Digital Commons Network^™

Quantifying Sedimentation Dynamics Of Regulated River Backwater Confluences With Low-Order Tributaries, Abby Kathryne Berry

Theses and Dissertations--Biosystems and Agricultural Engineering

Sediment dynamics in backwater confluences of regulated rivers have received limited study, despite being recognized as hotspots for sedimentation and nutrient attenuation. Development of management and restoration strategies in these landscapes require improved understanding of fluvial geomorphology and sediment transport dynamics due to the alterations in hydraulic regimes and sediment inputs associated with riverine backwaters. The objective of this study was to couple remote sensing, high frequency sensing, and numerical modeling to quantify drivers of erosion and deposition dynamics within regulated river backwater tributary confluences. To meet the objective of this study, data was collected and analyzed from the Fourpole …

Development Of Non-Destructive Methods For The Detection And Quantification Of Gluten Sources In Foods, Adewale Abiola Oloyede

Theses and Dissertations--Biosystems and Agricultural Engineering

Cross-contamination of food with gluten-rich grains such as wheat, barley, and rye remains a significant challenge in gluten-free food production, posing health risks to individuals with gluten-related disorders. Traditional detection methods are often time-consuming and labor-intensive, highlighting the need for rapid and reliable alternatives. This study investigates the use of hyperspectral imaging (HSI) combined with machine learning (ML) and deep learning (DL) techniques for the detection and quantification of gluten contamination in grain-based foods through three main approaches: (i) classification of gluten source contaminants in gluten-free flour, (ii) quantification of gluten content from wheat, rye, and barley flours, and …

“What We Say Matters”: Reducing Drug Use Stigmatization By Healthcare Professionals Through A Narrative-Based Awareness Campaign, Adam M. Traugott

DNP Projects

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma …

Impact Of Obesity On The Gut Microbiome And Inflammatory Markers During Siv Infection And Antiretroviral Therapy, Casey M. Mcguire, Isaac R. Cinco, Diana Takahashi, Kristin A. Sauter, Melissa Kirigiti, Ilhem Messaoudi, Jonah B. Sacha, Charles T. Roberts, Paul Kievit

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Dysbiosis and impaired gut barrier integrity contribute to chronic immune activation associated with both obesity and HIV infection. Given the increased incidence of obesity in people living with HIV, we explored the impact of obesity on the gut microbiome and microbial translocation (MT) biomarkers during HIV infection and antiretroviral therapy (ART). Lean and obese rhesus macaques were infected with simian immunodeficiency virus (SIV) and subsequently treated with ART. Obese animals exhibited higher initial MT and inflammation biomarkers that remained constant throughout the study, while lean animals exhibited significant increases in these biomarkers that approached levels observed in obese animals. Lean …

Evaluating A Public Health Program Using The Cdc Framework: A Case Study Approach, Brooke A. Poe

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

In Bourbon County, Kentucky, where rural health challenges and chronic disease burdens persist, a coalition of public health partners set out to improve population-level physical activity through an innovative, community-centered initiative. The Bourbon County Physical Activity Program emerged through collaboration between the Bourbon County Health Department, the University of Kentucky College of Public Health, and UK HealthCare. Together, these partners designed a six-month intervention that combined discounted YMCA memberships, partnerships with employers, a physical activity tracking app with behavioral incentives, and community-wide events to promote accessible and sustained engagement.

Guided by the CDC’s framework for program evaluation in public health, …

Influence Of Perceived Health Provider Communication, Diabetes Duration And Age At Diagnosis With Confidence In Diabetes Self-Care, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, William B. Burrows, Brittany L. Smalls

Family and Community Medicine Faculty Publications

Introduction: Several factors influence individuals’ confidence to perform diabetes-related self-care activities, including perceived patient-provider communication, diabetes duration and age at diagnosis. It has been well-documented that patient-provider communication is essential when managing chronic diseases such as diabetes; however, the impact of this communication with diabetes duration and age at diabetes diagnosis on confidence in performing self-care behaviors is obscure.

