Digital Commons Network^™

Emergency Department-Initiated Standard Versus High-Dose Buprenorphine Induction (Envision): A Randomised Clinical Trial Protocol, Kathryn Hawk, Andrew Herring, Marek Chawarski, Erik S. Anderson, Michael Baumann, Alyrene Dorey, August F. Holtyn, Christopher Jones, Shara Martel, Patricia Owens, Kaitlin Kmiecik, Tania D. Strout, Peter Taillac, Michelle R. Lofwall, Sharon L. Walsh, Gail D’Onofrio

Center on Drug and Alcohol Research Faculty Publications

Introduction: The initiation of buprenorphine for patients with opioid use disorder (OUD) in the emergency department (ED) has been associated with improved outcomes including reduced ED visits and increased treatment engagement. Though both standard-dose (8 mg buprenorphine equivalent) and high-dose (24 mg buprenorphine equivalent) strategies to initiate buprenorphine have been used in the ED, no prospective trials comparing outcomes among patients receiving these treatments have been reported.

Methods and analysis: This multisite randomised clinical trial is a multisite double-blind, double-dummy, randomised clinical trial enrolling 360 emergency department patients with moderate-to-severe OUD. Enrolled patients will be randomised to one of two …

Evolution Of A Client‐Level Dataset: 20 Years Of National Child Traumatic Stress Network Data Collection, C. A. Purbeck, A. N. Cooke, L. J. Liang, C. Smith, J. Staten, J. Epstein, H. B. Hodgdon, Jessica Eslinger, A. Wells, J. Goodrich, T. H. Bethel, K. Willett, Y. C. Fu, J. A. Fairbank, E. C. Briggs

Center on Trauma and Children Faculty Publications

Objectives: For 20 years, the National Child Traumatic Stress Network's (NCTSN) data collection efforts have been a central mechanism for Clinical Quality Improvement (ClQI). The NCTSN is a federally funded initiative in the United States composed of programs dedicated to raising the standard of care and increasing access to services for children and families who have experienced traumatic events.

Methods: These efforts span three initiatives: the Core Data Set (CDS), the Clinical Improvement through Measurement Initiative (CIMI) Measurement Based Care (MBC), and CIMI Data Sharing (CIMI-DS) that collected and analyzed client-level data to improve care for children and families served …

Music-Based Storytelling For Older Adult Well-Being: An Adapted Multiple Case Study, Zachary Michael Palma

Theses and Dissertations--Music

Autobiographical storytelling can be a meaningful way for older adults to reflect on life experience and support social and emotional well-being. Music has been widely documented as a cue for autobiographical memory. Although the benefits of storytelling and music as a memory cue have been independently examined, limited research has explored its combination with older adults. The purpose of this study was to explore music-based autobiographical storytelling in the lives of older adults. There were three research questions: (1) How do older adults describe their experiences with music-based storytelling? (2) How do they describe the social experience with music-based storytelling? …

Contemporary Commercial Music: A Scoping Review With Implications For Music Therapy Practice, John A. Lawwill

Theses and Dissertations--Music

Contemporary Commercial Music (CCM) is an increasingly popular group of non-classical musical styles. Music therapists need to know how to sing a wide variety of CCM genres authentically, yet little information exists on effectively teaching vocal CCM techniques to music therapists. The purpose of this study was to conduct a scoping review on CCM singing instruction and to synthesize implications for music therapists. I used EBSCOhost and ProQuest to search for reports in English published after 2002 containing the terms “Contemporary Commercial Music” or “CCM,” and variations of the term “sing.” I identified 26 reports that met inclusion criteria, including …

Structuring The Musical Year: Dance, Topic, And Semiosis In Eighteenth-Century Calendar Music, Braden Shaw

Theses and Dissertations--Music

In this thesis, I apply a multifaceted analytical approach to examine a niche category of music called calendar music. In chapter one, I discuss Gregor Joseph Werner’s composition, the New and Very Curious Musical Calendar, and specifically address the minuets found within this work. Werner composes irregular measure groupings in his binary minuets and did so to represent the number of hours in day and night. This irregularity of measure groupings might superficially suggest that Werner’s pieces are stylized minuets only, unintended to accompany physical dancing and far removed from any actual choreographic influence of embodied performance. Werner, …

