Digital Commons Network^™

Evaluating The Burnout Mitigating Effects Of A Structured Mentorship Program In Newly Hired Advanced Practice Providers, Melissa Soper

DNP Projects

Importance: Burnout is a leading driver of clinician intent to leave, lower productivity, increased medical errors, and increased resource use.

Objective: The purpose of this project was to evaluate the effects of an evidence-based mentorship program on newly hired advanced practice providers’ (APPs’) level of stress, burnout, and professional fulfillment.

Results: At baseline, APPs demonstrated higher stress levels, moderate professional fulfillment, and low burnout. Outcomes showed improvement at the end of a mentorship program.

Conclusion: Longitudinal studies with larger sample sizes are needed to determine the true effect of a 6-month mentorship intervention on APP burnout, stress, and professional fulfillment.

Establishing An Advanced Practice Provider-Led Transient Ischemic Attack Clinic: A Quality Improvement Initiative, Brittany A. Young

DNP Projects

Background: Due to lack of subspecialized neurological care in many rural community settings, care in tertiary hospitals is in demand. Insufficient care pathways can lead to lack of bed and provider availability. Advanced Practice Provider Transient Ischemic Attack clinics have been shown to be safe alternatives to hospital admission, for patients who meet criteria. This study targeted practice change at a 1000 bed tertiary academic hospital.

Methods: The quasi-experimental study sample inclusion criteria included Transient Ischemic Attack patients presenting to the emergency department with an ABCD2 < 4, complete symptom resolution, and no new cardiac changes on monitoring. A pre and post survey with educational PowerPoint intervention was provided to all emergency department and Neurology providers and nurses. A Transient Ischemic Attack clinic was established with a corresponding order set to be utilized for streamlined outpatient work up.

Results: During the pilot period, 29 admissions were deferred with 69% …

Sepsis In Sight: Immersive Vr Simulation For Pediatric Training, Kelsey Wagler

DNP Projects

Abstract

Objectives: This project aimed to decrease the time required to administer antibiotics and fluid boluses to pediatric patients with sepsis by implementing a virtual reality (VR) simulation program. The initiative sought to enhance bedside nurses’ and pediatric residents’ knowledge, clinical reasoning, and confidence in sepsis assessment, early recognition, and evidence-based management. A secondary objective was to evaluate the effectiveness of VR simulation as an educational strategy for nurses in a high-acuity pediatric setting.

Design: This quality improvement project used a quasi-experimental design that incorporated a VR simulation intervention followed by a structured debriefing and targeted education session. Participants completed …

Stronger Together: Exploring The Impact Of Peer Support Meetings On Stress And Burnout In Ambulatory Nurse Managers, Sara Wellman

DNP Projects

Background

Nurse manager (NM) burnout is common and leads to decreased staff productivity, departmental effectiveness, and leadership capacity. This results in decreased staff morale, poor conflict management, and ineffective communication. Stress reduction and resilience programs have been shown to reduce burnout and enhance resilience in NMs, but more focus needs to be directed toward NMs who work in ambulatory settings.

Purpose

The aim of this project was to evaluate the effectiveness of a peer-to-peer resilience intervention in reducing stress and burnout among ambulatory nurse managers.

Methods

This project used a pre-test/post-test survey design and a convenience sample of ambulatory NMs. …

Rural Oral Health Access Coordination Program Proposal, Anna Luu

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

Oral health disparities remain a major public health issue in the United States, particularly in rural Kentucky, with barriers such as limited access to preventive dental services, transportation, and insurance coverage contributing to delayed treatment and worsening oral health outcomes. In response, the proposed Rural Oral Health Access Coordination Program aims to improve care access by strengthening referral systems, integrating oral health screenings into public health settings, and enhancing care coordination for high-risk populations. The program intends to focus on the Kentucky River District Health Department Region, connecting individuals to existing services rather than providing direct clinical care. Expected outcomes …

Perry County Perinatal Access Navigator Program (Pc-Pamp) A Public Health Program Proposal To Improve Timely Prenatal Care Access In Perry County, Kentucky, Amber E. Mcguire-Chun

