Digital Commons Network^™

From Centralized To Decentralized Care: Assessing The Role Of Design In Cardiovascular Unit Performance, Lindsey Fay

Interiors Faculty Publications

This report presents a comprehensive pre- and post-occupancy evaluation of the University of Kentucky HealthCare Cardiovascular Unit, conducted through a collaborative effort between the College of Design, College of Communication and Information, UK HealthCare, and GBBN Architects. The study examines the transition from a centralized to a decentralized care delivery model within a newly constructed hospital environment, with the goal of understanding how spatial design influences healthcare delivery, staff performance, and patient experience.

Using a mixed-methods approach, the research integrates quantitative and qualitative data collection techniques, including behavioral mapping, communication tracking, pedometer data, acoustic measurements, and staff and user feedback. …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

Non-Metropolitan Vs. Metropolitan Variations In Alcohol, Illicit Drug, And Prescription Therapeutic Drug Misuse, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Key Findings

Alcohol Use. The prevalence of past year and past 30-day drinking was lower among non-metropolitan (non-metro) than metropolitan (metro) residents. However, non-metro drinkers engaged in more frequent binge drinking than metro drinkers. Drinking 3-5, 6-19, and 20-30 days over the past 30 days were higher among non-metro than metro residents.

Illicit Drug Use. Hallucinogens were the mostly commonly used illicit drugs among non-metro as well as metro residents. Methamphetamine use was significantly higher among non-metro than metro residents.

Prescription Pain Reliever Use. The misuse of prescription pain killers, primarily prescription opioids, was higher among non-metro than …

High-Deductible Health Plans In Rural And Urban Populations: Outpatient Utilization And Out-Of-Pocket Costs, Aaron P. Smith, Jefferey Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings This policy brief explores rural-urban differences in High-Deductible Health Plan (HDHP) enrollment, subsequent healthcare utilization, and out-of-pocket (OOP) costs. ▪ HDHP enrollment was uncommon. Rural residents were slightly less likely to enroll than urban residents across all demographic groups. ▪ Switching plans influenced utilization. Compared to those who did not change healthcare plans, switching from a Traditional plan to a HDHP was associated with a larger reduction in 2022 outpatient visits for both rural and urban residents. Moving from a HDHP to a Traditional plan was associated with a smaller reduction in 2022 outpatient visits for …

Development Of Reduced Conflict U-Turn (Rcut) Guidance In Kentucky, Travis Thompson, Duane Thomas, Jill Asher, Jeff Jasper

Kentucky Transportation Center Research Report

A reduced conflict U-turn (RCUT) intersection eliminates left-turn and through movements from the minor road. Instead, drivers must turn right onto the main road and complete a U-turn at a downstream median opening. Recognized by the Federal Highway Administration (FHWA) as a proven safety countermeasure, RCUT intersections have reduced fatal and injury crashes 22 – 63%. Despite more than 35 RCUT intersections in operation across Kentucky, the Kentucky Transportation Cabinet (KYTC) lacked specific guidance for their planning, design, construction, and operation.

This project, conducted by the Kentucky Transportation Center (KTC) in cooperation with KYTC, addressed this gap through a comprehensive …

Locus Coeruleus Tdp-43 Pathology In A Community-Based Cohort, Allison M. Neltner, Ryan K. Shahidehpour, Megan E. Hall, Xiaotong Ning, Shuling Fister, Hannah Kang, Sonya Anderson, Gregory A. Jicha, Tiffany L. Lee, Erin L. Abner, David W. Fardo, Peter T. Nelson

Epidemiology and Environmental Health Faculty Publications

The locus coeruleus (LC) is the source of norepinephrinergic innervation in the human brain. Locus coeruleus pathology has been linked to clinical conditions such as cognitive impairment and behavioral and psychiatric symptoms of dementia (BPSD). However, phosphorylated TDP-43 (pTDP-43) pathology in the LC has been understudied, particularly in the contexts of aging and limbic predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). Here, a convenience sample (n = 134) of autopsied participants from the University of Kentucky Alzheimer’s Disease Research Center community-based cohort was analyzed for LC pTDP-43 and phosphorylated tau (pTau) pathologies. Locus coeruleus pTDP-43 pathology was found in 28/134 …

Chameleon Carriers In Trucking: Detection, Enforcement, And Financial And Safety Impacts, Brian Howell, Drew Law, Andrew Martin

