Digital Commons Network^™

Improving Evaluation Practices Of Community Arts Extension Agents: A Mixed-Methods Study Leveraging Theory Of Change And Open Systems Theory, Melissa G. Bond

Theses and Dissertations--Arts Administration

This dissertation examines how a structured evaluation training and subject-based evaluation tool can strengthen evaluation practices among Community Arts Extension professionals in Kentucky. Community Arts programs often support outcomes such as belonging, connection, skill development, and cultural engagement, yet those outcomes can be difficult to document within standardized public reporting systems. Guided by Theory of Change and Open Systems Theory, this mixed-methods study combines an environmental scan of FY2020–FY2025 Community Arts indicator records and agent-authored Success Stories with three survey waves administered before training, immediately after training, and approximately 60 days later.

Findings show that routine reporting captured substantial activity …

Molecular Mechanisms And Metabolic Consequences Of Glucocorticoid Resistance, Genesee J. Martinez

Theses and Dissertations--Pharmacology and Nutritional Sciences

Glucocorticoids are vital steroid hormones that govern metabolism, stress responses, and immune functions through intricate, tissue-specific mechanisms, both genomic and non-genomic. These hormones bind to the glucocorticoid receptor (GR), which then acts as a transcription factor to modulate gene expression. Chronic elevation of glucocorticoid levels may lead to glucocorticoid resistance, resulting in adiposity, inflammation, and insulin resistance, thereby adversely affecting multiple metabolic tissues. Whether produced endogenously or administered exogenously, excessive, chronic glucocorticoid concentrations impair glucocorticoid signaling. Although there are two primary isoforms of the receptor, GR⍺ and GRβ, only GR⍺ interacts with glucocorticoids.Through the research conducted in this dissertation, we …

Expanding The Role Of Muscle Stem Cell Fusion In Muscle Under Hypertrophic Stimulus, Jensen Goh Zhong Sheng

Theses and Dissertations--Physiology

Muscle stem cells (MuSCs) are a unique stem cell population that can activate in response to both injury and growth stimuli. Studies on muscle regeneration have shown MuSC activation follows a uniform progression through proliferation, differentiation, and fusion. Therefore, to determine whether MuSC replication is a prerequisite for differentiation under hypertrophic stimulus, I used a lineage-tracking mouse model (Pax7^rtTA; TRE-H2B-GFP) to label MuSC nuclei and simultaneously tracked DNA synthesis via EdU incorporation. This dual-labeling approach allowed us to not only distinguish MuSC-derived nuclei but also demarcate which MuSC had proliferated prior to fusion. I then employed a mechanical …

A Tale Of Two Serpins: Pathologic And Protective Roles Of Agt And Pai-1 In Metabolic And Cardiovascular Disease, Alex C. Pettey

Theses and Dissertations--Physiology

Metabolic and cardiovascular diseases are leading causes of morbidity and mortality worldwide. Conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD), aortic aneurysm, and cardiac fibrosis have limited pharmacological therapies, underscoring the need for deeper mechanistic investigations. Serine protease inhibitors (serpins) have been implicated in these pathologies and represent potential therapeutic targets. Despite structural homology, serpins regulate diverse physiological processes through both protease inhibition and non-inhibitory mechanisms. This dissertation examines the roles of two serpins, angiotensinogen (AGT) and plasminogen activator inhibitor-1 (PAI-1), in preclinical models of metabolic and cardiovascular disease to identify novel mechanisms that may inform future therapeutic strategies. …

Investigation Into The A/Ss Of Cervical Cancer And Its Effects On Tumor Control Probability In Radiation Therapy, Cameron Thayer-Freeman

Theses and Dissertations--Radiation Medicine

The standard of care for locally advanced cervical cancer is chemoradiation, consisting of conventional external beam therapy (EBT) followed by a boost of high dose rate (HDR) brachytherapy. These two radiation treatments will illicit different degrees of biological response depending on the tissue in question, and quantifying the overall effect the combined treatments will have require some form of biological modeling. The linear quadratic (LQ) model of cell survival is the most widely used radiobiological model in clinics across the nation.

