Digital Commons Network^™

Predicting Self-Administered Biologic Nonadherence In Medicare Fee-For-Service Beneficiaries With Inflammatory Bowel Disease Using Machine Learning Models, Christian Rhudy, Courtney Perry, Cody Bumgardner, Michael J. Wesley, David W. Fardo, Terrence Barrett, Jeffery Talbert

Psychiatry Faculty Publications

BACKGROUND: Nonadherence to self-administered biologic therapies increases risk for disease flares and adverse outcomes in inflammatory bowel disease (IBD). OBJECTIVE: To use machine learning and Medicare fee-for-service claims to create models predictive of medication nonadherence. METHODS: This study included Medicare fee-for-service beneficiaries with at least 2 IBD claims separated by 30 days between 2017 and 2021 and analyzed claims data from 2021. Beneficiaries with missing data or fewer than 3 self-administered biologic dispenses (adalimumab, certolizumab, golimumab, ustekinumab) on different dates in 2021 were excluded. Beneficiary-level nonadherence was defined as a proportion of days covered less than 0.8, and dispenselevel nonadherence …

Person‑Level Health Factors Partially Mediate The Association Between Lesbian, Gay, Or Bisexual (Lgb) Identity, Allostatic Load, And Cancer Mortality In Nhanes, Justin Xavier Moore, Alisha Patel, Missy Spears, Tracy Casanova, Heidi L. Weiss, Marvin E. Langston, Keith J. Watts, Donte Boyd, Prajakta Adsul, Meredith S. Duncan, Sydney Howard

Markey Cancer Center Faculty Publications

Purpose: Individuals identifying as Lesbian, Gay, or Bisexual (LGB) with high allostatic load have more than double the cancer mortality risk of heterosexual individuals with high allostatic load. This study explored how person-level health factors mediate the relationship between individuals identifying as LGB with high allostatic load and subsequent risk of cancer mortality.

Methods: We conducted a retrospective analysis of 12,470 participants in the National Health and Nutrition Examination Survey (2001–2010) linked to the National Death Index through 31 December 2019. Survey-weighted Cox regression assessed associations of individuals identifying as LGB and allostatic load with cancer mortality. Person-level health factors …

Eef2k Promotes Immune Evasion In Melanoma Via Cyclin D1–Mediated Stabilization Of Pd-L1, Yijie Ren, Darby J. Ballard, Anil Kumar, Andy F. Song, Mitiksha Gupta, Xiaofang Xiong, Xingcong Ren, Jugal Kishore Das, Jin-Ming Yang, Jianxun Song

Markey Cancer Center Faculty Publications

Eukaryotic elongation factor 2 kinase (eEF2K) is a stress-responsive regulator of protein synthesis implicated in melanoma progression, but its role in tumor immune evasion remains poorly defined. We investigated how eEF2K influences programmed death ligand 1 (PD-L1) expression through modulation of Cyclin D1. We analyzed gene expression and dependency datasets from The Cancer Genome Atlas and the Cancer Dependency Map. Protein–protein interactions were assessed by co-immunoprecipitation. Cyclin D1 was inhibited pharmacologically with palbociclib. Immune responses were evaluated in murine B16-OVA and human A2058 melanoma models using flow cytometry and immunohistochemistry after genetic or pharmacologic modulation of eEF2K and Cyclin D1. …

Evaluation Of A Nicotine Prevention Program In A Third Grade Classroom, Jennifer A. Pile

DNP Projects

Purpose: The purpose of this project was to increase knowledge of nicotine products and promote negative perceptions of nicotine use among third-grade students through early prevention education.

Background: Prevention is key and to prevent nicotine use, there must be an educational program with that aim in a much younger population. Third grade encompasses 8-, 9-, and 10-year-olds. This group is in the middle childhood stage and begin more complex thinking and problem-solving skills. There is physical and emotional development among this group.

