB. This study aimed to describe the demographic and clinical characteristics of people with active TB in Kentucky and to identify factors associated with extrapulmonary TB.

Methods: Secondary surveillance data were obtained from the Kentucky Department for Public Health (KDPH) using the National Tuberculosis Surveillance System (NTSS). The study sample included 301 confirmed active TB cases reported in Kentucky. Descriptive statistics were …

In Vivo Telemetry To Record Long-Term Cardiovascular Parameters, Temperature, And Activity In Spinal Cord Injury Rat Models, Sajeev Kaur, Anna M. Baur, Jillian A. Condrey, Dorottya P. Gal, Samir P. Patel, John C. Gensel

Spinal Cord and Brain Injury Research Center Faculty Publications

Higher-level spinal cord injury (SCI) above thoracic level 6 (T6) disrupts autonomic function and contributes to secondary complications, including fluctuations in blood pressure, heart rate, and temperature. In rats, the placement of telemetric implants in the descending aorta offers a robust methodology for assessing various cardiovascular parameters, such as systolic and diastolic pressure, mean arterial pressure, and heart rate. Core body temperature and animal activity can also be recorded following telemetric implant placement. A rat with a telemetric implant is kept on the receiver plate connected to a computer system for recording various parameters. Continuous long-term recordings at defined time …

Granulomatous Cellular Signatures In Nontuberculous And Tuberculous Mycobacterial Infections, Brianna M. Doratt, Ethan G. Napier, Mahdi Eskandarian Boroujeni, Sarah Douglas, Michael H. Davies, Luiz Bermudez, Eliot Spindel, Erin F. Mccaffrey, Ilhem Messaoudi

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Mycobacterium tuberculosis (Mtb) and nontuberculous mycobacteria (NTM) are acid-fast bacilli that trigger granuloma formation, a hallmark immune response aimed at containing infection. While the biology of Mtb granulomas has been widely investigated, far less is known about granulomas caused by NTM infection, despite the increasing prevalence and clinical challenge of NTM cases worldwide. Because granulomas influence infection control, pathology, and treatment response, understanding their cellular organization and signaling is critical to improving therapeutic strategies. Therefore, we characterized granulomas formed following infection of rhesus macaques with Mycobacterium avium subsp. hominissuis (MAH) and compared them to granulomas from cynomolgus macaques infected with …

Glycoprotein-Specific Transcriptional Response Contributes To Differential Vaccine Protection Against Lethal Ebola Virus Infection, Sheridan B. Wagner, Delphine C. Malherbe, Ethan G. Napier, Andrea Marzi, Ilhem Messaoudi

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Since the West African Ebola virus (EBOV) epidemic in 2014-2016, recurrent outbreaks of the EBOV-Makona variant have been driven by recrudescence and human-to-human transmission emphasizing the need for effective vaccination strategies. A live-attenuated recombinant vesicular stomatitis virus (VSV)-based vaccine expressing the EBOV-Kikwit variant glycoprotein (VSV-Kik) received FDA approval in December 2019 and provides complete, rapid protection against EBOV-Makona as early as 7 days post-vaccination (DPV). During the 2018-2020 Ebola outbreak, the VSV-Kik vaccine, known as ERVEBO, was administered to lower-risk individuals at a 5-fold dose reduction of the standard 2 × 10 ⁷ PFU to provide broader population protection. Identification …

Preventing Teen Pregnancy Through Expanded Contraceptive Access In Mccreary County, Kentucky, Dacey B. Chitwood

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

This capstone project proposes a school-based Condom Availability Program to reduce teen pregnancy risk by expanding discreet contraceptive access for adolescents in McCreary County, Kentucky. Teen pregnancy remains a persistent public health concern in rural communities where stigma, privacy concerns, transportation barriers, and limited healthcare access can prevent adolescents from obtaining reproductive health resources. McCreary County faces elevated teen birth rates, socioeconomic disadvantage, and limited maternal healthcare infrastructure, making teen pregnancy prevention an important local priority. The proposed program would place free latex and non-latex condoms in student restrooms at McCreary Central High School, with QR-code-linked information connecting students to …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

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

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

Community Place Attachment As A Significant Correlate Of Motivation To Change Substance Use Behavior Among Adults Who Inject Drugs In Rural U.S., Janet K. Otachi, Shawndaya S. Thrasher, Keith J. Watts, Juma S. Mwenda, Hilary L. Surratt

Social Work Faculty Publications

Introduction: While motivation is critical for substance use disorder (SUD) recovery, many individuals fail to engage in treatment. The need to belong is a fundamental human motivation, yet the role of community place attachment (CPA) as a social asset in fostering motivation to change substance use behaviors (MCSUB) among people who inject drugs (PWID) is understudied. This paper examines the effect of CPA on PWIDs’ MCSUB.