Belting In Musical Theatre: Vocal Pathologies, Injuries, And Pedagogical Implications, Kaylee Piatt

Theses and Dissertations--Music

Belting has become one of the most defining and contested vocal styles in contemporary musical theatre. Valued for its dramatic immediacy, speech-like intensity, and ability to cut through amplified orchestration, belting is frequently associated with heightened injury risk and pedagogical controversy. This thesis examines the relationship between belting, vocal pathology, and pedagogy through an interdisciplinary lens that integrates voice science, clinical literature, and professional performance practice. Rather than framing belting as an inherently harmful or stylistically aberrant technique, this study conceptualizes belting as a functional vocal coordination shaped by physiological mechanisms, cumulative vocal load, and occupational demands.

Drawing on existing …

Reimagining The Reduction: A Pianist’S Guide To The Piano Reductions Of Korngold’S Violin Concerto And Vaughan Williams’S Tuba Concerto, Zhongyue Zhang

Theses and Dissertations--Music

Piano reductions are an essential medium through which collaborative pianists work with orchestral concertos. However, many existing reductions, particularly of 20th century works, hinder effective performance in terms of orchestral fidelity and feasibility of execution. The problem is twofold: reductions may contain technically cumbersome passages with diminishing musical returns; they may also omit or misrepresent important orchestral effects and textures. For these problematic situations, this work presents pianistic revisions that aim to preserve essential orchestral sound characteristics. Using the first movements of Erich Wolfgang Korngold’s Violin Concerto and Ralph Vaughan Williams’s Tuba Concerto as examples, this work demonstrates a systematic …

A Conductor's Guide To All-State Orchestra: An Overview Of Repertoire And Best Practices, Nicoletta Moss

Theses and Dissertations--Music

For over one-hundred years, all-state orchestras have served as the premier gatherings of high school musicians across the United States. These short-term events offer intensive ensemble experiences that bring together students from diverse musical and social backgrounds. While conductors play a central role in shaping these experiences, research is limited examining the areas of repertoire programming, pedagogical practices, and other logistical considerations associated with all-state orchestra leadership. In this dissertation, I address these gaps and develop a comprehensive resource for current and future all-state conductors. The present study employs a two-study design: 1) a content analysis of repertoire performed between …

A Method For Beginners Volume 1: The Intersection Of The Yaqui Tribe And Guitar Pedagogy, Daniel Preciado Arreola

Theses and Dissertations--Music

This dissertation is divided into four chapters. The first is an introduction explaining the project; the second describes the Yaqui Tribe's background, significance, and musical traditions, primarily based on three sources: the thesis Sones de Pascola by Cristian Salvador Islas Miranda, the biographical book El Viaje de Mechabili by Daniel Librado Luna, and the album Juya Ánia. The third chapter details the methodological framework and development process used to construct the guitar method presented in Chapter 4. This fourth chapter consists of the first volume of an ongoing multi-volume guitar method—authored by me—focused largely on the melodies from the aforementioned …

Implementations Of Improvisation And Existing Materials In Electroacoustic Composition, Jeffrey Todd-Voyten

Theses and Dissertations--Music

I have developed my compositional process through the use of sound synthesis, existing materials, and improvisation. When combining these techniques and resources, human gestures can emerge from inhuman materials in a dialogue between machines and humans. This thesis is an overview of my initial inquiries into the continuum of human agency and machine intervention, considering aspects of patch-programming, formal structure, and performance practice. In addition to the aforementioned compositional methods, this thesis also considers musico-dramatic meaning and personal musical influences outside the scope of electroacoustic music.

A Technical And Performance Re-Examination Of Mario Castelnuovo-Tedesco’S Escarramán, Op. 177: Beyond The Angelo Gilardino Publication. A New Performance Edition Of Gallarda, Daniel Monroy Reyes

Theses and Dissertations--Music

This dissertation provides a technical and performance-oriented re-examination of the first four movements of Escarramán: A Suite of Spanish Dances from the XVIth Century (After Cervantes), Op. 177, by Mario Castelnuovo-Tedesco. It argues that the suite embodies a fundamental tension between the composer’s original compositional and structural intentions and the ergonomic limitations of the guitar, and evaluates the proposed solutions by Angelo Gilardino in the 1979 Bèrben edition.

