Digital Commons Network^™

Therapist Perspective Of Therapeutic Alliance And Treatment Outcome In Systemic Psychotherapy, Benjamin Larkin Mize Patterson

Theses and Dissertations--Family Sciences

One of the most robust findings in psychotherapy outcome research has been the relationship of a strong therapeutic alliance with improvement in treatment. Most research, however, has measured therapeutic alliance from the client’s point of view, disregarding the therapist’s perspective of this phenomenon. In this naturalistic study of adults in systemic individual, couple, or family psychotherapy (N = 627), both client- and therapist-ratings of alliance were assessed for their associations with treatment outcomes. Multilevel modeling was employed to analyze data from the Marriage and Family Therapy Practice Research Network (MFT-PRN). Client-ratings of the therapeutic alliance and general functioning/relationship satisfaction …

Bed Bugs: Health Risks And Control, Simona Principato

Theses and Dissertations--Entomology

Bed bugs are blood-feeding hemipterans strongly associated with humans. Their detection in indoor environments, such as homes, hotels, trains, and public facilities, has increased gradually over the past 20 years. The exact cause of their resurgence is still unclear, but the increase of international travel and insecticide resistance are thought to have contributed to it.

Although bed bugs are not known to transmit diseases, the EPA, CDC, and USDA have classified them as a pest of significant public health concern, mainly due to the dermatitis that they can cause. Beyond the dermatological burden of the bites, other health implications often …

Exportin 1 Is The Central Hub In Antiviral Defensive Mobilization Of Nuclear Factors And The Target Of Counter-Defence By Tombusviruses, Biao Sun Dr.

Theses and Dissertations--Plant Pathology

Positive-strand RNA viruses, such as coronaviruses and flaviviruses, are obligate parasites whose genomic RNAs function as mRNAs. These viruses infect a wide range of hosts-including plants, animals, and humans-resulting in significant economic losses and posing serious threats to public health. Due to the relatively simple structure of the genome of positive-strand RNA viruses, many host factors and physiological processes are co-opted to support virus infection and replication. In our previous studies, we identified numerous host factors and associated physiological processes involved in the replication of tombusviruses, a cytosolic-replicating model that includes tomato bushy stunt virus (TBSV) and carnation Italian ringspot …

Gene Expression In Relation To Bone Fractures In Throughbred Racehorses, Anna M. Rauber-Ramos

Theses and Dissertations--Veterinary Science

Evidence that fractures in Thoroughbred racehorses are outcomes of chronic bone microdamage has led to extensive research into identifying horses at increased risk of fracture. This includes the use of biomarkers and messenger RNA (mRNA) as a measure of bone turnover. Previous research has found expression differences in horses with fractures compared to controls. Utilizing pre-race whole blood samples collected over an 18-month period from Thoroughbred racehorses in Southern California, RNA-sequencing was conducted on horses with bone fractures and race-matched controls to identify differences in gene expression. Focusing on third metacarpal (MC3) and proximal sesamoid bone (PSB) fractures, differentially expressed …

Does Participation In An Innovative Livestock Exhibition Program Foster The Development Of Grit In Youth Across Rural, Micro, And Metropolitan Communities?, Reba V. Prather

Theses and Dissertations--Community & Leadership Development

This research examined whether livestock exhibition could be used to foster grit in youth across rural, micropolitan, and metropolitan communities. More specifically, the researcher sought to evaluate the impact an innovative livestock exhibition program had on youth resilience. Through partnerships with 4-H clubs and agricultural organizations, the initiative encourages community-driven involvement, allowing youth to take ownership of their growth and development. The program utilized agricultural animal husbandry experiences as a mechanism for youth development, exploring the broader impact of livestock engagement on character-building. By assessing the outcomes of these experiences, the research highlights the trials and tribulations associated with fostering …

Impacts Of Utilizing Reverse Osmosis Concentrate On Mashing, Fermentation, And Water Use In Bourbon Whiskey Production, Ryan C. Sarhan

Theses and Dissertations--Biosystems and Agricultural Engineering

This thesis addresses the feasibility of reusing reverse osmosis concentrate (ROC) in the bourbon whiskey fermentation processes. Initial work compared laboratory-scale mashing and fermentation methods, demonstrating that simultaneous saccharification and fermentation reliably reflects industrial-scale processes, with lower complexity and process time. Building upon this, laboratory and distillery-scale experiments demonstrated that reusing ROC in the mashing and fermentation steps does not negatively impact ethanol yields. ROC produced by systems with a water softener was found to significantly increase mash rheology, suggesting a need for potential process adjustments. Softened ROC also altered the production of flavor-influencing volatile congeners. Under worst case conditions, …

Development Of A Cultivation System For Producing Pure Mycelium Materials From Distillers' Spent Grains, Keya Rani Roy

Theses and Dissertations--Biosystems and Agricultural Engineering

Stillage is a byproduct of distilleries which is rich in organic matter, minerals, and acidic components. It is commonly used as animal feed and has high potential for use as an alternative substrate for microorganisms. Filamentous fungi are saprophytes that can utilize stillage solids to grow as threadlike mycelium. The structure and composition of the filamentous mycelium has shown promise to produce pure mycelium materials (PMM), which might have many potential applications, for instance as a leather-like material or alternative protein food ingredient. Basidiomycota fungi (including true mushrooms) species are presently used in industry to produce PMM due to the …

Utilitzing A Nurse Triage Model To Decrease The Administrative Burden Of Emr Messaging, Pamela B. Schneider

DNP Projects

Abstract

Background: The volume of Electronic Medical Records (EMR) messages from patients to providers continues to rise, yet clinic workflows have not been adequately restructured to accommodate. Increased EMR, especially the inbasket, is associated with provider burnout and decreased job satisfaction, contributing to provider turnover.

