Kentucky Research Articles

Effect of Socioeconomic and Demographic Factors on Crash Occurrence

The number of crashes and fatalities rate in the Commonwealth of Kentucky, U.S., have been higher than the national average for the past decades. It has been hypothesized that the distinct socioeconomic conditions of the state could be contributing to and explaining these trends. This study investigated the influence of socioeconomic characteristics on highway safety in Kentucky and attempted to identify the high-risk driver groups, based on crash data and the socioeconomic and demographic features of their residence zip codes. The quasi-induced exposure technique and binary logistic regression were employed to develop a predictive modeling approach for determining the probability of being the at-fault driver in a single- and two-unit crashes, based on socioeconomic characteristics of the driver residence zip code. The study identified that socioeconomic features such as income, poverty level, employment, age, gender, rurality, and number of traffic-related convictions of a driver’s zip code influence their likelihood to be at fault in a two-unit crash, while for single-unit crashes, in addition to these variables, educational attainment had also an impact. Younger and older drivers living in zip codes with low socioeconomic conditions have a higher probability to be the at-fault driver in both single- and two-unit crashes. The conclusions of the study can be used to determine the regions (zip codes) and driver groups with higher likelihood to be the at-fault driver in a crash and develop effective safety programs for the target groups.

Impact of preoperative opioid use disorder on outcomes following lumbar-spine surgery

ObjectivesOpioid use disorder (OUD) has previously been shown to negatively impact postoperative outcomes. As the number of spine surgeries continues to rise annually, more patients with preexisting OUD will be seen in operating rooms. Our retrospective cohort study aims to expand on the independent association between preoperative OUD and outcomes following lumbar-spine surgery. Patients and methodsUsing 2007–2014 data from the State Inpatient Databases (SID) for the states of California (2007–2011), Florida, New York, Maryland, and Kentucky, we identified patients ≥18 years of age undergoing lumbar-spine surgery. Our primary variable of interest was present-on-admission OUD. Outcomes of interest included a range of postoperative complications divided into those specific to spinal surgery and general surgical complications, length of stay (LOS), 30- and 90-day readmission rates, and total hospital charges. ResultsOf the 267,976 patients undergoing lumbar-spine surgery, 1902 patients were identified as having OUD. After adjusting for patient- and hospital-level confounders, we found that patients with OUD were more likely to experience complications related specifically to spine surgery (aOR = 1.51, 95%CI = 1.33–1.71) as well as general postoperative complications (aOR = 1.63, 95%CI = 1.36–1.96) compared to those without OUD. OUD was additionally associated with longer LOS (aIRR = 1.29, CI = 1.24–1.34) and higher total charges (aIRR = 1.14, CI = 1.11–1.18). Whereas no statistically significant difference was detected for 30-day-readmission rates, patients with OUD experienced higher rates of readmission within 90 days of discharge (aOR = 1.20, CI = 1.08–1.35). ConclusionsOur study strengthens the evidence that patients with OUD fare poorly after lumbar-spine surgery. More research is needed to determine whether reducing opioid use before surgery can mitigate the postoperative risks associated with OUD.

Abstract 108: The Relationship Between Cervical Cancer and Women Living with Disabilities in Kentucky

Abstract Purpose: Despite many national interventions, cervical cancer (CC) rates persist, and in Kentucky (KY), CC incidence rates are on the rise. Additionally, women with disabilities are medically underserved and face more barriers to secondary prevention and healthcare access, have more known risks, and experience more health disparities than women without disabilities. Given that 1 in 4 persons live with a disability in the USA, the purpose of this observational, cross-sectional, quantitative study was to explore the relationship between CC and women with disabilities as evidenced by reproductive cancer discharges from inpatient hospital (IHD) and outpatient services databases (OSD) so as to compare population-specific differences from social determinants of health framework. Methods: Data from the Kentucky Cabinet for Health and Family Services for 2015 to 2018 were analyzed using MLR. In total, the sample included 584 women with disabilities and 32,773 women without disabilities living in KY. Results: The IHD data analysis found that county of residence (p =.014) and insurance payer (p = .000) were statistically significant and that women on public insurance were 9.6 times as likely to be diagnosed with CC. Results: of the OSD data analysis found that place of residence (p = .000) and age group (p = .000) were statistically significant and that women aged 40-44 were 9.5 and 2.9 times as likely to have breast cancer and CC respectively. Conclusion: This study's findings call for; greater attention to strengthening public health surveillance and infrastructure affording visibility of women with disabilities who are underserved, increased proportion of breast and cervical cancer screening at an early age, and increase health access interventions for low resource settings. Citation Format: Carolyn Akakpo. The Relationship Between Cervical Cancer and Women Living with Disabilities in Kentucky [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 108.

