Digital Commons Network^™

Medicare Reimagined: Past, Present And Future Envisioned For Aging In Place, Nancy Patterson

DSW Capstone Projects

The older population is persons aged 65 and older. Many older adults live healthy and active lives while others have one or more illnesses or comorbidities that make it difficult for them to live alone. Older adults aged sixty-five and older who have one or more comorbidities often require assistance to remain in their homes for as long as possible. Older adults who do not have this needed assistance often have frequent falls, make frequent trips to the emergency room, have frequent hospital admissions, or end up in a nursing home.

Product one of the Capstone Presentation is the systematic …

Disparities In Uptake Of The Primary Sars-Cov-2 Vaccine Series In A Southern Indiana Vaccine Clinic, Cassidy Padgett

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

Objective: COVID-19 is a potentially severe respiratory disease caused by infection from the SARS-CoV-2 virus. COVID-19 was first discovered in 2019 and vaccines against the virus began development in early 2020. COVID-19 vaccines are effective at preventing severe illness, hospitalizations, and death from SARS-CoV-2 infection. Clark Memorial Health is a 236-bed community health system located in southern Indiana. As one of the first four hospitals in the state of Indiana to receive the Pfizer-BioNTech’s COVID-19 vaccine in December of 2020, this health system led the area in vaccine administration. Prior to the emergency use authorization (EUA) of the COVID-19 vaccines, …

Identifying Factors Associated With Syringe Reuse Among People Who Inject Drugs (Pwid) In Appalachia Kentucky, Grayson Keith Fuller

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

Aim: Syringe reuse contributes to the spread of infectious diseases. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs (PWID) in Kentucky.

Methods: PWID (n=238) completed interviewer-administered questionnaires to collect data on syringe reuse and demographic, behavioral, and clinical characteristics. Negative log binomial regression was used to model the associations.

Results: On average, people reused each syringe 9.3 times (median: 3; IQR: 2-10, range 1-95). Syringe reuse was higher among men [aOR=1.386; 95% CI: 1.041-1.845] and those who injected methamphetamine [aOR=2.122; 95% CI: 1.445-3.116]. Reuse was also higher among those who …

An Analysis Of The Association Between Cognitive Decline And Geographic Residence Among Women Over 65 In The Southeastern United States, Christine Invergo

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

Abstract

Introduction: The United States is an increasingly aging nation, and aging increases the risk of cognitive decline. Information on the relationship between cognitive decline and geographic residence in the U.S. is limited. Available evidence suggests that rural residents tend to suffer persistent disadvantages in cognitive functioning when compared to sociodemographically similar urban peers. This analysis focused on women over 65 years of age living in the southeastern U.S. The primary objective of this analysis was to determine if there was a significant association between geographic residence and cognitive decline. A secondary objective was to explore variables of interest that …

An Analysis Of The Association Between Cognitive Decline And Geographic Residence Among Women Over 65 In The Southeastern United States, Christine Invergo

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

Abstract

Introduction: The United States is an increasingly aging nation, and aging increases the risk of cognitive decline. Information on the relationship between cognitive decline and geographic residence in the U.S. is limited. Available evidence suggests that rural residents tend to suffer persistent disadvantages in cognitive functioning when compared to sociodemographically similar urban peers. This analysis focused on women over 65 years of age living in the southeastern U.S. The primary objective of this analysis was to determine if there was a significant association between geographic residence and cognitive decline. A secondary objective was to explore variables of interest that …

Disparities In Access To Chemotherapy Among Kentucky Stage Iv Non-Small Cell Lung Cancer Patients, Joshua Brown

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

OBJECTIVE: This population-based retrospective cohort study examines the association of sociodemographic disparities with the receipt of chemotherapy among patients with metastatic non-small cell lung cancer in the Commonwealth of Kentucky in the precision oncology and immunotherapy era.

METHODS: Kentucky Cancer Registry data from 2010 through 2017 was analyzed using univariate, bivariate, unadjusted, and adjusted multivariate regressions to assess disparities in our population (N = 9490).

