Digital Commons Network^™

Feasibility Study Of A Screening Decision Tool For Allocating Adults Into Food Is Medicine Programs As An Effective Approach To Target Clinical And Dietary Outcomes Among Rural And Urban Adults, Alison Gustafson, Carolyn Lauckner, Joshua L. Bush, Emily Dimond, Carolina Morales Serrano, Christa Mayfield, Elizabeth T. Anderson Steeves

Dietetics and Human Nutrition Faculty Publications

Objective: Evaluate feasibility (primary), clinical, and cost outcomes (secondary) associated with the use of a screening decision tool for allocating rural and urban adults with hypertension into in a food is medicine (FIM) program.

Design: Participants were allocated to receive either medically tailored meals or grocery prescription (Rx), based on a user-centered designed screening decision tool. Medically tailored meals (MTM) provided 5 meals per week for 12 weeks. The grocery Rx program provided $100 each month for 3 months to purchase food consistent with guidelines for hypertension. Feasibility outcomes included engagement, dose, and program acceptability. Semi-structured interviews were completed with …

Three Essays On Disparities And Outcomes Among Patients With Diabetes, Aiemere O. Oikeh

Theses and Dissertations--Health Services Research (HSR)

The American Diabetes Association (ADA) recommends that patients with diabetes adopt 7 preventive care measures to improve their health outcomes. The recommendations are to check their blood glucose levels daily, undergo biennial hemoglobin A1c tests, undergo dilated eye exams once every 2 years, engage in regular physical activity, check their feet daily, have annual feet examinations performed by a clinician, and receive diabetes self-management education services (DSMES). Marital status has been found to be associated with positive health outcomes; thus, it is ideal to evaluate if there is an association between marital status and diabetes preventive care. The ADA also …

Bariatric Surgery Impacts Immune Cell Metabolism And Function Dependent On Metabolic Status, Samantha N. Hart

University of Kentucky Doctoral Dissertations

Type 2 Diabetes (T2D), one of the top ten causes of death worldwide, is fueled by chronic inflammation. T2D is considered a metabolic disease, and there is a great push to target metabolic and associated inflammatory pathways to ameliorate the disease & its comorbidities i.e., obesity and cardiovascular disease. Thus far, clinical trials of anti-inflammatory drugs have had modest impacts on T2D and have not led to changes in clinical practice. This may in part be due to a gap in knowledge in the mechanism(s) driving obesity-associated chronic inflammation. I posit that metabolic abnormalities in immune cells in those with …

Stacked Risks, Unequal Returns: Stratified Risk Allocation In Housing And Higher Education, Regina M. Lewis

University of Kentucky Doctoral Dissertations

In the United States, public policy does more than distribute resources. It distributes risk. The same policy can create profoundly different consequences for different people because policies operate on landscapes shaped by generations of unequal investment and opportunity.

To explore this process, I introduce the Stratified Risk Allocation (SRA) Framework to demonstrate how facially neutral policies reproduce inequality by allocating risk across populations with unequal capacity to absorb it. Drawing on risk society theory, historical institutionalism, critical race theory, intersectionality, and stratification economics, the SRA framework distinguishes between Exposure, the likelihood of encountering policy-generated risk, and Capacity, the resources available …

Metabolomics Driven Discovery Of Bioactive Natural Products Leads From Marine And Terrestrial Sources For The Development Of Analgesics, Sahar Mofidi Tabatabaei

University of Kentucky Doctoral Dissertations

Natural products remain a rich source of structurally diverse bioactive compounds for drug discovery, particularly for pain therapeutics. However, the chemical complexity of natural product extracts presents significant challenges for the efficient identification and prioritization of bioactive metabolites. This dissertation integrates untargeted LC-MS/MS-based metabolomics, molecular networking, classical natural products chemistry, and neurobiological assays to accelerate the discovery of analgesic lead compounds targeting the emerging pain-associated receptor σ₂R/TMEM97.