Kentucky Transportation Center Research Report

Chameleon carriers are motor carriers that evade regulatory enforcement by dissolving and reregistering under new corporate identities. This study, commissioned by the Kentucky Transportation Cabinet (KYTC), examined how states characterize, detect, and respond to chameleon carrier activity and assessed its financial and safety impacts in Kentucky from 2020 through 2025. The research team conducted a literature review of existing agency practices and relevant stakeholder perspectives, reviewed administrative codes and statutes across 13 pilot states, and administered two structured surveys to state motor carrier credentialing officials examining carrier characterization and enforcement practices. An analysis of KYTC's carrier data flagged by CVIEW …

Sex-Specific Adaptive Immune Responses In Spinal Cord Injury, Reena Kumari, John C. Gensel

Markey Cancer Center Faculty Publications

No abstract provided.

Rural And Urban Availability Of Substance Use Treatment Facilities, Aaron P. Smith, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Rural counties have higher per capita numbers of substance use disorder treatment facilities than urban counties on average, but also greater variability and large pockets of unmet need.

• The highest proportions of residents living in counties without any treatment facilities are concentrated in rural areas within the Midwestern and Southern United States.

• Rural and urban treatment facilities offer medications for opioid use disorder (MOUD) at similar rates, with inpatient facilities most likely to provide MOUD, followed by residential and outpatient settings.

Impaired Microvascular Reactivity To Passive Limb Movement After Stroke Is Improved By A Single Session Of Ischemic Conditioning, Alicen A. Whitaker-Hilbig, Jennifer N. Nguyen, Amanda Wietrzny, Akash Desai, Samuel Wietrzny, Macey Dunn, Yelyzaveta Merenzon, Sergey Tarima, Emilie Klevenow, Allison S. Hyngstrom, Matthew J. Durand

Biostatistics Faculty Publications

BACKGROUND: Microvascular dysfunction post stroke remains insufficiently investigated and may contribute to impairments in physical function. Single passive limb movement (sPLM) provides a clinically relevant assessment of microvascular vasodilation. We hypothesized the response to sPLM would be attenuated in the paretic leg compared with age- and sex-matched controls (CON) and would improve following a single session of ischemic conditioning (IC), an intervention known to enhance vasodilation. METHODS: In this randomized crossover trial, superficial femoral artery leg blood flow was measured during sPLM, using a Biodex dynamometer, which passively moved the leg 90° at 1Hz. A thigh cuff was placed around …

Performance Evaluation Of The Xpert® Hcv Test On Fingerstick Blood In A Prospective Observational Clinical Study At Clia-Waived Sites In The United States, Jennifer R. Havens, Shelly Ann Fluker, Jonathan Schimmel, L. Madeline Mccrary, Lesley S. Miller, Tomoko Udo, Yukari C. Manabe, Anne Luetkemeyer, Greer Burkholder, Andrew M. Moon, Cody A. Chastain, Jennifer C. Price, John Cafardi, Juan F. Gallegos-Orozco, Brittany A. Young, Jesse Young, Carlos Aparicio, Yu Song, Eric Lai, Gail E. Louw

Epidemiology and Environmental Health Faculty Publications

Background: A major barrier to hepatitis C virus (HCV) elimination in the United States is the lack of a point-of-care test to confirm the presence of HCV RNA. The purpose of this clinical trial was to evaluate the performance of the Xpert® HCV test at CLIA-waived sites in the United States. Methods: Participants at risk and/or with signs/symptoms of HCV infection provided fingerstick blood that was tested on the Xpert® HCV test and venous blood tested using the cobas® HCV and Elecsys® Anti-HCV II tests. Fingerstick blood was collected at CLIA-waived sites by individuals self-trained on collection procedures. Results: Participants …

Elemental Analysis Of Upper Devonian To Lower Mississippian Organic-Rich Mudstone Cores From Kentucky By Portable X-Ray Fluorescence (Pxrf), Alex M. Washburn

KGS Research Data Set

This dataset contains high-density portable X-ray fluorescence (pXRF) elemental analyses of 1,867 m (6,125 ft) of Upper Devonian to Lower Mississippian organic-rich mudstone cores from Kentucky. Analyses were collected from cores across the Illinois Basin, Cincinnati Arch, and Appalachian Basin to support regional evaluation of elemental variability, chemostratigraphy, and redox-sensitive trace-metal enrichment in Devonian–Mississippian mudstone successions. All measurements were conducted using a Bruker Tracer 5 pXRF analyzer with the factory “Mudrock Air” calibration, using analytical settings optimized for both low-atomic-number elements and transition metals/redox-sensitive trace elements. Reference materials SARM-41 and SGR-1 were analyzed throughout the analytical sequence to monitor instrument …