It is quantified by the parameters a and ß, which model how radiation generates lethal damage in a population …

The Association Between Learned Helplessness And Future Outlook And The Mediating Effects Of Parental Support, Engagement, And Closeness, Allison N. Loosle

Theses and Dissertations--Family Sciences

The present study examined the direct and indirect associations between learned helplessness and future outlook among emerging adults, with parental support, engagement, and closeness as potential mediating factors. Using data from 375 participants drawn from G3, Wave 4 of the Youth Development Study, two path analytic models were tested: one including a composite measure of learned helplessness and one examining its components (contingency, cognition, and behavior) individually. Results indicated that higher levels of learned helplessness were associated with a less positive future outlook. When separated, the cognition and behavior components were negatively associated with future outlook, whereas contingency was not …

Breaking The Cycle: Financial Abuse And Mental Health Outcomes Among Women Survivors Of Intimate Partner Violence Through The Abc-X Model Of Family Stress, Angel Martinez-Johnson`

Theses and Dissertations--Family Sciences

The present study examined the relationship between financial abuse and mental health outcomes among women survivors of intimate partner violence (IPV) with particular attention to the roles of perceived financial knowledge and resilience. Guided by the ABC-X Model of Family Stress, this study explored whether these perceived resources function as mediators in the association between financial abuse and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD). Findings indicated that financial abuse was significantly associated with increased psychological distress across all three outcomes. Although perceived financial knowledge and resilience were significantly related to certain mental health outcomes, analyses did not …

Fusarium Head Blight Of Hemp: A Destructive Disease Emerges On A New Host, Henry Smith

Theses and Dissertations--Plant Pathology

Hemp was reintroduced as a commercial crop in 2018 after a near 50-year production ban under the Controlled Substances Act. Since reintroduction, Kentucky has consistently ranked among the top five hemp producing states in the US. Surveys have shown that hemp is susceptible to a multitude of diseases that impact production. Among the most concerning diseases in Kentucky is Fusarium head blight (FHB). FHB is a major disease of cereals that is caused by various Fusarium species, predominately F. graminearum. FHB of hemp caused by F. graminearum was first reported in Kentucky in 2020. A survey of 25 different …

Managing Dietary Nonstructural Carbohydrates In Insulin Dysregulated Horses: Pasture, Long-Stem Forage, And Restrictive Grazing Strategies, Morgan J. Askins

Theses and Dissertations--Veterinary Science

Insulin dysregulation (ID) is a complex endocrine disorder, impacting a large percentage of the equine population. ID is the defining characteristic of equine metabolic syndrome (EMS). Within the various classifications of EMS horses, the commonality is ID and their higher risk of laminitis. To mitigate insulin response and laminitis risk in ID horses, current management focuses on restricting pasture exposure and feeding low nonstructural carbohydrate (NSC) rations. Minimal studies have evaluated how ID horses respond to pasture of various NSC, long-stem forages, and restrictive grazing strategies. Providing horse owners and managers with improved nutritional management recommendations for ID horses with …

Environmental Detection And Quantification Of Equid Alphaherpesviruses In Equine Facilities Using Air Sampling, Emma E. Hyde

Theses and Dissertations--Veterinary Science

Equid alphaherpesvirus 1 and 4 (EHV-1/-4) circulate at equestrian facilities, contributing to outbreaks. Due to the complexities of the pathogen, including the limited predictability of reactivation from latency and the effects associated with secondary sites of viral replication, abortion, and neurologic disease, EHV infections are of utmost concern to the equine industry. Recent studies have highlighted the prevalence of the viruses in stabling areas at competitions, though little is known about this phenomenon in other high-traffic equine environments. This thesis presents two studies using air sampling surveillance methods to further explore the viral detection in other equine environments (veterinary facility …

Using Camera-Based Unmarked Spatial Capture-Recapture Modeling To Estimate Reintroduced Elk (Cervus Canadensis) Population Parameters And Distribution In Southeastern Kentucky, Claire Marie Muia

