Digital Commons Network^™

Clinical And Demographic Characteristics Of Participants In A Hepatitis C Treatment Trial In Rural Kentucky: How Policies Around Treatment Access May Impact Elimination Efforts In The United States, Jennifer R. Havens, Brittney D. Williams, Takako Schaninger, Virginia A. Shepherd-Tackett, Michelle R. Lofwall, Michele Staton, Sharon L. Walsh, Hannah K. Knudsen

Behavioral Science Faculty Publications

Introduction: The advent of curative direct acting antiviral (DAA) drugs to treat those actively infected with the hepatitis C virus (HCV) has allowed for discussion around HCV elimination. Restrictive state-by-state policies for the coverage of DAAs for Medicaid recipients may hamper elimination efforts in the United States by limiting access to these curative treatments. Methods: The purpose of the current analysis was to examine the sociodemographic, drug use and clinical characteristics of participants in the Kentucky Viral Hepatitis C Treatment (KeY Treat) study in the context of Medicaid policies in the United States. The goal of KeY Treat was to …

The Interaction Of Tobacco Retailer Density And Rurality With Tobacco Use Prevalence In Kentucky, Shyanika W. Rose, W. Jay Christian, Judy Van De Venne, Delvon T. Mattingly, Bethany Shorey Fennell, Saber Feizy, Mary Kay Rayens

Behavioral Science Faculty Publications

Purpose: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population.

Methods: We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor’s access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance …

Acceptability And Appropriateness Of Harm Reduction Vending Machines Compared To Syringe Service Programs In Appalachian Kentucky, Hannah K. Knudsen, Jennifer R. Havens, April M. Young

Behavioral Science Faculty Publications

Objective:

Many rural people who inject drugs do not use syringe service programs (SSPs). In addition, people who use drugs but do not inject may perceive that SSPs are not intended for their use. Harm reduction vending machines (HRVMs) may be preferred by some individuals. This study examines attitudes and preferences regarding HRVMs to consider possibilities for enhancing the reach of harm reduction services. Method:

Structured surveys were conducted with 712 people who use drugs in two rural Appalachian counties in Kentucky. Participants rated the acceptability/appropriateness of SSPs and HRVMs; HRVM preference was the difference between the two scales. Linear …

Perceived Neighborhood Disadvantage And Current Nicotine Pouch Use Among U.S. Youth, Delvon T. Mattingly, Meman Diaby, Jing Zhang, Juhan Lee, Melinda J. Ickes

Behavioral Science Faculty Publications

Introduction: Nicotine pouches (NPs) are emerging nicotine products that appeal to youth due to their discreet use, tobacco-free formulation, and flavor availability. However, given their recent introduction to the market, little is known about how neighborhood environments may influence US youth NP use.

Methods: We imputed cross-sectional data from the 2023 National Youth Tobacco Survey (n = 22,069, ages 9 + years) and developed a neighborhood risk score (range: 1–4) by averaging 10 items related to neighborhood disorder, safety, and disadvantage. To estimate associations between the risk score and current (past 30-day) NP use, we fit logistic regression models adjusted …

Beyond Weak Ties In Prison: An Investigation Of Core Support Networks Of Incarcerated Persons, Siyun Peng, Martha Tillson, Maria Rockett, Marisa Booty, Carrie B. Oser

Behavioral Science Faculty Publications

Tie formation has been a core interest of network researchers. However, most existing research on tie formation in prisons has focused on weak ties, assuming that a core network approach is less applicable within total institutions such as prisons. Drawing on egocentric network data from 389 incarcerated individuals and 1352 named network members, this study demonstrates that relationships between incarcerated persons can be examined using a core support network framework. We find that about 20 % of participants include at least one incarcerated peer in their core support networks, with these ties providing both practical and emotional support comparable to …

Decreasing Prevalence In Youth Depressive Episodes: Evidence From The 2021-2024 National Survey On Drug Use And Health, R. Andrew Yockey, Aminul Apu, Timothy Grigsby, Jacob Bleasdale, Delvon T. Mattingly, Rachel Hoopsick

Behavioral Science Faculty Publications

Background: Major depressive disorder (MDD) is a leading contributor to the global burden of disease and commonly develops during adolescence. The COVID-19 pandemic was linked to significant increases in depressive symptoms among youth, but less is known about whether these increases have continued in recent years.

