Digital Commons Network^™

Outcomes Of Liver Transplantation In Patients With Severe Obesity, Alejandro Cracco, Mackenzie Donoho, Siddharth Desai, Meera Gupta, Alexandre Ancheta, Malay B. Shah, Xiaonan Mei, Francesc Marti, Roberto Gedaly

Surgery Faculty Publications

Background. – This study aims to evaluate the impact of obesity on post–liver transplant outcomes stratified by low- and high-performance status. Methods. – Patients undergoing liver transplantation between 2006 and 2023 were identified in the United Network for Organ Sharing data set. Patients with severe obesity body mass index ([BMI] ≥40 kg/m²) and super obesity (BMI >50 kg/m²) were compared with those with lower BMI on perioperative and long-term outcomes stratified by preoperative performance status. Results. – Severe obesity has a significant negative impact on perioperative and long-term outcomes on the low-performance group (LPG). This effect …

Abnormal Invasive Hemodynamics In Heart Transplant Recipients, Navin Rajagopalan, Donna R. Dennis, Julia Akhtarekhavari, Kenneth Campbell

Physiology Faculty Publications

BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients. AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics. METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed. Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded. Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at …

Complex Interplay Between Facilitation And Competition In Two Invasive Fruit Pests Data, Eleanor Mccabe, Nicholas Teets Phd

Entomology Research Data

When one invasive species facilitates the invasion of another species, it can lead to invasional meltdown. However, when the two species depend on the same finite resource, facilitation and competition can occur simultaneously and impact population dynamics. Furthermore, factors like resource availability and population density could alter the balance between facilitation and competition. Drosophila suzukii and Zaprionus indianus are two invasive insect pests that infest small fruit crops. The co-localization of these species in the same fields, coupled with the fact that Z. indianus lacks a hardened ovipositor that can penetrate the skin of fruit, has led to the hypothesis …

Health On The Rocks: Geohealth In Kentucky, Rachel L. Washburn

Special Publication--KGS

Geohealth bridges the earth and life sciences, revealing how Kentucky’s unique geology directly shapes public health risks, clinical outcomes, and opportunities for innovation. This factsheet highlights the critical intersections between geologic processes and human health across the Commonwealth—from landslides, floods, and tornadoes to radon, mine drainage, and microbial contamination. It outlines how natural and anthropogenic forces influence respiratory illness, cancer, trauma, and infectious disease, and how bedrock and weather extremes define local exposure pathways. Beyond risk, it also showcases Kentucky’s leadership in developing geoscience-informed health solutions: bioremediation, microbial drug discovery, and geologic-health monitoring networks that strengthen preparedness and resilience. Understanding …

Iodinated Disinfection Byproduct Formation From Iohexol In Sunlit And Chlorinated Urban Wastewaters, Reagan Patton Witt, Marcelo I. Guzman

Chemistry Faculty Publications

No abstract provided.

Leveraging Academic Health Departments For Place-Based Disaster Response: Lessons From Helene In Western North Carolina, Danny Scalise Ii, Sarah B. Thach, Ellis V. Matheson

Journal of Appalachian Health

This article examines the role of two Academic Health Departments (AHDs) in Buncombe and Burke Counties, North Carolina in responding to Hurricane Helene in 2024. The partnership between local health departments and the UNC Asheville – UNC Gillings Master of Public Health (MPH) Program fostered a place-based approach to public health. After the hurricane disrupted regional infrastructure, the AHDs integrated students and faculty into recovery efforts. This paper identifies key lessons for strengthening public health preparedness through academic-practice partnerships and highlights the importance of embedding education in local contexts.

Understanding Rural Health Through Rae Garringer's Country Queers: A Love Letter, Bradley A. Firchow

Journal of Appalachian Health

Rae Garringer’s Country Queers: A Love Letter examines the experiences of queer individuals in rural America, emphasizing the relationship between place and identity. Through oral histories, the book presents perspectives on community, resilience, and healthcare access. While not centered on medical care, it highlights challenges in obtaining affirming services in rural areas. Garringer’s experience as a standardized patient provides additional context on healthcare gaps. For public health professionals, Country Queers offers insight into the structural and social factors affecting rural LGBTQ2+ populations, contributing to a broader understanding of community health and identity in Appalachia and similar regions.