This research employs a comparative, practice-led framework to address the paradox of Castelnuovo-Tedesco’s non-idiomatic writing. Its primary contribution is the development of a performance synthesis that maintains harmonic integrity while enhancing …

Cantate Fratres: Forming And Sustaining Traditional Catholic Music, Liturgy And Culture In The Institute Of Christ The King Sovereign Priest, Reyers P. Brusoe

Theses and Dissertations--Music

The Institute of Christ the King Sovereign Priest is an understudied member of the Traditional Catholic and Latin Mass Communities whose unique approach to Catholic liturgy, culture, and formation offers a sustainable model for the Catholic Church's longevity and renewal. This study is the first of its kind, combining the theoretical positions of affect theory, ecomusicology/musical sustainability, and the musicology of religion to explore and explain the success of this growing classical community. This dissertation examines Church documents, theological literature, and multidisciplinary academic sources as a foundation for the study.             In studying the Institute of Christ the King Sovereign Priest, …

Burnout And Mindful Self-Care Practices Among Bipoc Women Music Therapists: A Cross-Sectional Survey, Melissa V. Peters

Theses and Dissertations--Music

Music therapy as a profession has long acknowledged burnout as a significant occupational concern, yet the experiences of marginalized therapists remain understudied. In particular, little research has explored how burnout and self-care manifest for those who identify as Black, Indigenous, or People of Color (BIPOC) women in a field historically dominated by white women. Most of the existing literature on this topic is focused on the majority identity of music therapists, white women. The purpose of this thesis was to examine the reported levels of burnout among BIPOC women music therapists as well as their reported frequency of engagement in …

The Ache Of Modernism: Death, Affect, And Intersubjectivity In Twentieth-Century American Literature, Alex Gergely

Theses and Dissertations--English

This dissertation suggests that we can locate, describe, and experience death as an aesthetic mood called the ache of modernism. The ache is an atmosphere found in twentieth-century literature that goes beyond simply “positive” or “negative” feeling and encourages audiences to come to an affective and existential relationship with their mortality. As an intersubjective mood deriving from an attunement on death, it illuminates the historical and philosophical moment of many twentieth-century authors while clarifying their texts’ continued resonance today. This project therefore draws on the thought of major philosophers like Emmanuel Levinas, Martin Buber, Gabriel Marcel, Maurice Merleau-Ponty, Heidegger, …

Cultus: Eco-Phenomenology In The Work Of John Steinbeck, Robinson Jeffers, And Jack London, Carter D. Johnson

Theses and Dissertations--English

In the face of increasingly dire environmental crises, proposed solutions have gravitated toward imperatives for faster, cleaner, and more efficient technologies and resources. While practical solutions are necessary, they are entirely insufficient to deal with an underlying issue driving environmental degradation: unbridled instrumental reason. In this dissertation, I suggest a theoretical posture, cultus, which attempts to balance the necessity of instrumental action with the guiding counterweight of receptivity. Furthermore, I argue that such personal receptivity is uniquely fostered in aesthetic experiences, attuning the individual to the non-identical and renewing a relationship of care.

I examine the life and work of …

We Need To Care About Care: (Un)Caring Relations In Victorian Fiction, Roslyn Fleming

Theses and Dissertations--English

The professionalization and institutionalization of care in the Victorian era ushered in a growing societal concern about the pitfalls of care being “systematized and depersonalized” and treating people as burdens, problems to be solved. Given the increasing attention paid to people’s welfare and well-being during this period, the cultural shift from intimate community care to professional and institutional care, and the growing stigmatization of disabled bodyminds, the fiction produced amidst these cultural changes makes a compelling site for a study of care. Critical scholarship attending to Victorian novels’ representations of care, however, has largely concentrated on specific categorizations of care …

The Impact Of Congenital Heart Disease On The Timing Of Alzheimer's Disease In Down Syndrome, Julianne G. Clina, Brian C. Helsel, Sigan L. Hartley, David A. White, Victoria L. Fleming-Batayneh, Benjamin Handen, Bradley Christian, Elizabeth Head, Mark Mapstone, Christy L. Hom, Beau Ances, Jeffrey Burns, H. Diana Rosas, Florence Lai, Sharon Krinsky Mchale, Joseph H. Lee, Frederick A. Schmitt, Jordan Harp, Ira T. Lott, Shahid Zaman, Lauren T. Ptomey