Theses and Dissertations--Forestry and Natural Resources

Estimation of population parameters is important for wildlife management decisions. Elk reintroduced to southeastern Kentucky experienced early irruptive population growth and are currently monitored using a statewide harvest-based statistical population reconstruction model (SPR) across the Kentucky Elk Restoration Zone (KERZ). Because the SPR model is spatially coarse and difficult to scale to the smaller management units comprising the KERZ, we conducted a spatially explicit capture-recapture study using a clustered camera-trapping array deployed for 10 weeks from June–August 2024 to estimate elk population parameters within Management Unit 4. Due to a lack of resights of GPS-marked elk, population parameters were estimated …

Understanding Knowledge And Perceptions Of The Beef Industry On A Land-Grant University Campus, Allison E. Reaves

Theses and Dissertations--Community & Leadership Development

A well-researched phenomenon in the agricultural industry is the effects of constant innovation coupled with an increasing divide between producer and consumer. This issue has been presented as especially prevalent within animal agriculture and the beef industry, a predominant concern considering Kentucky’s agricultural commodities. This study (n = 31) utilized a mixed-methods approach to understand the knowledge, perceptions, and behavior of beef consumers on a land-grant university campus. Methodologies included Python’s DeepFace emotion recognition, semi-structured interviews, and the JMALI agricultural literacy assessment. Findings revealed participants to be below expected agricultural literacy levels of high school graduates (M=11), with no …

From Floodplain To Floodplain: Analyzing Stream And Riparian Restoration Methodologies And Impacts, Noah P. Lane

Theses and Dissertations--Biosystems and Agricultural Engineering

Stream restoration is a relatively new scientific field. Currently, there is not a definitive methodology for performing restorations that all professionals in industry and academia can agree upon. This has allowed for multiple ideologies to be developed and altered that vary by geographic location and the professional using them. In addition to the methodologies used, the publicly available design guidance published by state government organizations also varies by regulatory authority, method of analysis, ecoregion, and restoration objectives. In some cases, design guidance is replicated from a different geographical area and may not satisfy local needs or existing site conditions. Since …

“They Don't Care If I'M Here Or Not”: The Impact Of Exclusionary Discipline On Black Boys In Elementary Schools, Arielle Gulley

DSW Capstone Projects

Disproportionate and exclusionary school discipline practices continue to affect African American boys as early as elementary school, with significant implications for their mental health, academic engagement, and long-term educational trajectories. This capstone project examines how racially biased discipline contributes to disparities in belonging, emotional well-being, and student-teacher relationships, and advances the need to reframe discipline as a site of mental health intervention rather than punishment.

The systematic literature review synthesizes peer-reviewed research to examine the relationship between exclusionary discipline and mental health outcomes among African American boys in elementary settings, with particular attention to patterns emerging in early educational environments. …

Unseen To Unstoppable: Critically Redefining Care For Rural Women With Alcohol Use Disorders, Nicole Gerace

DSW Capstone Projects

Research reveals that rural women with alcohol use disorders (AUDs) are up to 90% less likely to seek treatment than men or urban women. This Doctor of Social Work capstone project brings together a systematic literature review (SLR), a conceptual paper, and a practice application paper to examine the clinical social work practice problem of rural women with AUDs underutilizing treatment. Collectively, these products investigate factors contributing to these disparities, identify gaps in care, and propose more equitable and responsive approaches to treatment for these women. This project began with an SLR (2020–2025) that investigated clinical treatment interventions that demonstrated …

Evaluating The Burnout Mitigating Effects Of A Structured Mentorship Program In Newly Hired Advanced Practice Providers, Melissa Soper

DNP Projects

Importance: Burnout is a leading driver of clinician intent to leave, lower productivity, increased medical errors, and increased resource use.

Objective: The purpose of this project was to evaluate the effects of an evidence-based mentorship program on newly hired advanced practice providers’ (APPs’) level of stress, burnout, and professional fulfillment.

Results: At baseline, APPs demonstrated higher stress levels, moderate professional fulfillment, and low burnout. Outcomes showed improvement at the end of a mentorship program.

Conclusion: Longitudinal studies with larger sample sizes are needed to determine the true effect of a 6-month mentorship intervention on APP burnout, stress, and professional fulfillment.