The Heart Score Has Less Utility With High Sensitivity Troponin, Austin Harris, Kory Heier, Jeffrey F. Spindel, Weston Mccowan, Emily Slade, Mansi Parekh, Dealla Samadi, Vedant Gupta

Biostatistics Faculty Publications

Background – Clinical risk scores for acute chest pain evaluation were largely validated using older troponin assays. We sought to analyze the HEART score and clinical decision pathways utilizing high sensitivity troponin. Methods – This was a retrospective study of all adult patients presenting with nontraumatic chest pain to a single center, quaternary-care emergency department over a 6-month time period. Patients were risk-stratified by the HEART score using an institution-specific clinical decision pathway that aligns with current guidelines. Predictive models and optimal cutoff values were constructed via logistic regression for the primary outcome of acute coronary syndrome at presentation or …

Pathologic Misclassification Of Renal Cell Carcinoma In Adolescents And Young Adults, Megan Stout, Derek B. Allison, Leslie Peard, Will Cranford, Yana B. Feygin, Kara Mcabee, Christopher J. Mclouth, Patrick J. Hensley, Jason R. Bylund, Amanda F. Buchanan

Biostatistics Faculty Publications

Background and Objective: Diagnosis of TFE3-rearranged RCC (tRCC) requires a pathologist’s expertise and a high index of suspicion. The objectives of this study were to determine the rate of misclassification of RCC in the adolescent and young adult (AYA) patient population, identify any clinically significant impact associated with misclassification, and compare oncologic outcomes between patients with tRCC vs. other RCC subtypes. Methods: All patients < 50 years who underwent renal surgery and were diagnosed with renal cell carcinoma at a single institution from 2004 to 2019 were identified retrospectively. Pathology specimens were reviewed by a genitourinary pathologist. Changes in a pathologic diagnosis were denoted as “misclassified.” Clinical and oncologic data were analyzed comparing misclassified and non-misclassified groups as well as tRCC and other RCC diagnoses. A survival analysis was used to compare oncologic outcomes. Results: In total, 169 patients were identified, and 20/169 (11.8%) patients were misclassified after pathologic review, with 50% (n = 84) of this cohort < 40 years of age at diagnosis. There were significant differences between misclassified and non-misclassified groups with respect to race (p = 0.002), Appalachian county status (p = 0.035), and initial RCC subtype (p = 0.004). There were no significant differences in clinical or oncologic outcomes between tRCC and other RCC groups. There were no significant differences in time to death or recurrence in misclassified vs. non-misclassified patients (p = 0.83 and 0.68, respectively) or between patients with tRCC and other RCC subtypes (p = 0.45 and 0.062, respectively). Conclusions: >10% of patients with RCC were misclassified on the original pathologic diagnosis; however, there was no significant impact on oncologic outcomes. This identifies diagnostic blind spots for tRCC diagnosis in a young cohort. Perhaps reflex IHC …

Inflammation Associated With Obesity, Aging, And Amyloid Burden In Adults With Down Syndrome, Victoria L. Fleming-Batayneh, Brian C. Helsel, Lauren T. Ptomey, Benjamin L. Handen, Mark Mapstone, Melissa Petersen, Sharon J. Krinsky-Mchale, Christy L. Hom, Davneet Minhas, Weiquan Luo, Charles Laymon, Joseph H. Lee, Annie Cohen, Beau M. Ances, Adam M. Brickman, Margaret Pulsifer, H. Diana Rosas, Florencia Lai, Shahid H. Zaman, Elizabeth Head, Dana Tudorascu, Julie Price, Fredrick Schmitt, Bradley T. Christian, Ozioma Okonkwo, Sigan L. Hartley, Beau M. Ances, Howard F. Andrews, Karen Bell, Rasmus M. Birn, Adam M. Brickman

Neurology Faculty Publications

Objective: Adults with Down syndrome (DS) often show elevated systemic inflammation, but the association with obesity, aging, and Alzheimer's disease (AD) pathology is not well understood. Methods: Data were drawn from 188 nondemented adults with DS participating in the Alzheimer Biomarkers Consortium-DS (ABC-DS). Participants completed clinical assessments, blood draws, and neuroimaging. Plasma biomarkers included indicators of general, pro-, and anti-inflammation. Mixed linear models tested associations between BMI, age, PET-measured amyloid burden, and inflammatory biomarkers, adjusting for sex, trisomy type, and collection site. False discovery rate correction was applied. Results: The majority of the participants met criteria for obesity. Higher BMI …