Research design and methods: We utilized data from the 2021 Household Component of the Medical Expenditure Survey among participants 18 years or older who had completed the Diabetes Care Survey. Ordinal logistic regression models were utilized to assess the association between …

Effects Of An Active Ankle Exoskeleton On The Walking Biomechanics Of Healthy Men, Sridevi Nagaraja, Jose E. Rubio, Junfei Tong, Aravind Sundaramurthy, Anup Pant, Meredith K. Owen, Michael A. Samaan, Brian W. Noehren, Jaques Reifman

Physical Therapy Faculty Publications

Active lower-body exoskeleton devices can decrease the energy requirement of the human body by providing mechanical assistance to lower-body muscles. However, they also alter gait kinematics and kinetics, and it is not well understood whether such alterations are detrimental or beneficial to the human body. In this pilot study, we investigated the impact of walking with an ankle exoskeleton device on the biomechanics of men while carrying a heavy load. We collected computed tomography images and motion-capture data for five young, healthy men who walked 5 km (∼60 min) with a 22.7-kg load, with and without an active ankle exoskeleton …

Patterns Of Inpatient Antibiotic Utilization By Race And Ethnicity At Us Children’S Hospitals, Bethany A. Wattles, Jeffrey I. Campbell, Theresa Kluthe, Yana B. Feygin, Kahir Jawad, Michelle D. Stevenson, Deborah Winders Davis, Jennifer Porter, V. Faye Jones, Matt Hall, Michael J. Smith

Biostatistics Faculty Publications

Background and Objectives: Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity. Methods: This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates. Results: There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT. Conclusions: Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.

A Demographic Description Of Children And Adolescents With Concomitant Autism And Anxiety Along With A Comparison Of Receipt Of Psychological Services, Elizabeth Salt, Amanda T. Wiggins, David N. Toupin, Emma Parks, Chizimuzo Okoli, Mary Kay Rayens

Biostatistics Faculty Publications

Objective:(1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism.Methods:Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann-Whitney U tests, χ² tests of association, and logistic regression.Results:Demographic differences …

Leveraging Machine Learning Models To Explore Disparities In Prostate Cancer Diagnosis, Treatment, And Survival, Reuben Adatorwovor, Rasaq Oladapo, Parisa Ghasemi, Gaurav Kumar, Daniel J. Morton, Motolani E. Ogunsanya, Olufunmilola Abraham

Biostatistics Faculty Publications

Introduction: Prostate cancer (CaP) is the second most common cancer in men globally and a leading cause of cancer-related mortality, particularly among older men. In the United States, disparities in incidence, stage at diagnosis, and outcomes persist across racial, socioeconomic, and geographic lines. Men in medically underserved regions like Appalachia experience higher mortality due to limited access to timely screening and treatment. Given the complex interplay of clinical, behavioral, and sociodemographic factors, machine learning (ML) offers promise in identifying survival predictors that traditional models may overlook. This study applies ML models to assess the impact of age at diagnosis, treatment …

Outcomes Of A Pilot Randomized Clinical Trial Testing Brief Interventions To Increase Hiv Pre-Exposure Prophylaxis Uptake Among Rural People Who Inject Drugs Attending Syringe Services Programs, Hilary L. Surratt, Sarah Brown, Abby L. Burton, Will Cranford, Laura C. Fanucchi, Christie Green, Stephanie M. Mersch, Rebecca Rains, Philip M. Westgate

Biostatistics Faculty Publications

Background: Kentucky is one of seven states with high, sustained rural HIV transmission tied to injection drug use. Expanding access to pre-exposure prophylaxis (PrEP) has been endorsed as a key HIV prevention strategy; however, uptake among people who inject drugs (PWID) has been negligible in rural areas. Syringe services programs (SSPs) have been implemented throughout Kentucky’s Appalachian region, providing an important opportunity to integrate PrEP services. Objectives: The primary objective was to examine preliminary efficacy and effect sizes of the study interventions on PrEP initiation among HIV-negative PWID. Design: Parallel group randomized controlled trial. Methods: Eighty participants were enrolled from …

Code Status Discussions, Hunter Bechtold, Reagan T. Smith, Peter Wallenhorst, Kaylee Gouge, Sarah Schaefer, Kelsey Karnik, Kristen Mcquerry, Kristen E. Fletcher

Biostatistics Faculty Publications

Introduction: Residents frequently conduct code status discussions (CSDs) with patients, but many report not receiving formal training in this skill. While institutions have attempted to address this, there remains a need for a curriculum that uses standardized patients (SPs), is generalizable to students interested in different medical specialties, and has been tested on a large sample of students. Methods: We trained 192 fourth-year medical students across four different campuses in how to conduct CSDs during one 2-hour workshop as part of their Transition to Residency course in April 2024. Students worked with SPs as part of this workshop. Students at …

How Patient, Infection, And Cysticercus Characteristics Impact The Evolution Of Taenia Solium Larva In The Human Brain, Hongbin Zhang, Meghana G. Shamsunder, Pryanka Bawa, Arturo Carpio, W. Allen Hauser, Karina Quinde-Herrera, Alex Jaramillo, Elizabeth A. Kelvin