Objective: Using the first four consecutive years of methodologically comparable national data since the pandemic, we examined changes in past-year major depressive episode (MDE) among U.S. adolescents aged 12–17 years from 2021 to 2024 and evaluated demographic and substance use factors.

Methods: We analyzed pooled, cross-sectional data from the 2021–2024 National Survey on Drug …

Differences In The Use Of Smokeless Tobacco, Alcohol, And Co-Use Among U.S. High-School Students: Analysis Of National Youth Risk Behavior Survey Data, Ganna Kostygina, Yoonsang Kim, Alex Kresovich, Simon Page, Shyanika W. Rose, Sherry L. Emery

Behavioral Science Faculty Publications

Introduction: This study was aimed to examine the bidirectional relationships and patterns of concurrent smokeless tobacco and alcohol use among U.S. high-school students, investigating whether demographic characteristics and behavioral factors differentially predict concurrent versus single substance use of smokeless tobacco or alcohol (referred to as either-alone use in the remaining parts of this paper).

Methods: Analysis of nationally representative Youth Risk Behavior Survey data was perfomed, combining 3 cross-sectional surveys (2019, 2021, 2023) from 39,164 students in Grades 9–12. Logistic regression examined the bidirectional smokeless tobacco–alcohol associations, whereas multinomial models compared the characteristics of concurrent users, users of smokeless tobacco …

An Exploratory Study To Determine The Feasibility And Processes Needed To Implement The Immunization Neighborhood To Increase Hpv Vaccination Among African American Adolescents And Adolescents In The General Population: A Multi-Partner Perspective, Jennifer Cunningham-Erves, Freneka Minter, Pamela C. Hull, Amanda F. Dempsey, Alexandria Demons, Mariya Chalise, Consuelo H. Wilkins

Behavioral Science Faculty Publications

Limited education and healthcare access are major contributors to Human Papillomavirus (HPV) vaccination disparities among African American adolescents. The Immunization Neighborhood (IN) involves enhanced communication and collaboration among providers to address people’s needs by expanding access points and education to increase vaccination. Because needs of immunization providers and parents to effectively collaborate are unknown, this study explored the feasibility of and processes needed for IN utilization across key partners: pediatricians, pharmacists, school nurses, health department staff, and African American parent–child dyads. We conducted a semi-structured interviews in a qualitative, descriptive study with a purposive sample of 30 African American parent–child …

Extended-Release Vs Sublingual Buprenorphine In Pregnancy Through 12 Months Post Partum: A Randomized Clinical Trial, T. John Winhusen, Michelle R. Lofwall, Frankie Kropp, Daniel Lewis, Marcela C. Smid, Jessica L. Young, Candace Hodgkins, Elizabeth E. Krans, Zachary Hansen, Elisha M. Wachman, Davida M. Schiff, Constance Guille, Vania Rudolf, Tara Chowdhury, Lawrence Leeman, Mitra Lewis, Abigail G. Matthews, Gerald Cochran, Jacquie King, Christine Wilder, Carmen Rosa

Behavioral Science Faculty Publications

Importance: Treating opioid use disorder (OUD) in pregnancy with sublingual buprenorphine is an evidence-based practice, but it has disadvantages that could be addressed with an extended-release formulation.

Objective: To evaluate the effectiveness and safety of extended-release buprenorphine vs sublingual buprenorphine for OUD in pregnancy through 12 months post partum.

Design, Setting, and Participants: This 2-group, open-label, noninferiority, randomized clinical trial was conducted between July 2, 2020, and October 30, 2024, among adults with OUD and a singleton pregnancy of 6 to 30 weeks’ gestational age at 13 outpatient cross-disciplinary peripartum OUD treatment sites.