Purpose: To improve the triage and distribution of the EMR messaging workload

Method: A Nurse Triage Flowchart was implemented in the Gastroenterology Clinic at the University of Kentucky to help RNs/MAs triage patient messages for improved workflow. Surveys were completed by RNs/MAs and providers before and three months post-implementation. Data from EPIC over six …

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

DNP Projects

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

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

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

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

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

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

Impact Of Bourbon Continuous Column Operations On Ethyl Carbamate Levels, Brad J. Berron, Jon Brown, Jason Gambrell, Travis Cantrell, Meghan Mcintosh, Sarah A. Wilson, Jarrad Gollihue, Harmonie M. Bettenhausen

James B. Beam Institute for Kentucky Spirits Faculty Publications

European and Canadian regulators enforce strict limits on the ethyl carbamate content of alcoholic beverages. North American distillers’ malt have high glycosidic nitrile levels which amplify the ethyl carbamate level of whiskey. Guidelines are required to produce low ethyl carbamate whiskey from North American distillers’ malts. This work challenges several strategies for reducing ethyl carbamate levels in bourbon and American whiskey products. New make spirit was produced using a bourbon mash bill on a continuous beer still with doubler. The low wines alcohol content and beer feed tray were systematically varied while the caustic cleaning schedules were monitored to generate …

Alterations In Whole Muscle Quality And Physiological Cross-Sectional Area Measured With Quantitative Mri Following Acl Injury, Meredith K. Owen, Lauren Richardson, Darren L. Johnson, Moriel H. Vandsburger, Thorsten Feiweier, Katherine L. Thompson, Christopher S. Fry, Peter A. Hardy, Brian W. Noehren

Physical Therapy Faculty Publications

Background: Emerging evidence suggests that there are morphological and physiological changes to the vastus lateralis after an anterior cruciate ligament (ACL) tear. However, it is unclear whether these alterations are limited to just the vastus lateralis or are more representative of widespread changes across the thigh musculature and/or if these changes precede reconstruction. The purpose of this study was to determine T1ρ relaxation time, a measure of extracellular matrix organization in muscle, and physiological cross-sectional area (PCSA) for muscles of the quadriceps and hamstrings of the ACL-deficient and contralateral limbs soon after ACL injury.

Methods: T1ρ and diffusion …

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

Physical Therapy Faculty Publications

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

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

Biostatistics Faculty Publications

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

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

Biostatistics Faculty Publications

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

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

Biostatistics Faculty Publications

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

Clinical Criteria For Limbic-Predominant Age-Related Tdp-43 Encephalopathy, David A. Wolk, Peter T. Nelson, Liana Apostolova, Konstantinos Arfanakis, Patricia A. Boyle, Cynthia M. Carlsson, Nick Corriveau-Lecavalier, Penny Dacks, Bradford C. Dickerson, Kimiko Domoto-Reilly, Brittany N. Dugger, Rebecca Edelmayer, David W. Fardo, Michel J. Grothe, Timothy J. Hohman, David J. Irwin, Gregory A. Jicha, David T. Jones, Claudia H. Kawas, Edward B. Lee, Karen Lincoln, Gladys E. Maestre, Elizabeth C. Mormino, Chiadi U. Onyike, Ronald C. Petersen, Gil D. Rabinovici, Rosa Rademakers, Rema Raman

Biostatistics Faculty Publications

Limbic predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is highly prevalent in late life and a common co-pathology with Alzheimer's disease neuropathologic change (ADNC). LATE-NC is a slowly progressive, amnestic clinical syndrome. Alternatively, when present with ADNC, LATE-NC is associated with a more rapid course. With the emergence of anti-amyloid therapeutics, discrimination of LATE-NC from ADNC is critical and will lead to greater clinical recognition of amnestic patients without ADNC. Furthermore, co-pathology with LATE-NC may influence outcomes of these therapeutics. Thus there is a need to identify patients during life with likely LATE-NC. We propose criteria for clinical diagnosis of …

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

Biostatistics Faculty Publications

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

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

Biostatistics Faculty Publications

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

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

Biostatistics Faculty Publications

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

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

Biostatistics Faculty Publications

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

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

Biostatistics Faculty Publications

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

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

MPA/MPP/MPFM Capstone Projects

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

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

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

MPA/MPP/MPFM Capstone Projects

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

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

MPA/MPP/MPFM Capstone Projects

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

To evaluate Kentucky’s oversight of SPGEs compared to …

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

MPA/MPP/MPFM Capstone Projects

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

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

MPA/MPP/MPFM Capstone Projects

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

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

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

MPA/MPP/MPFM Capstone Projects

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

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

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

MPA/MPP/MPFM Capstone Projects

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

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

MPA/MPP/MPFM Capstone Projects

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