Biostatistics Faculty Publications

Neurocysticercosis is a poorly understood infection of the central nervous system with Taenia solium larva and treatment often fails to kill all the parasitic larva. Most research on this infection has used patient-level data, looking at summaries of the encysted parasitic cysticercus burden. Cyst-level analysis is needed to identify factors that impact individual cyst trajectories and how that may vary based on characteristics of the patient, infection, and cyst being followed. We disaggregated data on 221 cysts from 117 patients who participated in a trial evaluating the impact of albendazole treatment to identify factors that impact cyst evolution over time …

A Myostatin Inhibitory Antibody Combined With Insulin, Partially Rescues The Musculoskeletal Phenotype Of Female Insulin-Deficient Diabetic Mice, R. Clay Bunn, Reuben Adatorwovor, Philip D. Ray, Alexander R. Keeble, Christopher S. Fry, Sasidhar Uppuganti, Jeffry S. Nyman, John L. Fowlkes, Evangelia Kalaitzoglou

Biostatistics Faculty Publications

Introduction: Type 1 diabetes is associated with deficits in both skeletal muscle and bone. Inhibition of myostatin, a negative regulator of muscle mass, was explored as a druggable target to improve the musculoskeletal phenotype associated with insulin-deficient diabetes in female mice. Methods: We investigated whether administration of an inhibitory myostatin antibody (MyoAb) in streptozotocin-induced diabetes in female mice is protective for skeletal muscle and bone. DBA/2J female mice were injected with low-dose streptozotocin or with citrate buffer (vehicle). Subsequently, mice were implanted with insulin-containing or vehicle pellets, with groups being randomized to myostatin or control antibody for 8 weeks. At …

Diagnosing Statistical Education Needs Of Health Science Learners, Amy S. Nowacki, Ann M. Brearley, Robert A. Oster, Emily Slade, Katrina L. Devick, Matthew J. Hayat, Sally W. Thurston

Biostatistics Faculty Publications

Many types of health science learners, including clinical and translational scientists, students, researchers, and clinicians, seek to increase their knowledge of biostatistics. These learners are heterogeneous in their field, career stage and career focus. Based on the collective experience of an expert panel with over 115 years teaching statistics to health science learners, we propose a framework for considering the needs of health science learners motivated by their career goals. This framework defines four types of health science learners seeking statistical training: (a) consumers, (b) “milestone makers”, (c) biomedical researchers with statistical support, and (d) biomedical researchers without statistical support. …

Pecto-Intercostal Fascial Plane Block With Or Without Rectus Sheath Block In Cardiac Surgery, Anne L. Castro, Hemanckur Makker, Laura S. Gonzalez, Audrey Jensen, Sergey S. Tarima, Adam Pagryzinski, Rozalin Thapa, Ali Qureshi, Christopher Fadumiye, Krystal Weierstahl, Paul Pearson, Julie K. Freed

Biostatistics Faculty Publications

Background Median sternotomy and chest tube sites drive pain following cardiac surgery. Prior research has demonstrated that pecto-intercostal fascial plane blocks (PIFBs) reduce median sternotomy pain after cardiac surgery. Prior studies examining the addition of a rectus sheath block (RSB) to localize the insertion site of subxiphoid chest tubes have had mixed results. Methods In this single-center, randomized, double-blind, placebo-controlled trial, 62 patients undergoing cardiac surgery with median sternotomy and subxiphoid chest tubes were randomized to receive PIFB and RSB with local anesthetic versus PIFB with local anesthetic and RSB with saline placebo. The primary outcome was pain at rest …

Utilization And Outcomes Of Single-Troponin Discharge From The Emergency Department In A Low-Risk Population, Zhengqiu Zhou, Kory Heier, Jeffrey F. Spindel, Austin Harris, Emily Slade, Weston Mccowan, Dealla Samadi, Joshua Kim, James D. Moore, Seth T. Stearley, Vedant Gupta

Biostatistics Faculty Publications

Objectives: There is emerging data supporting rapid triage of low-risk chest pain patients to help facilitate Emergency Department (ED) throughput. We assessed an algorithm for accelerated rule-out of acute coronary syndrome in low-risk patients with an undetectable initial high sensitivity cardiac troponin (hs-cTn assays; Roche Diagnostics) in a real-world clinical setting. Methods: All adults presenting with chief complaint of non-traumatic chest pain to our tertiary care ED with HEART score ≤3 with at least one hs-cTn and EKG obtained were included in our study. Data and outcomes were compared three months before and after implementation of our updated Acute Chest …

Comparative Analysis Of Community Solar Energy Programs For Developing Sustainable Solar Initiatives In Lexington-Fayette County, Kentucky, Benjamin Kokkonen, Nelson Stone, Widodo Tri Saputro

MPA/MPP/MPFM Capstone Projects

The transition to renewable energy is a critical policy priority for Lexington-Fayette County, Kentucky, as the city aims to achieve net-zero greenhouse gas emissions by 2050. However, expanding solar energy presents a complex challenge: increasing renewable energy capacity while preserving the county’s prime agricultural land. This capstone examines how community solar programs in Virginia, Maryland, and New Jersey can inform the development of a sustainable and equitable solar initiative in Lexington.