Interventions: Randomization to sublingual or extended-release buprenorphine …

Feeding The Family—A Food Is Medicine Intervention: Preliminary Baseline Results Of Clinical Data From Caregivers And Children, Gabriela Drucker, Christa Mayfield, Elizabeth T. Anderson Steeves, Sara Maksi, Tabitha Underwood, Julie Brown, Marissa Frick, Alison Gustafson

Behavioral Science Faculty Publications

Background/Objectives: Food is Medicine (FIM) programs have been shown to be effective at addressing food and nutrition insecurity among individuals. However, more evidence is needed to determine effective interventions at the household level and their impact on child health outcomes. Feeding the Family is a randomized controlled trial which aims to determine whether the amount of food provided and the ability to select foods in FIM interventions have an incremental effect on child and caregiver clinical outcomes relative to nutrition counseling alone. The objective of this paper is to describe the population at baseline among those enrolled in Feeding the …

Frequent Police Contact And Nonfatal Overdose Among People Who Use Drugs In Rural Appalachia, Javier A. Cepeda, Talia Loeb, Zach R. Salazar, Brittney D. Williams, Brooke Hiltz, Brandon Del Pozo, Eileen V. Pitpitan, Leo Beletsky, April M. Young, Jennifer R. Havens

Behavioral Science Faculty Publications

Introduction: Police contact shapes subsequent health practices and outcomes among people who use drugs (PWUD). However, the relationship between police encounters with overdose remains under-researched. We evaluated how police stop-and-search was associated with nonfatal overdose and identified correlates of frequent police contact among PWUD in rural Kentucky.

Methods: From May 2023– April 2024, 774 PWUD were enrolled in the Social Networks of Appalachian People and KyOSK studies. The exposure of interest was self-reported police stop-and-search in the past 6 months (0, 1–3, ≥4 times). The primary outcome was self-reported nonfatal overdose in the past 6 months. We evaluated the association …

The Receipt Of Psychological Services And Acceptability Of Local Follow- Up Care For Childhood Cancer Survivors: Are There Rural Vs. Urban Differences?, Tyrone F. Borders, Abigayle Feather, Jerod L. Stapleton, John A. D’Orazio, Eric B. Durbin

Psychology Faculty Publications

Purpose This study examined rural and urban parents’ reports of their children’s receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2–17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural …

Formative Research To Identify Contributors To Risky Drinking And Adapt An Alcohol Reduction Intervention Among Young Adults Vulnerable To Hiv: Qualitative Focus Group Study, Fidelis Y. Sesenu, Sally Kirklewski, Bryce Takenaka, Jaime Brown, Erin Nicholson, Kimberly Haney, Kaylia Carroll, Arjee Restar, Donte Travon Boyd, Keisa Fallin-Bennett, Trace Kershaw, Carolyn Lauckner

Communication Faculty Publications

Background: Across populations, risky drinking has been demonstrated to increase HIV risk behaviors. This is of special concern for sexually minoritized cisgender men and gender-diverse young adults (aged 18‐34 years), who report greater incidence of hazardous drinking (as defined by the Alcohol Use Disorders Identification Test - Consumption criteria) and HIV compared to their heterosexual and/or cisgender peers.

Objective: This study aimed to examine alcohol perceptions, patterns of use, and the role that anti-LGBTQ+ (lesbian, gay, bisexual, transgender, queer) policies and discrimination played in alcohol risk behaviors for sexually minoritized cisgender men and gender-diverse individuals. Results were used to inform …

A Ubiquitous Organophosphate Flame Retardant Disrupts Energy And Glucose Homeostasis In Mice, Krystal M. Sewell, Kelly Oriakhi, Sara Y. Ngo Tenlep, Megan L. Weaver, Mansura Shahad Bawa, Se-Hyung Park, Shubh Saraswat, Xiaohua D. Zhang, Robert N. Helsley, Samir Softic, Cetewayo S. Rashid

Pharmacology and Nutritional Sciences Faculty Publications

Organophosphate flame retardants (OPFRs) are used in many consumer products, and their presence in our environment raises concerns about potential health dangers. In humans, exposure to OPFRs, such as tris(1,3-dichloro-2-propyl) phosphate (TDCPP) is associated with metabolic disorders such as obesity, hyperglycemia, and insulin resistance. Our current study seeks to determine how TDCPP exposure affects body composition, glucose homeostasis, and energy balance in a rodent model. C57Bl/6 J mice were divided into two weight-matched groups and fed purified low phytoestrogen diets containing either 0.1 % DMSO (control) or TDCPP 415 mg/kg resulting in an approximate exposure of 50 mg/kg/day. Both male …

Contribution Of Metabolism-Independent Glucose Sensing To Metabolic Homeostasis, Nadia Rashid, Kavaljit H. Chhabra