New lock at Kentucky Dam: Analysis and design of precast concrete cofferdams

New lock at Kentucky Dam: Analysis and design of precast concrete cofferdams

450-P: Increasing Trends in Major Amputations among Patients with Diabetes in Kentucky, 2008-2018

Objective: CDC’s recent data (Harding et al. 2020) showed that rates of major lower-extremity amputations (ankle or above) rapidly decreased in 2000 - 2010 and then stabilized at slightly lower than 0.1% of Medicare beneficiaries with diabetes since then. We examined the commonwealth of Kentucky (KY) inpatient data to track trends in diabetic major amputations in 2008 - 2018. Methods: We used KY HCUP inpatient data to identify all patients with diabetes using ICD9/10 codes and those who have underwent major amputations using CPT codes. Results: The number of hospitalizations by patients with diabetes in KY decreased by 8% in 2008 - 2018 but the number of major amputations increased from 560 to 795 limbs, representing a 42% increase in the same period. Medicare paid for 44% of these surgeries in 2008 and 61% in 2018, while Medicaid covered 38% in 2008 but only 31% in 2018 despite the expansion in Medicaid coverage since 2014. KY inpatient users with diabetes had 46% higher odds of having a major amputation in 2018 compared to those in 2008, adjusting for age, sex, and race/ethnicity. Compared to pre-2014 era, the odds of having a major amputation was 27% higher after the Medicaid expansion in 2014. Conclusion: It is concerning that, while the rest of the country showed decreasing or stationary trends in major amputation rates, KY experienced continuously increasing number of major amputations in the last two decades. Although Medicaid expansion era had a significantly higher odds of major amputations compared to the pre-expansion era, it is not clear whether this reflects the effect of policy or is part of a secular trend since 2010. More careful analysis is needed to better understand the underlying causes of this trend and what needs to done to reverse it. Disclosure M. Sohn: None. W. Kim: None. M. Lacy: None.

Building design, resident's behavior, and indoor radon in the Commonwealth of Kentucky

This research aims to identify the impact of foundation type on average indoor radon levels in houses in the Commonwealth of Kentucky. It compares the averages of indoor Radon in 4 houses in Warren County, Kentucky, an area classified as zone 1 by the US Environmental Protection Agency. The predicted averages of indoor Radon greater than four pCi/L. The four houses are wood-frame structures; two of them are built on slabs-on-grade, the other two are raised on crawl spaces. A questionnaire was used to gather data about the occupant's behavior towards the indoor air quality in their houses during the test period. A T-test was performed to analyze the radon readings. The data analysis shows a significant difference in indoor Radon between houses of different foundation types. Unlike the previous studies, the houses built on slabs-ongrade show significantly lower averages of indoor Radon than those built on crawlspaces. Also, the results confirm earlier studies regarding the impact of the user's behavior on indoor air quality. Natural ventilation can significantly reduce the averages of indoor Radon. A limitation of this study is that it was carried out in only four houses. More surveys of indoor Radon in buildings with different foundation types are required for results to be generalizable.

Workplace Health in Kentucky: A Statewide Comparison.

The objectives of this study were to assess the state of Kentucky’s workplace health promotion and occupational safety and health programs, to ensure the ability to comprehend any possible trends over the past six years in the state’s progress in offering workplace health promotion and health protection programs, to compare the results of this survey with the 2013 Kentucky state-wide assessment, and to identify gaps in Kentucky’s workplace health promotion and occupational safety and health based on Total Worker Health® (TWH) concepts. Using Qualtrics research software, the Workplace Health in America assessment was sent to companies located in Kentucky and having 10 or more employees. Participants were identified using Dun and Bradstreet’s Hoover’s database. The results showed that, as with the 2013 survey, larger workplaces significantly were more likely to offer workplace health promotion programs than smaller companies (X2 = 24.30; p < 0.001). However, more companies (78%) reported offering programs compared to the 2013 assessment (49%). Given the results of the current study as compared to the statewide assessment conducted in 2013, Kentucky’s WHP is moving in a positive direction; yet, there is still much to be done. There remains a strong need to provide cost-effective and accessible resources for all elements of TWH to small workplaces.