Using a comparative program analysis of three state-level community solar models, the research evaluates policies on site selection, financial incentives, equity measures, regulatory enforcement, and program implementation. Findings indicate …

From Campus To Career: Enhancing Career Support Services For Graduate International Students At The University Of Kentucky, Aku Fiagbeto, Ratwah Alhazmi

MPA/MPP/MPFM Capstone Projects

During the 2023–2024 academic year, the University of Kentucky enrolled a total of 1,285 international students, with 784 (61%) being graduate students. International students play a crucial role in enriching the university’s cultural and academic landscape. While UK has achieved record enrollment and improved student success rates, including a 66% graduation rate that places it among the top 100 public institutions in the U.S., it is important to consider whether these trends apply to international students as well. Retention and graduation rates for this demographic may differ from those of domestic students, highlighting potential challenges such as visa restrictions, financial …

Integrating Deconstruction And Historic Preservation: A Best Practices Policy Comparison, Kelsey M. Baldwin

MPA/MPP/MPFM Capstone Projects

Carl Elefante, the former president of the American Institute of Architects, famously said, “The greenest building is…one that is already built” (Elefante, 2012). Elefante articulated the environmental benefits of reuse and the significant energy costs associated with demolition and new construction. In 2022, the commercial and residential building sectors produced 31% of the United States’ greenhouse gas (GHG) emissions (EPA, 2025). A large percentage of this is tied to the production of building materials.

Analysis Of State And Local Requirements For Special Taxing District Fiduciary Managers And How Kentucky Could Improve, Zach Waller

MPA/MPP/MPFM Capstone Projects

This paper examines the oversight and training requirements for fiduciary managers within Special Purpose Government Entities (SPGEs), comparing practices in Kentucky with those in a select group of peer states. The analysis highlights notable deficiencies in fiduciary training, enforcement, and accountability standards in Kentucky, which lead to ongoing issues of financial mismanagement. A review of exemplary practices from other states highlights the importance of mandatory training, robust oversight frameworks, and effective enforcement measures in enhancing fiduciary outcomes. Recommended actions involve implementing mandatory fiduciary training programs, strengthening enforcement authority, and improving transparency mechanisms.

To evaluate Kentucky’s oversight of SPGEs compared to …

Managing Kentucky's Coal Severance Tax Decline: Lessons From Other States, Ryan Reed

MPA/MPP/MPFM Capstone Projects

Governments levy severance taxes on the extraction of natural resources such as coal, oil, and natural gas. This can be a substantial source of revenue for these entities, but overreliance on this has led to what is now known through extensive research as the so-called ‘resource curse’. This has been observed to create political instability, corruption, and repression within resource-rich areas. Additionally, it cripples the ability of the area to pursue future non-resource related economic development after the resource is depleted. A Sovereign Wealth Fund has been touted as one such solution to bridge this gap as an intergenerational wealth …

Beyond The Gas Tax: Evaluating Oregon’S Road Usage Charge (Orego) As A Model For Sustainable Infrastructure Funding, Gilles David Kwekam

MPA/MPP/MPFM Capstone Projects

Fuel tax revenues are declining nationwide due to electric vehicle adoption, improved fuel efficiency, and long periods without rate adjustments. This erosion has created long-term instability in transportation funding, including in Oregon, where revenue no longer aligns with road use. Road usage charges (RUCs) offer a potential replacement by charging drivers per mile traveled rather than per gallon consumed. However, their success depends less on technology and more on how programs are designed and governed.

This capstone examines which design features make RUC programs effective, using Oregon’s OReGO program as the central case. A Qualitative Comparative Analysis (QCA) comparing Oregon, …

Targeted Federal Advocacy For Financial Stability: Recommendations For United Way Of The Bluegrass, Jefferson Abney, Lou Hurst

MPA/MPP/MPFM Capstone Projects

Advocacy refers to activities undertaken with the intent of influencing policy change. For nonprofit organizations, advocacy can be a critical aspect of furthering their mission. Successful advocacy requires a comprehensive, dynamic understanding of the needs and priorities of stakeholders, as well as an understanding of the political context in which the organization operates and the challenges and opportunities that context poses for its institutional goals. A policy agenda helps nonprofit organizations identify and communicate the most pertinent policy needs for consideration when making decisions around advocacy.