Methods: This is a quasi-experimental study among third grade students in Breckinridge County Kentucky with pretest and …

Integrated Crop Management For Hemp (Cannabis Sativa L.) Grain Production In Kentucky, Maria M. Ricciardi

Theses and Dissertations--Plant and Soil Sciences

Cannabis sativa L. is legally defined (U.S.) as hemp if the total tetrahydrocannabinol (THC) concentration remains less than 0.3% on a dry weight basis. Hemp can be produced for cannabinoid extraction, fiber, or grain. Hempseed meal and hempseed oil were approved as feed ingredients for chickens and performance horses in Kentucky. To leverage this opportunity, production requires improvement through an integrated crop management approach. This dissertation (1) reports the main arthropod and disease pests impacting hemp grain; (2) identifies grain yield components and their relationship with corn earworm, Helicoverpa zea (Boddie) (CEW); (3) evaluates Fusarium head blight (FHB) development across …

Breeding For Fhb Resistance And Post-Harvest Quality In Soft Red Winter Wheat, Margaret E. Gillum

Theses and Dissertations--Plant and Soil Sciences

Soft red winter wheat (Triticum aestivum L.) is both an economically and nutritionally important crop in the global food supply. Despite its global importance, wheat is continually threatened by fungal diseases. Fusarium head blight (FHB), caused by Fusarium graminearum, is a devastating fungal disease affecting wheat worldwide, resulting in low yields, reduced test weight and mycotoxin production. The mycotoxin deoxynivalenol (DON) is toxic to humans, results in feed rejection in livestock, and is heavily monitored in the food supply. Because of wheat’s importance in the food system, post-harvest quality (milling, baking, and flavor) has been a growing area of …

Evaluating Spatial Variability Of Corn Yield Response To Phosphorus Fertilizer For Improved Precision Phosphorus Management, Jennifer Fridgen

Theses and Dissertations--Plant and Soil Sciences

Soil scientists did not develop soil test-based fertilizer recommendations to support precision nutrient management. Knowledge of crop responses to applied essential nutrients, such as phosphorus (P), and the processes governing these responses at high spatial resolution are necessary to improve precision agronomic recommendations. This dissertation investigates the limitations of current soil sampling methodologies and recommendation frameworks for crop response to fertilizer, with particular emphasis on P fertility in Kentucky (KY) corn production. The first study examined the relationship between the resolution of systematic grid sampling and the spatial structure of soil test variables (Mehlich-3 P (M3P), Mehlich-3 potassium (M3K), and …

Characterization And Antimicrobial Activity Of Lignin-Derived Compounds In Ground Hurd Tissue Of Cannabis Sativa L. (Hemp) Cultivars, Jourdan E. Lakes, Anjam Sadik, Robert C. Pearce, Barbara L. Knutson, Stephen E. Rankin, Bert C. Lynn, Michael D. Flythe

Chemistry Faculty Publications

Objectives: Characterize lignin-derived compounds from the hurd of 10 fiber/grain Cannabis sativa L. cultivars and investigate the antimicrobial activity of select compounds on the wasteful ruminant bacterium, Acetoanaerobium sticklandii SR.   Methods: Hurd was processed using an aqueous ethanol solvent system and analyzed via GC-MS to identify and characterize lignin derivatives. Antimicrobial activity of the hurd and three monomers was assessed using solid (hurd) and liquid medium (monomers) bioassays against SR.   Results: 27 compounds were identified, most as monomers but a few were dimers, ethylated derivatives, and organic acids. There were approximately equal G- and S-units with substantially fewer H-units. Several …

Amustaline/Glutathione Pathogen-Reduced Red Cell Hemoglobin Utilization In Complex Cardiac Surgery, Ian J. Welsby, Michael E. Sekela, Edward L. Snyder, James D. Gorham, John S. Mcneil, Kathy Liu, Stanley Bentow, Thomas Gniadek, Laurence Corash, Nina Mufti, Richard J. Benjamin