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

Delayed initiation of prenatal care remains a significant public health concern in rural Appalachian communities, including Perry County, Kentucky, where structural barriers such as limited provider availability, transportation challenges, and fragmented referral systems contribute to inadequate access to timely care. This capstone project proposes the Perry County Prenatal Access Navigator Program (PC-PANP), a community-based patient navigation model designed to improve initiation of prenatal care in the first trimester. The program is led by the local health department and leverages partnerships with healthcare providers, the University of Kentucky College of Public Health, WIC, Extension services, and community organizations to support early …

Wastewater Surveillance For Sars-Cov-2 In Rural Kentucky, 2021–2023, James W. Keck, Reuben Adatorwovor, Ann Noble, Savannah Tucker, William Strike, Soroosh Torabi, Mohammad Dehghan Banadaki, Blazan Mijatovic, Steven K. Roggenkamp, Donna Mcneil, Lindell Ormsbee, Scott M. Berry

Family and Community Medicine Faculty Publications

Wastewater testing for SARS-CoV-2 provided useful public health information during the COVID-19 pandemic yet was underutilized in rural communities. We addressed this gap by implementing wastewater surveillance and assessing its performance in 10 communities in Eastern Kentucky. We collected wastewater samples 1–2 times weekly at 10 wastewater treatment plants (WWTPs) from May 2021 until April 2023 and measured SARS-CoV-2 RNA concentrations using polymerase chain reaction testing. We calculated time-lagged correlations between wastewater concentrations and county-level reported COVID-19 cases by site. We developed a generalized linear model to estimate COVID-19 incidence from wastewater SARS-CoV-2 concentrations. The 10 participating WWTPs served 2430 …

Perceptions Of The Proposed Food And Drug Administration Graphic Cigarette Warnings Among Adults Who Smoke On A Nondaily Or Daily Basis: A Within-Subjects Experiment, Bethany Shorey Fennell, Renee E. Magnan, Jennifer I. Vidrine, Damon J. Vidrine

Family and Community Medicine Faculty Publications

Introduction: People who smoke nondaily represent nearly one third of U.S. adults who smoke and experience significant smoking-related morbidity and mortality, yet they are rarely considered when evaluating the efficacy of graphic cigarette warnings.

Method: In October 2019, U.S. adults who smoked nondaily ( n =59) and daily ( n =183) evaluated 13 Food and Drug Administration–proposed graphic warnings and 13 equivalent text-only warnings on the extent to which they elicited understanding, perceived new knowledge, worry about smoking, and discouragement to smoke and were believable. Repeated-measures ANOVA and planned comparisons tested for between-subjects (smoking status) and within-subjects (warning type) effects. …

Adsorptive Gas Sensor Response Forecasting To Enable Breath-By-Breath Analysis, Samuel Bellaire, Samir Ahmed Rawashdeh, Kirby P. Mayer, Jamie L. Sturgill

Physical Therapy Faculty Publications

MOS gas sensors have proven to be useful in electronic noses, which utilize these sensors to detect volatile organic compounds in human breath to detect various lung diseases. Unfortunately, the long settling time of MOS gas sensors is ill-suited to measuring human breath, where complete breathing cycles are often shorter than 5 s. Existing studies circumvent this limitation by collecting gas samples and injecting them into a sealed chamber to react with the sensors. However, it would be convenient if breath-by-breath analysis could be conducted without the need to store breath samples. To accomplish this, we present a novel forecasting …

Exploring The Influence Of Quadriceps Peak Torque And Rate Of Torque Development On Running Mechanics After Anterior Cruciate Ligament Reconstruction, Amit M. Gohil, Gregory S. Hawk, Darren L. Johnson, Christopher S. Fry, Brian W. Noehren

Physical Therapy Faculty Publications

Background: After anterior cruciate ligament reconstruction (ACLR), chronic changes in knee joint biomechanics during higher level tasks, such as running, may negatively impact long-term knee joint health. Among the factors that contribute to these chronic changes, the influence of quadriceps strength on knee joint biomechanics during running is not well understood.   Hypothesis: Higher involved limb quadriceps strength (peak torque and rate of torque development [RTD]) and limb symmetry index (LSI) will be positively associated with greater peak knee flexion angle and peak knee extensor moment during running.   Study Design: Cross-sectional study.   Level of Evidence: Level 3.   Methods: Peak knee extensor …