Pharmacology and Nutritional Sciences Faculty Publications

Glucose sensing and signaling are central to cellular metabolic machinery for the regulation of metabolic homeostasis. Glucose sensing has been almost always assumed to be coupled with glucose metabolism; however, recent findings have unraveled metabolism-independent sensing mechanisms. Here, we discuss whether glucose transporters (GLUTs) and sodium-glucose co-transporters (SGLTs) may also function as glucose sensors independent of their roles in transporting glucose. Moreover, we review the emerging roles of G protein-coupled receptors (GPCRs) in sensing glucose and, consequently, initiating its signaling pathways in a cell-specific manner. Altogether, this review offers insights into the newly identified glucose sensing mechanisms and highlights the …

Anatomical Atlas Of Kinase Responsiveness To Weight Gain: Adipose Depot Reprogramming In Diet-Induced Adiposity, Wang-Hsin Lee, Zachary A. Kipp, Sally N. Pauss, Genesee J. Martinez, Mei Xu, Terry D. Hinds, Jr.

Pharmacology and Nutritional Sciences Faculty Publications

Background/Objectives: Adipose tissue depots located at different anatomical sites exert differential functions in response to adiposity and glucose intolerance. These fat depots exhibit distinct metabolic signaling patterns that may influence pathological fat accumulation, thereby affecting the efficacy of anti-obesity interventions. Nonetheless, the mechanisms underpinning depot-specific signaling and pathway responsiveness remain insufficiently understood.

Methods: Kinase activity was characterized during the progression of adiposity across five adipose tissue depots in obese versus lean mice using the advanced PamGene kinome technology. Furthermore, kinase pathways in human preadipocytes and mouse 3T3-L1 preadipocytes were analyzed and compared with those in their differentiated, mature adipocytes. The …

Social Engagement Moderates The Relationship Between Cognitive Functioning, Depressive Symptoms, And Restless Sleep In Older Black Adults, Sunkanmi Folorunsho, Olufunmilola Abraham, Darlingtina K. Esiaka

Pharmacy Practice and Science Faculty Publications

INTRODUCTION: Older Black adults face higher dementia risk, but it is unclear whether social engagement offsets the effects of depression and restless sleep.

METHODS: We analyzed 1,905 Black adults aged 50+ from the 2016-2020 Health and Retirement Study (HRS). Linear mixed-effects models tested how depressive symptoms, restless sleep, and social engagement predicted baseline cognition and cognitive decline.

RESULTS: Higher depressive symptoms and restless sleep were associated with lower baseline cognition (about 0.2 and 0.5 points lower) and faster decline (β×time ≈ −0.07 and −0.05). Greater social engagement predicted higher baseline cognition (about 0.6 points higher) and slower decline (β×time ≈ …

A Deimplementation Framework For Curricular Hoarding In Pharmacy Education, Mary E. Fredrickson, Ashleigh Barrickman, Krista L. Donohoe, Angela L. Goodhart, Caroline Lindsay Ko, Daniel R. Malcom, Frank Romanelli, Marissa C. Salvo

Pharmacy Practice and Science Faculty Publications

Objective: To propose a holistic approach to managing curricular transformation that addresses various curricular obligations, incorporates the emotional component of curricular overload, and utilizes deimplementation science to reframe curricular change decisions. Findings: Given the need to codify processes and interventions that continually seek to ensure curricula are modernized, contemporary, and free of outdated teaching materials, we have developed a systematic deimplementation approach to address curricular overload. Its intent is to free space for more impactful learning and practices within pharmacy curricula that can lead to measurable improvements in workload, satisfaction, and learning outcomes for both students and faculty. Summary: By …

Behavioral And Transcriptomic Markers Of Susceptibility To Escalate Fentanyl Intake, Jack V. Keady, Richard Charnigo, Jakob D. Shaykin, Emily Prantzalos, Mengfan Xia, Emily D. Denehy, Cody Bumgardner, Justin Miller, Pavel I. Ortinski, Michael Thomas Bardo, Jill R. Turner

Pharmacy Practice and Science Faculty Publications

The “loss of control” over drug consumption, known as escalation of intake in opioid use disorder (OUD), is well-established in preclinical rodent models. However, little is known about how antecedent behavioral characteristics, such as valuation of hedonic reinforcers prior to drug use, influence fentanyl intake trajectories. Moreover, it is unclear if distinct escalation phenotypes are driven by transcriptomic markers predictive of OUD susceptibility. Male and female Sprague-Dawley rats (n = 72) were trained in a sucrose reinforcement task using a progressive ratio schedule. Individual differences in responsivity to sucrose were hypothesized to predict escalation of fentanyl intake. Rats underwent daily …