Surgery Faculty Publications

Background: The ReCePI randomized, controlled trial compared amustaline/glutathione pathogen-reduced (PR) and conventional red blood cell (RBC) transfusions in cardiac surgery. Study design and methods: We performed a post-hoc analysis of hemoglobin (Hb) utilization and safety outcomes. Hb content of study RBCs was measured at manufacture. Subject Hb levels, estimated blood loss and blood product use were recorded during and for 7 days post-surgery. Acute kidney injury (AKI) incidence was graded over 7 days, and adverse events were assessed for 28 days. Results: PR-RBCs contained 5.2% less Hb (mean [SD] Test 58.1 [6.5] g; Control 61.5 [6.8] g Hb, p <.001) due to manufacturing volume losses. Four hundred fifty-six PR- and 524 conventional RBCs were transfused to 159 Test and 162 Control subjects, respectively. Mean subject baseline and post-surgery Hb levels, and blood loss were not different between groups. Test subjects tended to require fewer total RBCs (3.5 [2.7] Test vs. 4.0 [3.5] Control, p =.08) resulting in 17.6% significantly less mean total Hb transfused (Test 203.2 g; Control 246.8 g Hb, p =.01). The proportions of subjects transfused with, and the number of platelet and cryoprecipitate units transfused were not different. Test subjects received less plasma (2.3 [1.8] units Test vs. 3.5 [3.8] Control, p =.03). Overall incidence of adverse events and AKI were not clinically different. Imbalances in AKI severity (Grade III Test 15/159 [9.4%]; Control 7/162 [4.3%], p =.07) may suggest under-transfusion in the highest-risk Test subjects. Discussion: Test patients required less transfused Hb than control subjects to maintain equivalent daily hemoglobin levels following similar blood loss.

Mouse Models For Post-Sepsis Syndrome, John Matthew K. Ang, Stephanie F. Mori, Erick Lewis, Maria E.C. Bruno, Arnold Stromberg, Hiroshi Saito

Surgery Faculty Publications

Background – Sepsis survivors commonly suffer from chronic Post-Sepsis Syndrome (PSS). To understand the mechanisms of PSS, it is critical to utilize appropriate animal models. While cecal ligation and puncture (CLP) is a widely used model of sepsis, a concern exists regarding its suitability for studying long-term outcomes. Alternatively, we previously optimized a highly reproducible murine cecal slurry (CS)-injection model of sepsis. The objective of this study was to compare the suitability of CS and CLP models for investigating PSS. Methods – Male 4-month-old C57BL/6 mice were divided into 7 groups: (1) Naïve control; (2) Sham: laparotomy control; (3) CL: …

Effect Of Substrate Dispersion Method And Particle Size On In Vitro Digestibility, Gas Production Kinetics And Composition, And Fermentation Characteristics In Different Feed Types, Luiz C. O. Sousa, Ellem M. A. Matos, Ronald J. Trotta, Edenio Detmann, David L. Harmon

Animal and Food Sciences Faculty Publications

Our objective was to evaluate the influence of substrate dispersion method and particle size on in vitro digestibility, gas production kinetics and composition, and fermentation characteristics of different feed types. Alfalfa hay, tall fescue hay, ground corn, soybean meal, and a total mixed ration (TMR) were used as substrates. Treatments were designed according to a 2 × 2 × 5 factorial arrangement: two substrate dispersion methods (loose substrate and in filter bags), two particle sizes (1 mm and 2 mm), and five feeds. Filter bags decreased (P ≤ 0.001) digestibility and gas production compared with loose samples. Filter bags decreased …

Soybean Meal Mitigates Vasoconstriction And Serotonin Suppression During Fescue Toxicosis In Beef Cattle, Luiz C.O. Sousa, Brittany E. Davis, David L. Harmon, Ronald J. Trotta