Comparison Of The 1c2 Reference Filtered Cigar To The 1r6f Reference Filtered Cigarette, Amrita Machwe, Samuel B. Clark, Halle Harned, Tanvi Sawardekar, Stacey A. Slone, Huihua Ji, David K. Orren

Markey Cancer Center Faculty Publications

Introduction: Filtered cigars are a class of tobacco products that can be consumed similarly as conventional cigarettes. Here we have compared tobacco smoke condensates prepared from the 1C2 reference filtered cigar with those from the 1R6F reference cigarette with respect to effects on cell proliferation and viability and AhR-mediated gene expression. Methods: Tobacco smoke condensates were prepared using ISO, Health Canada Intense (HCI) or Cigar Smoking (CSR) regimens and certain HPHCs were measured. Cell proliferation and viability assays were performed on immortalized human bronchial or oral epithelial cell lines. AHR-mediated gene expression was measured using a mouse hepatoma cell line …

[5,5]-Fused Anhydride, Thioanhydride, And Imide Derivatives Of Cyclopentadienyl Complexes, Uttam R. Pokharel, Sean Parkin, John P. Selegue

Chemistry Faculty Publications

A new approach to 5,5-fused heterocyclic derivatives of cyclopentadienylmanganese tricarbonyl and pentamethylruthenocene is presented. 1,2-Dicarbophenoxycyclopentadienyl complexes of manganese and ruthenium were hydrolyzed to 1,2-dicarboxylic acids. Oxalyl chloride converted the acids to chlorocarbonyls, which reacted with bis(trimethylsilyl)sulfide to give the cyclopentadienyl-fused thioanhydrides. Alternatively, dehydration of the diacids with trifluoroacetic anhydride closed the diacids to cyclopentadienyl-fused anhydrides. Treatment of the anhydrides with p-toluidine followed by oxalyl chloride led to cyclopentadienyl-fused carboxylic imides. This approach enables direct comparison of electron-deficient Mn(CO)₃ and electron-rich Ru(Cp*) coordination environments on the 5,5-fused heterocycles. Spectroscopic data reveal systematic downfield NMR shifts and higher infrared carbonyl stretching …

Permanent Winter Hay-Feeding Stations Concentrate Soil Nutrients In Kentucky Pastures, Alan J. Franzluebbers, Jeffrey W. Lehmkuhler, Matt H. Poore, Arjun Kafle, Rodolfo Zentella, Tommy Yankey, S. Ray Smith, Gregory Halich

Animal and Food Sciences Faculty Publications

Distribution of soil nutrients as a function of centralized winter hay-feeding stations can lead to inefficient nutrient utilization and environmental quality concerns, but distributions have not been adequately characterized across a diversity of soils. We investigated spatial distribution of soil nutrients and organic matter fractions on three farms with concrete feeding pads for winter hay feeding. Soils were silt loam at the Princeton and Oran Little Research Stations and silty clay loam and silty clay at the Eden Shale Farm in ≥20-year-old tall fescue (Lolium arundinaceum) pastures in Kentucky. An anticipated impact zone of 0.7–1.0 ha around the winter hay-feeding …

Three Centuries Of Technological Innovation, Jordan G. Okie, James H. Brown, Astrid Kodric-Brown, Joseph R. Burger, Tatiana P. Flanagan, Trevor S. Fristoe, Sean T. Hammond, Norman Mercado-Silva, Jeffrey C. Nekola, Jennifer Richter

Biology Faculty Publications

What socioecological conditions nurture the ingenuity and collaborative interactions underlying transformative technological innovations? We compiled a dataset on more than 400 major technological inventions from 1690 to 1990 spanning seven categories (agriculture, armaments, information and communication, household, industry, medical, and transportation) and performed inductive macroecological analyses to address how attributes of inventors, teams, and their social and geographic environments contributed to the innovation of new technologies that have changed the way people live. The vast majority of inventions were attributed to single inventors of various ages. The frequency, size, and cultural diversity of teams increased in the 20th Century, as …

Role And Effectiveness Of U.S. Universities In Training Professionals For Work In International Agriculture, D F. Fienup