RESULTS:We found no significant difference in receipt of chemotherapy between sexes (OR 0.99, P=0.90) nor races (OR 1.12, P=0.22). Patients diagnosed in an Appalachia county were significantly less likely to receive chemotherapy (OR 0.71, …

Demographic Characteristics Of Individuals Needing Treatment For Substance Use Disorder, Amber Hill

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

Introduction:

While multiple options are available for the treatment of substance use disorders (SUD), 9% of individuals reported needing treatment within the last year for illicit drug or alcohol use, according to the 2020 National Survey for Drug Use and Health (NSDUH). Despite concerns about widespread disparities in healthcare access and outcomes, there are limited current data regarding demographic characteristics of individuals that need treatment. It is crucial to identify these characteristics from population-based data in order to develop and implement targeted public health interventions.

Methods:

The NSDUH is an annual, nationwide survey that collects data about substance use and …

Policy Approaches To Address Childhood Obesity, Omoadoni Roseline Obielodan

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

Background: Childhood obesity continues to be a serious international public health concern. Unfortunately, there are limited treatment options for obesity. One notable intervention option is the University of Kentucky (UK) Pediatric high BMI clinic intervention for childhood obesity. The Clinic provides intervention for childhood obesity through healthy lifestyle habits. This intervention has been reported to be effective.

Even though there is evidence that public health policies that promote healthy behaviors would substantially reduce and prevent the alarming prevalence of childhood obesity, the state of Kentucky does not have well-established practical policies that promote healthy behaviors in children. Studies have shown …

Covid-19, Chronic Stress, And Adolescent Mental Health, Corina Barker

DSW Capstone Projects

The COVID-19 pandemic has had an undeniable impact on adolescent mental health. Though not considered to be high risk when it comes to physically contracting the virus itself, adolescents have shown to be significantly impacted by the indirect effects of the pandemic. Because of the unique and formative time, this is in their lives, adolescents are already vulnerable to the impact of social stressors. Risk factors associated with the COVID-19 pandemic such as social isolation, disruption in routine, uncertainty, fear, and chronic stress have all proven to have a profound negative impact on adolescent mental health and overall well-being. It …

The Isolated As The Revolutionary: How “Leftover” Men In China Challenge Heteronormativity, Ruwen Chang

Theses and Dissertations--Gender and Women's Studies

In contemporary China, demographers estimate that 30 million men are single because there are simply not enough women in the Chinese population, and the 2020 Chinese census shows that there are 34.9 million more men than women. These men are called guanggun, which can be directly translated to “bare sticks/branches,” a slur that indicates a lack of marriage and sex. In this project, I demonstrate that guanggun’s singlehood marks them as the marginalized at the intersection of heteronormativity, patriarchy, globalizing capitalism, and pronatalist governmentality. In a highly heteronormative and patrilineal culture, guanggun are branded as abnormal/incomplete. However, because …

An Electrochemical, Fluidic, Chip-Based Biosensor For Biomarker Detection, Lauren Bell

Theses and Dissertations--Biomedical Engineering

Biosensors and their use in both the research and clinical field for the detection and monitoring of critical biomarkers are prevalent and constantly improving. However, continued research needs to be done to address shortcomings, such as low sensitivity, poor specificity, and poor readiness for integration into research use and patient care. The objective of this research was to create a combined fluidic, chip-based biosensor that could detect different biomarkers with high sensitivity and ease of use. For assessing the developed sensor, three separate biomarkers were tested: glucose, cholesterol, and oxygen. Both the glucose biosensor and cholesterol biosensor were combined with …

Characterizing The Internal Porous Structure Of Equine Proximal Sesamoid Bones Subjected To Race Training Using Fast Fourier Transforms, Joseph Erik Davis

Theses and Dissertations--Biomedical Engineering

The equine racing industry is one of the main proponents in Kentucky’s economic infrastructure. In this industry there has come a need to investigate the nature of the proximal sesamoid bone (PSB). Breakdowns involving the PSBs are the leading cause in racehorse deaths in the industry, with still little known about what causes this bone to fracture. This study seeks to shed insight by investigating the internal structure of the PSB. Using microCT scanning, the internal porous structure was captured. From there, noticeable differences in the pores were noticed and quantified using fast Fourier transform (FFT) analysis.

