published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

The inmate population is increasing, aging and generally in poorer health than the non-incarcerated population. Providing healthcare to inmates is constitutionally mandated, and expensive. Little published research exists to assist corrections health policy makers strategically plan for future inmate healthcare needs. This research provides an extensive description of the healthcare utilization patterns of a sample of 577 male and female inmates incarcerated at state-operated prisons in Kentucky during the period January 1, 2007, to December 31, 2007 and who have at least one of the chronic conditions of diabetes, hypertension or hyperlipidemia. The primary outcome measures were a count of the number of encounters documented in the inmate‟s electronic health record by 1) medical doctors and advanced registered nurse practitioners (medical care utilization) and 2) psychiatrists and psychologists (mental healthcare utilization), and 3) a dichotomous variable indicating if the inmate had received care from a health provider located outside the prison. The explanatory variables included demographic variables, health status variables, health risk factors, sentence-related variables, facility characteristics, inmate to corrections and medical staff ratios and quality of care indicators. Differences in healthcare utilization between various groups of inmates were tested using Pearson‟s chi-squared test for categorical variables and Student t-test for continuous variables. In the bivariate analysis increasing age, being female, having comorbidities, having a diagnosis of mental illness, being obese, not adhering to diet, exercise and medications, refusing or missing treatment, being at a facility with more corrections or medical staff and having better quality of care were all associated with greater healthcare utilization. Negative binomial regression was used to analyze the count outcomes, and multivariate logistic regression analysis was used to analyze the dichotomous outcome. Regression analysis revealed that the number of problems an inmate had recorded in their electronic health record and increasing age were the two greatest predictors of within facility and secondary healthcare utilization. Carrying out case management and disease management for inmates with comorbidities may have benefits for Departments of Corrections and inmates.

5 pp.

14 pp. / A primary expression of stocking levels on rangeland vegetation is utilization defined as the proportion or degree of current years forage production that is consumed or destroyed by animals (including insects). Utilization may refer either to a single plant species, a group of species, or the vegetation as a whole. Utilization is an important factor in influencing changes in the soil, water, animal, and vegetation resources. The impact of a specific intensity of use on a plant species is highly variable depending on past and present use, period of use, duration of use, inter-specific competition, weather, availability of soil moisture for regrowth, and how these factors interact. Utilization data can be used as a guideline for moving livestock within an allotment with due consideration to season, weather conditions and the availability of forage and water in pastures scheduled for use during the same grazing season. In combination with actual use and climatic data, utilization measurements on key areas and utilization pattern mapping are useful for estimating proper stocking levels under current management. Utilization studies are helpful in identifying key and problem areas, and in identifying range improvements needed to improve livestock distribution.

An experiment involving three feeding trials was conducted to study the effect of substituting chopped wheat straw for alfalfa in diets for lactating dairy cows. The results of these trials have shown that in complete mixed diets or diets containing long alfalfa hay, replacement of half of the alfalfa in rations containing 45% roughage for lactating dairy cows with chopped wheat straw does not adversely affect DM intake or milk yield and increase milk fat percentage. Replacing half of the long alfalfa with chopped alfalfa also apparently improved lactational performance although not as dramatically as that of chopped straw. Ammoniation of wheat straw did not improve the performance response by lactating cows. Inclusion of chopped straw in the diets seemed to enhance the efficiency of milk production. Higher ruminal acetate:propionate ratios and increased digestibility of ether extract resulted from feeding straw. Digestibility of other nutrients were generally either not affected or were depressed by straw feeding. Increasing the chopped wheat straw level to 75% of the roughage resulted in lower DM intake and milk yield and negative body weight gains but higher milk fat levels. It did not appear that maintenance of constant ADF level in a dairy ration regardless of roughage level was the solution to the maintenance of milk fat levels. Thus it has been indicated that under the conditions of this experiment a combination of chopped alfalfa and wheat straw can be used successfully in complete mixed rations for high producing dairy cows. For the most part all productive parameters measured were improved by the addition of straw and by the feeding of complete mixed diets. This was especially true for milk fat which, from a dairyman's viewpoint, is very important because of its impact on milk pricing. It would also have a direct bearing on management by reducing labor costs through elimination of labor intensive handling of long alfalfa. Mechanical handling of complete mixed rations is relatively easier and cheaper.

Four studies were conducted to determine the effect of synchronization of protein and starch degradation on nutrient utilization, microbial protein synthesis and milk production in dairy cows. In Experiment 1, five cereal grains and five protein supplements were compared for extent of solubility and degradability of their starch and nitrogen fractions. Results indicated large differences which permitted their ranking from high to low degradability as follows: grains, oats > wheat > barley > corn > milo protein supplements, soybean meal > cottonseed meal, (CSM) > corn gluten meal > brewers dried grains, (BDG) > blood meal. In Experiment 2, the five grains were incubated for varying times in vitro (with added amylase) or in situ to determine rate and extent of degradation of dry matter, crude protein and starch. Results showed that rate of starch degradation followed a similar, but slightly different trend than in trial 1 (wheat > barley > oats > corn > milo). Rates for DM and CP degradation were similar than those for starch. In Experiment 3, high (barley, HS) and low (milo, LS) degradable starch sources were combined with a high (CSM, HP) and a low (BDG, LP) degradable protein sources to formulate four diets; HSHP, HSLP, LSHP and LSLP. Diets were fed to 32 cows, starting two to four weeks postpartum, for a 60-d milk production and digestibility study. Apparent digestibility was calculated using chromium oxide. Organic matter digestibility was higher (P < .05) was found in nutrient output to the small intestine among diets and microbial CP synthesis was higher (P > .05) for barley diets.

Four experiments were carried out with laying hens to evaluate the effects of body weight, age, dietary protein, and tallow levels on performance, nutrient intake and energy utilization. In the first experiment, Single Comb White Leghorn birds were divided into four body weight groups at the onset of egg production. Voluntary feed intake was 18% less for the lightest (1.39 kg) in comparison with the heaviest group (1.83 kg). Egg weight was directly related to body weight with the heavy birds producing an average egg weighing 65.3 g and the lightest birds having an average egg weight of 58.9 g. Feed conversion was also significantly better for the lighter birds. Maintenance requirements for the heaviest and lightest birds were 60.5 and 57.9% of metabolizable energy consumed, respectively. Metabolizable energy intakes above maintenance were 131 kcal/d for the heavy birds and only 119 kcal for the light group. A composite regression analysis indicated a maintenance requirement of 127.7 kcal/d/kg('0(.)75) and an energetic efficiency of 75.2% for the conversion of metabolizable energy to net energy. In order to evaluate the effects of age and body weight on laying hen performance, the last three experiments were designed using old, molted, and young hens which were divided into the heaviest and lightest body weight groups. The old birds were 72 weeks old, the molted birds were 106 weeks old, and the young birds were 27 weeks old at the start of the studies. In each experiment the birds were fed ten experimental diets with 12, 14, 16, 18, and 20% dietary protein in combination of 1 and 4% supplemental fat. Egg output was increased with the supplementation of tallow in only the young birds; while energy retentions were improved in the old and molted birds with fat feeding. Average energy retentions per kg physiological body weight were 58.8, 41.7, and 38.6 kcal for the young, molted, and old hens, respectively. The light-bodied birds showed 9% better gross energetic efficiencies than the heavy-bodied birds. Estimated daily protein intake requirements were 16.8, 13.3, and 12.8 g/d to support production levels of 84, 64, and 66% for the young, old, and molted birds, respectively.

No description available.