IGC Proceedings (1977-2023)

Problems of hunger, malnutrition, and world food security became a major world concern in the 1970s. Two U.S. presiden­tial reports have emphasized the seriousness of the situation and the need to expand food production and distribution, par­ticularly in the less-developed countries (LDCs) where hunger is most severe. The LDCs need to strengthen agricultural teaching, research, and extension in order to develop and disseminate the ap­propriate technology farmers need to increase food production. The most limiting factor is often the lack of trained scientists to provide local leadership and expertise. Here U.S. and other developed-country universities are needed to train LDC …

Adoption Of Leucaena For Cattle Grazing In Australia, J H. Wildin

IGC Proceedings (1977-2023)

The tree legume Leucaena leucocephala is a high-quality cattle forage in many tropical countries. For the past 30 years, cat­tlemen have not planted leucaena despite conclusive evidence from small grazing experiments that it improved beef production and was suited to a large area of northern Australia. Seed of four cultivars was available in the 1960s. In 1968 cv. Peru, an ex­ cellent forage type, was planted in a 24-ha block specifically for seed production. But little of this seed was used in Australia. There were sev.eral probable reasons for the nonadoption of leucaena. Adverse publicity on the extreme effects of …

Endoplasmic Reticulum-Resident Α-Glucosidase Ii Drives Non-Small Cell Lung Cancer Progression Via Regulation Of Secretory Glycoproteins, Shike Wang, Na Ding, Angelo Chen, Derrick Cardin, Yuting Xu, Kate Grimley, William K. Russell, Jun Xu, Jonathan M. Kurie, Guan Yu Xiao, Xiaochao Tan

Markey Cancer Center Faculty Publications

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide, yet its molecular drivers are not fully defined. Emerging evidence highlights the importance of tumor-stroma interactions mediated by secreted glycoproteins. However, the mechanisms by which cancer cells regulate the secretion of these protumorigenic proteins remain largely unknown. Endoplasmic reticulum-resident (ER-resident) N-glycan-processing enzymes regulate proper protein folding, a prerequisite for glycoproteins to exit the ER and undergo secretion. By evaluating their prognostic significance in lung tumors and conducting functional screening in lung cancer cells, we identify α-glucosidase II (α-Glc II) as a key regulator of NSCLC progression. α-Glc …

Frontal Release Signs And Future Decline In Research Participants With Intact Cognition, Lauren G. Bojarski, Gregory A. Jicha, Elif Pinar Coskun, Frederick A. Schmitt, Linda Van Eldik, Erin L. Abner

Neurology Faculty Publications

Importance Frontal release signs (FRS) are primitive reflexes that regress with brain maturation and reappear in the setting of brain injury or neurodegeneration. Despite their association with dementia, the prognostic utility of this finding in the setting of early cognitive decline and preclinical disease is poorly understood. Objective To evaluate the association of FRS with future cognitive decline in research participants. Design, Setting, and Participants This cohort study examined the presence of FRS (from 2005-2024) among research cohort participants with intact cognition or mild impairment at study baseline. The study used single-center data collection of longitudinal research cohort data through …

Research And Assessment Of Needs For Sign And Signal Maintenance, Megan White, Eric Green

Kentucky Transportation Center Research Report

Kentucky Transportation Cabinet (KYTC) sign and signal crews have expressed multiple concerns related to compensation, expertise, and having the financial and personnel resources needed to help the agency comply with Manual on Uniform Traffic Control Devices (MUTCD) guidelines while continuing to perform routine job duties. Internal reorganizations and personnel changes have reduced staffing and budgets available to underwrite the activities of sign and signal crews even as workloads have remained steady or increased. To document the challenges facing sign and signal crews and associated engineering staff, Kentucky Transportation Center (KTC) researchers administered a statewide survey. Respondents gave their perspectives on …

Transportability Analyses In Comparative Effectiveness Research, Blythe Adamson, Wei Liu, Stephen Duffield, Anouk Déruaz-Luyet, Dimitri Bennett, Montse Soriano Gabarró, Mehmet Burcu, Daniela Claudia Moga, Sarah Welby, Tianze Jiao, Xuerong Wen, Grammati Sarri