The dominant peak …

Use Of Image Processing Techniques And Machine Learning For Better Understanding Of T Gondii Biology, Amer Asiri

Theses and Dissertations--Biomedical Engineering

Almost one in every three people worldwide is infected with Toxoplasma gondii (T. gondii). The biology and growth of the parasite’s bradyzoite form in host tissue cysts are not well understood. T. gondii’s metabolic state influences the morphology of its single mitochondrion, which can be visualized using fluorescence microscopy with specific dyes. Hence, fluorescence microscopy images of cysts purified from infected mouse brains carry biological information about bradyzoites, the poorly understood form of the parasite within them. With the help of fluorescence microscopy techniques, previous studies extracted images of the mitochondrion, nucleus, and the inner membrane complex (IMC) …

Investigation Of Pfas Exposure Risks In Kentucky Using Mapping Tools, Sweta Ojha

Theses and Dissertations--Civil Engineering

Per- and polyfluoroalkyl substances (PFAS), a group of environmentally-persistent compounds, are environmentally ubiquitous and challenging to remediate. Several studies show that PFAS are detected in drinking water systems when sampling is conducted, making human exposure via drinking water an important health consideration. This research: 1) develops a mapping tool for prioritizing sampling locations; 2) establishes a method for making GIS data and meta(data) in the mapping tool accessible; 3) fosters decision making by integrating knowledge brokering and the alignment interest and influence matrix (AIIM). The tool developed is this research is a geospatial and statistical PFAS hot-spot screening model that …

(Dis)Possessed Black Youth: How America's Architecture Challenges Coming Of Age In Twentieth And Twenty-First Century African American Women's Literature, Margaret Frymire Kelly

Theses and Dissertations--English

This dissertation advances studies of Black childhood, particularly Black girlhood, by examining how African American women writers depict the troubled journey to adulthood in stories of segregation, immigration, and incarceration. I argue that authors of four representative literary works emphasize architectural structures as well as ancestral hauntings among which Black children grow up. Without examining the material structures, we cannot understand the strategies these haunted Black youth deploy to reach adulthood. Examining the architectural structures that the protagonists of Maud Martha (1953), Brown Girl, Brownstones (1959), Zami (1982), and Sing, Unburied, Sing (2017) grow up in and around, I demonstrate …

Investigating The Role Of Chd7 And Sox11 In Retinal Cell Development And The Ocular Complications Of Charge Syndrome, Laura Krueger

Theses and Dissertations--Biology

Proper formation of the visual system requires the precise interaction of several embryonic cell lineages, including the neuroectoderm (forms the retina and retinal pigment epithelium), surface ectoderm (forms the lens), mesoderm and cranial neural crest cells (form the ocular blood vessels and anterior ocular structures). When this process is disrupted structural birth defects such as coloboma result, leading to pediatric visual deficits. Ocular developmental defects are often present in larger syndromic disorders. One example is CHARGE syndrome, a genetic disorder characterized by coloboma, heart defects, choanal atresia, growth retardation, genital abnormalities, and ear abnormalities. Pathogenic variants in CHD7 have been …

Metabolic Diversity Among Fibroblasts From Regenerating And Non-Regenerating Mammals, Ebenezer Aryee

Theses and Dissertations--Biology

Regeneration is a wound repair process that terminates in the restoration of tissue function and structure. Fibroblasts play pivotal roles in regenerative and fibrotic wound repair. Reports of extensive regenerative ability in mammals have been historically rare, but more recently spiny mice (Acomys) have emerged as a bona fide model of complex tissue regeneration. Recent work has indicated that fibroblasts from regenerators (Acomys and Oryctolagus) are more resistant to reactive oxygen species (ROS)-induced senescence compared to non-regenerating species, suggesting the influence of intrinsic cellular states on the fate of wound repair. Determining the basal metabolic signature …

The Ecology And Evolution Of Human Reproductive Behavior, Kaylynne Glover

Theses and Dissertations--Biology

The complexity of human reproductive behavior has necessitated its examination through a variety of scientific disciplines, each focusing on specific elements of our biology, behavior, and society. However, this complexity also necessitates that we reintegrate the information learned from each discipline into a single framework, one rooted in the evolutionary principles that have shaped the development of all life on earth. In this dissertation, I use this framework to explore human reproductive behavior, with a particular focus on sexual coercion and fertility-mediated sexual behavior.

