Navigating Access To Pre-Exposure Prophylaxis (Prep), Carlos C. Mahaffey, Rohan D. Jeremiah, Andrew M. O’Neil, Déjà N. Clement, Isabel Cava, Fracisco R. Ruiz, Randolph D. Hubach, Danelle Stevens-Watkins

Educational, School, and Counseling Psychology Faculty Publications

Pre-exposure prophylaxis (PrEP) has contributed significantly to stabilizing HIV incidence rates across most populations. However, significant disparities in HIV incidence and PrEP uptake persist among Black men who have sex with men (BMSM). This study delved into the individual, sociocultural, and structural factors associated with PrEP access and uptake among 28 BMSM residing in designated HIV hotspots. Participants were recruited from communities identified as “high priority” by the US Department of Health and Human Services’ Ending the HIV Epidemic in the US initiative. Participants completed semi-structured interviews focusing on PrEP awareness, access, and barriers to uptake. Guided by the Socioecological …

Mental Health And Treatment Use In Undergraduate Engineering Students, Matthew D. Whitwer, Sarah A. Wilson, Joseph H. Hammer, Brenna Gomer

Educational, School, and Counseling Psychology Faculty Publications

Background: Engineering students experience high levels of distress and low rates of mental health treatment seeking, yet there is a gap in knowledge around how this compares with that of students in other fields of study. Given the influence of social identity (e.g., gender identity, race/ethnicity) on mental health and treatment seeking, it is important to account for sociodemographic variation across fields when performing such comparisons. Purpose: This study used Andersen's Behavioral Model to compare mental health distress and treatment use between students in engineering and other fields while controlling for sociodemographic factors. Methods: Survey data came from the 2021–2022 …

Dissecting The Biophysical Mechanisms Of Oleate Hydratase Association With Membranes, William A. Lathram, Robert J. Neff, Ashley N. Zalla, James D. Brien, Vivekanandan Subramanian, Christopher D. Radka

Markey Cancer Center Faculty Publications

This study investigates the dynamics of oleate hydratase (OhyA), a bacterial flavoenzyme from Staphylococcus aureus, and its interactions with lipid membranes, focusing on the factors influencing membrane binding and oligomerization. OhyA catalyzes the hydration of unsaturated fatty acids, playing a key role in bacterial pathogenesis by neutralizing host antimicrobial fatty acids. OhyA binds the membrane bilayer to access membrane-embedded substrates for catalysis, and structural studies have revealed that OhyA forms oligomers on membrane surfaces, stabilized by both protein-protein and protein-lipid interactions. Using fluorescence correlation spectroscopy (FCS), we examined the effects of membrane curvature and lipid availability on OhyA binding to …

Mir-27a-3p Regulates Intestinal Cell Proliferation And Differentiation Through Wnt/Β-Catenin Signalling, Chang Li, Yuning Zhou, Yinping Jiang, Zhijie Yin, Heidi L. Weiss, Qingding Wang, B. Mark Evers

Markey Cancer Center Faculty Publications

Intestinal stem cells differentiate into absorptive enterocytes, characterised by increased brush border enzymes such as intestinal alkaline phosphatase (IAP), making up the majority (95%) of the terminally differentiated cells in the villus. Loss of integrity of the intestinal epithelium plays a key role in inflammatory diseases and gastrointestinal infection. Here, we show that the intestinal microRNA (miR)-27a-3p is an important regulator of intestinal epithelial cell proliferation and enterocyte differentiation. Repression of endogenous miR-27a-3p leads to increased enterocyte differentiation and decreased intestinal epithelial cell proliferation in mouse and human small intestinal organoids. Mechanistically, miR-27a-3p regulates intestinal cell differentiation and proliferation at …

Measuring The Impact Of A Catchment Area Surveillance Tool On Cancer Center Adopters, Todd Burus, Caree R. Mcafee, Natalie P. Wilhite, Pamela C. Hull

Markey Cancer Center Faculty Publications

Background: The University of Kentucky Markey Cancer Center developed the data gathering and visualization platform Cancer InFocus (CIF) as a solution for cancer center catchment area surveillance. CIF was released in June 2022 and made available for use to other institutions through a no‐cost licensing agreement. The purpose of this study was to evaluate the impact CIF has had on cancer centers since its release.