Epidemiology and Environmental Health Faculty Publications

The Problem: Transportability considerations are increasingly important to answer research questions in comparative effectiveness research (CER) to support the transfer of evidence on medicinal products across countries or settings. As drug development costs rise and healthcare systems and professionals face economic and resource pressures, leveraging existing data and evidence generated across borders or settings can improve efficiency and inform decisions in product development and decision-making (regulatory, health technology assessment [HTA] and clinical care). Differences in population characteristics, healthcare systems, and data availability, including coding discrepancies, may present significant challenges to the transportability of CER evidence. Without rigorous methodological approaches, the …

Kytc Crash Modification Factor Recommendation List Online Tool, William Staats, Reginald Souleyrette, Teng Alex Wang, Mohammad Zana Majidi

Kentucky Transportation Center Research Report

Transportation practitioners use crash modification factors/functions (CMFs) to calculate the number of crashes expected once a countermeasure has been implemented. When evaluating design alternatives, CMFs can be used in conjunction with safety performance functions (SPFs) to derive crash predictions. The Federal Highway Administration (FHWA) maintains the CMF Clearinghouse as a repository for CMFs. Contributions are submitted by researchers across the U.S., Canada, and throughout the world. Typically, individual countermeasures are associated with multiple CMFs. Some CMFs only apply to a specific facility or crash types. CMF quality varies, and some only apply to a specific facility and/or crash types, regions, …

The Polysubstance Assessment Tool, Amanda M. Bunting, Charles M. Cleland, S. Michaela Barratt, Brittany Griffin, Jaimee Williams, Carrie B. Oser, Joshua D. Lee, Jennifer Mcneely

Sociology Faculty Publications

Background and aims: There are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined the retest reliability, acceptability and feasibility of a new quantitative assessment to measure polysubstance use. Design: A tool for assessing simultaneous and same-day polysubstance behaviors, the polysubstance assessment tool (PAT) was developed in interviewer-administered and electronic self-administered formats. Participants were allocated 1:1 to receive either version of the PAT and returned one to three days later to repeat the assessment. Setting: New York City, …

Sums Of Kloosterman Sums Over Square-Free And Smooth Integers, Xuancheng Shao, Igor E. Shparlinski, Laurence P. Wijaya

Mathematics Faculty Publications

Recently, there has been a large number of works on bilinear sums with Kloosterman sums and on sums of Kloosterman sums twisted by arithmetic functions. Motivated by these, we consider several related new questions about sums of Kloosterman sums parametrised by square-free and smooth integers. Some of our results are presented in the much more general setting of trace functions.

Missed Clinic Appointments For Human Papillomavirus-Related Oropharyngeal Cancer, John M. Vieth, Anthony A. Mangino, Melina J. Windon, Joseph Valentino

Biostatistics Faculty Publications

Background: Missing appointments delay treatment affecting patient outcomes and healthcare resource utilization. Adherence to scheduled appointments has not been studied in patients with HPV-related oropharyngeal squamous cell carcinoma (HPV-OPSCC). Methods: We collected data from 36,690,000 scheduled medical outpatient encounters at the University of Kentucky Health Care from 2012 to 2021. A total of 36,579 of these encounters were from 334 patients with HPV-OPSCC. We performed regression analysis of no-show appointments by demographics, tumor characteristics, and insurance factors. Results: The no-shows rate for appointments was significantly higher for the HPV-OPSCC cohort (4.6% vs. 2.2% p < 0.001). The HPV-OPSCC cohort missed 36% of their appointments. Black, Hispanic, younger, those who have ever smoked and patients with advanced tumor stage all had statistically significantly higher no-show rates (p < 0.01). Conclusions: Treatment delay impacts cancer treatment efficacy and no-show appointments burden medical systems. Further research into targeted interventions is needed to lower barriers for attending appointments.

From Lineage Discovery To Conservation Prioritisation, Zachary G. Macdonald, Joscha Beninde, Julian R. Dupuis, Thomas W. Gillespie, H. Bradley Shaffer, Gregory F. Grether

Entomology Faculty Publications

Accurate inferences of diversification and evolutionary processes depend on knowing how many independently evolving lineages exist within nominally widespread taxa. Uncertainty in lineage number and composition also limits our ability to meaningfully prioritise conservation efforts. Addressing these knowledge gaps requires frameworks that sequentially identify distinct lineages, assess mechanisms that contribute to their divergence, and quantify spatial and environmental determinants of their genomic diversity. With these goals in mind, we apply whole-genome, ecological, and morphological analyses to the American rubyspot damselfly (Hetaerina americana), a widespread and well-studied North American insect that has been long regarded as a single species of least …