Prevalence And Incidence Of Heart Failure Phenotypes Among Transgender And Gender-Diverse Adults In The United States, Ian K. Everitt, Emily K. Quinn, Meredith S. Duncan, Chris Grasso, Sari L. Reisner, Guneet K. Jasuja, Tonia Poteat, Ayelet Shapira-Daniels, Howard Cabral, Vin Tangpricha, Michael K. Paasche-Orlow, Emelia J. Benjamin, Monica Mukherjee, Carl G. Streed

Biostatistics Faculty Publications

BACKGROUND: Prevalent and incident heart failure (HF) and its comorbidities have not been characterized in transgender and gender-diverse (TGD) populations. This study determines the prevalence and incidence of HF phenotypes by gender identity. METHODS: A retrospective cohort analysis was performed using deidentified administrative claims from the Optum Labs Data Warehouse (2006-2022). TGD adults and a sample of demographically similar cisgender comparators were identified using a validated algorithm, and gender identity was categorized as cisgender man, cisgender woman, transmasculine, transfeminine, or unclassified TGD. Prevalent and incident HF, including systolic, diastolic, and unclassified phenotypes, were assessed using diagnosis codes. Multivariable logistic and …

Unexpected Longevity In Myasthenia Gravis, Bhupendra O. Khatri, Scott Schutten, Sergey Tarima

Biostatistics Faculty Publications

Background: This study compares age at death in patients with myasthenia gravis (MG) and multiple sclerosis (MS) with the general U.S. population and examines age at death patterns during a period preceding modern high-efficacy therapies. Objective: To compare age at death among individuals with MG and MS with the general population and assess differences in age at death between MG and MS. Design: Retrospective population-based study using death certificate data from four U.S. states (Florida, Wisconsin, Texas, and New York) for 2000, 2005, 2010, and 2015. Methods: Individuals with MG or MS listed on death certificates were identified. Age at …

Catwalk Xt Enables Sensitive Detection Of Locomotor Deficits After C2 Hemisection And Integrates Readily Into Ongoing Experimental Workflows In Adult Female Rats, Aaron L. Silverstein, Christopher M. Calulot, Christopher J. Mclouth, John C. Gensel, Warren J. Alilain

Biostatistics Faculty Publications

Over half of all spinal cord injuries (SCIs) in the United States occur at the cervical level and often cause both life-threatening breathing dysfunction and profound locomotor deficits. Although the C2 hemisection (C2Hx) model is vital for study of breathing dysfunction after experimental SCI, post-C2Hx locomotor deficits have only been assessed by metrics such as the Martínez Scale and ladder tests, which require time-intensive scoring by human observers. However, the CatWalk XT Gait Analysis system (Noldus Information Technology) delivers automated, quantitative assessment of interlimb coordination, gait cycle, and paw function, providing robust locomotor data in a time-efficient and practical manner. …

Integration Of Community-Engaged Research Technology And Methods To Guide Tobacco Regulatory Science In Rural Communities, Melissa H. Abadi, Stephen R. Shamblen, Mary Kay Rayens, Kirsten T. Thompson, Amy Wildman, Kathy Rademacher, William Wieczorek, Raphael Nishimura, Shyanika W. Rose, Mikhail N. Koffarnus, Seth Himelhoch, Ellen J. Hahn

Biostatistics Faculty Publications

Objective – This study aims to build a rural Appalachian cohort to examine how US Food and Drug Administration (FDA) Center for Tobacco Products (CTP) regulatory policies influence tobacco and nicotine product use across levels of rurality. Methods – The AppalTRUST (Appalachian Tobacco Regulatory Science Team) Cohort integrates four inter-connected Community-engaged Research + Technology (CEnRT) elements to support recruitment and retention: (1) building trust and cultural relevance; (2) addressing barriers to participation in research; (3) focusing on ethics and confidentiality; and (4) fostering ongoing and consistent collaboration between the scientific and field teams. The study uses a dual sampling design …

