Digital Commons Network^™

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

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

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

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

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

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

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

Improving Prenatal And Postpartum Care Gaps In Breathitt County, Megan Deaton

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

Maternal and infant health remain a major public health issue across the United States, particularly in rural communities. Barriers such as shortages of obstetric providers, transportation challenges, and limited access to prenatal and postpartum care contribute to delayed care, low follow-up rates, and an increased risk of poor outcomes, including preterm birth and low birth weight. In response, the proposed Maternal and Infant Health Program aims to address gaps in care access through a home visiting model that provides in-home support, maternal health education, care coordination, and referrals to healthcare services, with a direct focus on Breathitt County. Expected outcomes …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

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

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Strengthening Rural Mental Health Crisis Response: Integrating Broadband Telehealth Care Across Counties Served By Kentucky River District Health Department, Mary K. Mcnabb

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

Rural communities in Eastern Kentucky face persistent barriers to timely and effective mental health crisis care, including provider shortages, transportation challenges, and limited broadband infrastructure. Counties served by the Kentucky River Health Department Wolfe, Lee, Owsley, Perry, Knott, Leslie, and Letcher experience disproportionately high behavioral health needs while relying on shared regional resources. The Broadband-Enabled Rural Crisis Stabilization Initiative (BERCSI) is a proposed public health program designed to strengthen rural mental health crisis response through integrated, technology-enabled care. Grounded in evidence-based practices, including tele-mental health and crisis stabilization models, BERCSI leverages broadband expansion to facilitate rapid assessment, coordinated care, and …

Using Behavioral Skills Training To Teach And Promote Generalized Self-Instruction For High School Students With Intellectual Disability, Elise J. Slavey

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

This study presents findings from a multiple probe design that evaluated the effects of Behavioral Skills Training (BST) as a method of teaching an increase in self-instruction in completing vocational tasks for individuals with intellectual disability. The research included three U.S. high school students with intellectual disability and the data were analyzed across conditions. Throughout the intervention of BST, generalization sessions were conducted alongside. All participants acquired self-instruction for the skill acquisition targets. However, only one participant was able to generalize self-instruction to novel vocational tasks. Results and suggestions for future research regarding generalization for self-instruction and procedure reliability data …

Evaluating Dosage Within A Rapid Caregiver Coaching Model, Emma L. Lovell

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

Rapid caregiver coaching models are designed to increase caregiver implementation of naturalistic language strategies while prioritizing feasibility for both families and providers. Participants of the current study were caregivers with young children (ages 1-4) with expressive language delays and autism risk or diagnosis. The current study took place in families’ homes and examined whether a predetermined number of brief coaching and feedback cycles was sufficient to produce clinically meaningful improvements in caregiver strategy use. Target behaviors for caregivers included play-based imitation and expansion, responsive language input, and structured teaching episodes designed to expand child communication. Results were variable but demonstrated …

Effects Of Tech-Based Self-Monitoring And An Interdependent Group Contingency On Group Engagement, Ariana K. Hefter

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

This study evaluated the effects of a class-wide self-monitoring (SM) intervention delivered via the I-Connect app and paired with an interdependent group contingency, on whole-group engagement in a general fourth grade classroom. Participants included 23 students during a 30-min instructional period. The researcher measured group engagement using momentary time sampling (MTS) with planned activity check (PLACHECK) with a fixed rotation schedule in 30-s intervals and recorded the percentage of students on-task per session. A withdrawal (ABAB) design was used to examine the effects across the baseline and intervention phases. Results indicated a slight increase in group engagement during the intervention …

Zero Tolerance Or Strong Cultural Diversity: The Hard Case Of Female Genital Surgery, James M. Donovan, Christiane Canant

Law Faculty Scholarly Articles

This article applies a thesis favoring strong cultural diversity to defend a subject-centered policy regarding female genital surgeries (FGS). That idea posits that cultural variation holds an intrinsic value that should be presumptively respected when setting policy and creating law. Correlatively, cultural homogenization, especially by force, should be resisted. 