Methods: The authors adapted an existing management evaluation framework to assess the impact of CIF across three spheres—idea dissemination, product engagement, and adopter satisfaction. This assessment included an online survey administered between the dates of …

Tracking Community Outreach And Engagement Activities Among National Cancer Institute-Designated Cancer Centers, Todd Burus, Caree R. Mcafee, Pamela C. Hull, Amy E. Leader, Christopher Mcnair

Markey Cancer Center Faculty Publications

The National Cancer Institute’s (NCI) Cancer Center Support Grant mandates that NCI-designated cancer centers establish a Community Outreach and Engagement (COE) component to help direct efforts at reducing cancer burden within their catchment areas. Despite the critical role of COE offices, little is known about how they track and evaluate outreach activities and outcomes. We gathered information on current practices from representatives of 40 out of 65 COE offices using an online survey. Although nearly all responding centers (97.5%) tracked COE activities, no consensus existed on resources used, and satisfaction with current solutions was mixed (51.0% not satisfied). Respondents expressed …

Analysis Of Facilitators Of And Barriers To Enactment Of State Regulation Of Indoor Tanning By Minors, Carolyn J. Heckman, Anna Mitarotondo, David B. Buller, Julia Berteletti, Kevin Schroth, Jerod L. Stapleton, Robert P. Dellavalle

Markey Cancer Center Faculty Publications

Background: Indoor tanning (IT) causes skin cancers, including potentially deadly melanoma. IT often starts during youth, a critical time for deleterious skin damage. About half of the US states have enacted laws banning IT for minors under age 18.

Purpose: This study reports qualitative findings from interviews with key informants (KIs) involved in IT legislative efforts to identify/describe factors influencing law enactment, based on the multiple streams framework.

Methods: Guided by expert advisors and using snowball-sampling, KIs from 16 states with most recently enacted IT laws regulating minor access and states without restrictions were contacted. In virtual interviews, KIs shared …

Examining Associations Between Sociodemographic Characteristics And Ever Breastfed Children, Nhanes 1999–2020, Jessica Amezcua, Lindsey M. West, Camelia Malkami, Marlo M. Vernon, Elinita Pollard, Justin X. Moore

Markey Cancer Center Faculty Publications

Although breastfeeding provides health benefits to both mother and child, this study aimed to explore whether disparities in breastfeeding continue to exist, particularly among non-Hispanic Black (NHB) mothers and children. We performed a cross-sectional analysis among 19,830 children in the United States (US) using the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2020. Breastfeeding initiation and duration rates increased overall from 1999 to 2020. Children who were ever breastfed were more likely to have higher body weight, older mothers, mothers who did not smoke during pregnancy, a higher family poverty–income ratio (PIR), food security, mothers in …

Examining Geographic Disparity: Variation In Cancer Outcomes Within Appalachia, Todd Burus, Pamela C. Hull, Krystle A. Lang Kuhs, Tianyan Gao, Christine F. Brainson, B. Mark Evers

Markey Cancer Center Faculty Publications

BACKGROUND: 

The Appalachian region of the US extends from the Mississippi Delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed.

STUDY DESIGN: 

We calculated 5-year age-adjusted US cancer incidence and mortality rates for 2017 to 2021, stratified into Appalachian and non-Appalachian populations, as well as Appalachian subregions, using the US Cancer Statistics Incidence Analytics Database and National Center for Health Statistics mortality files. Annual rates for 2004 to 2021 were also calculated.

