Briding The Gap: Treatment Engagement Profiles And Outcomes Utilizing Novel Models, Allison Koetter

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

Background. The opioid epidemic is a public health emergency that requires collaboration between both private and public sectors to increase access to and capacity for efforts directed at treatment, prevention, and recovery. The Commonwealth of Kentucky via funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) created their State Targeted Response to the Opioid Crisis (Opioid STR) in order to help address these needs. The University of Kentucky, as an awardee of these funds, decided on an approach to highlight the Emergency Department (ED) bridge model, which links patients discharged from EDs and the hospital (inpatient addiction consult …

Prevalence Of Restricted Spirometry Within Two Eastern Kentucky Counties A Cross Sectional Study, Quincy Bascombe

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

Objective: This study examines the prevalence of restrictive spirometry in Eastern Kentucky and its association among men and women with various demographic and exposure (occupational and environmental) factors.

Methods: A cross sectional, cluster sample (N = 685) of participants from Letcher and Harlan Counties, aged 21 and over, answered a questionnaire focused on risk factors for respiratory health outcomes including questions on demographic, health, occupational, and environmental exposures variables. Pulmonary function tests were administered to all participants with no significant cardiovascular or cerebrovascular events within the past 30 days. Log-binomial regression was used to calculate prevalence ratios (PRs) …

Analysis Of High Potency Anticholinergic Prescribing In Scottish Nursing Home Patients, Alexandra Nugent

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

Purpose: The aim of this study was to compare the use of two or more high-potency anticholinergic (HPA) medications between patients 65 years and older in nursing homes and in the greater community using prescribing data. Methods: This secondary data analysis of the NHS Scotland PIS databased used prescription data from a nationally representative patient-level database. Patients were included were ≥65 years old, received ≥2HPA prescriptions from 2011Q2-2012Q1(11/12), 2016Q1-2017Q2(16/17), 2018Q2-2017Q1(18/19). The principle endpoint of this study was to assess for a change in patient’s relative risk of receiving ≥2HPA prescriptions. Results: 29,301 patients were identified. From 11/12 to 16/17 all …

Policy Analysis Of California Senate Bill 1138: Mandating Plant-Based Meal Options In Hospitals And Prisons, David Morton

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

Obesity, chronic disease, and poor nutrition are prevalent in the United States while healthcare costs rise. Nutritional research advancements have suggested the healthfulness of plant-based diets. In 2018, the California state senate passed Senate Bill 1138, requiring plant-based meal options in hospitals and prisons. This paper sought to examine the context surrounding the bill, determine the appropriateness of the bill, and recommend next steps for nutritional policies in the United States. In a review of the literature, malnutrition in hospitals and prisons is highly prevalent, and state governments have already made efforts to improve their citizens’ nutrition. In this analysis, …

Utilization Of A Community Pharmacy-Based Service For The Treatment Of Uncomplicated Urinary Tract Infections In Scotland, Robert Borchardt

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

Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim …

Assessing The Impact Of Raising The National Minimum Purchase Age Of Tobacco To 21 On Tobacco Use In Youth, Nicholas D. Guerra

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

Introduction: Tobacco use is the number one cause of preventable death in the United States with roughly 500,000 premature deaths a year and 3,200 youth smoking their first cigarette daily. On December 20, 2019, President Trump signed legislation to raise the federal minimum age of sale of tobacco products from 18 to 21 years, effective immediately. Prior to this recent regulation, over half of the US population was enforcing this age restriction. The objective of this research is to investigate the impact of tobacco 21 laws on tobacco use and project the national tobacco impact by using the state experiences …

Community Collaborations For Health Improvement In Laurel County, Kentucky: A Case Study, Kendall Ferrell