Establishing An Advanced Practice Provider-Led Transient Ischemic Attack Clinic: A Quality Improvement Initiative, Brittany A. Young

DNP Projects

Background: Due to lack of subspecialized neurological care in many rural community settings, care in tertiary hospitals is in demand. Insufficient care pathways can lead to lack of bed and provider availability. Advanced Practice Provider Transient Ischemic Attack clinics have been shown to be safe alternatives to hospital admission, for patients who meet criteria. This study targeted practice change at a 1000 bed tertiary academic hospital.

Methods: The quasi-experimental study sample inclusion criteria included Transient Ischemic Attack patients presenting to the emergency department with an ABCD2 < 4, complete symptom resolution, and no new cardiac changes on monitoring. A pre and post survey with educational PowerPoint intervention was provided to all emergency department and Neurology providers and nurses. A Transient Ischemic Attack clinic was established with a corresponding order set to be utilized for streamlined outpatient work up.

Results: During the pilot period, 29 admissions were deferred with 69% …

Sepsis In Sight: Immersive Vr Simulation For Pediatric Training, Kelsey Wagler

DNP Projects

Abstract

Objectives: This project aimed to decrease the time required to administer antibiotics and fluid boluses to pediatric patients with sepsis by implementing a virtual reality (VR) simulation program. The initiative sought to enhance bedside nurses’ and pediatric residents’ knowledge, clinical reasoning, and confidence in sepsis assessment, early recognition, and evidence-based management. A secondary objective was to evaluate the effectiveness of VR simulation as an educational strategy for nurses in a high-acuity pediatric setting.

Design: This quality improvement project used a quasi-experimental design that incorporated a VR simulation intervention followed by a structured debriefing and targeted education session. Participants completed …

Stronger Together: Exploring The Impact Of Peer Support Meetings On Stress And Burnout In Ambulatory Nurse Managers, Sara Wellman

DNP Projects

Background

Nurse manager (NM) burnout is common and leads to decreased staff productivity, departmental effectiveness, and leadership capacity. This results in decreased staff morale, poor conflict management, and ineffective communication. Stress reduction and resilience programs have been shown to reduce burnout and enhance resilience in NMs, but more focus needs to be directed toward NMs who work in ambulatory settings.

Purpose

The aim of this project was to evaluate the effectiveness of a peer-to-peer resilience intervention in reducing stress and burnout among ambulatory nurse managers.

Methods

This project used a pre-test/post-test survey design and a convenience sample of ambulatory NMs. …

Rural Oral Health Access Coordination Program Proposal, Anna Luu

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

Oral health disparities remain a major public health issue in the United States, particularly in rural Kentucky, with barriers such as limited access to preventive dental services, transportation, and insurance coverage contributing to delayed treatment and worsening oral health outcomes. In response, the proposed Rural Oral Health Access Coordination Program aims to improve care access by strengthening referral systems, integrating oral health screenings into public health settings, and enhancing care coordination for high-risk populations. The program intends to focus on the Kentucky River District Health Department Region, connecting individuals to existing services rather than providing direct clinical care. Expected outcomes …

Perry County Perinatal Access Navigator Program (Pc-Pamp) A Public Health Program Proposal To Improve Timely Prenatal Care Access In Perry County, Kentucky, Amber E. Mcguire-Chun

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

Delayed initiation of prenatal care remains a significant public health concern in rural Appalachian communities, including Perry County, Kentucky, where structural barriers such as limited provider availability, transportation challenges, and fragmented referral systems contribute to inadequate access to timely care. This capstone project proposes the Perry County Prenatal Access Navigator Program (PC-PANP), a community-based patient navigation model designed to improve initiation of prenatal care in the first trimester. The program is led by the local health department and leverages partnerships with healthcare providers, the University of Kentucky College of Public Health, WIC, Extension services, and community organizations to support early …

Wastewater Surveillance For Sars-Cov-2 In Rural Kentucky, 2021–2023, James W. Keck, Reuben Adatorwovor, Ann Noble, Savannah Tucker, William Strike, Soroosh Torabi, Mohammad Dehghan Banadaki, Blazan Mijatovic, Steven K. Roggenkamp, Donna Mcneil, Lindell Ormsbee, Scott M. Berry