Animal and Food Sciences Faculty Publications

Legume supplementation has been shown to mitigate fescue toxicosis in beef cattle. However, no studies have directly compared the use of soybean-based feeds to alleviate symptoms of fescue toxicosis under controlled environmental heat and equalized feed intake. The objectives were to evaluate the effects of soybean hulls, whole soybeans, or soybean meal (SBM) supplementation on the mitigation of vasoconstriction, heat stress, and inflammatory responses in beef cattle during fescue toxicosis. Ten ruminally-cannulated Angus × Holstein steers were used in a 5 × 10 Latin rectangle design. Five treatments were evaluated: 1) non-toxic endophyte-infected tall fescue seed (NTE), 2) toxic endophyte-infected …

Daily Rhythms In Psychosocial Stress, Sleep, And Mood: A Multimethod Approach To Transdiagnostic Psychopathology Risk And Intervention, Gabriel Gilmore

Theses and Dissertations--Psychology

Rhythms are central to nearly every core physiological and psychological process and have profound influences on overall health and well-being, particularly in the context of mood disorders. This dissertation emphasizes a rhythm-centered framework for understanding transdiagnostic psychopathology, proposing that the temporal organization of psychosocial stress, sleep, and mood provides crucial information for the development and treatment of mood disorder symptomology. Current literature relies primarily on mean symptom levels, overlooking day-to-day patterns in psychosocial experiences. To address this key methodological gap, three studies are examined. Study 1 develops and validates the Psychosocial Stress Regularity Measure (PSRM), a brief single-item measure of …

Relative Utility Governs Working Memory For Drug-Associated Stimuli In A Novel Translational Paradigm, Maxwell E. Boileau

Theses and Dissertations--Psychology

Substance use disorder (SUD) remains a prevalent health concern, partially characterized by continued drug use despite aversive consequences. Contrary to accounts emphasizing cognitive deficits, drug versus non-drug choice data reflect sensitivity to reinforcement dimensions, with preference shifting systematically as a function of magnitude and probability. The present study tested whether another cognitive system, working memory, is similarly affected by relative utility. Preclinical studies have demonstrated sensitivity of working memory to reinforcement dimensions, but these are often attributed to the differential outcomes effect. Generalized matching models were fit to allomorphic choice data, allowing estimation of exchange rate parameters. A concurrent solid- …

A Mixed Method Investigation On The Effects Of Information And Motivation On Self-Regulation Skills And Fruit And Vegetable Consumption, Kristen Buford

Theses and Dissertations--Psychology

Introduction: The purpose of this research study is to understand the interplay between health information and health motivation on eating behaviors in African American emerging adults. Greater knowledge of nutrition is linked to healthier eating outcomes, but the motivations that individuals possess about their ability to improve their health also play a pivotal role. However, the joint effect of such constructs (i.e., information and motivation) on eating behaviors is unknown. Emerging adults are still developing their capacities to exercise their health autonomy, and this developmental period represents an opportunity to intervene before the onset of age-related chronic diseases in middle …

Coalition Building And Citizen Science For Radon Risk Reduction, Stacy Stanifer, Kathy Rademacher, Whitney Sedio, Naomi Cheek, David Gross, Caitlyn Curtis, Amanda Thaxton-Wiggins, Mary Kay Rayens, Ellen J. Hahn

Nursing Faculty Publications

We evaluated the implementation of local coalitions led in partnership with citizen scientists, community-based organizations, and public libraries in four rural communities to lower exposure to radon in the home. The objectives were to (1) describe the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) of four radon coalitions, and (2) compare RE-AIM factors among citizen scientists who participated in the coalitions and those who did not. A larger community-engaged research project embedded coalition building using a citizen science approach. Three of the four coalitions focused on health and wellness more broadly (18–34 members); one focused solely on radon (10 members). Coalition membership and activities varied …

Associations Between Social Media Usage, Physical Activity And Flourishing In Rural University Students, Anna Dysart, Minu Sara Thomas

Journal of Appalachian Health

Introduction: Most adolescents and young adults report significant use of social media.^1-3 However, there is limited research on the effect of social media use, specifically on physical activity and flourishing.

Purpose: This pilot research study examines the correlation between social media usage and the physical activity and flourishing levels of college students at a rural university in Appalachia.