RESULTS: 

In 2017 to 2021, all-site cancer incidence (466.6; 95% CI 465.5 to 467.6) …

Health Care Access Domains And Treatment As Mediators Of Ovarian Cancer Racial Disparities In Survival: A Structural Equation Modeling Analysis In Seer-Medicare, Clare Meernik, Quan Chen, Lauren E. Wilson, Ashwini Joshi, Fariha Rahman, Maria Pisu, Margaret Liang, Kevin C. Ward, Margaret Gates Kuliszewski, Thomas Tucker, Andrew Berchuck, Bin Huang, Tomi Akinyemiju

Markey Cancer Center Faculty Publications

Racial differences in health care access (HCA) may contribute to disparities in ovarian cancer (OC) survival. We used structural equation models (SEMs) to examine associations between race and HCA domains (affordability, availability, accessibility) in relation to overall and OC-specific mortality. Non-Hispanic (NH)–Black and non-Black (Hispanic, NH-White) women diagnosed with OC in 2008-2015 were identified from Surveillance, Epidemiology, and End Results–Medicare. Cox proportional hazards regression was used to conduct mediation analysis for associations between race and HCA domains with overall and OC-specific mortality. SEM models adjusting for demographic and clinical covariates were used to estimate hazard ratios (HRs) and 95% CIs. …

Cancer Advocacy Empowers Appalachian Kentucky Youth, Lauren Hudson Rose, Holly Burke, Olivia Thornsbury, Kameron Jackson, Rebecca Spradlin, Nathan L. Vanderford

Markey Cancer Center Faculty Publications

Kentucky has the highest cancer incidence rate and second highest cancer mortality rate in the United States, and the Appalachian region of the state experiences a disproportionate cancer burden. Cancer-related advocacy, a movement that strives to provide support to cancer patients, families, and organizations, along with policy creation, could help address this disparity by enhancing cancer-related prevention and control efforts. The University of Kentucky Markey Cancer Center’s Appalachian Career Training in Oncology (ACTION) Program partners with the American Cancer Society Cancer Advocacy Network (ACS CAN) to involve Appalachian Kentucky high school and undergraduate students in cancer advocacy activities at the …

Identifying Risk Factors For Adverse Lung Health Outcomes Among Rural Appalachian Women, Jessica R. Thompson, Courtney J. Walker, John C. Flunker, W. Jay Christian, Wayne T. Sanderson, Nancy E. Schoenberg, Steven R. Browning

Markey Cancer Center Faculty Publications

Purpose: Despite high rates of lung disease and lung cancer among women, few studies have focused on adverse lung health risk factors among rural Appalachian women. We aim to describe the prevalence of demographic, behavioral, and economic characteristics among a cohort of rural Appalachian women and ascertain the association between these risk factors and lung function.

Methods: Through a cross-sectional study in two rural Appalachian Kentucky counties (2015–2017), we collected demographics, health history/behaviors, and lung function via pulmonary function tests. Restricting to female participants with interpretable pulmonary function tests (N = 456), we estimated prevalence ratios of the association …

Surface Morphology And Moisture Adsorption/Desorption Characteristics Of Hybrid-Dielectric Moisture Sensors, Ronak Ali

Theses and Dissertations--Electrical and Computer Engineering

Relative humidity sensors are used for high-humidity measurement. Moisture sensors, or dew point sensors are used for low-humidity measurement (< 1 ppm_v). The dissertation contains two parts of studies. In the first part, the effect of surface morphology on the response speed of moisture sensors is studied. Moisture sensors using α-Al₂O₃ films as porous dielectric materials deposited by anodic spark deposition are studied. In this part of the study, a variety of small pores have been studied to investigate the response speed of moisture sensors. Three different surface morphologies have been studied using scanning electron microscopy. One …

Computing With Photonic Phase Change Memory, David B. Pippen

Theses and Dissertations--Electrical and Computer Engineering

A recent breakthrough in silicon photonics includes the discovery and use of phase changing materials (PCMs). These materials can be programmed to store nonvolatile values, and when a stored value in a PCM cell is read, it changes the amplitude of the read signal, imprinting the value held into the PCM cell on the amplitude of the read signal. This thesis proposes a new approach to using PCM cells not only for photonic memory but also as a substrate to perform multiplications in the photonic domain. The proposed multiplier uses PCM cells to encode amplitude-analog weight values and differing lengths …