An untargeted metabolomics workflow was developed to systematically profile complex biological extracts and guide bioactive compound isolation. High-resolution LC-MS/MS data were analyzed using molecular networking (GNPS/GNPS2) to visualize chemical space, dereplicate known metabolites, …

Promptable Segmentation For Adaptive And Data-Efficient Medical Image Analysis, Tyler Ward

University of Kentucky Doctoral Dissertations

Image segmentation is a fundamental task in computer vision. While segmentation models have traditionally been trained in a fully-supervised manner, recent approaches have leveraged large-scale pre-training and prompting mechanisms to great effect. However, the performance of such approaches often degrades when applied to domain-specific tasks like medical image analysis. A major reason for this lies is that these models are trained on large, labeled datasets of natural images, which have drastically different characteristics compared to medical images, limiting the generalizability of the methods when applied to medical data. This dissertation presents several data-efficient, adaptive, and promptable medical image segmentation models. …

Technology-Facilitated Violence And Abuse: Portrayals And Perceptions, Christina S. Walker

University of Kentucky Doctoral Dissertations

In the past, intimate partner violence (IPV) was primarily perpetrated in person. However, due to new mediated communication technologies and capabilities like social media and artificial intelligence (AI), perpetrators can use this technology for various purposes including subjecting others to violence, harassment, and abuse. Such violence can be a form of IPV and is referred to as technology-facilitated violence and abuse (TFVA). TFVA is becoming increasingly prevalent and is encountered by a staggering percent of women. Furthermore, unlike traditional forms of IPV, even men are subjected to TFVA at increasing and disproportionate rates, particularly male teens.

In the current state …

Innovative Strategies For Incorporating Clinical Experiences Into An Rn To Bsn Program, Angie Hensley, Jessica Rice, Brooke Kuns-Adkins

Nursing Faculty Publications

Curricula for Registered Nurse to Baccalaureate (RN to BSN) programs need to enhance nurse’s scope of practice, critical reasoning, and analytical skills. The purpose of this paper is to demonstrate how one RN to BSN program innovatively integrated clinical experiences into the curriculum.  Students enrolled in the RN to BSN program were required to complete 40 hours of an on-site practice experience that integrated classroom learning with direct clinical experiences incorporated into the Capstone course.

Adult Tobacco Product Use Patterns Across The Urban–Rural Continuum: The Longitudinal Population Assessment Of Tobacco And Health (Path) Study, 2016–2023, Jing Zhang, Shyanika W. Rose, Ellen J. Hahn, Megan E. Roberts, Bethany Shorey Fennell, Jenny E. Ozga, Seth Himelhoch, Saber Feizy, W. Jay Christian, Amanda Thaxton Wiggins, Melissa Abadi, Delvon T. Mattingly, Mary Kay Rayens

Nursing Faculty Publications

Purpose: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics.

Methods: Data from Waves 4–7 (2016–2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products).

Findings: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) …

Association Between Perioperative Patient-Reported Outcomes And Upper Extremity Functional Performance In Degenerative Cervical Myelopathy, Harshit Arora, Hassan Darabi, Vishwajeet Singh, Aysha Alsahlawi, Jared T. Wilcox, Francis Farhadi

Neurosurgery Faculty Publications

Background: Degenerative cervical myelopathy (DCM) is caused by chronic compression of the cervical spinal cord. Individuals usually present with a combination of upper extremity dysfunction, imbalance, and bladder dysfunction, which impact overall quality of life. Various questionnaires like mJOA, Nurick, NDI, and DCM-72 have been used for disease stratification. Our study aims to evaluate the clinical correlation between self-reported measures and objective upper extremity assessments and to derive the minimal clinically important difference (MCID) for individuals with DCM.

Methods: A prospective two-center study of consecutive patients diagnosed with DCM was undertaken. A comprehensive assessment of upper extremity functioning including dexterity, …

Abca12 Frameshift Deletion In Domestic Cats With Ichthyosis Fetalis, Jeanna M. Blake, Melissa P. Swan, Kari J. Ekenstedt

Veterinary Science Faculty Publications

Background: Ichthyosis fetalis (IF), also known as harlequin ichthyosis, is a rare and often fatal autosomal recessive congenital skin disorder. It is characterized by thickened, hard skin plaques and deep skin fissures that limit mobility and cause malformations of the eyes, lips and ears. Affected individuals are highly susceptible to life-threatening infections due to the disruption of the skin's protective barrier. To date, IF and its genetic basis have not been described in domestic cats.