For this project, in response to a request from United Way of The Bluegrass …

Mortgage Lending Discrimination: Racial Differences In A Post-Covid Society, Zachary Owen

MPA/MPP/MPFM Capstone Projects

Researchers have studied the disparities of the mortgage lending process extensively, but their research fails to examine the process following the COVID-19 pandemic. Throughout the aftermath of the pandemic, home sale prices increased, interest rates rose, and rental costs skyrocketed. As such, the housing landscape changed drastically, and research must be conducted to assess new trends and relationships. In this report, I will estimate the relationship between applicant characteristics, such as race, debt-to-income ratio, and income and the outcome of their mortgage loan application and their expected credit score. Prior to COVID-19, Black and White applicants for mortgage loans were …

Public University Gift Management Policies: Building A Best Practice Guide, Cristin Costello

MPA/MPP/MPFM Capstone Projects

Currently, no consistent standards exist for how institutions of higher education should manage their non-endowed gift revenue. Good stewardship of gift funds is vital to ensuring the maintenance of donor relationships to create unions that bring further financial opportunities to universities for years to come. Public institutions, as recipients of government dollars, are especially vulnerable to the negative repercussions that could come with the scandal of misappropriated gift dollars. Overall cash donations to higher education have significantly increased in the past few decades as state appropriations fall short and the need to keep tuition rates stable increases. It is more …

Reforming Need: How Certificate Of Need Laws In North Carolina Can Be Reformed To Promote Rural To Regional Health Network Integration, Taylor Fulk

MPA/MPP/MPFM Capstone Projects

Across North Carolina, many rural hospitals are facing closures, staffing shortages, and financial turmoil. Many hospitals, such as Morehead Hospital in Eden, NC (now UNC Rockingham), have utilized mergers with larger regional networks (e.g., UNC Health, Duke, Novant, Atrium) to stabilize operations and preserve local access to care. (deBruyn, 2017). However, even after successful integration efforts to bring some rural hospitals into larger regional networks, Certificate of Need laws in North Carolina are preventing these smaller, rural integrated hospitals from expanding their service offerings, thereby driving up healthcare expenditures for residents. As a result, patients experience longer-than-normal travel times and …

Boys & Girls Clubs Of Greater Cincinnati Strategic Plan, Emily Yellman

MPA/MPP/MPFM Capstone Projects

After-school organizations nationwide, such as Boys & Girls Clubs, provide youth with out-of-school opportunities for academic and social-emotional learning. Strategic plans can help after-school organizations maximize their impact. This paper outlines a strategic plan for Boys & Girls Clubs of Greater Cincinnati, specifically to increase the number of members they serve on an average daily basis. The plan addresses both Club member recruitment and retention techniques, and includes specific action items, communication, and monitoring plans.

Improvement Of Cellular Pattern Organization And Clarity Through Centrifugal Force, Lauren E. Mehanna, James D. Boyd, Shelley Remus-Williams, Nicole M. Racca, Dawson P. Spraggins, Martha E. Grady, Brad J. Berron

Chemical and Materials Engineering Faculty Publications

Rapid and strategic cell placement is necessary for high throughput tissue fabrication. Current adhesive cell patterning systems rely on fluidic shear flow to remove cells outside of the patterned regions, but limitations in washing complexity and uniformity prevent adhesive patterns from being widely applied. Centrifugation is commonly used to study the adhesive strength of cells to various substrates; however, the approach has not been applied to selective cell adhesion systems to create highly organized cell patterns. This study shows centrifugation as a promising method to wash cellular patterns after selective binding of cells to the surface has taken place. After …

Mind The Gap: Supporting Freshmen Voice Students Transitioning To Higher Education Through Coaching Conversations, Erica L. Gabriel

Theses and Dissertations--Music

The experiences one may encounter while matriculating through the K-12 system of education are vastly different from the world of higher education. While one feeds directly into the other, the transition can be a difficult one for young singers also navigating the developmental leap from adolescence to adulthood. This is due to several systematic and instructional differences, compounded with unique challenges encountered by freshman voice students in the first year. Gaps in support systems compiled with new and increasing financial, social, and academic demands can lead to a decline in overall student well-being and an increase in stress.

This increase …