Dino-Lg: Enhancing Vision Transformers With Label Guidance For Coronary Artery Calcium Detection, Mahmut Selman Gokmen, Caner Ozcan, Moneera N. Haque, Steve W. Leung, Seth Parker, Brent Seales, Cody Bumgardner

Biomedical Engineering Faculty Publications

Coronary artery disease (CAD), one of the leading causes of mortality worldwide, necessitates effective risk assessment strategies, with coronary artery calcium (CAC) scoring via computed tomography (CT) being a key method for prevention. Traditional methods, primarily based on UNET architectures implemented on pre-built models, face challenges like the scarcity of annotated CT scans containing CAC and imbalanced datasets, leading to reduced performance in segmentation and scoring tasks. In this study, we address these limitations by introducing DINO-LG, a novel label-guided extension of DINO (self-distillation with no labels) that incorporates targeted augmentation on annotated calcified regions during self-supervised pre-training. Our three-stage …

Validity And Reliability Of Force Insoles To Measure Center Of Pressure During Return-To-Sport Testing, Delaney Mcneese, Charles Eisner, Rachel Todd, Brian W. Noehren, Meredith K. Owen

Biomedical Engineering Faculty Publications

Center of pressure is a valuable biomechanical variable, predicting joint loading contributions during movement and giving insight into compensatory patterns. The purpose of this study was to assess the validity and reliability of force insoles in calculating vertical ground reaction force and center of pressure during return-to-sport jump testing. Ten healthy individuals performed double- and single-leg vertical and horizontal jumps on an instrumented treadmill while wearing instrumented force insoles. Vertical ground reaction force and anterior–posterior and medial–lateral center of pressure were collected at peak vertical ground reaction force from both devices. Repeat testing occurred 7 ± 5 days following the …

Non-Contact Optical Spectroscopy For Metabolic And Vascular Characterizations Of Orthotopic Tongue Cancer Models In Vivo, Md Zahid Hasan, Jing Yan, Sumit Sarker, Pranto Soumik Saha, Caigang Zhu

Biomedical Engineering Faculty Publications

Most tissue optical spectroscopy platforms use a fiber probe for light delivery and collection, while the inconsistent probe-sample contact could induce significant distortions in the measured optical signals, which consequently bring analysis errors. Moreover, it will be practically difficult to use a fiber probe for measurements in some cases such as oral cancer investigations using small animal models. To address the critical challenge, we report a portable, lens-based, optical spectroscopy device capable of quantifying key vascular and metabolic parameters in vivo without probe-sample contact. We combined lenses based diffuse reflectance and fluorescence spectroscopy into one portable platform to enable multi-parametric …

Combined Autofluorescence And Diffuse Reflectance Spectroscopy For Rapid Metabolic And Vascular Characterizations Of Orthotopic Tongue Tumors In Vivo, Pranto Soumik Saha, Jing Yan, Sumit Sarker, Zahid Hasan, Caigang Zhu

Biomedical Engineering Faculty Publications

Precise label-free quantification of tissue metabolic and vascular dynamics in vivo represents a critical challenge for cancer therapy prediction and longitudinal treatment assessment. In this study, we demonstrated a portable autofluorescence and diffuse reflectance spectroscopy device along with novel spectroscopic algorithms to quantify tissue vascular and metabolic parameters of orthotopic head and neck cancer models in vivo. Tissue-mimicking phantom studies were used to verify the dual-modal optical spectroscopy and easy-to-use spectroscopic algorithms for rapid and accurate estimation of tissue oxygen saturation, total hemoglobin contents, and intrinsic optical redox ratio. Animal studies were conducted to demonstrate the feasibility of our …

Noninvasive Diffuse Optical Monitoring Of Cerebral Blood Flow And Oxygenation Responses To Intermittent Hypoxia In Neonatal Rats, Pegah Safavi, Mehrana Mohtasebi, Chowdhury Azimul Haque, Faezeh Akbari, Xuhui Liu, Yiqi Yuan, Li Chen, Lei Chen, Guoqiang Yu

Biomedical Engineering Faculty Publications

Significance: Intermittent hypoxia (IH) is common in preterm neonates and can cause hypoxic–ischemic brain injury. Simultaneous monitoring of cerebral blood flow (CBF) and oxygenation is essential to detect oxygen delivery-extraction mismatches and guide intervention.