The root-Gaussian Cox process and a generalized EMS algorithm

We propose a root-Gaussian Cox process for the analysis of data that is aggregated in space and where the boundaries of geographic regions change over time. A generalized EMS algorithm exploits sparse structure resulting in significant computational gains. Inference for a spatial intensity surface is conducted using a non-central chi-square distribution. A simulation study over the state of Kentucky demonstrates the efficacy of the methodology. An application to a large region in India allows the investigation of the spatial structure of the incidence of Plasmodium falciparum, a severe strain of malaria.

Antibiotic prescribing to Kentucky Medicaid children, 2012‐2017: Prescribing is higher in rural areas

Antibiotic resistance is a major public health threat. Antibiotic use is the main driver of resistance, with children and the state of Kentucky having particularly high rates of outpatient antibiotic prescribing. The purpose of this study was to describe patient and provider characteristics associated with pediatric antibiotic use in Kentucky Medicaid children. We used Medicaid prescription claims data from 2012 to 2017 to describe patterns of pediatric antibiotic receipt in Kentucky. Patient and provider variables were analyzed to identify variations in prescribing. Children who were female, less than 2 years old, White, and living in a rural area had consistently higher rates of antibiotic prescriptions. There was significant geographic variability in prescribing, with children in Eastern Kentucky receiving more than 3 courses of antibiotics a year. Most antibiotic prescriptions for children were written by general practitioners and nurse practitioners rather than pediatricians. These findings support the need for extensive antibiotic stewardship efforts inclusive of rural outpatient practices.

Examining Driver Injury Severity in Single-Vehicle Road Departure Crashes Involving Large Trucks

Road departure (RD) crashes are among the most severe crashes that can result in fatal or serious injuries, especially when involving large trucks. Most previous studies neglected to incorporate both roadside and median hazards into large-truck RD crash severity analysis. The objective of this study was to identify the significant factors affecting driver injury severity in single-vehicle RD crashes involving large trucks. A random-parameters ordered probit (RPOP) model was developed using extensive crash data collected on roadways in the state of Kentucky between 2015 and 2019. The RPOP model results showed that the effect of local roadways, the natural logarithm of annual average daily traffic (AADT), the presence of median concrete barriers, cable barrier-involved collisions, and dry surfaces were found to be random across the crash observations. The results also showed that older drivers, ejected drivers, and drivers trapped in their truck were more likely to sustain severe single-vehicle RD crashes. Other variables increasing the probability of driver injury severity have included rural areas, dry road surfaces, higher speed limits, single-unit truck types, principal arterials, overturning-consequences, truck fire occurrence, segments with median concrete barriers, and roadside fixed object strikes. On the other hand, wearing seatbelt, local roads and minor collectors, higher AADT, and hitting median cable barriers were associated with lower injury severities. Potential safety countermeasures from the study findings include installing median cable barriers and flattening steep roadside embankments along those roadway stretches with high history of RD large-truck-related crashes.

Federal, state, and institutional barriers to the expansion of medication and telemedicine abortion services in Ohio, Kentucky, and West Virginia during the COVID-19 pandemic

ObjectivesWe aimed to characterize the combined impact of federal, state, and institutional policies on barriers to expanding medication and telemedicine abortion care delivery during the COVID-19 pandemic in the abortion-restrictive states of Ohio, Kentucky, and West Virginia. Study DesignWe analyzed 4 state policies, 2 COVID-related state executive orders, and clinic-level survey data on medication abortion provision from fourteen abortion facilities in Ohio, Kentucky, and West Virginia from December 2019 to December 2020. We calculated the percent of medication abortions provided at these facilities during the study period by state, to assess changes in medication abortion use during the pandemic. ResultsWe ascertained that COVID-19-executive orders in Ohio and West Virginia that limited procedural abortion in Spring 2020 coincided with an increase in the overall number and proportion of medication abortions in this region, peaking at 1613 medication abortions (70%) in April 2020. Ohio and West Virginia, which had executive orders limiting procedural abortion, saw relatively greater increases in April compared to Kentucky. Despite temporary lifting of the mifepristone REMS, prepandemic regulations banning telemedicine abortion in Kentucky and West Virginia and requiring in-person clinic visits for medication abortion distribution in Ohio limited clinics’ ability to adapt to offer medication abortion by mail. ConclusionsOur findings illustrate how restrictive medication and telemedicine abortion policies in Ohio, Kentucky, and West Virginia created additional obstacles for patients seeking medication abortion during the pandemic. Permanently lifting federal regulations on in-clinic distribution of mifepristone would only advantage abortion seekers in states without restrictive telehealth and medication abortion policies. State policies that limit access to comprehensive abortion services should be central in larger efforts toward dismantling barriers that impinge upon reproductive autonomy. Implication StatementWe find that abolishing the REMS on mifepristone would not be enough to expand access to patients in abortion-restrictive states with telemedicine and medication abortion laws. While the REMS is a barrier, it represents one of several hindrances to the expansion of telemedicine abortion distribution across the United States.