In Chapter 1, I introduce the approach taken in this document, identify several key limitations, and …

Estrogen Regulation Of Daily Metabolic Rhythms In Female Mice, Oluwabukola Omotola

Theses and Dissertations--Biology

Circadian rhythms are approximately 24-hour cycles of behavior, physiology, and gene expression. In mammals, these circadian rhythms are generated by clocks located in nearly every tissue in the body. The function of circadian clocks is to synchronize physiology and behavior with environmental cycles such as the light-dark cycle. After menopause, when circulating levels of estrogens are very low, women are more susceptible to obesity comorbidities such as metabolic syndrome and cardiovascular disease, suggesting that estrogens regulate these processes. Estrogens could protect females from metabolic dysfunction by regulating circadian rhythms. Consumption of diets that are high in fat contribute to obesity. …

Distribution Of Particulate Organic Carbon – Fluxes And Inventories – In Growth-Faulted Coastal Wetlands, Samuel Joel Whitehead

Theses and Dissertations--Earth and Environmental Sciences

Coastal wetlands along the Northern Gulf of Mexico (NGOMx) are critically important but threatened environments which provide significant and diverse economic, social, and environmental value. These environments are essential components to the global carbon cycle, serving as one of the most efficient terrestrial carbon sinks. Since onset of the Industrial Revolution increasing rates of coastal wetland loss have been documented due to a variety of anthropogenic activities, neotectonic processes, subsidence, and rising sea-levels. This research utilized an array of methods and sedimentological analyses to test the hypothesis that growth-fault induced changes at Earth’s surface affects the delivery to, and storage …

Tryptophan-Like Fluorescence And Non-Point Source Pollution In Karst Basins, Inner Bluegrass Region, Kentucky, Ryan Dapkus

Theses and Dissertations--Earth and Environmental Sciences

Typically, the degree of fecal contamination of water is assessed by the concentration of thermotolerant coliforms, like E. coli. This method is time-consuming, taking > 18 hours between the start of incubation and subsequent enumeration. The current study examines the utility of monitoring tryptophan-like fluorescence (TLF) using in-situ fluorometers as a proxy for fecal contamination, particularly E. coli. Relative timing of discharge peaks and TLF peaks is considered, as well as differences in E. coli concentrations and major anion concentrations between two different basins that were monitored weekly. Results indicate that TLF is somewhat useful in the prediction of …

The Role Of Sox4 In Ocular Morphogenesis And Retinal Differentiation, Rebecca Petersen

Theses and Dissertations--Biology

Visual impairment ranges from mild forms that can be corrected with glasses to more severe cases that result in permanent loss of vision. Microphthalmia, anophthalmia, and coloboma (collectively referred to as MAC) account for 11% of cases of pediatric blindness and are a result of improper ocular morphogenesis. Retinitis Pigmentosa (RP) is a retinal degenerative disease that affects 1 in 3000 people worldwide. It is a progressive disorder that initially begins with loss of vision in low light settings due to rod photoreceptor degeneration but progresses to complete blindness upon loss of cone photoreceptors. Currently, there is no cure for …

Undoing Colorblind Ecologies: Redlining And Just Green Enough In The Urban Forest Of Boston's Franklin Park, Chelsea M. Parise

Theses and Dissertations--Geography

Urban political ecology research increasingly engages multi-disciplinary methodologies to clarify the role that the botanic plays in creating, maintaining, or subverting ecological geographies of power. Fredrick Law Olmsted intended the forest within Franklin Park to heal the physical degeneration and social disunity he believed resulted from urban living conditions but instead the forest within Franklin Park has grown in contexts of increasingly complex environmental and racial difference. I examine how the urban forest in Boston’s Franklin Park has ecologically manifested racialized power relations through distinct periods of elite nature-making and segregated grassroots stewardship. I utilized archival research, forest surveys, and …

Elephants In The Room: Covid-19 Pandemic Political Ecologies Of Tourism In Tanzania, Helen C. Richardson