Scalable Hypergraph Structure Learning With Diverse Smoothness Priors, Benjamin T. Brown

Theses and Dissertations--Electrical and Computer Engineering

In graph signal processing, learning weighted connections between nodes from signals is a fundamental task when the underlying relationships are unknown. With the extension of graphs to hypergraphs, where edges can connect more than two nodes, graph learning methods have similarly been generalized to hypergraphs. However, the absence of a unified framework for calculating total variation has led to divergent definitions of smoothness and, consequently, differing approaches to hyperedge recovery. This challenge is confronted in this work through generalization of several previously proposed hypergraph total variations, allowing ease of substitution into a vector-based optimization. To this end, a novel hypergraph …

Multi-Objective Design Optimization Of Power Converters For Electric Aircraft Propulsion, Ben Luckett

Theses and Dissertations--Electrical and Computer Engineering

As global focus shifts to the electrification of the aviation sector, the need for high efficiency, lightweight, and reliable electric aircraft propulsion power converter systems has become apparent. These goals can be somewhat conflicting with each other, and a single multi-domain-optimized solution is not guaranteed. The search for a design which presents satisfactory merits becomes a drudge through various trade-off studies which can expend vast quantities of manpower and time. As a remedy to this, design automation allows the process to be computer-assisted. This dissertation presents the core fundamentals for a general multi-objective design optimization framework intended for the design …

A Nurse-Driven Protocol To Increase Music Therapy Referrals To Manage Patient Pain And Anxiety In The Medicine Intensive Care Unit, Ashley Fox

DNP Projects

Background: Critically ill patients often suffer from pain and anxiety. Music therapy is a safe and effective treatment option. However, most nurses never receive education or training on it, resulting in a lack of awareness of its value and its actual usage in care.

Purpose: The purpose of this project was to increase the number of music therapy referrals to manage pain and anxiety in eligible medicine intensive care unit (MICU) patients via a music therapy protocol that increased nurses’ knowledge, attitudes, and skills related to the use of music as an alternative treatment option for pain and anxiety in …

Evaluating The Efficacy Of A Progressive Mobility Protocol Among Adult Icu Patients, Clayton Chroust

DNP Projects

Background: Many intensive care unit (ICU) patients are critically ill and require ventilator support, and they often do not receive any progressive mobility interventions until after they are liberated from the ventilator or receive transfer orders out of the ICU. Current literature suggests that patients in the ICU face deconditioning, increased ventilator days, development of deep vein thrombosis, pressure ulcers, pulmonary embolism, muscular atrophy, and increased days in the ICU which can be attributed to a lack of mobility. Current evidence-based research identifies that utilization of a progressive mobility protocol is one way to improve patient outcomes and reduce …

Implementation Of A Process To Improve Compliance With A Nurse Driven Foley Catheter Removal Protocol In Nursing Staff Of A Medicine Intensive Care Unit, Kendall L. Pfister

DNP Projects

Background: Catheter associated urinary tract infections (CAUTI) are the most prevalent healthcare acquired infection (HAI) in the acute care setting. Unfortunately, CAUTIs can lead to high morbidity and mortality rates, longer length of stay (LOS) and increased healthcare costs. Unfortunately, in critically ill patients which often suffer multi-organ failure/injury, there remains an increased risk for infection and poor outcomes.