Objectives: To characterize the gross clinical, histopathological and genetic features of IF in two stray, random-bred domestic short-hair (DSH) littermates.

Animals: Two deceased female neonatal …

Associations Between Traumatic Life Events And Substance Use Among Black Men Who Are Incarcerated, Jasmine K. Jester, Brittany Miller-Roenigk, Paris B. Wheeler, Danelle Stevens-Watkins

Educational, School, and Counseling Psychology Faculty Publications

The current study examined associations between traumatic life events, current and lifetime importance of mental health and substance use treatment, and crack cocaine use among 201 Black men who were incarcerated and nearing community reentry. Results indicated age, sexual trauma and lifetime importance of drug treatment were significantly associated with an increased likelihood of crack cocaine use. Substance abuse treatment in correctional settings should consider culturally tailored assessment and treatment for history of unaddressed sexual trauma among Black men who are incarcerated and use crack cocaine.

County-Level Surveillance For The American Dog Tick (Dermacentor Variabilis) And Rickettsia Species In Kentucky, Callista W. Vandegriff, Jun Seok Ryoo, Maria C. Carrasquilla, Anna Rosalee Pasternak, Wayne T. Sanderson, Subba R. Palli

Entomology Faculty Publications

Spotted fever group (SFG) rickettsiosis includes a group of illnesses with similar symptoms caused by Rickettsia species bacteria. While Rickettsia rickettsii, the agent of Rocky Mountain spotted fever (RMSF) is a well-known pathogen, other SFG Rickettsia spp. can infect ticks and occasionally contribute to human disease. We conducted county-level surveillance of Dermacentor variabilis ticks in Kentucky to characterize the distribution and diversity of SFG Rickettsia. Ticks were collected from the environment from 2019 to 2024 by dragging a white cloth and through our Kentucky Tick Submission Program. In total, 2,023 D. variabilis ticks were collected from 114 …

Clinical Manifestations Of Bed Bug Bites: A Systematic Review Of Case Reports, Julian Felipe Porras-Villamil, Zachary C. Devries

Entomology Faculty Publications

Importance: Clinical characterization of bed bug (Cimex spp.) bite manifestations remains limited.   Objective: This systematic review synthesizes case reports to describe dermatological, systemic, and psychological outcomes of bed bug bites.   Evidence review: Following PRISMA guidelines, multiple databases, including Pubmed and Scopus, were searched using terms such as “bed bug,” “Cimex lectularius,” “Cimex hemipterus,” “case report,” and “case series.” Extracted data included demographics, species, lesion type, anatomical distribution, and clinical manifestations. Quantitative and qualitative analyses were conducted.   Results: Eighty-four patients were included: 76 with C. lectularius (90.5%) and, 8 with C. hemipterus (9.5%). Sex distribution was …

Evolutionary Transitions In Social Behavior Are Associated With Convergent And Partially Reversible Expansions Of Transcription Factor Binding Sites, Savanna G. Ploessl, Beryl M. Jones

Entomology Faculty Publications

The evolution of sociality involves shifts in physiology and behavior, most notably the emergence of a reproductive division of labor. Within social colonies, these distinct behavioral phenotypes arise from differential regulation of a shared genome. Changes in transcription factor (TF) binding motifs are one potential mechanism underpinning this plasticity, with prior studies suggesting that social species exhibit expansions in TF binding sites. However, it remains unclear whether motif expansions are reversed when sociality is lost. Here we analyze predicted TF motif occurrences across gene promoters in 42 bee species spanning millions of years of evolutionary divergence and multiple independent gains …