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

Kentucky is currently ranked fifth in the United States for opioid-involved overdose deaths. This study assesses how the results of a community health needs assessment have developed collaborative community effort to create and expand services and programs to address opioid and substance use disorder in Laurel County, Kentucky. This particular community continues to rank opioid and substance abuse as a major health concern causing efforts to be put in place to create an opioid response program. A consortium was formed that developed the community health needs assessment survey. The results from the survey were then incorporated in to a strategic …

Asthma In Scotland: Prescribing Trends Since The National Review Of Asthma Deaths (Nrad), Quentin Kenner

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

Asthma in Scotland: prescribing trends since the National Review of Asthma Deaths (NRAD)

Purpose: Asthma remains prevalent worldwide with implications for morbidity and mortality. In Scotland, 1 in 14 people are currently being treated for asthma. Asthma burden prompted the creation of the National Review of Asthma Deaths (NRAD), which identified contributing factors. Since the NRAD, guidelines have changed and therapeutic indicators have been developed with an increased emphasis on controller medications. Few publications describe how the NRAD study affected prescribing and if inequalities among the asthmatic population exist. This study aimed to determine whether patients were receiving appropriate treatment …

Dalbavancin In The Community Emergency Department, Wesley Johnson

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

Introduction

Dalbavancin is an antibiotic within the class of medications known as lipoglycopeptides. This medication is given to patients presenting to the hospital with acute skin and skin-structure infections (ABSSSI). This is a unique medication because it is given as a one-time dose in the outpatient setting and it could prevent patients from requiring admission to the hospital.

Methods

The emergency department (ED) at Good Samaritan community hospital performed a trial period with dalbavancin and data was collected from November 2018 to March 2020. Retrospective chart review was performed to obtain patient data and outcomes. Patients would be contacted by …

Describing Interventional Approaches To The E-Cigarette/Juuling/Vaping Epidemic In Eastern Kentucky High Schools: A Case Study, Taylor Miller

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

Problem: Over the past few years there has been significant increase in vaping/juuling/e-cigarette use among the adolescent population. Since this is a new health issue, there are very few intervention programs for teens to receive education about these devices and support for quitting/treatment. The aim of this study was to provide insight on interventions that have already been implemented to provide direction for those seeking to design their own vape/juul/e-cigarette intervention. This was assessed by comparing approaches and lessons learned during the intervention implementation process.

Methods: The study was conducted using a case study approach. The researcher conducted interviews with …

Improving Colorectal Cancer Screening Rates In Perry County, Vashisht Madabhushi

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

Appalachian Kentucky has one of the highest incidence and mortality rates from colorectal cancer (CRC) in the country. CRC is curable if identified early through screening. However, Perry County has suboptimal screening levels. A multimodal program of patient reminders and mailed screenings will be used to increase CRC screening rates in Perry County. The primary outcome will be evaluated using a T-test for this prospective cohort study. Short term outcomes include increased CRC screening rates in delinquent patients. Long term outcomes include increased CRC detection rates and decreased CRC mortality in Perry County.

Implementing The Be Proud! Be Responsible! Program In Wolfe County Public Schools, Casey Gill

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

Kentucky’s teen pregnancy rate is higher than the national average, and Wolfe County has one of the highest rates of teen pregnancy in the state. Teen pregnancy causes adverse health effects for both mother and baby. Teen mothers have a higher likelihood of dropping out of high school, increased health problems related to pregnancy such as preterm labor and preeclampsia, increased risk of being a single parent, and lower income and SES status. The baby is also affected, with an increased risk of living in a single parent household, and living in poverty. The Kentucky River District Health Department plans …

An Analysis Of The Association Between Adverse Childhood Experiences And Food Insecurity Within The United States, Margaret Brooks

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

Adverse childhood experiences and food insecurity are significant public health issues within the United States. Previous studies have established the overall relationship between ACEs and food insecurity. This research investigates the statistical relationship between individual ACE indicators and food insecurity as well as the relationship between having two or more ACEs and food insecurity.