Taking as a starting point the recent celebration of the United Nation’s Day of Zero-Tolerance for Female Genital Mutilation, the paper reviews the context of FGS practices in various societies and critiques the inconsistencies of U.N. arguments to advance its goal of total elimination by 2030. Especially problematic for the U.N. …

Characteristics Of Pulmonary Vs. Extrapulmonary Tuberculosis Cases In Kentucky From 2020 To 2024, Mariam M. Alkhairat

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

Objective: Tuberculosis (TB) remains an important public health concern in the United States, especially among people experiencing social and clinical vulnerabilities. Extrapulmonary TB, which occurs outside of the lungs, can be harder to detect and diagnose than pulmonary TB. This study aimed to describe the demographic and clinical characteristics of people with active TB in Kentucky and to identify factors associated with extrapulmonary TB.

Methods: Secondary surveillance data were obtained from the Kentucky Department for Public Health (KDPH) using the National Tuberculosis Surveillance System (NTSS). The study sample included 301 confirmed active TB cases reported in Kentucky. Descriptive statistics were …

In Vivo Telemetry To Record Long-Term Cardiovascular Parameters, Temperature, And Activity In Spinal Cord Injury Rat Models, Sajeev Kaur, Anna M. Baur, Jillian A. Condrey, Dorottya P. Gal, Samir P. Patel, John C. Gensel

Spinal Cord and Brain Injury Research Center Faculty Publications

Higher-level spinal cord injury (SCI) above thoracic level 6 (T6) disrupts autonomic function and contributes to secondary complications, including fluctuations in blood pressure, heart rate, and temperature. In rats, the placement of telemetric implants in the descending aorta offers a robust methodology for assessing various cardiovascular parameters, such as systolic and diastolic pressure, mean arterial pressure, and heart rate. Core body temperature and animal activity can also be recorded following telemetric implant placement. A rat with a telemetric implant is kept on the receiver plate connected to a computer system for recording various parameters. Continuous long-term recordings at defined time …

Granulomatous Cellular Signatures In Nontuberculous And Tuberculous Mycobacterial Infections, Brianna M. Doratt, Ethan G. Napier, Mahdi Eskandarian Boroujeni, Sarah Douglas, Michael H. Davies, Luiz Bermudez, Eliot Spindel, Erin F. Mccaffrey, Ilhem Messaoudi

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Mycobacterium tuberculosis (Mtb) and nontuberculous mycobacteria (NTM) are acid-fast bacilli that trigger granuloma formation, a hallmark immune response aimed at containing infection. While the biology of Mtb granulomas has been widely investigated, far less is known about granulomas caused by NTM infection, despite the increasing prevalence and clinical challenge of NTM cases worldwide. Because granulomas influence infection control, pathology, and treatment response, understanding their cellular organization and signaling is critical to improving therapeutic strategies. Therefore, we characterized granulomas formed following infection of rhesus macaques with Mycobacterium avium subsp. hominissuis (MAH) and compared them to granulomas from cynomolgus macaques infected with …

Glycoprotein-Specific Transcriptional Response Contributes To Differential Vaccine Protection Against Lethal Ebola Virus Infection, Sheridan B. Wagner, Delphine C. Malherbe, Ethan G. Napier, Andrea Marzi, Ilhem Messaoudi

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Since the West African Ebola virus (EBOV) epidemic in 2014-2016, recurrent outbreaks of the EBOV-Makona variant have been driven by recrudescence and human-to-human transmission emphasizing the need for effective vaccination strategies. A live-attenuated recombinant vesicular stomatitis virus (VSV)-based vaccine expressing the EBOV-Kikwit variant glycoprotein (VSV-Kik) received FDA approval in December 2019 and provides complete, rapid protection against EBOV-Makona as early as 7 days post-vaccination (DPV). During the 2018-2020 Ebola outbreak, the VSV-Kik vaccine, known as ERVEBO, was administered to lower-risk individuals at a 5-fold dose reduction of the standard 2 × 10 ⁷ PFU to provide broader population protection. Identification …

Preventing Teen Pregnancy Through Expanded Contraceptive Access In Mccreary County, Kentucky, Dacey B. Chitwood

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

This capstone project proposes a school-based Condom Availability Program to reduce teen pregnancy risk by expanding discreet contraceptive access for adolescents in McCreary County, Kentucky. Teen pregnancy remains a persistent public health concern in rural communities where stigma, privacy concerns, transportation barriers, and limited healthcare access can prevent adolescents from obtaining reproductive health resources. McCreary County faces elevated teen birth rates, socioeconomic disadvantage, and limited maternal healthcare infrastructure, making teen pregnancy prevention an important local priority. The proposed program would place free latex and non-latex condoms in student restrooms at McCreary Central High School, with QR-code-linked information connecting students to …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

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

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

Community Place Attachment As A Significant Correlate Of Motivation To Change Substance Use Behavior Among Adults Who Inject Drugs In Rural U.S., Janet K. Otachi, Shawndaya S. Thrasher, Keith J. Watts, Juma S. Mwenda, Hilary L. Surratt

Social Work Faculty Publications

Introduction: While motivation is critical for substance use disorder (SUD) recovery, many individuals fail to engage in treatment. The need to belong is a fundamental human motivation, yet the role of community place attachment (CPA) as a social asset in fostering motivation to change substance use behaviors (MCSUB) among people who inject drugs (PWID) is understudied. This paper examines the effect of CPA on PWIDs’ MCSUB.