Evidence-Based Best Practices For Diabetes Education And Self-Care In Appalachia: A Literature Review, Angela J. Occidental, Inga M. Zadvinskis, Jacqueline Hoying

Journal of Appalachian Health

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize …

The Status Of Children’S Dental Health In Rural Appalachian West Virginia, R. Constance Wiener, Gina Graziani

Journal of Appalachian Health

Introduction: Non-metro/rural Appalachian West Virginia (WV) residents have been stigmatized for poor oral health (OH), despite many advances.

Purpose: The aims of this study were to examine current OH in children in WV, as compared to children in the greater United States (U.S.), and secondarily in subgroup non-metro/rural comparisons.

Methods: This observational study involved the U.S. National Survey of Children’s Health 2022–2023 data from parents/guardians who were asked about their child’s previous 12-month OH. Rao-Scott Chi-square and logistic regression analyses were used.

Results: Nationally, the mean age was 9.7 years; for WV children, it was 9.9 years. Nationally, 12.4% of …

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Intensive Telemedicine Transitions Of Care Clinic: A Prospective Feasibility Study Of A Novel Ambulatory Model Serving Appalachian Patients, Jessica Thayer, Brett Miller, Marcelino Mederos Liriano, Kathryn Hoffman, Gina Baugh, Jenna Sizemore

Journal of Appalachian Health

Introduction: Hospital discharge is a complex process plagued with medical errors and poor coordination. Disjointed discharges are detrimental to Appalachian patients with access barriers and multiple chronic diseases. Telehealth is a tool used to improve access within rural Appalachia. To address this high-risk transition period, an interprofessional team deployed telemedicine to improve post-hospital care for Appalachian patients.

Purpose: Patients with uncontrolled chronic medical conditions were enrolled into the Intensive Telemedicine Transition of Care Clinic (I-TTC) with a primary outcome of 30-day Emergency Department (ED) presentations and hospital readmissions. Secondary outcomes included improved control of chronic conditions and patient cost savings. …

Person-Centered Trauma-Informed Care (Pctic): A Training Needs Assessment For Home And Community-Based Services In West Virginia, Ranjita Misra, A. Brianna Sheppard, Natalie Wilson, Megan C. Govindan, Matthew Myers, Amanda Acord-Vira, Steven Wheeler, Heather Henderson, Christena Ross, Laura Cooper, Rachel A. Goff

Journal of Appalachian Health

Introduction: Person-centered, trauma-informed care (PCTIC) is a combined, holistic service model promoting the well-being and empowerment of trauma survivors.

Purpose: This study examined the PCTIC knowledge, skills, and abilities needed by West Virginia (WV) Medicaid Home and Community-Based Services (HCBS) direct service professionals (DSPs) to serve clients that may have experienced trauma.

Methods: Semi-structured interviews were conducted with diverse stakeholders (n = 32) from 19 organizations that provide HCBS services in all 55 counties. Interviews focused on identifying current training, needs and knowledge gaps, and priority areas for additional PCTIC training. ATLAS.ti software was used to manage and code. Validity …

Radon Environmental Health Literacy Among Health Council Participants In Northeast Tennessee, Kawther Al Ksir, Stacy Stanifer, Hadii M. Mamudu, Megan Quinn, Deborah L. Slawson

Journal of Appalachian Health

Introduction: Radon, a radioactive gas, poses significant health risks, including lung cancer, and is prevalent in indoor environments. Understanding radon testing behavior and Environmental Health Literacy (EHL) is crucial for individuals to take appropriate preventive measures.

Purpose: This study assessed radon-related EHL among Health Council participants in seven Northeast Tennessee (NETN) counties and examined associations between sociodemographic factors and EHL levels. Understanding radon knowledge and behaviors within this influential group is critical, as they often serve as trusted public health advocates.

Methods: A cross-sectional survey was conducted from September – November 2023 among Health Council participants across seven counties in …

Prevalence Of Screening Patients For Alcohol Use In West Virginia: A Cross-Sectional Observational Study, Bayan Abuhalimeh, Christopher Waters, R. Constance Wiener

Journal of Appalachian Health

Introduction: Consequences of alcohol consumption are well-established and compounded by physiological changes of aging (increased sensitivity; medication interactions; etc.). Alcohol screening for all ages is recommended, especially as most Americans believe moderate drinking is acceptable. Screening is important in high alcohol use regions, such as rural areas where isolation is more likely, especially for older adults. The Appalachian Region has a significant rural population of older adults. West Virginia (WV) is representative of Appalachia. It is a rural state, has many older adults, and all counties are Appalachian.