Variability In Mountain Pine Beetle (Coleoptera: Curculionidae) Gene Expression In Response To Increasing Concentrations Of Species-Specific Double-Stranded Rna, Kylie J. Bickler, Zachary Bragg, Flávia Pampolini, Bethany R. Kyre, Lynne K. Rieske

Entomology Faculty Publications

Sensitivity to double-stranded RNA (dsRNA)-induced gene silencing has been observed in multiple coleopterans. Initial work with mountain pine beetle, Dendroctonus ponderosae Hopkins, determined that specific ubiquitously expressed essential genes can cause mortality when silenced by carefully designed dsRNAs. However, current dsRNA production methods are not economically feasible for production at scale. Therefore, identifying the minimum efficacious dose is a critical step to deployment. To investigate the relationship between dsRNA dose and subsequent gene expression, adult mountain pine beetles were fed either a target or control dsRNA across a gradient of concentrations, including 2.5, 1.0, 0.25, and 0.025µg/µl, and relative gene …

Indoor Allergens And Endotoxins In Relation To Cockroach Infestations In Low-Income Urban Homes, Madhavi L. Kakumanu, Zachary C. Devries, Richard G. Santangelo, Jeffrey Siegel, Coby Schal

Entomology Faculty Publications

Background: Cockroach allergens are well recognized as important risk factors in the development and prevalence of allergic rhinitis and asthma in children, especially in low-income urban households. The German cockroach gut hosts a diverse community of highly abundant microbes, including gram-negative bacteria that shed large amounts of endotoxins in cockroach feces. Objective: We sought to delineate the causal relationship between the presence of cockroaches in homes and levels of household endotoxins. Methods: In laboratory assays, we measured the amount of endotoxin produced by cockroaches. In-home monitoring estimated the size of the cockroach population in each home and quantified cockroach allergen …

Dissolution Or Restructuring? Fiscal Implications For Taxpayers In Special Tax Districts: A Case Study Of The Reedy Creek Improvement District, Tasha Huber

MPA/MPP/MPFM Capstone Projects

Although extensive research has examined the creation and function of special tax districts in the U.S., little research has been done regarding the fiscal and governance implications of dissolution of these entities. This study examines the fiscal outcomes of dissolution versus restructuring special districts, using the former Reedy Creek Improvement District as the primary case study. Using a qualitative approach, the analysis compares restructuring and dissolution cases in California, Vermont, and Tennessee. Drawing on publicly available material such as financial documents, media coverage, and legislative records, this research evaluates impacts on taxpayer burden. Findings suggest that dissolving large, active special …

Expenditure Management Strategies For Long-Term Fiscal Sustainability In South Korea, Jaehyun Ryu

MPA/MPP/MPFM Capstone Projects

This capstone examines strategies for managing government expenditures to secure long-term fiscal sustainability in South Korea. Although South Korea currently maintains a relatively low public debt-to-GDP ratio compared with other OECD countries, rapid population aging, slowing economic growth, and the continued expansion of mandatory expenditures pose significant long-term fiscal risks. Given the political and economic constraints associated with tax increases and growth-led debt management, this study focuses on expenditure management as a primary and feasible policy instrument for sustaining fiscal soundness.

The research combines empirical analysis with comparative case studies. First, the study examines the relationship between government debt and …

A Comparative Policy Analysis Of Lung Cancer, Maternal Mortality, And Obesity, Destiny M. Rucker, Rhonda M. Lawson, Trinity Olmstead

MPA/MPP/MPFM Capstone Projects

Kentucky has significantly poorer outcomes than peer states across key women's health indicators. This capstone focuses on lung cancer, maternal mortality, and obesity to evaluate the structural and policy factors behind these disparities. Using a quantitative comparative research design, the study analyzes secondary data from sources including CDC WONDER, the Behavioral Risk Factor Surveillance System (BRFSS), America’s Health Rankings, and the March of Dimes. Data were analyzed in Excel to create comparative figures, benchmarking Kentucky’s outcomes against the U.S. average and four regional peer states: Tennessee, Indiana, Illinois, and Virginia. These states were chosen for their demographic and geographic similarities …

Ai Data Center Boom: An Analysis Of Economic And Legislative Impacts, Shelby Jackson

MPA/MPP/MPFM Capstone Projects

The United States is currently experiencing an Artificial Intelligence (AI) data center boom due to increased demand for generative AI following the launch of models such as ChatGPT. Data centers, particularly hyperscale data centers, have become a flashpoint due to environmental and public health concerns, along with rising utility costs. Although more than 70% of Americans do not want data centers in their community, state and local governments often offer tax incentives to attract data center development with the aim of job creation and tax revenue.