Purpose: The purpose of this project is to increase medical intensive care unit (MICU) nursing staffs’ knowledge of existing nurse driven indwelling urinary catheter removal protocol and to implement an electronic medical record (EMR) prompt for removal of unnecessary urinary catheters …

Utilizing Integrative Medicine Services For Yoga To Reduce Cancer Related Fatigue, Leah R. Yeager

DNP Projects

Background: Cancer related fatigue (CRF) is one of the most prevalent and distressing side effects experienced by individuals undergoing cancer treatment. In fact, many patients report CRF as more debilitating than pain itself. CRF is characterized by persistent, severe exhaustion that is not alleviated by sleep and is not linked to prior exertion. Despite its widespread impact, the options available to manage CRF are limited, typically including practices like good sleep hygiene, balanced nutrition, mindfulness, and supplements. Integrative medicine, particularly yoga, has emerged as a promising intervention for reducing CRF. However, yoga is underutilized as a therapeutic approach to combat …

Implementation And Evaluation Of A Competency-Based Phased Orientation Program For Nurse Practitioners In The Intensive Care Unit Setting, Meredith Sherer

DNP Projects

Background: Research has demonstrated that structured orientation helps to integrate new nurse practitioners (NPs) into practice, ease role transition, decrease NP turnover, and lead to better patient care. However, at University of Kentucky HealthCare (UKHC) clinical orientation programs for NPs are not standardized.

Purpose: The purpose of this project was to implement and evaluate a competency-based phased orientation program for NPs in the intensive care unit (ICU) setting at UKHC.

Methods: This project utilized a prospective, single group, presurvey-postsurvey design to examine the effect of a three-phased competency-based orientation program on the outcome variables of NP confidence, autonomy, proficiency of …

Evaluating Knowledge, Skills, Attitudes, And Suicide Hotline Referrals In Aprns Screening Children For Depression And Suicide In Primary Care, Brooklyn D. Higginbotham

DNP Projects

Background: Suicide is the 2nd leading cause of death in adolescents across the United States (US). Primary care providers (PCPs) are often the first people an adolescent sees for depression or suicide symptoms; however, evidence shows PCPs may not be comprehensively screening for suicide in the primary care setting by using the Patient Health Questionnaire (PHQ) alone. Screening tool usage for depression and suicide among PCPs is currently at rates as low as 26% due to lack of knowledge and insufficient resources. Evidence-based education on American Academy of Pediatrics (AAP) recommendations can improve PCPs’ knowledge, skills, and attitudes when assessing …

The Effect Of A Hospital Community Garden On Healthcare Workers’ Professional Quality Of Life, Madelyn Renee Cline

DNP Projects

Background: Healthcare professionals experience a variety of stressors which negatively impact their professional quality of life (ProQOL) potentially leading to increased turnover and nurse shortages in hospitals. There are growing studies addressing ways to improve healthcare ProQOL, yet few have examined the impact of alterations to the workplace on these outcomes.

Purpose: The purpose of this project was to evaluate the effect of a dedicated outdoor green space for nurses during shift breaks on their ProQOL.

Methods: This project used a one-group pretest-posttest design. Data analysis was completed using descriptive and inferential statistics using SPSS software. The Professional Quality of …

Implementation Of A Pilot Post-Code Debrief Tool Initiated By The Chaplains And Unit Lead Nurses Within The Medicine Intensive Care Unit, Sarah Stigall

DNP Projects

Background: Post-code debriefs are shown to improve teamwork and communication, increase performance, and reduce burnout. According to the University of Kentucky HealthCare (UKHC) policy, teams are to perform a post-code debrief immediately after an in-hospital cardiac arrest (IHCA). However, the current policy does not provide guidance on what to include during a debrief session. At UK post-code debrief sessions are documented as occurring 60-72% of the time; however, personal observation and discussions with other bedside and rapid response nurses suggest that post-code debriefs are underperformed when compared to the documentation. Purpose: This study aimed to explore barriers to post-code debriefs …

Nurse-Led Cbt For Depression In Heart Transplant Patients: A Feasibility Study, Matthew R. Wallace

DNP Projects

Background: Heart transplant recipients are at an elevated risk of experiencing depressive symptoms compared to the general population. Those with depression post-transplant face increased complications, e.g., infection, organ rejection, prolonged hospitalization, and higher mortality rates. However, specific psychotherapeutic interventions tailored for heart transplant recipients remain limited. Nevertheless, there is substantial evidence supporting the effectiveness of various interventions for adults with heart failure, a condition frequently diagnosed in these patients. This suggests that successful strategies for managing depressive symptoms in heart failure patients could be adapted for heart transplant recipients.