Methodology: Cross-sectional data were collected from 350 PWID recruited from syringe service programs in rural Appalachian Kentucky (2018–2021). We used hierarchical multivariable linear regression to assess the association between CPA and MCSUB, controlling for …

Hepatitis C Virus Transmission Among People Who Inject Drugs In Rural United States: Mathematical Modeling Study Using Stochastic Agent-Based Network Simulation, Lin Zhu, Jennifer R. Havens, Abby E. Rudolph, April M. Young, Golnaz Eftekhari Yazdi, William W. Thompson, Liesl M. Hagan, Liisa M. Randall, Jianing Wang, Rebecca Earnest, Shayla Nolen, Benjamin P. Linas, Joshua A. Salomon

Center on Drug and Alcohol Research Faculty Publications

People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the United States. The injection-equipment-sharing network likely plays an important role in shaping the dynamics of HCV transmission. Recognizing the emerging HCV epidemic in rural communities, we developed an agent-based network simulation model of HCV transmission via injection equipment sharing and used data on rural PWID networks to inform model parameterization and calibration. We then simulated an array of networks that varied key network properties to understand their impact on the magnitude and distribution of HCV incidence. The results show substantial heterogeneity in HCV …

Adolescent Relationships With Digital Actors And Their Influence In A Classroom Setting: An Interpretive Case Study, Kerry A. Hancock

Theses and Dissertations--Curriculum and Instruction

In this post-COVID-19 society students are strongly influenced by their use of digital text and electronic devices. The assumption of the study was that if students spend time with devices and digital text that it might be possible for them to develop relationships with the non-human actors that exist as part of the learning environments in schools. This  interpretive case study rooted, in Posthumanist ideology, used Latour’s Actor Network Theory to approach data collection.

A comparative approach was adopted for this interpretive case study research and data were collected in three stages: initial classroom observation and analysis to determine the …

Industry To Classroom: The Role Of Academic Program Consultants In Building Self-Efficacy Among Occupation-Based Career And Technical Education Teachers, Erica L. Settelen

Theses and Dissertations--Educational Leadership Studies

Occupation-based career and technical education (CTE) teachers bring industry expertise to secondary classrooms but often begin teaching without traditional pedagogical preparation or familiarity with public school systems. In Kentucky’s New Teacher Institute (NTI), academic program consultants (APCs) provide program-area support to strengthen induction. Using the framework of self-efficacy and guided by Ivankova’s mixed methods action research (MMAR) framework, this study examined how occupation-based CTE teachers perceived APC engagement during induction and how APC-created asynchronous supports were experienced.

In the Reconnaissance Phase, a sequential Quantitative → Qualitative design included an initial survey followed by interviews. Survey results indicated midrange familiarity with …

From Trauma To Triumph: The Relationship Between Psychological Resilience And Academic Resilience In Graduate School Students With Adverse Childhood Experiences, Jade Gingue

Theses and Dissertations--Educational Leadership Studies

This dissertation investigated the relationship between adverse childhood experiences (ACEs), psychological resilience, and academic resilience among graduate students. Grounded in resilience theory and interpreted through a trauma-informed, strengths-based lens, the study examined whether psychological resilience functions as a buffering moderator or as a direct protective factor among graduate students.

Using a quantitative design, data were collected via Qualtrics from graduate students (n = 391). This study used three previously validated instruments, including the Adverse Childhood Experiences Questionnaire (ACE-10), the Connor-Davidson Resilience Scale (CD-RISC-25), and the Academic Resilience Scale (ARS-6), along with demographic measures. Hierarchical multiple regression analyses were conducted …

Responding To The Needs Of First-Generation Students: An Action Research Study Of Professional Development Opportunities For Faculty And Staff, Kyle G. Phillips

Theses and Dissertations--Educational Leadership Studies

First-generation college students have historically been considered marginalized in institutions of higher education, with diminished success rates and disproportionately higher incidents of imposter syndrome. This Mixed Methods Action Research study assessed the extent to which faculty and staff are able to recognize and implement research-based best practices to improve the support system surrounding this student demographic. In particular, it assessed current levels of preparation to support first-generation students and sought to identify and implement an appropriate professional development program as part of the study's intervention. The efficacy of the intervention was then assessed, with the result delineated in this dissertation. …

The Development Of Self-Efficacy Among New Residence Life Professionals, Kenyatta S. Jeter

Theses and Dissertations--Educational Leadership Studies

New professionals in student affairs, particularly those working in housing and residence life, face complex job responsibilities that demand a high level of confidence and preparation. The purpose of this study was to increase resident directors’ sense of self-efficacy as they transition into their new role. This study employs a mixed methods action research (MMAR) design to explore the development of an effective onboarding and training framework to support housing and residence life professionals in successfully transitioning new resident directors into their roles.

An intervention plan was developed in collaboration with key stakeholders to increase resident directors’ sense of self-efficacy …