Diabetes Locus Of Control And Depression In Older Adults With Type 1 And Type 2 Diabetes: The Study Of Longevity In Diabetes, Jahvona Pretty

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

Abstract:

Objective: To determine if diabetes locus of control (dLOC) is associated with depression in older adults with type 1 and type 2 diabetes and whether this association differs by diabetes type.

Methods: Data for the current study were obtained from The Study of Longevity in Diabetes (SOLID), a prospective cohort study of aging, and diabetes. SOLID participants aged 60 and older with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes were recruited from members of Kaiser Permanente Northern California (KPNC). For the current study, we excluded all of the participants without diabetes since the primary exposure, …

Maternal Demographic And Psychosocial Factors Associated With Low Attendance Of A Centeringpregnancy Prenatal Care Program Among A Group Of High-Risk Women From Kentucky., Javeria Zafar

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

Abstract

Aim: To identify maternal demographic and psychosocial risk factors associated with poor attendance of CenteringPregnancy group prenatal care, and whether past or current experience of intimate partner violence is related to poor attendance.

Methods: Data from the EMPOWR (Efforts to Maximize Perinatal Outcomes in Women at risk) were used in a cross-sectional study design. Self-reported data from 607 high-risk pregnant women from Kentucky was used. Poor-attendance or non-compliance was defined as attending less than 6 out of the 10 group prenatal care session. Multivariable logistic regression was performed to assess the association between risk factors and compliance with the …

Analysis Of Health Survey Data To Address Topics In Environmental And Public Health, Nimish Valvi

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

Introduction: Manganese is an essential trace element that can cause adverse health effects with deficiency and in excess amounts. The purpose of this study is to determine the asscociation of blood manganese levels and the prevalence of myocardial infarction, stroke, and renal dysfunction in a general US population.

Methods: Data were used from the National Health and Nutritional Examination Survey (NHANES) of non-institutionalized US adults 20 years and older using the 2011-2012, 2013-2014, and 2015-2016 survey cycles (n=16629). Weighted multivariable logistic regression models adjusted for age, race/ethnicity, sex, and poverty income ratio (PIR), were used to determine the association of …

Evaluating The Effects Of Meditation On Students’ With Disabilities On-Task Performance, Lauren Ashley Johnson

Theses and Dissertations--Early Childhood, Special Education, and Counselor Education

This document will address the following prompts: (a) compare and contrast A-B-A-B designs and multiple probe designs for their applications to research questions, respective strengths and weaknesses, and threats to internal validity, (b) evaluate Wilson and Dixon (2010) for rigor, risk of bias, and quality based on What Works Clearinghouse’s measures, and (c) provide a rationale for the use of meditation with students with disabilities and outline procedures a practitioner could follow to implement meditation with a student with behavioral challenges.

A Comparison Of Multiple Baseline Family Of Designs, An Analysis Of A Multiple Probe Study, And Coaching For Practitioners, Katherine Jordan

Theses and Dissertations--Early Childhood, Special Education, and Counselor Education

Overview of Alternative Thesis Project

During the Spring 2020 semester, students within the applied behavior analysis program were conducting applied thesis projects within typical contexts as part of their fulfillment of the requirements of a master’s degree program. Due to the coronavirus disease 2019 (COVID-19), public schools and related facilities closed with no plans to reopen within the time frame to allow for graduation for students in the last semester of their graduate program. Students were allowed to complete an alternative thesis assignment in the form of responding to writing prompts followed by an oral defense of the written products, …

Microbial Interactions Between Compost Bedded Pack Barn Bedding And Teat Exposure In Transition Dairy Cattle, Tanya Lynn France

Theses and Dissertations--Animal and Food Sciences

Compost bedded pack barns utilize composting methods which provide a soft surface for dairy cows to lie on. This requires optimal microbial growth, which may increase the exposure of mastitis-causing pathogens to the teats of early lactation animals. Bedding characteristics, bedding bacteria, and bacterial counts on the teat skin, teat ends, and in the milk of early lactation dairy cows housed on a compost bedded pack were assessed over a 6-month time. The main objective was to determine the relationship between environmental effects (bedding characteristics and weather conditions) and cow-level (teat skin, teat end, milk) bacteria counts over time in …