Family and Community Medicine Faculty Publications

Wastewater testing for SARS-CoV-2 provided useful public health information during the COVID-19 pandemic yet was underutilized in rural communities. We addressed this gap by implementing wastewater surveillance and assessing its performance in 10 communities in Eastern Kentucky. We collected wastewater samples 1–2 times weekly at 10 wastewater treatment plants (WWTPs) from May 2021 until April 2023 and measured SARS-CoV-2 RNA concentrations using polymerase chain reaction testing. We calculated time-lagged correlations between wastewater concentrations and county-level reported COVID-19 cases by site. We developed a generalized linear model to estimate COVID-19 incidence from wastewater SARS-CoV-2 concentrations. The 10 participating WWTPs served 2430 …

Perceptions Of The Proposed Food And Drug Administration Graphic Cigarette Warnings Among Adults Who Smoke On A Nondaily Or Daily Basis: A Within-Subjects Experiment, Bethany Shorey Fennell, Renee E. Magnan, Jennifer I. Vidrine, Damon J. Vidrine

Family and Community Medicine Faculty Publications

Introduction: People who smoke nondaily represent nearly one third of U.S. adults who smoke and experience significant smoking-related morbidity and mortality, yet they are rarely considered when evaluating the efficacy of graphic cigarette warnings.

Method: In October 2019, U.S. adults who smoked nondaily ( n =59) and daily ( n =183) evaluated 13 Food and Drug Administration–proposed graphic warnings and 13 equivalent text-only warnings on the extent to which they elicited understanding, perceived new knowledge, worry about smoking, and discouragement to smoke and were believable. Repeated-measures ANOVA and planned comparisons tested for between-subjects (smoking status) and within-subjects (warning type) effects. …

Exploring High School Students’ Learning Interests And Information Sources On Viruses And Covid-19, Sahar Alameh, James W. Keck, Elizabeth Loh, Lin Xiang, Scott M. Berry, Anna G. Hoover, Abigail Knapp, Savannah Tucker

Science, Technology, Engineering, and Mathematics (STEM) Education Faculty Publications

This study investigates high school students’ health-information seeking behaviors related to COVID-19 and viruses in a rural area of the south-central United States, and how these behaviors relate to students’ knowledge, perceptions, and learning interests. Survey data were collected from 83 students in Spring 2023, during the post-pandemic period, as part of a STEM and public health unit. Drawing on frameworks from Health Information-Seeking Behavior and student interest, the study examines students’ COVID-19 information sources, how these sources relate to their knowledge about viruses and their perceptions of COVID-19, and the specific topics about which they were most interested in …

Exploring The Relationships Between Social Influence, Vaping Behaviors, And Susceptibility Across Grade Levels In Kentucky, Raphael Adesiyan, Odunayo O. Omotilewa, Saber Feizy, Melinda J. Ickes

Kinesiology and Health Promotion Faculty Publications

Purpose: This study explored the relationships between social influence, vaping behavior, and susceptibility across different grade levels.   Design: The study design was cross-sectional. Data were collected from middle and high school students who voluntarily participated between September 2022 and April 2023.   Sample: A convenience sample of students in 6^th to 12^th grades in Kentucky (N = 4677).   Measures: Demographic information, including age, grade level, school location, and race/ethnicity, was collected. The outcome variables included social influence, susceptibility, and vaping behavior.   Analysis: Logistic regression analysis was used to explore the relationships between social influence, vaping behavior, and susceptibility.   Results: …

Adsorptive Gas Sensor Response Forecasting To Enable Breath-By-Breath Analysis, Samuel Bellaire, Samir Ahmed Rawashdeh, Kirby P. Mayer, Jamie L. Sturgill