Neurology Faculty Publications

INTRODUCTION: The incidence of Alzheimer's disease (AD) in Down syndrome (DS) exceeds 90%. Approximately 50% of people with DS have congenital heart disease (CHD). Having CHD increases risk for early-onset AD in populations without DS, but it is unclear if CHD influences AD in DS. METHODS: Data from the Alzheimer Biomarker Consortium-Down Syndrome (ABC-DS) were used. Participants with CHD (n = 82, mean age = 39.9 ± 8.5 years, 97.6% White race) were age- and sex-matched to participants without CHD (n = 82, mean age = 40.5 ± 8.1 years, 98.8% White race). Cognitive assessments and Centiloid load (CL) (positron …

Impact Of Covid-19 Positive Status On Outcome For Individuals With Stroke Treated In Acute Inpatient Rehabilitation, Amy Ziems, Christopher J. Mclouth, Nicholas Elwert, Elissa Charbonneau, Joseph Stillo, Susan Mcdowell

Neurology Faculty Publications

Background: Stroke, whether or not accompanied by concurrent COVID-19 infection, has been associated with varying acute care outcomes, with patients who are COVID-19 positive typically faring worse. This study aims to explore the functional outcomes of patients with stroke —with and without simultaneous COVID-19 infection—who survived their acute care stay and progressed to acute inpatient rehabilitation (IRF). Objectives: To identify differences in sociodemographic factors, medical complexity, and rehabilitation outcomes from an IRF stay between patients with stroke with concurrent COVID-19 and those without. Design: A retrospective, observational cohort study using electronic medical records (EMR) data. Setting: EMR data from 138 …

Decoding The Human Pbmc Isonome, Patricia Hayes Doyle, Madeline L. Page, J. Anthony Brandon, Bernardo Aguzzoli Heberle, Brendan J. White, Ann Marie Stowe, Mark T.W. Ebbert

Neurology Faculty Publications

Long-read single-cell RNA sequencing provides an opportunity to understand human health and disease at a level difficult to resolve with bulk or short-read methods. This approach enables isoform-level investigation of cellular diversity and disease mechanisms and definition of cell-types, rather than using genes alone. Using a modified, microfluidic-free PIPseq workflow and computational pipeline adapted for Oxford Nanopore long-read sequencing, we generated the largest long-read single-cell dataset of human peripheral blood mononuclear cells (PBMCs) from a single donor to date, the first with sufficient cell numbers to detect megakaryocytes. This study profiled isoform usage across immune cells, integrating marker expression and …

Climate Change Effects On Biomass And Greenhouse Gas Emissions Are Ameliorated By Nontoxic Endophytes In Southeastern Usa Transition Zone Tall Fescue Pastures, Rebecca Kay Mcgrail, Jonathan D. Moore, A. Elizabeth Carlisle, Jim A. Nelson, Rebecca L. Mcculley

Plant and Soil Sciences Faculty Publications

Background: The plant–microbe interaction between tall fescue and its endophyte Epichloë coenophiala can affect ecosystem responses to changing rainfall patterns and increasing temperatures. Endophyte-infected (E+) stands often exhibit improved stress tolerance and differing soil greenhouse gas (GHG) emissions compared to endophyte-free (E−) stands. However, it is unknown if mammalian nontoxic endophyte (NTE) strains introduced into some tall fescue cultivars confer differing stress tolerances or reduce soil GHG emissions.