Purpose: The purpose of this project was to evaluate …

Effectiveness Of A Multi-Departmental Nursing Tiered Orientation Model On Service Line Culture, Self-Efficacy Of Nurses, Positive Patient Outcomes And Nurse Satisfaction, Kimberly Thompson

DNP Projects

Abstract
Background: Nurses who transition into specialty practice areas in healthcare settings may demonstrate a lack of confidence and a high level of stress. Decreased levels of nursing engagement, self-efficacy, and interdepartmental team collaboration may also be seen. Multi-departmental tiered orientation models can help facilitate the development of increased confidence and competence and ultimately lead to improved patient outcomes.

Purpose: The purpose of this doctoral project was to evaluate the effectiveness of a multi-departmental tiered orientation model for nurses hired into a specialty area. The specific objectives included were to a) determine the effectiveness of the model on service line …

Evaluation On The Effectiveness Of A Virtual Reality (Vr) Guided Meditation Intervention On Pre-Procedural Anxiety In An Outpatient Dental Clinic, Anansa Thompson

DNP Projects

Background: Mental health issues, particularly anxiety, represent a significant public health concern in the United States, with dental anxiety affecting anywhere between 50% and 80% of adults (White et al., 2017). Pre-procedural anxiety in outpatient dental clinics complicates patient care and can lead to avoidance of necessary dental treatments, impacting both oral and overall health. Non-pharmacological interventions, such as immersive virtual reality (VR) guided meditation, offer promising solutions to address anxiety in healthcare settings.

Purpose: This study aims to evaluate the effectiveness of VR guided meditation on pre-procedural anxiety among adults undergoing painful dental procedures at an outpatient …

A Triage Process To Decrease Door To Ekg Times For Adult Patients With Suspected Cardiac Abnormalities In The Emergency Department, Khay Douangdara

DNP Projects

Objective: The emergency department (ED) triage process for adult patients presenting with suspected cardiac abnormalities should be reliable; however, delays in identifying significant cardiac rhythms can negatively impact patient outcomes. The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend that patients presenting to the ED with cardiac-related concerns undergo an electrocardiogram (EKG) within 10 minutes of arrival. This project aimed to educate ED nurses and implement changes in the triage process to reduce door-to-EKG times for adult patients with suspected cardiac abnormalities.

Methods: This quasi-experimental study utilized a pre- and post-intervention design to evaluate the effectiveness …

Implementation And Evaluation Of Diet And Physical Activity Screening Tools For Adults With Type 2 Diabetes Mellitus In Primary Care, Ashley O. Dalton

DNP Projects

Background: Only half of individuals with type 2 diabetes mellitus (T2DM) have a hemoglobin A1C (HbA1c) of less than 7%, indicating poor glycemic control and contributing to a global diabetes epidemic. Diabetes is considered a diet-sensitive disease and an individual’s diabetes-related nutrition knowledge is one of the most challenging aspects of the treatment plan. Empirical evidence supports that a combination of dietary and physical activity interventions is more effective than nutrition education alone. Performing a dietary evaluation is fundamental to establishing nutrition goals. The use of the Starting the Conversation (STC) tool, which assesses an individual’s dietary practices, and Physical …

Screening For The Unseen: Depression Detection Through Phq-9 And Provider Education In Pain Management, Veronica Shaw

DNP Projects

Background: Depression leads to significant economic and health burdens, causing 200 million lost workdays and costing employers $17 to $44 billion annually (CDC, 2022). It accounts for 4.3% of the global disease burden and is a leading cause of disability worldwide (WHO, 2021). Chronic pain, affecting 20.9% of United States adults, often exacerbates depression, creating a vicious cycle of physical and emotional suffering (Rikard et al., 2023). Despite the availability of effective treatments, depression is frequently missed in primary care settings, with 50% of cases undiagnosed (Hawkes, 2019). Addressing both depression and chronic pain through improved screening and holistic care …