Aim: We aimed to adapt and test an innovative diffuse speckle contrast flow oximetry (DSCFO) system for continuous monitoring of cerebral hemodynamics during IH in neonatal rats, a model approximating human neonates.

Approach: Two compact laser diodes and a miniature CMOS camera were integrated into a fiber-free probe for continuous monitoring of changes in relative CBF (rCBF) and oxy- and deoxy-hemoglobin concentrations (Δ[HbO₂] and …

Comparative Evaluation Of R134a And Hfo‐1234ze Cryogen Spray Cooling Using A Mouse Model With Controllable Epidermal Pigmentation, Wangcun Jia, Yurie Jeong, Crystal Huynh, Oswald Lai, Emily Nguyen, Grant Swajian, Jade Niu, Ayana Kashikar, Joshua Khaw, Hong Pu, Bernard Choi, John August D'Orazio, J. Stuart Nelson, Bahman Anvari

Pediatrics Faculty Publications

Objectives: Cryogen spray cooling (CSC) is critical for protecting the epidermis during laser dermatologic procedures. The widely used cryogen, R134a, has a high global warming potential (GWP), motivating interest in environmentally favorable alternatives such as HFO-1234ze. This study evaluated whether HFO-1234ze provides epidermal protection comparable to R134a during laser exposure and investigated the mechanistic basis underlying any differences in cooling performance.

Methods: Laser-induced epidermal injury in conjunction with two cryogens was assessed in K14-SCF Mc1r^e/e mice with pharmacologically controllable interfollicular epidermal pigmentation. Laser treatment sites were assigned fluences relative to baseline skin lightness (L*) to span subthreshold …

Metabolomics Driven Discovery Of Bioactive Natural Products Leads From Marine And Terrestrial Sources For The Development Of Analgesics, Sahar Mofidi Tabatabaei

University of Kentucky Doctoral Dissertations

Natural products remain a rich source of structurally diverse bioactive compounds for drug discovery, particularly for pain therapeutics. However, the chemical complexity of natural product extracts presents significant challenges for the efficient identification and prioritization of bioactive metabolites. This dissertation integrates untargeted LC-MS/MS-based metabolomics, molecular networking, classical natural products chemistry, and neurobiological assays to accelerate the discovery of analgesic lead compounds targeting the emerging pain-associated receptor σ₂R/TMEM97.

An untargeted metabolomics workflow was developed to systematically profile complex biological extracts and guide bioactive compound isolation. High-resolution LC-MS/MS data were analyzed using molecular networking (GNPS/GNPS2) to visualize chemical space, dereplicate known metabolites, …

From Barriers To Breakthroughs: Academic Advising And Resilience Among Online Social Work Students In Appalachia, Jessica Williamson

DSW Capstone Projects

This Doctor of Social Work (DSW) capstone project examines how academic advising can be leveraged as a resilience-informed intervention to support persistence among online social work students in the Appalachian region. Although online education has expanded access to higher education, Appalachian students continue to face significant structural, technological, and cultural barriers, including limited broadband access, financial instability, geographic isolation, and norms that emphasize self-reliance. These challenges contribute to lower retention and degree-completion rates, highlighting the need for intentional, context-responsive support strategies. This project integrates three scholarly products: a systematic literature review (SLR), a conceptual paper, and a practice application paper. …

Non-Invasive Digital Restoration Of Damaged Photographic Film Negatives, Ankan Bhattacharyya

University of Kentucky Doctoral Dissertations

Physical restoration of damaged photographic film causes more damage. Also, existing non-invasive digital restoration of film negatives does not produce print-quality optical images. Instead, they produce X-ray projections, which are not the same as optical projections. This thesis addresses these problems and establishes a framework that can digitally restore old, damaged films without the need to open them physically. Virtual Unwrapping is an existing pipeline that has proven itself over the last couple of decades to work on unopenable papyrus scrolls, like the Herculaneum Scrolls. This thesis utilizes the concept of virtual unwrapping to restore damaged photographic film negatives. Due …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

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

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

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

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

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

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