Methods: The authors conducted a survey including the validated Secure Flourishing Index and Stanford Leisure-Time Activity Categorical Item, containing questions on social media use and demographics. Spearman’s rho was used for nonparametric correlations. Pearson’s correlation was used to determine the correlation …

Leveraging Community Health Worker’S Deep Community Knowledge To Address Food And Nutrition Security In Appalachia, Alexis Kimbro Scott, Melissa D. Olfert, Dawn Brewer, Makenzie Barr, Julie Plasencia

Journal of Appalachian Health

Introduction: Community health workers (CHWs) are trusted professionals in communities because of the deep understanding and cultural insights learned from their lived experiences. In Appalachia, CHWs are embedded in the community, giving them a unique understanding of how social determinants, like food and nutrition security, impact health outcomes.

Purpose: This study aimed to examine the professional characteristics and knowledge of CHWs while identifying culturally sensitive practices around food insecurity.

Methods: This cross-sectional, mixed-methods study used an online survey and in-depth phone interviews with CHWs in the Appalachian Region to examine their professional characteristics and knowledge on food security in their …

Stigmatization And Healthcare Inequity Perceived By Individuals Served By Homeless Shelters In An Appalachian City, Molly Powney, James M. Mears, Reagan Sharp, Lisa Calderwood

Journal of Appalachian Health

Introduction: People experiencing homelessness are medically vulnerable and suffer disproportionately from chronic physical and mental health conditions. Evidence-based standards to inform decisions surrounding care would be valuable for this population. Studies exploring how homeless individuals in Appalachia perceive their interactions with the healthcare system remain limited, however.

Purpose: The purpose of this study is to assess perceptions of the healthcare system among homeless individuals served by temporary housing shelters in an Appalachian city.

Methods: A voluntary anonymous survey was administered to residents at three shelters in Charleston, West Virginia (WV) from September 2023 – March 2024. Responses were collected utilizing …

Influence Of Family Health History And Parental Education On Body Mass Index, Blood Pressure, And Lipid Levels In 5th Grade Children: A Secondary Data Analysis Of The Cardiac Project, Madha Rani Das, Lee A. Plyes, Eloise Elliott, Christa L. Lilly

Journal of Appalachian Health

Introduction: Childhood obesity and related cardiovascular risks reflect the interplay of genetic predispositions and socioeconomic adversity. Appalachia’s poverty, limited health care, and educational gaps worsen family health risks, driving early cardio-metabolic problems in children, highlighting the need for effective interventions.

Purpose: The purpose of this study is to examine the association of family health history and parental education with BMI, BP, and lipid profiles among 5^th grade children in West Virginia (WV).

Methods: The study used WV CARDIAC data from 2006–2009. Outcomes were BMI, SBP/DBP, and fasting lipids (HDL, LDL, TG). Predictors were parental education and family health history …

Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery

Journal of Appalachian Health

Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.

Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).

Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.

Results: About 32% of the …

Just A Place Or A Just Place?: Domestic Violence, Urban-Rural Differences, And Access To Justice, Cassie Chambers Armstrong

Kentucky Law Journal

No abstract provided.

Seasonal And Diurnal Variation In Forage Nutritive Value Of Cool-Season Grasses As Predicted By Near-Infrared Reflectance Spectroscopy (Nirs), Ann Marie C. Riley, Isabelle A. Kagan, Brittany E. Davis, Laurie M. Lawrence, Chris D. Teutsch, S. Ray Smith

Animal and Food Sciences Faculty Publications

A better understanding of seasonal and diurnal variation in forage nutritive value may help to maximize protein intake and digestibility for grazing livestock. Forage nutritive value was evaluated in four cool-season grasses common to Kentucky pastures: orchardgrass (Dactylis glomerata L.; OG), perennial ryegrass (Lolium perenne L. ssp. perenne; PRG), Kentucky bluegrass (Poa pratensis L.; KBG), and tall fescue [Schedonorus arundinaceus (Schreb.) Dumort.; TF]. In 2015 and 2017, 10 cool-season grass cultivars representing four species, planted in quadruplicate (40 plots) in central Kentucky, were maintained vegetatively with 2–4 week mowing and sampled in the morning and the afternoon at the same …

The Interpretive Foundations Of Arbitrary Or Capricious Review, Alexander Mechanick

Kentucky Law Journal

No abstract provided.