The Application Of The Food Safety Modernization Act’S Produce Safety Rule For Produce Auctions, Mari Schroeder

Theses and Dissertations--Animal and Food Sciences

Produce is a high-risk commodity that is associated with numerous foodborne outbreaks each year. The Food Safety Modernization Act’s Produce Safety Rule was designed to address these issues by requiring farms that grow, harvest, package, and/or hold produce to comply with science-based minimum guidelines. However, with the revival of the local food movement there is a subsequent flux in alternative food networks that handle produce but are not covered by this rule. Produce auctions represent only a fraction of these alternative food networks but are the focus of this study because of their interaction with the Plain community whose relationship …

The Role Of Feed Additives In Mitigating The Effect Of Stressors On Growth, Digestibility, Intestinal Morphology, Permeability, And Immune Response In Poultry, Yemi Olojede Burden

Theses and Dissertations--Animal and Food Sciences

Three experiments were conducted to evaluate the interactive effects of dietary supplements in birds exposed to different stressors, on growth performance, nutrient, and energy digestibility, antioxidant status, intestinal permeability, and immune status. The first study was conducted to evaluate the effect of a commercially available algae-based antioxidant, containing Selenium yeast (EconomasE™, EcoE) and two inorganic sodium sources (NaCl and NaCl+NaHCO3) on growth performance, nutrient and energy digestibility and utilization, antioxidant, and immune status of broilers challenged with oral gavage of dexamethasone (DEX). The inclusion of either of the sodium sources did not affect plasma corticosterone and antioxidant status levels, growth …

Flesh Markets: Sex Trafficking, Opioids, And The Legal Process To Eradicate The Demand, Blanche Cook

Law Faculty Scholarly Articles

On February 5, 2021, the University of Kentucky J. David Rosenberg College of Law, grateful steward of the community it serves, held a symposium for students, practitioners, stakeholders, and the public. The symposium, the first of its kind, examined the converging and rising tides of sex trafficking vulnerability and opioid dependency. The Kentucky Law Journal and the University of Kentucky Department of Gender and Women's Studies sponsored the symposium.

In order to provide necessary context, the following introduction briefly outlines sex trafficking and is followed by an overview of the symposium. For a more detailed review of the generous expertise …

Against Deaccessioning Rules, Brian L. Frye

Law Faculty Scholarly Articles

Art museums are the aristocrats of the charitable sector, with all

the virtues and vices of the aristocracy. In their prime, they are glorious

exemplars of the finest in cultural expression. But in their dotage,

they are weak and vulnerable, constitutionally incapable of avoiding

financial ruin. Some art museums have even gone bankrupt and dissolved,

despite owning large collections of extremely valuable objects.

What explains this paradox? Deaccessioning rules: professional

rules governing art museums and art museum directors that prohibit

the sale of works of art for the purpose of generating capital. When

art museums find themselves in financial distress, …

The Fragile Future Of Aquifer Storage And Recovery, Zachary A. Bray

Law Faculty Scholarly Articles

Buda, Texas-a small town that lies between Austin and San Antonio,

on the banks of Onion Creek and above the Edwards Aquifer-is perhaps

best known, though it is not particularly well known, as the "Wiener Dog

Capital of Texas." Buda's claim to this title is based upon its annual

dachshund races, which are opposed by the Dachshund Club of America

but lauded by locals, tourists, and the international press as an "event that

combines the pageantry of the Kentucky Derby and the excitement of

NASCAR with dachshunds, animals known for their small stature." Buda

is certainly unusual in relying so …

Patents & Legal Expenditures, Christopher J. Ryan, Brian L. Frye

Law Faculty Scholarly Articles

Universities are engines of innovation. To encourage further innovation, the federal government and charitable foundations give universities grants in order to enable university researchers to produce the inventions and discoveries that will continue to fuel our knowledge economy. Among other things, the Bayh-Dole Act of 1980 was supposed to encourage additional innovation by enabling universities to patent inventions and discoveries produced using federal funds and to license those patents to private companies, rather than turning their patent rights over to the government. The Bayh-Dole Act unquestionably encouraged universities to patent inventions and license their patents. Since the passage of the …