This study assessed whether the financial benefits that AI data centers may offer state …

A Comparative Analysis Of Governance And Financial Frameworks In Public Transit Systems: A Case Study Of Lextran And Peer Transit Agencies, Kelin E. Beattie

MPA/MPP/MPFM Capstone Projects

Public transportation serves as a vital community "lifeline," providing essential mobility for the 45% of Americans without private vehicle access and generating a 5-to-1 economic return on investment. This research investigates a critical fiscal paradox within Lextran, the transit authority for Lexington, Kentucky: despite achieving a cost per passenger trip 22% lower than the national peer average, the agency faces a $25.95 million unfunded capital gap over the current five-year planning horizon. Utilizing a comparative case study methodology, this paper evaluates the "rules of the game"—the hybrid governance and fiscal frameworks—that influence long-term financial sustainability.

The study benchmarks Lextran against …

Allocation And Governance Of Opioid Response Funding In Rural Kentucky: A Case Study Of The Big Sandy Area Development District, Hayley M. Mccarty

MPA/MPP/MPFM Capstone Projects

The opioid epidemic continues to present significant public health, economic, and administrative challenges throughout the United States, with rural Kentucky experiencing some of the nation's highest rates of opioid-related morbidity and mortality.

Effectively responding to this crisis requires not only adequate financial resources but also transparent governance, coordinated implementation, and accountability for how public funds are distributed.

This study examines the allocation, governance, and implementation of opioid response funding within the Big Sandy Area Development District (BSADD), a rural multi-county region in eastern Kentucky. Using a qualitative case study and policy analysis approach, the research evaluates four primary funding sources: …

Best Practices For Budgeting In Small Non-Profit Organizations: The Arts Commission Of Danville/Boyle County, Esther Rugerio

MPA/MPP/MPFM Capstone Projects

Nonprofit arts organizations face unique financial management challenges due to limited staffing, restricted funding sources, and fluctuating revenue streams. This thesis examines the Arts Commission of Danville/Boyle County located in Danville, KY. It identifies opportunities to strengthen financial oversight, accountability, and long-term sustainability. Using a qualitative research approach and document-based analysis, the study evaluated organizational budgets, governance documents, and nonprofit financial management best practices.

The findings revealed several areas for improvement, including reliance on line-item budgeting, recurring use of carry-forward funds, limited board financial oversight, fiscal sponsorship complexities, and a lack of formal financial policies. Recommendations include adopting a program-informed …

Should Kentucky Adopt A Formal Statewide Framework To Address The Local Fiscal Effects Of Tax-Exempt Public Universities On Host Communities?, Trina Shields, Catie Baumstark

MPA/MPP/MPFM Capstone Projects

Kentucky’s public universities provide significant educational, economic, and workforce development benefits to the Commonwealth. However, because these institutions are exempt from local property taxes, questions arise about the fiscal effects on the communities that host them. While the benefits generated by universities extend beyond municipal boundaries, the fiscal effects of tax-exempt property are often concentrated within host communities. As universities expand their campuses and acquire additional property, local governments may face increased demands for public services without a corresponding increase in property tax revenue.