The Racial Wealth Gap Is A Racial Health Gap, Aurora J. Grutman

Kentucky Law Journal

No abstract provided.

Interest Convergence And The Racial Wealth Gap: Defusing Racism's Divide-And-Conquer Via Universal Basic Income, Palma Joy Strand, Nicholas A. Mirkay

Kentucky Law Journal

No abstract provided.

Wage Enslavement: How The Tax System Holds Back Historically Disadvantaged Groups Of Americans, Goldburn P. Maynard Jr., David Gamage

Kentucky Law Journal

No abstract provided.

Performance Of Dried Blood Spot Cards For Serologic Detection Of Hpv16 Antibodies In Oropharyngeal Squamous Cell Carcinoma Patients, Maisha Maliha Rahman, Soma Bose, Li Chen, Jessica L. Burris, Rony Aouad, Susanne M. Arnold, Melvyn Yeoh, Birgitta Michels, Tim Waterboer, Krystle A. Lang Kuhs

Epidemiology and Environmental Health Faculty Publications

Antibodies against the human papillomavirus type 16 (HPV16) E6 oncoprotein are promising biomarkers for the early detection of HPV-driven oropharyngeal squamous cell carcinoma (HPV+OPSCC). Standard serologic testing is challenging in underserved regions with high HPV+OPSCC incidence. Dried blood spot (DBS) cards offer a low-resource alternative but remain unevaluated for HPV antibody detection. A total of 25 OPSCC patients who provided paired serum (venipuncture) and DBS (finger-prick) samples were recruited from the University of Kentucky. HPV16 antibodies (L1, E1, E2, E4, E6, E7) were measured using multiplex serology, quantified as median fluorescence intensity (MFI) and dichotomized using established cutoffs. Correlation between …

Frequency Dependence Favours Social Plasticity And Facilitates Socio-Eco-Evolutionary Feedback In Fluctuating Environments, Jordan S. Martin, David F. Westneat, Alastair J. Wilson, Niels J. Dingemanse, Yimen G. Araya-Ajoy

Biology Faculty Publications

Increasing attention is being devoted to the study of phenotypic plasticity in social environments. However, much remains unknown about the selection pressures driving the evolution of social plasticity, as well as the pathways by which social plasticity may facilitate or constrain feedback between ecological and evolutionary dynamics. Here, we explore these questions using quantitative genetic models, providing general results regarding the causes of selection on social reaction norms, as well as their consequences for adaptive microevolution in fluctuating environments. We model the fitness effects of character states expressed across spatially heterogeneous microhabitats, with variation in the degree to which trait …

Effect Of Maternal Moringa Oleifera Leaf Supplementation On Maternal And Infant Nutritional Status And Human Milk Output, Suzanna L. Attia, Patrick M. Owuor, Silvia A. Odhiambo, Jerusha N. Mogaka, Raphael Ondondo, Irma Castro Navarro, Aric Schadler, Kristen Mcquerry, George J. Fuchs, Janet E. Williams, Katlyn N. Scarrow, Mark A. Mcguire, Michelle K. Mcguire, Carrie Waterman

Biostatistics Faculty Publications

Background: Feeding of human milk enhances infant health and survival over alternative feeding methods, but early cessation often occurs due to perceived or real insufficient milk supply. Moringa oleifera leaves are nutrient dense and may increase milk output. Objectives: We investigated the impact of maternal dried moringa leaf powder supplementation (moringa) on milk composition and output and infant and maternal health. Methods: Breastfeeding mother–infant pairs (n = 50) living in Kisumu County, Kenya, were cluster-randomized by location to consume moringa powder (20 g/d) in corn porridge (the moringa group) or corn porridge alone (the control group) for 3 mo. Milk …