Methodology: Cross-sectional data were collected from 350 PWID recruited from syringe service programs in rural Appalachian Kentucky (2018–2021). We used hierarchical multivariable linear regression to assess the association between CPA and MCSUB, controlling for …

Hepatitis C Virus Transmission Among People Who Inject Drugs In Rural United States: Mathematical Modeling Study Using Stochastic Agent-Based Network Simulation, Lin Zhu, Jennifer R. Havens, Abby E. Rudolph, April M. Young, Golnaz Eftekhari Yazdi, William W. Thompson, Liesl M. Hagan, Liisa M. Randall, Jianing Wang, Rebecca Earnest, Shayla Nolen, Benjamin P. Linas, Joshua A. Salomon

Center on Drug and Alcohol Research Faculty Publications

People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the United States. The injection-equipment-sharing network likely plays an important role in shaping the dynamics of HCV transmission. Recognizing the emerging HCV epidemic in rural communities, we developed an agent-based network simulation model of HCV transmission via injection equipment sharing and used data on rural PWID networks to inform model parameterization and calibration. We then simulated an array of networks that varied key network properties to understand their impact on the magnitude and distribution of HCV incidence. The results show substantial heterogeneity in HCV …

Evaluating Training Effectiveness And Learning Transfer In The Kentucky Transportation Cabinet Safety Academy, Amanda L. Casolare

Theses and Dissertations--Civil Engineering

Effective evaluation of safety training is crucial to ensure that learning translates into safe work practices, particularly in high-risk public sector environments. The Kentucky Transportation Cabinet (KYTC) is developing a Safety Academy to enhance hazard recognition, risk management, and safety leadership within the organization. However, the Safety Academy has not yet been implemented, and formal evaluation methods for training have not been established. This study aimed to examine evidence-based training evaluation techniques and develop recommendations for evaluating the KYTC Safety Academy prior to program implementation.

This study employed an applied pre-implementation research design grounded in a comprehensive review of safety …

Mental Health And Help-Seeking In Engineering Education: Beliefs, Norms, And Intervention Pathways For Undergraduate Students, Matthew D. Whitwer

Theses and Dissertations--Chemical and Materials Engineering

Engineering education is at a critical juncture where supporting student mental health is essential for fostering persistence, equity, and the development of a resilient and innovative workforce. While engineering students experience high levels of distress and low rates of mental health treatment seeking (known as a mental health treatment gap), there is a gap in knowledge around how this compares to that of students in other fields of study. Further, while efforts have been made to improve the mental health treatment gap in engineering, they are limited by a lack of actionable, theory-based targets. Therefore, this dissertation aims to characterize …

A Specification-Driven Framework For Self-Supervised Learning In Specialized Vision Domains, Mahmut S. Gokmen

Theses and Dissertations--Computer Science

Self-supervised learning (SSL) has emerged as a principled approach to visual representation learning that derives supervisory signal directly from unlabeled data, enabling foundation models to be trained at scale without manual annotation. Deployments in medical imaging and biometric recognition have demonstrated the potential of this paradigm, yet the assumptions that make SSL effective on natural image benchmarks fail systematically in specialized domains. Generic SSL pipelines encode a tacit assumption that the most informative correspondence is spatial proximity within a single acquisition. In specialized domains this assumption breaks at the level of the data-generating process: the signal that carries domain-specific information …

The Ache Of Modernism: Death, Affect, And Intersubjectivity In Twentieth-Century American Literature, Alex Gergely