Methods: We quantified the impact of fescue-NTE symbioses in Jesup and Texoma on biomass and GHG emissions in response to increased temperature (+3°C) and altered precipitation (50% lengthened interval between events) using …

A Global Synthesis Of Fragipan Silicon Concentrations And Relationships With Soil Physicochemical Properties As A Function Of Soil Parent Materials, Christopher Shepard

Plant and Soil Sciences Faculty Publications

Fragipans are dense, brittle subsurface horizons that restrict root growth and limit water-holding capacity. A common factor in these soils is a binding agent, potentially either phyllosilicate clay bridging, amorphous aluminosilicate/silica, or silica sorbed to Fe oxides. Others have suggested that no binding agent is present within these soil horizons and that the arrangement of individual particles is solely responsible for these horizons. In this article, a secondary data synthesis was utilized to demonstrate that silicon (Si) accumulation is a key pedogenic process in loess-derived fragipan horizons, but not in all fragipans. The average dithionite-extractable Si (Si_d) content …

Disrupted Circadian Rhythms Affect Hallmark Pathologies In Alzheimer’S Disease-Related Mouse Models, Valeria Buzinova

Theses and Dissertations--Molecular and Cellular Biochemistry

Alzheimer’s Disease (AD) is a complex neurodegenerative disease with two hallmark pathologies: extracellular amyloid-b (Ab) and intracellular neurofibrillary tangles (NFTs). Ab is proteolytically processed from amyloid precursor protein (APP) by b-secretase and g-secretase as a monomeric peptide prone to aggregation. Eventually, the aggregate-prone monomers will form dense plaques that are difficult to break down and remove. These plaques begin to deposit into the cortex decades prior to the formation of NFTs and the onset of cognitive decline. NFTs are comprised of hyper-phosphorylated tau. Tau is a protein that serves to promote and stabilize the formation of microtubules. The formation of …

Positive Developmental Cascades, Melody R. Altschuler, Xiaoran Tong, Punit Shah, Edelyn Verona, Julianne M. Bowling, Robert F. Krueger, Roman Kotov, Jordan H. Mcallister, Michaela Voit, Sachina Paudel, Scott C. Leon, Shashwat Kala, John S. Lyons

Psychiatry Faculty Publications

Background: Strength development in children across a range of psychiatric diagnoses may reduce needs for mental health, social, and functioning support over time. A strength-based adjunct to child and adolescent mental health may foster the developmental context most helpful for achieving desired outcomes with positive developmental cascading effects. Methods: We longitudinally examined changes across 5 years in the Child and Adolescent Needs and Strengths Assessment in 2- to 18-year-old children (N = 30,103) from a public mental health system. Results: First, children who began with a greater number of strengths consistently had fewer support needs, not only at entry but …

Eigenvalue Spacing Distributions And The Weak Disorder Limit For Random Schrodinger Operators, Kyle E. Hammer

Theses and Dissertations--Mathematics

We study a collection of discrete Schrodinger Operators with random potentials through the lens of global and local eigenvalue spacings. We discuss the three models: the standard scaled disorder Anderson Model, the Anderson-Bernoulli Polymer Model, and the Discrete Fractional Laplacian Anderson Model. First, we discuss the scaled disorder case using the invariant measure and its application to the density of states in the weak disorder limit. We also prove the limit of the local and global eigenvalue spacings in the non random case, and demonstrate numerically how randomness affects the eigenvalue spacings. We then discuss a special family of random …

Spectral Properties And The Behavior Of The Current-Current Correlation Measure For The Luttinger-Sy Model, Jonathan Benoit

Theses and Dissertations--Mathematics

The Luttinger-Sy Model, sometimes referred to as the Pieces Model, is a Random Schrodinger Operator on L²(R) which is characterized in part by "pieces" whose endpoints are chosen by a Poisson Point Process. The Hamiltonian in this setting is then given as a direct sum of Laplacians with Dirchlet boundary conditions on each piece. In this work, we show several spectral properties of the Luttinger-Sy Model, including proving the deterministic spectrum is [0,infinity) and that a Wegner-type and Minami-type estimate both hold. Additionally, we show that the finite-volume Current-Current Correlation Measure is singular continuous with respect …

A Major Update And Improved Validation Functionality In The Mwtab Python Library And The Metabolomics Workbench File Status Website, P. Travis Thompson, Hunter N. B. Moseley

Markey Cancer Center Faculty Publications

Background: The Metabolomics Workbench (MW) is a public scientific data repository consisting of experimental data and metadata from metabolomics studies collected with mass spectroscopy (MS) and nuclear magnetic resonance (NMR) analyses. Although not as rapidly as in the past, MW has steadily evolved, updating its mwTab and JSON deposition text file formats and its web-based infrastructure. However, the growth of MW has been exponential since its inception in 2013 and continues to be exponential, with the number of datasets hosted on the repository increasing by 50% since April 2024. As part of regular maintenance to keep up with changes to …