Raising The Profile Of Collaborative Biostatisticians In Team Science, Margaret R. Stedman, C. Christina Mehta, Emily Slade, Patricia L. Hibberd, Glenn M. Chertow, Robert H. Podolsky, Sowmya R. Rao

Biostatistics Faculty Publications

Recent emphasis on transdisciplinary teams in science offers an opportunity for biostatisticians to assume roles beyond data management and analysis. Biostatisticians contribute to all phases of research, from hypothesis formulation and rigorous study design to data analysis and interpretation. Yet, their contributions are often underrecognized. We argue for better integration of biostatisticians in research training and team structures. Postgraduate physician-scientist training should include mentorship from biostatisticians and education on collaborative skills. Fully integrating biostatisticians as co-investigators improves rigor, reproducibility, and innovation. Institutional support, including protected time and updated promotion criteria, is essential to support sustained collaboration. Structural changes must address …

Rethinking Team Science Metrics Through Collaborative Guideposts, Kristen J. Mcquerry, Kelsey Karnik, Megan E. Hall, Caitline Phan, Yana Feygin, Emily Slade

Biostatistics Faculty Publications

Introduction – The increasing reliance on interdisciplinary and transdisciplinary teams has reshaped how science is conducted, yet evaluating the success of such teams remains a persistent challenge. Traditional metrics, such as publication counts, impact factors, and citation indices, fail to capture the full scope of team contributions, particularly in contexts where success may be defined by community engagement, mentorship, or long-term collaboration. Methods – In this Perspective, we introduce Collaborative Guideposts, a framework designed to align success metrics with a team’s organizing priorities. We illustrate this approach through two contrasting team models from a biostatistical collaboration center: Team A, a …

The Influence Of Support From Family, Friends, And Community On Perceived Mental Health Status In Diabetes, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, Suraksha Khanal, Brittany Smalls

Biostatistics Faculty Publications

Strong social support is a protective factor in diabetes and mental health management. The purpose of this study was to examine the influence of the type of support on perceived mental health status among people with diabetes. We used data from the 2021 Household Component of the Medical Expenditure Survey (MEPS). Regression models assessed the association between mental well-being (outcome) and expected help from family, friends, and the community (exposure). Support from both friends and family were significantly associated with better mental well-being, adjusting for covariates. Secondary analyses showed that those who reported greater anticipated support from family were more …

Body Mass Index Has No Impact On Complications And Mortality For Patients With Stage Iv Pancreatic Ductal Adenocarcinoma, Ren Bryant, Hannah Darnell, Megan Hall, Kelsey N. Karnik, Kristen J. Mcquerry, Ruben R. Plentz

Biostatistics Faculty Publications

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of United States (USA) cancer death. Overweight and obesity developing into a growing global medical and socio-economic problem, affecting approximately 42% of adults in the USA population. The aim of our analysis was to evaluate the influence of overweight and obesity on complications and clinical outcome in patients with stage IV PDAC.

Methods: We retrospectively reviewed electronic health records of patients diagnosed with stage IV PDAC (n=162) who followed with the University of Kentucky from January 2017–October 2024. Comparisons were based on the body mass index (BMI): low BMI …

A Practitioner’S Guide To Panel Data Quantile Regression, Antonio F. Galvao, Carlos Lamarche

Economics Faculty Publications

Quantile regression for panel data has become a common model of interest for econometricians and statisticians. The theoretical literature has addressed important questions, including identification, estimation, and statistical inference. Although recent advances have enabled practitioners to estimate flexible models under a wide range of assumptions, practical issues have not been fully addressed. In this paper, we offer a guide to empirical practice intended to help applied researchers navigate the challenges of estimation and inference for panel quantile models. We also present a series of practical recommendations and illustrations, emphasizing both “why” and the “how” to help researchers with the implementation …

A Simple Statistical Tool To Correct The Daily Temperature Effect On Dielectric Soil Matric Potential Sensor Readings, Sebastián Bravo Peña, Meindert Commelin, Ole O. Wendroth