Physical Therapy Faculty Publications

MOS gas sensors have proven to be useful in electronic noses, which utilize these sensors to detect volatile organic compounds in human breath to detect various lung diseases. Unfortunately, the long settling time of MOS gas sensors is ill-suited to measuring human breath, where complete breathing cycles are often shorter than 5 s. Existing studies circumvent this limitation by collecting gas samples and injecting them into a sealed chamber to react with the sensors. However, it would be convenient if breath-by-breath analysis could be conducted without the need to store breath samples. To accomplish this, we present a novel forecasting …

Exploring The Influence Of Quadriceps Peak Torque And Rate Of Torque Development On Running Mechanics After Anterior Cruciate Ligament Reconstruction, Amit M. Gohil, Gregory S. Hawk, Darren L. Johnson, Christopher S. Fry, Brian W. Noehren

Physical Therapy Faculty Publications

Background: After anterior cruciate ligament reconstruction (ACLR), chronic changes in knee joint biomechanics during higher level tasks, such as running, may negatively impact long-term knee joint health. Among the factors that contribute to these chronic changes, the influence of quadriceps strength on knee joint biomechanics during running is not well understood.   Hypothesis: Higher involved limb quadriceps strength (peak torque and rate of torque development [RTD]) and limb symmetry index (LSI) will be positively associated with greater peak knee flexion angle and peak knee extensor moment during running.   Study Design: Cross-sectional study.   Level of Evidence: Level 3.   Methods: Peak knee extensor …

Prevalence And Incidence Of Heart Failure Phenotypes Among Transgender And Gender-Diverse Adults In The United States, Ian K. Everitt, Emily K. Quinn, Meredith S. Duncan, Chris Grasso, Sari L. Reisner, Guneet K. Jasuja, Tonia Poteat, Ayelet Shapira-Daniels, Howard Cabral, Vin Tangpricha, Michael K. Paasche-Orlow, Emelia J. Benjamin, Monica Mukherjee, Carl G. Streed

Biostatistics Faculty Publications

BACKGROUND: Prevalent and incident heart failure (HF) and its comorbidities have not been characterized in transgender and gender-diverse (TGD) populations. This study determines the prevalence and incidence of HF phenotypes by gender identity. METHODS: A retrospective cohort analysis was performed using deidentified administrative claims from the Optum Labs Data Warehouse (2006-2022). TGD adults and a sample of demographically similar cisgender comparators were identified using a validated algorithm, and gender identity was categorized as cisgender man, cisgender woman, transmasculine, transfeminine, or unclassified TGD. Prevalent and incident HF, including systolic, diastolic, and unclassified phenotypes, were assessed using diagnosis codes. Multivariable logistic and …

Unexpected Longevity In Myasthenia Gravis, Bhupendra O. Khatri, Scott Schutten, Sergey Tarima

Biostatistics Faculty Publications

Background: This study compares age at death in patients with myasthenia gravis (MG) and multiple sclerosis (MS) with the general U.S. population and examines age at death patterns during a period preceding modern high-efficacy therapies. Objective: To compare age at death among individuals with MG and MS with the general population and assess differences in age at death between MG and MS. Design: Retrospective population-based study using death certificate data from four U.S. states (Florida, Wisconsin, Texas, and New York) for 2000, 2005, 2010, and 2015. Methods: Individuals with MG or MS listed on death certificates were identified. Age at …

Catwalk Xt Enables Sensitive Detection Of Locomotor Deficits After C2 Hemisection And Integrates Readily Into Ongoing Experimental Workflows In Adult Female Rats, Aaron L. Silverstein, Christopher M. Calulot, Christopher J. Mclouth, John C. Gensel, Warren J. Alilain

Biostatistics Faculty Publications

Over half of all spinal cord injuries (SCIs) in the United States occur at the cervical level and often cause both life-threatening breathing dysfunction and profound locomotor deficits. Although the C2 hemisection (C2Hx) model is vital for study of breathing dysfunction after experimental SCI, post-C2Hx locomotor deficits have only been assessed by metrics such as the Martínez Scale and ladder tests, which require time-intensive scoring by human observers. However, the CatWalk XT Gait Analysis system (Noldus Information Technology) delivers automated, quantitative assessment of interlimb coordination, gait cycle, and paw function, providing robust locomotor data in a time-efficient and practical manner. …