Theses and Dissertations--English

This dissertation suggests that we can locate, describe, and experience death as an aesthetic mood called the ache of modernism. The ache is an atmosphere found in twentieth-century literature that goes beyond simply “positive” or “negative” feeling and encourages audiences to come to an affective and existential relationship with their mortality. As an intersubjective mood deriving from an attunement on death, it illuminates the historical and philosophical moment of many twentieth-century authors while clarifying their texts’ continued resonance today. This project therefore draws on the thought of major philosophers like Emmanuel Levinas, Martin Buber, Gabriel Marcel, Maurice Merleau-Ponty, Heidegger, …

Other Eyes: The Dilemma Of Authorship And Autobiography In Sylvia Plath, John Ashbery, And Cristina García, Kevin J.B. O'Connor

Theses and Dissertations--English

This dissertation analyzes authorship in contemporary American literature, harnessing the writings—prose and poetry—of Sylvia Plath, John Ashbery, and Cristina García to challenge traditional classification and periodization schema. Hewing to the notion of authorship as a dilemma—a simultaneity of forces pressing upon the author, demanding a response—each chapter unravels critical moments of authorial expression that continually inscribe the importance of praxis and futurity. Comprehending authorship as a relational dilemma to be brooked, and indeed, overcome in a panoply of gestures, frees it theoretically from the perils of prior models by drawing attention to authorship’s agential and multi-modal aspects. Melding archival research …

Shakespeare’S Martyrs And The Poetics Of Transformation, Robert Keim

Theses and Dissertations--English

At the beginning of William Shakespeare’s career as a playwright, England’s most widely read book, after the Bible, was Acts and Monuments of These Latter and Perilous Days, commonly known as John Foxe’s Book of Martyrs. Foxe’s martyrological literature, along with the inherently theatrical nature of martyrdom itself, helped the lives and deaths of Reformation martyrs to assume a prominent place in England’s literary consciousness. Shakespeare was not immune to their influential presence, and though overt representations of martyrdom were too controversial for the popular stage, he did enrich his plays by endowing certain characters—through imagery, allusive diction, …

Sylvia Plath, Ted Hughes, And The Question Of The “True” Ariel: Complicating Binaries In Plath’S Literary Legacy, Jacob C. Quinn

Theses and Dissertations--English

This thesis aims to complicate common binaries that have defined critical responses to Sylvia Plath’s Ariel since its first publication in 1965, and which emerged as the result of her husband Ted Hughes’ alterations to her original selection and arrangement of poems. Hughes’ editing emphasizes a narrative which ends in bleak fatality, whereas Plath’s original narrative concludes on a note of bittersweet hope. I read Hughes’ choice of ending as highly influential on Plath’s reception and legacy. The tone of her immediate reception, largely shaped by Al Alvarez, characterized Plath as an “extremist” poet whose work should be read through …

We Need To Care About Care: (Un)Caring Relations In Victorian Fiction, Roslyn Fleming

Theses and Dissertations--English

The professionalization and institutionalization of care in the Victorian era ushered in a growing societal concern about the pitfalls of care being “systematized and depersonalized” and treating people as burdens, problems to be solved. Given the increasing attention paid to people’s welfare and well-being during this period, the cultural shift from intimate community care to professional and institutional care, and the growing stigmatization of disabled bodyminds, the fiction produced amidst these cultural changes makes a compelling site for a study of care. Critical scholarship attending to Victorian novels’ representations of care, however, has largely concentrated on specific categorizations of care …

Benjy's Personhood In The Sound And The Fury, Addison D. Tighe

Theses and Dissertations--English

This thesis will take a look at the way Benjy Compson’s character in William Faulkner’s novel The Sound and the Fury can be used to form an anti-eugenic argument. By taking a close look at the historical context of America’s twentieth century eugenic movement, the ways in which the novel presents an argument of personhood for those with disabilities come forth despite the eugenic pressures of the time. By taking the time to closely read Benjy’s section within the novel, a mix of disability studies and feminist disability studies, and understanding the complexity of character and stream of conscious writing, …

Inside The Box: Containerization And The Limits Of Trade Unionism In The International Longshoremen's Association, 1945-1977, Calvin Horning

Theses and Dissertations--Geography

The International Longshoremen’s Association (ILA), the union of dock workers on the East Coast of the United States, saw a dramatic change in form and fortune in the middle of the 20^th century as the shipping industry and global labor underwent an immense reorganization. In the context of this reorganization, I argue that due to internal conservatism and racism alongside external state pressure, the ILA moved from an unruly, mafia-ruled union to a highly organized, professionalized, well-paid core of workers that served to support the United States’ capitalist-imperialist project.

Through archival material spanning over three decades, I analyze the …