Reflections On Moving Toward Integration And Modern Exclusionary-Zoning Cases Under The Fair Housing Act, Robert G. Schwemm

Law Faculty Scholarly Articles

This Article has two parts: Part I presents my views on Moving Toward Integration [Richard H. Sander et al., Moving Toward Integration: The Past and Future of Fair Housing (2018)], and Part II examines one of the book’s policy recommendations for furthering residential integration—exclusionary zoning litigation—along with some of the roadblocks to this and other pro-integration efforts erected by the Trump Administration.

Health-Related Quality Of Life And Ptsd-Symptoms In Survivors Of Extracorporeal Membrane Oxygenation (Ecmo) Support, Jennifer Bauman

DNP Projects

Background: Extracorporeal membrane oxygenation (ECMO) survivors have shown to have poor physical and mental health outcomes post decannulation and hospitalization; thus leading to an overall decreased quality of life. Identifying and managing the psychological components of care in this patient population can improve their physical, emotional, and mental well-being.

Purpose: To assess the incidence of impaired health related quality of life (HRQOL) and posttraumatic stress disorder (PTSD) like symptoms in survivors of ECMO; identify which constellation of patients (respiratory vs. cardiac) have poorer HRQOL outcomes post ECMO; and compare the tools used to measure post procedural outcomes in this patient …

An Empirical Pilot Study Examining The Relationship Between Intention To Participate In Food Security Efforts And Childhood Socioeconomic Status Among Conference Attendees, Liana Dixon

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

Hunger is a global public health issue and finding a solution is a priority for the United Nations. The United Nations Sustainable Development Goal 2.2 calls for ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture for all people by 2030. The Universities Fighting World Hunger (UFWH) Summit, originating with the United Nation’s originated World Food Programme (WFP) and Auburn University, convenes attendees annually to share their own knowledge and ideas about how to “fight hunger,” as well as benefit from others knowledge and ideas. An important factor in tackling hunger and achieving health is addressing poverty and …

Monitoring Opioid Use In Cancer Survivors: Implementation Of Screening, Brief Intervention, And Referral To Treatment (Sbirt) In A Clinical Setting, Jennifer M. Dolly Prothro

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

Kentucky is a disparate state, ranking as one of the top states in incidence, prevalence, and mortality for both opioid use disorders (OUD) and cancer. Due to the high volume of both diseases in the state, there is a rising concern about the overlap of these two populations. Cancer and its’ treatment are known to cause chronic pain, defined as daily pain lasting 3 months or longer. Generally, chronic pain patients of any type are known to experience higher rates of opioid misuse (21-28%) and opioid dependence (8-12%) than the general population (4.1%, 0.9% respectively). The risk of OUD must …

Implementing Centeringpregnancy, A Group Prenatal Care Model, In Hamilton County, Ohio, Morgan Avery

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

Target Population and Need

Hamilton County, Ohio exhibits high rates of poverty, unemployment, and negative health outcomes. Specifically, Hamilton County continues to perform poorly in maternal and child health outcomes such as infant mortality, low birth weight, gestational diabetes, and preterm birth rates. Many people in the community exbibit poor health behaviors such as inadequate prenatal care, drug use during pregnancy, and smoking during pregnancy.

Program Approach

The Hamilton County Health Department intends to implement an evidence based group prenatal care program, CenteringPregnancy, in three health centers around Hamilton County in an effort to reduce poor maternal and child health …