Purpose: The purpose of this cross-sectional study is to determine the likelihood …

Finding Community: A Thematic Analysis Of Resilience During The Pandemic, Myles Kwitny, Quinn Richards, Grace Digirolamo, Shannon Freedman, Sophie Wenzel

Journal of Appalachian Health

Introduction: The Covid-19 pandemic impacted those within rural Appalachian communities, particularly people with marginalized identities.

Purpose: Through interviewing 44 participants from New River Valley, an Appalachian community in Virginia, this study sought to understand how resilience impacted individuals' experiences during the pandemic.

Methods: Participants belonged to one of the following groups: African American, Hispanic, older adults, or people who use drugs. Participants were required to reside in the New River Valley and be older than 18. Each participant was interviewed either in person, by phone, or over video call. Interviews were recorded, transcribed, then thematically analyzed for themes of resilience. …

Addressing The Root Causes Of Population Health In Central Appalachian Virginia, David L. Driscoll, Kol Gold

Journal of Appalachian Health

Introduction: The Southwest Virginia Health Authority (SWVHA) recently commissioned a community health needs assessment (CHNA) to reduce the high rate of preventable health problems in Virginia’s (VA) Appalachian Region. The CHNA took place over a two-year period from 2023 – 2025.

Purpose: This iterative, mixed-method CHNA informed the development of a new iteration of the regional Blueprint for Health Improvement and Health-Enabled Prosperity identifying and prioritizing health issues and develop strategic planning to address them in VA’s three westernmost regional health districts.

Methods: The CHNA followed a sequential mixed methods design to assess the regional health status, the contextual factors …

Align Appalachia’S Opioid-Settlement Spending With Evidence And Emerging Threats, Bradley Firchow

Journal of Appalachian Health

State and local governments across Appalachia are allocating opioid-settlement dollars over the coming years. This funding opportunity can support lasting public health infrastructure or be spent on short-term programs anchored in the opioid crisis of the past. Evidence indicates that emerging synthetic drugs such as nitazenes and xylazine are altering overdose risk patterns in ways that require urgent policy attention.

Magnolia Tapichalacaensis (Magnoliaceae), A New Species From The Andean Foothills Of Zamora Chinchipe, Ecuador, Álvaro J. Pérez, Edison Rea, Jennifer Martínez, Fanny Hidalgo, Franco Mendoza, Ramiro Mendoza, Nelson Jaramillo Díaz, Fredy Archila, Kevin S. Burgess, Rosana Zenil-Ferguson, J. Antonio Vázquez-García

Biology Faculty Publications

The number of new species of Ecuadorian Magnolia Linnaeus (1753: 535) continues to increase as exploration of the Andes progresses. Currently, 24 species of Magnolia are recorded for Ecuador (Vázquez-García et al. 2012, 2013, 2015a, 2015b, 2016, 2017, 2018, Arroyo et al. 2013a, 2013b, 2019, Pérez et al. 2016, 2023), which belong to M. sect. Splendentes Dandy in Vázquez (1994: 4) and Talauma Baillon (1866: 3) (Wang et al. 2020), the former consisting of six species, including the new species described here, and the latter 19 species. There are 17 endemic species in Ecuador, three of which also occur in …

Integrated Clinical Research Ensembles, Sergey Tarima, John R. Meurer, David Friedland, Ndidiamaka Ojiako, Michael Anello, David Zimmerman, Renee Mccoy, Reza Shaker

Biostatistics Faculty Publications

Introduction: The study objective was to evaluate whether the formation and funding of team science-guided Integrated Clinical Research Ensembles (ICREs) enhance individual faculty productivity, measured by publication and impact factor adjusted citation rates. The setting was a multi-institutional NIH Clinical and Translational Science Award-supported hub. Methods: Monthly faculty publication and impact factor adjusted citation rates were analyzed using data extracted from the hub-managed Faculty Collaboration Database (FCD). The FCD imports indexed publications for all faculty members across four academic institutions, drawing from PubMed and faculty curriculum vitae. Monthly publication counts were modeled using Poisson regression, fitted using generalized estimating equations …

Performance Evaluation Of Kytc Bridge Deck Overlays Used For Maintenance Activities, Sudhir Palle, Christopher Goff