Case Report: Prolonged Response To Cabozantinib And Pembrolizumab In Treatment-Refractory Metastatic Pancreatic Ductal Adenocarcinoma, Anna M. Reagan, Hannah G. Mcdonald, Jaewon Kang, Hoda Saghaeiannejad Esfahani, Caroline G. Wright, Charles J. Bailey, Carleton S. Ellis, Kaylyn R. Collette, Reema A. Patel, Mayte Murillo, Samantha F. Stokley, Michael J. Cavnar, Prakash Pandalai, Mautin T. Barry-Hundeyin, Jessica Moss, Joseph Kim

Markey Cancer Center Faculty Publications

Immunotherapy has yet to demonstrate durable efficacy in pancreatic ductal adenocarcinoma (PDAC) despite the fact that pancreatic cancer cells have higher levels of immune checkpoint expression than other cancer cell types in which immunotherapy efficacy has been well established. We observed effective cytotoxicity with the combination therapy of pembrolizumab (an anti-PD-1 monoclonal antibody, mAb) and cabozantinib (an anti-MET small molecule) in vivo. This served as the basis for an investigator-initiated phase II clinical trial (NCT05052723). The trial was open to patients with treatment-refractory metastatic PDAC with a single-arm treatment protocol of pembrolizumab and cabozantinib. Here, we report the case of …

Mental Health Needs Of Families Of Patients In Intensive Care Units And The Role Of Mobile Health: Survey Study, Anthony Faiola, Saira Soroya, Zhonglin Hao, Reinhold Munker

Markey Cancer Center Faculty Publications

Background: The experiences of patients with COVID-19 and their families manifested the most devastating effects of family separation since the 1918 Spanish influenza pandemic and, with it, a call for solutions to patient isolation and its effect on family mental health.

Objective: This study examined the recent experiences of families of critical care (intensive care unit; ICU) patients related to anxiety and depression (AD), satisfaction with clinician-family communication, and counseling from mental health and social services. This study explored correlations between these factors and family interest in mobile health (mHealth) designed to improve information flow and communication from patient bedside …

Eef2k Promotes Immune Evasion In Melanoma Via Cyclin D1–Mediated Stabilization Of Pd-L1, Yijie Ren, Darby J. Ballard, Anil Kumar, Andy F. Song, Mitiksha Gupta, Xiaofang Xiong, Xingcong Ren, Jugal Kishore Das, Jin-Ming Yang, Jianxun Song

Markey Cancer Center Faculty Publications

Eukaryotic elongation factor 2 kinase (eEF2K) is a stress-responsive regulator of protein synthesis implicated in melanoma progression, but its role in tumor immune evasion remains poorly defined. We investigated how eEF2K influences programmed death ligand 1 (PD-L1) expression through modulation of Cyclin D1. We analyzed gene expression and dependency datasets from The Cancer Genome Atlas and the Cancer Dependency Map. Protein–protein interactions were assessed by co-immunoprecipitation. Cyclin D1 was inhibited pharmacologically with palbociclib. Immune responses were evaluated in murine B16-OVA and human A2058 melanoma models using flow cytometry and immunohistochemistry after genetic or pharmacologic modulation of eEF2K and Cyclin D1. …

Soil Solarization As A Sustainable Approach To Manage Weeds And Arthropod Pests, And Its Effects On Soil Nitrate And Lettuce (Lactuca Sativa L.) Yield In Kentucky And Tennessee High Tunnels, Paula Luize Lessmann

Theses and Dissertations--Plant and Soil Sciences

The use of high tunnels (HTs) has increased over the past 15 years, with more than 1,700 and 700 structures currently in Kentucky and Tennessee, respectively. High tunnels are widely used to extend the growing season and protect specialty crops from adverse weather conditions. However, continuous production and limited crop rotation within HTs can lead to the accumulation of soilborne pathogens, plant-parasitic nematodes, arthropod pests, and weeds, ultimately reducing crop yield and quality. Management of these biotic issues is particularly challenging in HTs due to limited pesticide options compared to open field production. Soil solarization, a non-chemical method that uses …