Plant and Soil Sciences Faculty Publications

High-resolution time series recorded by soil water dielectric sensors are often affected by other processes. Dielectric soil matric potential sensors, such as the TEROS 21, exhibit temperature sensitivity, resulting in deviations of readings from the true value due to soil temperature fluctuations. However, methods for correcting this effect remain limited. The objective of this study was to create a straightforward, scale-based statistical approach to mitigate the influence of daily temperature oscillations on matric potential dielectric readings. The temperature sensitivity correction function (TSCF) identifies, quantifies, and smooths diurnal fluctuations caused by soil temperature dynamics. We provide a detailed description of the …

Applying Photovoice To Uncover Fundamental Causes Of Health Inequality In Local Health Contexts, Marisa Booty, Madelyne G. Culbertson, Mason Taylor, Dakota Heise, Heather Stone, Katherine Leanne Kommer, Jennifer Gulley, Jeanette Hart, Christina Nentwick, Margaret Mcgladrey

Sociology Faculty Publications

Introduction: Participatory action research methods like Photovoice are uniquely equipped to identify structural determinants of health based on lived experiences of how they influence proximal and distal population health outcomes. This study uses Photovoice data to examine how structural determinants impact community health needs.

Methods: Qualitative thematic analysis used focus group discussion data (25 transcripts) from four Kentucky counties that embedded Photovoice into their local health department community health assessment processes. Coded excerpts were examined for ways in which participants' community health concerns reflected structural issues rather than individual health behaviors.

Results: Participants perceived issues such as houselessness, food insecurity, …

Factors Associated With Handgun Carriage Among U.S. Adolescents, 2021–2022, Marisa Booty, Maggie K. Richardson, Dylan B. Jackson, Delvon T. Mattingly

Sociology Faculty Publications

Objective: The rise in adolescent handgun carriage over the past decade represents a significant public health concern. Using nationally representative data, this study examines risk factors associated with handgun carriage among U.S. adolescents.

Methods: We used data on adolescents aged 12–17 years from the 2021 and 2022 National Survey on Drug Use and Health ( n = 20,869), with past-year handgun carriage defined as a binary variable. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) to determine factors associated with handgun carriage across adolescent age groups (12–13 years, 14–15 years, 16–17 years).

Results: The average prevalence of …

Prevalence And Characteristics For Mental Health Disorder Before And After Childhood Cancer Diagnosis—A Statewide Population-Based Study Among Medicaid Beneficiaries, Feitong Lei, Laurie E. Mclouth, Eric B. Durbin, Thomas T. Tucker, John L. Villano, Bin Huang

Internal Medicine Faculty Publications

Introduction: Pediatric cancer patients suffer mental health deficits. Patients who are vulnerable with respect to socioeconomic or other sociodemographic factors may be at heightened risk for worse mental health outcomes during cancer for many reasons including entering treatment with an existing mental health disorder. The purpose of this study was to describe the prevalence and trajectory of mental health before and after a childhood cancer diagnosis in a socio-demographically at-risk sample.

Methods: Data from the Kentucky Cancer Registry was utilized to identify patients aged 19 or under with a first primary childhood cancer diagnosis during 2001–2017. Linking KCR data with …

Facilitators Of And Barriers To Implementation Of A Tablet-Based Digital Health Program For Colorectal Cancer Screening In Primary Care: Qualitative Pragmatic Implementation Study, Mark Cromo, Aliza Randazzo, David P. Miller, Kristie Foley, Ajay Dharod, Anna C. Snavely, Elena Wright, Holly Brower, Mark Dignan

Internal Medicine Faculty Publications

Background: Colorectal cancer (CRC) incidence and mortality rates continue to be elevated even though effective screening methods are widely available. To increase CRC screening in primary care practices, our team developed a tablet-based digital health program (mPATH) designed to identify patients needing CRC screening, provide education, and empower patients to request a screening test via the program.

Objective: This study aimed to qualitatively assess facilitators of and barriers to implementing and maintaining mPATH in primary care clinics.