Kentucky Transportation Center Research Report

State departments of transportation use bridge deck overlay systems to prolong bridge deck service lives. Consisting of a thin layer of material applied to a concrete bridge deck surface, overlays form a protective barrier that improves ride quality, protects embedded reinforcement from harsh environmental conditions, enhances structure durability, and improves deck drainage. Over the past 20 years, the Kentucky Transportation Cabinet has made significant investments in overlays, rehabilitating nearly 5,000 bridge decks with them — roughly ¹/₃ of all bridges statewide. Given the significant investment in overlays, and the fact they degrade over time — eventually re-exposing bridge …

Formation Of A Prism-Focused Working Group To Address Mcrs Issues And Expanded Prism Requirements, Brian Howell, Robin Baskette, Jennifer Walton

Kentucky Transportation Center Research Report

This study, sponsored by the International Registration Plan (IRP), Inc. in partnership with the Kentucky Transportation Center (KTC), examined systemic challenges and opportunities to strengthen two critical safety oversight mechanisms in U.S. commercial vehicle operations—the Motor Carrier Responsible for Safety (MCRS) and the Expanded Performance and Registration Information Systems Management (PRISM) program. The research traced the evolution of federal and state data systems used to identify and monitor carriers, emphasizing the modernization role of the IRP Data Repository (IDR). The IDR now provides a secure, centralized platform for daily vehicle registration data and financial transactions, facilitating the exchange of carrier …

Association Of Fentanyl Test Strip Results And Change In Drug Use Behaviors, Kitty H. Gelberg, Nabila El-Bassel, Denise C. Babineau, Rachel A. Vickers-Smith, Laura C. Fanucchi, Janet E. Childerhose, Megan E. Hall, Megan E. Dzurec, Jennifer Villani, Mary R. Russo, Patricia Lebaron, Katherine R. Marks, Kathyrn E. Lancaster, Louisa Gilbert, James L. David, Barry S. Eggleston, Carter A. Roeber, Emmanuel A. Oga, Redonna K. Chandler, Sharon L. Walsh

Epidemiology and Environmental Health Faculty Publications

Background: The Stay Safe Study, conducted between May and December 2023 in the United States, investigated the association between fentanyl test strip (FTS) use and risk reduction behaviors. This paper examines the association between self-reported FTS results and change in drug use behaviors. Methods: We solicited self-reported drug and FTS use among people who use drugs (PWUD), with a baseline and four weekly surveys over a 28-day observation period in three states (Kentucky, New York and Ohio). For each day participants reported drug use, they were asked types of drugs used, use of FTS, FTS results, and 12 drug use …

Natural History And Burden Of Refractory Mycobacterium Avium Complex Pulmonary Disease, Timothy R. Aksamit, Radmila Choate, David M. Mannino, Amanda E. Brunton, Ping Wang, Mariam Hassan

Epidemiology and Environmental Health Faculty Publications

Background: Managing Mycobacterium avium complex pulmonary disease (MACPD) is challenging for refractory disease. This study used real-world data to describe natural history and burden of refractory MACPD. Methods: US Bronchiectasis and Nontuberculous Mycobacteria Research Registry data were analyzed retrospectively. Patients treated for MACPD were categorized as refractory (defined as receiving oral clofazimine, bedaquiline, inhaled amikacin, or amikacin liposome inhalation suspension, or remaining culture positive ≥6 months during treatment) or nonrefractory. Patient characteristics and healthcare resource utilization were compared. Longitudinal assessment over adjacent visits (pre-refractory and refractory) focused on hospitalizations and exacerbations among incident refractory cases. Results: Of 1064 patients treated …

Navigating Hepatitis C Care, Cheyenne R. Wagi, Renee Mcdowell, Anyssa Wright, Kathleen L. Egan, Christina S. Meade, April M. Young, Madison N. Enderle, Angela T. Estadt, Kathryn E. Lancaster

Epidemiology and Environmental Health Faculty Publications

Background Hepatitis C virus (HCV) and injection drug use among young women are dramatically rising in the rural United States. From 2004 to 2017, heroin use among non-pregnant women increased 22.4% biennially, mirroring increases in HCV cases, especially among younger populations. Young women who inject drugs (YWID, ages 18–35) face elevated HCV risk due to biological, behavioral, and socio-cultural factors. Barriers to HCV testing and treatment services further delay diagnoses, fuel transmission, and limit access to harm reduction services. This study applies the Theoretical Domains Framework (TDF) to identify factors influencing HCV testing and treatment among YWID in rural Appalachia …