Growth Inhibition Responses of Kentucky Bluegrass after Applying Trinexapac-Ethyl Solution Diluted to Two Concentration

Growth Inhibition Responses of Kentucky Bluegrass after Applying Trinexapac-Ethyl Solution Diluted to Two Concentration

Phosphorus Rates and Mulching Materials on Establishment of Kentucky bluegrass by Seed

Phosphorus Rates and Mulching Materials on Establishment of Kentucky bluegrass by Seed

College Readiness, Early Post-Secondary Academic Performance and the GED Degree: Evidence from Kentucky

The General Education Development (GED) certificate is recognized as a credible alternative to a high school diploma in the US. In this paper, we use detailed administrative data from the state of Kentucky to measure the efficacy of a GED degree. We examine the association between the GED college readiness and early post-secondary academic performance. Following previous work in this area, we address selection issues by focusing on a sample of students who are identified as at-risk prior to high school entry. Our results suggest the GED credential is not a credible signal of PSE readiness, particularly in the area of mathematics. GED graduates attain a lower first semester GPA and are also less likely to re-enroll in second semester courses. Differences in the highest level of high school math coursework between GED holders and traditional graduates account for a majority of the observed GED related math-readiness disparities. We also test whether the substantial changes made to the GED exam in 2014 improved student readiness in PSE institutions, however we find no meaningful improvements in PSE math readiness.

Abstract P552: Characteristics of Acute Stroke Intervention Therapies During Covid-19

Background and Purpose: We aimed to investigate the characteristics of acute stroke intervention therapies during coronavirus disease 2019 (COVID-19) pandemic. Methods: The data were obtained from a comprehensive stroke center in the central region of the state of Kentucky in the United States. Pre-COVID period, which is before the first confirmed case in Kentucky, from January 1 to March 5 , 2020, was compared with the COVID period from March 6 to May 9, 2020. The variables included were total number of stroke alerts, final diagnosis of stroke, stroke severity scale, thrombolysis including intravenous and intra-arterial tissue plasminogen activator administration and mechanical thrombectomy. The 2 time periods were compared using nonparametric statistics. Results: Total thrombectomies were increased from median, 3( Interquartile range, 1-7) during pre-COVID period to median of 7( Interquartile range, 2-17, p=0.01) during COVID period. Intravenous thrombolysis and adjunct therapy with intra-arterial thrombolysis did not differ between two time periods. Conclusions: We observed an increase in acute stroke intervention therapies during the surge of COVID-19 cases in Kentucky. This observation could be attributed to the increased association of COVID-19 and acute ischemic stroke.

The Politics of Richard Wright: Perspectives on Resistance. Edited by Jane Anna Gordon and Cyrus Ernesto Zirakzadeh. Lexington: University Press of Kentucky, 2019. 386p. $80.00 cloth, $40.00 paper.

The Politics of Richard Wright: Perspectives on Resistance. Edited by Jane Anna Gordon and Cyrus Ernesto Zirakzadeh. Lexington: University Press of Kentucky, 2019. 386p. 40.00 paper. - Volume 19 Issue 1

Real world clinicopathologic observations of patients with metastatic solid tumors receiving immune checkpoint inhibitor therapy: Analysis from Kentucky Cancer Registry.