Methods: In a pragmatic implementation trial, clinics were randomized to receive only in-person training and technological support via phone or email (low touch) …

Behavioral Interventions For Increasing Group Engagement In K-12 Classrooms: A Systematic Review And Meta-Analysis, Lauren M. Lejeune, Mark Devdas Samudre, Hongyang Zhao, Meredith Jeffords, Jason C. Chow

Early Childhood, Special Education, and Counselor Education Faculty Publications

This systematic review and meta-analysis synthesized the body of research on behavioral interventions for improving group engagement. Fifty studies were included (n = 10 group designs; n = 40 single case designs [SCDs]). Most research on interventions to improve group engagement was conducted in elementary and middle school general education settings. Class-Wide Function-Related Intervention Teams (n = 6), the Good Behavior Game (n = 6), Tootling (n = 8), and multicomponent approaches (n = 9) were the most commonly reported intervention types. Antecedent strategies that were most commonly embedded in behavioral interventions to increase group …

Disability Studies And Disability Evaluation In Healthcare—Themes And Challenges Moving Forward, Debra A. Harley, Si-Yi Chao

Early Childhood, Special Education, and Counselor Education Faculty Publications

No abstract provided.

Discrimination Distress And Current Combustible And Non-Combustible Tobacco Product Use Among Us Youth, 2023, Meman Diaby, Osayande Agbonlahor, Maggie K. Richardson, Joy L. Hart, Shyanika W. Rose, Delvon T. Mattingly

Markey Cancer Center Faculty Publications

Introduction: Discrimination is the unfair treatment of people based on their identity. Youth who experience discrimination may cope with associated distress by using tobacco products, with amplified health consequences depending on the type of product.

Methods: We used data from the 2023 National Youth Tobacco Survey (n = 22 069) and derived an overall continuous measure from the 15-item Adolescent Discrimination Distress Index, as well as three continuous discrimination distress sub-indices: educational, institutional, and peer (range for each: 0–5). We defined current tobacco use as two outcomes: any past 30-day use of combustible (cigarettes, cigars, hookah, roll- your-own, pipe, bidis) …

Poppers, Apps, And Pleasure: From Set To Setting Among Sexually Diverse Men In Mexico, Juan Carlos Mendoza-Pérez, Keith J. Watts

Social Work Faculty Publications

Background: Poppers (alkyl nitrites) are widely used among sexually diverse men to enhance sexual pleasure. However, research has historically been dominated by risk-centered frameworks such as associations with HIV or other STIs, overlooking user motivations related to hedonic reward, intimacy, and agency. This conceptual oversight is particularly evident in the Global South. This study explores the benefits, motivations, and social meanings of poppers consumption among sexually diverse men in Mexico, emphasizing its relationship with dating applications.   Methods: A mixed-methods cross-sectional study used an electronic survey administered in 2023 to sexually diverse cisgender men. The analytic sample included participants who reported …

Childhood Mental Health And Major Depression In Later Life: A Survival Analysis Across 12 Years, Xiaoling Xiang, Xiafei Wang, Xinyin Zhang, Josephine Abrials

Social Work Faculty Publications

Objectives: This study examined the relationship between childhood mental health conditions and incident major depression in middle-aged and older adults.

Methods: This longitudinal panel study used 12 years of data from 27,220 adults aged 51 and older in the U.S. Health and Retirement Study. Childhood mental health conditions were assessed retrospectively with a question about having a depression, drug/alcohol, or other emotional problem before age 16. Cox regression was used to estimate hazard ratios (HRs).

Results: Childhood mental health conditions were reported by 6.04% of the unweighted sample (n = 1643) and were associated with a more than 2-fold …

Cultus: Eco-Phenomenology In The Work Of John Steinbeck, Robinson Jeffers, And Jack London, Carter D. Johnson

Theses and Dissertations--English

In the face of increasingly dire environmental crises, proposed solutions have gravitated toward imperatives for faster, cleaner, and more efficient technologies and resources. While practical solutions are necessary, they are entirely insufficient to deal with an underlying issue driving environmental degradation: unbridled instrumental reason. In this dissertation, I suggest a theoretical posture, cultus, which attempts to balance the necessity of instrumental action with the guiding counterweight of receptivity. Furthermore, I argue that such personal receptivity is uniquely fostered in aesthetic experiences, attuning the individual to the non-identical and renewing a relationship of care.

I examine the life and work of …