The First Complete Assembly For A Lungless Urodelan With A “Miniaturized” Genome, The Northern Dusky Salamander (Plethodontidae: Desmognathus Fuscus), Edward A. Myers, Alexander A. Stewart, Aidan E. O’Brien, Jeramiah J. Smith, R. Alexander Pyron

Biology Faculty Publications

Salamanders have some of the largest genomes among animals, driven primarily by expansion of repeat elements and slow rates of DNA loss. However, species in the lungless genus Desmognathus (Plethodontidae) have some of the smallest genomes at ∼13 to 15 GB, though previous sequencing attempts with short-read assemblies were still fragmentary. Here, we assemble an annotated draft genome of Desmognathus fuscus using PacBio HiFi reads and transcriptomic data from 2 specimens from the same population. The combined dataset resulted in a 16.1 GB assembly in 19,632 contigs and an L/N50 of 2,459/1.74 MB, with the longest contig at 27.9 MB. …

Kentucky Model Minimum Uniform Crash Criteria (Mmucc) Sixth Edition Report Card, William Staats, Nikiforos Stamatiadis, Eric Green, Nathaniel Swallom

Kentucky Transportation Center Research Report

The National Highway Traffic Safety Administration published the Model Minimum Uniform Crash Criteria (6th Edition) (MMUCC) in 2024. This updated version of the MMUCC contains recommendations for improving and standardizing electronic crash data. Its guidelines address the collection and presentation of 105 data elements and 1,056 data attributes. To facilitate a possible redesign of Kentucky’s crash reporting process, Kentucky Transportation Center (KTC) researchers reviewed the updated criteria and evaluated the degree to which the state complies with its recommended methods of gathering, storing, and presenting crash data. At the level of data elements, Kentucky is 25 percent compliant; for data …

A Participatory Photovoice Investigation Of Community Assets, Barriers, And Opportunities To Curb The Opioid Epidemic, P. Balvanz, R. G. Olvera, M. Booty, J. Mcswiggan, C. Damato-Macpherson, S. Ellison, A. Farmer, K. Klingler, A. Kuntz, N. Lewis, C. B. Oser, L. Sprague Martinez, S. Stitzer, H. Surratt, O. Yamoah, A. Berkshire, T. Carter, K. Campbell, S. Dynes, B. Gealy, F. Harris, B. Herrington, S. Matthews, D. Myers, C. Rapier, A. Shouse, S. Szelagowsi, M. Mcgladrey

Sociology Faculty Publications

The opioid epidemic remains an entrenched issue in communities due to its multiple and interrelated risk factors. As part of the HEALing Communities Study, we recruited people with lived experience of substance use disorder and practitioners in the field to participate in multi-session Photovoice projects to contextualize the opioid use landscape in their respective communities. Photovoice combines photography and group discussion to explore concerns and strengths in a community. Researchers facilitated 21 Photovoice projects (N = 127 participants) across 19 communities in the Kentucky, Massachusetts, and Ohio HCS sites. We performed template analysis on the Photovoice discussion transcripts to develop …

Effects Of Parenting Styles On Academic Achievement, Tina Cupar, Rudi Klanjšek, Katja Košir, Miran Lavrič, Alexander T. Vazsonyi

Sociology Faculty Publications

Although numerous studies have examined the relationship between parenting styles and academic achievement in different socio-cultural contexts, the moderating role of specific macro contextual characteristics remains understudied. This cross-national study examined the effects of three parenting styles on two aspects of academic achievement (self-reported average grade and educational attainment) in a sample of adolescents and young adults from ten Southeast European countries (N = 10,909) and tested whether the associations were moderated by economic development as an indicator of socio-cultural context. Results indicated that country-level authoritative parenting style was positively associated with both academic outcomes, while authoritarian and permissive parenting …

Kentucky Traffic Collision Facts Calendar Year 2024 Report, Paul Ross, Eric Green, Christopher Blackden, Kenneth Agent, Christopher Van Dyke

Kentucky Transportation Center Research Report

No abstract provided.

2025 Safety Belt Usage Survey In Kentucky, Erin Lammers-Staats, Derek Young, Kenneth Agent

Kentucky Transportation Center Research Report

No abstract provided.