The state of Kentucky has the highest cancer incidence and mortality in the United States. High‐risk populations such as this are often underrepresented in clinical trials. The study aims to do a comprehensive analysis of molecular landscape of metastatic cancers among these patients with detailed evaluation of factors affecting response and outcomes to immune checkpoint inhibitor (ICI) therapy. We performed a retrospective analysis of metastatic solid tumor patients who received ICI and underwent molecular profiling at our institution.Sixty nine patients with metastatic solid tumors who received ICI were included in the study. Prevalence of smoking and secondhand tobacco exposure was 78.3% and 14.5%, respectively. TP53 (62.3%), CDKN1B/2A (40.5%), NOTCH and PIK3 (33.3%) were the most common alterations in tumors. 67.4% were PDL1 positive and 59.4% had intermediate‐high tumor mutational burden (TMB). Median TMB (12.6) was twofold to fourfold compared to clinical trials. The prevalence of mutations associated with smoking, homologous recombinant repair and PIK3/AKT/mTOR pathway mutations was higher compared to historic cohorts.PDL1 expression had no significant effect on radiologic response, but PFS improvement in patients with tumors expressing PDL1 trended toward statistical significance (median 18 vs. 40 weeks. HR = 1.43. 95%CI 0.93, 4.46). Median PFS was higher in the high‐TMB cohort compared to low‐intermediate TMB (median not reached vs. 26 weeks; HR = 0.37. 95%CI 0.13, 1.05). A statistically significant improvement in PFS was observed in the PIK3 mutated cohort (median 123 vs. 23 weeks. HR = 2.51. 95%CI 1.23, 5.14). This was independent of tumor mutational burden (TMB) status or PDL1 expression status. PIK3 mutants had a higher overall response rate than the wild type (69.6% vs. 43.5%, OR 0.34; p = 0.045). The results should prompt further evaluation of these potential biomarkers and more widespread real‐world data publications which might help determine biomarkers that could benefit specific populations.

Big Data Interprets US Opioid Crisis

Since 2010, there has been a new round of drug crises in the United States. The abuse of opioids has led to a sharp increase in the number of people involved in drug crimes in the United States. There is an urgent need to explore solutions to the drug crisis in the United States. In this paper, the model of in-depth analysis is established under the condition of obtaining the opioid data and the influence factor data of the large sample of five state[1]. In the first part, we use the Highway Safety Research Institute model based on the differential equation model to predict the initial value, find the initial position of the drug transfer, and obtain the curve of the number of different groups over time by fitting the data, so that the curves can be predicted the changing trends of the groups in the future. It was found that in Kentucky State, the county’s most likely to start using opioids were Pike and Bale. In Ohio, the county’s most likely to start using opioids are Jackson and Scioto. In Pennsylvania State, Mercer and Lackawanna are the counties most likely to start using opioids. Martinsville and Galax are the counties where Virginia State is most likely to start using opioids. Logan and Mingo are the counties where West Virginia State is most likely to start using opioids. In the second part, the gray prediction model is used to further analyze the time series of each factor, the maximum likelihood estimation method is used to obtain the weight of each factor, and the weight coefficient matrix is used to simulate the multivariate regression equation, and the factors that have the greatest influence on opioid abuse are educational background and family composition. In the third part, the hypothesis test model of two groups (the data type is proportional) is used to verify the difference between the influence factors (including the predicted values) in the first two parts of the states, thus verifying the feasibility between them. At the same time, we put forward a few suggestions to combine the current situation in the United States with the CDC data. We believe that in order to address the opium crisis, the U.S. government needs to strengthen not only oversight of doctors' prescriptions, but also make joint efforts of all sectors of society to fundamentally reduce the barriers to the use of opioids.

Effects of Light and Temperature on Germination of Eggert's Sunflower (Helianthus eggertii)

Helianthus eggertii is a rare perennial sunflower of barrens and open habitats in Kentucky, Tennessee, Alabama, and South Carolina in the United States (U.S.). Despite its delisting in the U.S. Endangered Species Act in 2005, little is known about the germination biology of H. eggertii other than seeds require cold stratification for optimal germination. Knowledge about the germination biology of rare species can aid in the management of natural populations and inform strategies for ex situ seed conservation and propagation. We examined how cold stratification, light, and temperature interact to affect seed germination in H. eggertii, and whether germination proportions varied among populations. At the time of maturity in October, seeds have primary physiological dormancy and require cold stratification or prolonged (> 8 wk) incubation in light at cool (15/6 C) temperatures to germinate. Seeds maintained a light requirement for germination when cold stratified in darkness, but not after cold stratification in light. However, seeds germinated to lower proportions after cold stratification in light relative to darkness, and when incubated at temperatures that mimic summer (35/20 C) compared to late spring (25/15 C). Germination varied widely among populations (23-58%), with plants from more open sites exhibiting lower germination proportions than those from partially shaded sites. Our results indicate seeds most likely germinate in early- to mid-spring, and light promotes germination of H. eggertii. Our results highlight the interactive role of light and temperature in determining seed dormancy break and germination in H. eggertii.

Growth Characteristics and Infiltration Rate in Kentucky Bluegrass, Perennial Ryegrass and Tall Fescue Grown under California Soil System in Soccer Field

Growth Characteristics and Infiltration Rate in Kentucky Bluegrass, Perennial Ryegrass and Tall Fescue Grown under California Soil System in Soccer Field