This study examines whether Kentucky should adopt a formal statewide framework to address the local fiscal …

Neighborhood Deprivation Associated With Impaired Sit-To-Stand Performance In Middle-Aged And Older Adults: A Cross-Sectional Analysis With Clinical Implications, Kenneth Harrison, Silvia Campos-Vargas, Brandon M. Peoples, Keven G. Santamaria-Guzman, David T. Redden, Michael A. Samaan, Jaimie A. Roper

Kinesiology and Health Promotion Faculty Publications

Background: Socioeconomic factors significantly influence health outcomes in older adults, yet their impact on specific aspects of mobility remains unclear. This study investigates the relationship between area-level socioeconomic disadvantage and mobility health in older adults.

Methods: We conducted a cross-sectional study of 110 community-dwelling older adults recruited and collected using voluntary response sampling at eight health fairs across rural Southeast Alabama in 2022–2024 (60 ± 16 years, 80% female). Area-level socioeconomic status was measured using the Area Deprivation Index (ADI), a validated composite measure of neighborhood disadvantage. Mobility was assessed using the Instrumented Timed Up and Go (iTUG) test and …

Brief Report: Naloxone Decline Among African American Kentuckians, Rayven Peterson, Mona Goggins, Destin L. Mizelle, Brittany Miller-Roenigk, Candice Hargons, Danelle Stevens-Watkins

Educational, School, and Counseling Psychology Faculty Publications

Background: Opioid-involved overdose fatalities among African Americans continue to rise. The current study examines African Americans who reported use of opioids in the past 6 months and declined overdose education and free naloxone.   Method: Eligible participants included African American Kentuckians who used opioids in the past 6 months and consented to a larger study examining their opioid use. This paper qualitatively explored their reasons for declining overdose education and naloxone using an adjusted and inductive application of structural tabular thematic analysis.   Results: Out of 588 participants, 70 (12%) declined naloxone: the most cited reason for declining naloxone was already possessing …

Effect Of Clinical Expertise On Efficacy Of Vocal Function Exercises In Individuals With Typical Voice, Maria H. Bane, Vrushali Angadi, Richard D. Andreatta, Joseph C. Stemple

Communication Sciences and Disorders Faculty Publications

Objectives/Hypothesis: To determine the effect of clinical expertise on efficacy of Vocal Function Exercises (VFEs) as measured by change in percent of maximum phonation time goal attained. The hypothesis was that clinical expertise would result in greater increases in percent of maximum phonation time goal attained.

Study Design: Randomized controlled trial.

Methods: A convenience sample of 19 individuals with typical voice was recruited in a university academic clinic setting. All participants completed baseline assessment and 17 completed all study procedures. Participants were randomized to receive VFEs from an expert voice clinician with more than 40 years’ experience (expert group (EG)) …

Exploring Pathways To Persistence And Self-Efficacy Among Historically Underrepresented Community College Students: A Mixed Methods Action Research Study, Sharmy Rene Davis

Theses and Dissertations--Educational Leadership Studies

Research indicates that postsecondary institutions have struggled to retain historically underrepresented college students. These students continue to experience lower levels of persistence and college self-efficacy compared to their peers (Monjaras-Gaytan & Sánchez, 2023).

This dissertation is a mixed methods action research study that identified the academic challenges historically underrepresented college students face. This study focused on diagnosing the problem, engaging in multiple Reconnaissance phases, and using those findings to plan a contextually responsive intervention.

Findings indicate that historically underrepresented college students may benefit from enhanced academic support, stronger advising relationships, and greater opportunities to build peer connections. The findings of …

Microglial Apoe Across Alzheimer’S Disease-Relevant Pathologies, Georgia Nolt

Theses and Dissertations--Physiology

APOE exists as three common alleles (APOE2, APOE3, APOE4) that encode their corresponding protein isoforms (apoE2, apoE3, apoE4). Despite differing by only one or two single-amino acid substitutions, each APOE allele confers a distinct AD risk profile with APOE4 increasing risk by 28% and APOE2 decreasing risk by 14% compared to the most commonly expressed APOE3 allele. While traditionally considered “neutral,” APOE3 still accounts for ~36% of AD cases while APOE4 contributes ~57%, indicating that the majority of AD cases would not occur in the absence of the APOE3 and APOE4 alleles. Microglia, the resident phagocytic immune cells …