Theses and Dissertations--Geography

The COVID-19 pandemic brought forth unprecedented and ever-changing crisis and disruption to societies and economies around the globe.[1] As the COVID-19 pandemic continues to interrupt travel worldwide, the tourism industry, and the countries who rely on it as a major source of income, are in crisis. These processes have reconfigured economic capital flows and foreign investment in the global south. This is particularly the case in Tanzania, as tourism was Tanzania’s highest foreign exchange earner and accounted for 17% of Tanzania’s gross domestic product in 2019.[2] This project draws upon a political ecology framework to examine the Tanzanian …

Speaking Of Home Here And There: Everyday Experiences Of Belonging Among Highly Educated Immigrants, Katherine Feske-Kirby

Theses and Dissertations--Geography

This thesis explores how highly educated immigrants articulate a sense of belonging upon relocating to the United States, more specifically to the Lexington, KY area. Engaging with feminist political geography as well as migration and cultural studies, I argue that articulations of belonging are framed through transnational attachments, which respectively expand individuals’ ability to employ everyday forms of belonging. Expressions and understandings of transnational belonging are framed through in-depth interviews on participants’ workplace, relational dynamics, and engagement with the geopolitical discourse on migration. Through these interviews, a broader representation belonging is presented, while questions on highly educated immigrants’ privilege and …

Mapping Memory: Locational Memory In The First-Person Narrative Of Three Latinx Writers, Stephanie R. Beasley

Theses and Dissertations--Hispanic Studies

Locational memory, which relies upon our natural inclination to store and recall images, adds spatial orientation to a narrative, and provides an accessible framework for the recreation of the past in first-person narrative. The power of locational imagery as a device of memory is both historically and scientifically supported. It is essential to the system of artificial memory that the ancient Greeks called a memory palace, described by both Mary Carruthers and Paul Ricouer. Scientifically, studies show that the strongest autobiographical memories are based on visual imagery and that recall of specific locations provides a cognitive basis for the recreation …

Colonial Contraception: American Birth Control Advocates And Their Work In Appalachia, Puerto Rico, And India; 1930-1970, Dana Johnson

Theses and Dissertations--History

By the beginning of the twentieth century, the development of better contraceptives and changing cultural attitudes led to an increased interest in contraceptive research. Although major political, legal, social, religious, and cultural obstacles remained, birth control advocates began to perform clinical trials to identify effective contraceptives and to disseminate contraceptive information. These trials began in the United States, but birth control advocates quickly introduced them into other areas. In this dissertation, I examine the research efforts of the American birth control movement through an analysis of the activities and discourse of its key advocates and promoters during the middle decades …

Batch Normalization Preconditioning For Neural Network Training, Susanna Luisa Gertrude Lange

Theses and Dissertations--Mathematics

Batch normalization (BN) is a popular and ubiquitous method in deep learning that has been shown to decrease training time and improve generalization performance of neural networks. Despite its success, BN is not theoretically well understood. It is not suitable for use with very small mini-batch sizes or online learning. In this work, we propose a new method called Batch Normalization Preconditioning (BNP). Instead of applying normalization explicitly through a batch normalization layer as is done in BN, BNP applies normalization by conditioning the parameter gradients directly during training. This is designed to improve the Hessian matrix of the loss …

The Role Of Sexual Difference In Plato's Timaeus, Mary Cunningham

Theses and Dissertations--Philosophy

My dissertation is a reading of Plato’s Timaeus that centers sexual difference and in particular femininity. I analyze the role of sexual difference in the framing of the dialogue as well as its accounts of body in the first and second discourse and its account of health in the third discourse. I argue that sexual difference, and, in particular, sexual reproduction, serves as a guiding paradigm of Timaeus’ entire project. I argue in each part of my dissertation that various aspects of the Timaeus depend on a certain notion of sexual difference—even aspects which are seemingly causally prior to the …

Significant Life Experiences Of Kentucky Youth Climate Activists, Jeri Katherine Howell

Theses and Dissertations--Community & Leadership Development

The purpose of this study is to better understand Kentucky youth climate activism. The research questions explore how youth define their climate activism in Kentucky, their Significant Life Experiences (SLE) that motivated them to commit to climate activism, and what challenges and sustains their involvement. This qualitative study utilizes a blended framework of social/environmental positionality and political ecology to analyze 7 semi-structured interviews with participants between the ages 18 to 24 years old who are acting to address climate change in Kentucky. New contributions to the existing body of SLE literature are discussed.