Digital Commons Network^™

Menopause-Related Changes In Sleep And The Associations With Cardiometabolic Health: A Narrative Review, Joshua R. Sparks, Xuewen Wang Ph.D., Faha

Faculty Publications

This narrative review examines the complex relationship between sleep changes during the menopausal transition and cardiometabolic risks. The most common complaint about sleep is increased awakenings during sleep. Other complaints include having trouble falling asleep, waking up too early, insufficient and non-restorative sleep, and overall poor quality. Sleep determined using objective methods also indicates that greater awakenings after sleep onset are associated with the period of menopausal transition. Polysomnography recordings suggest physiological hyperarousal during sleep. Changes in other sleep metrics, such as sleep latency and sleep duration, are less consistent, and some studies suggest they may not worsen during the …

Mental Distress And Resource Insecurity In The Kingdom Of Tonga After The 2022 Volcanic Eruption: Associations Of Water And Food Insecurity With Mental Distress, Hilary J. Bethanancourt, Indira Bose, Lupe Moala Tupou, Melissa Meinhart, Edward A. Frongillo Jr. Ph.D., Amelia Greaves, Sera L. Young

Faculty Publications

Background Water and food insecurity can harm mental health; all 3 may, in turn, be exacerbated by humanitarian crises. The linkages between food insecurity, water insecurity, and mental health are gaining attention but have not been investigated after a natural disaster.

Objective To investigate the associations between food insecurity, water insecurity, and mental distress, and how these relationships may differ between women and men, in the aftermath of the January 15, 2022, volcanic eruption in the Kingdom of Tonga.

Design Secondary analysis of nationally representative cross-sectional data from the Equality Insights Rapid survey collected 4 to 5 months after the …

The Relationship Between Hand Grip Strength And Cognitive Function In Middle-Aged And Elderly People In China: A Cross-Sectional Analysis Based On Charls Data, Haiwei Li, Jing Zhang, Peipei Cheng, Liwei Guo, Xuemei Sui M.D., M.P.H., Ph.D.

Faculty Publications

This study explores the relationship between hand grip strength (HGS) and cognitive function in China’s middle-aged and elderly population. We employed a cross-sectional design using data from 4535 participants aged ≥ 45 years from the 2015 China Health and Retirement Longitudinal Study national dataset. The relationships between HGS and various dimensions of cognitive function, as well as the association between HGS and cognitive impairment, were investigated using ordinary least squares regression models and logistic regression models. Dose–response relationships between HGS and cognitive impairment were modeled using restricted cubic spline curves. Subgroup and sensitivity analyses were performed to assess the robustness …

A Caffeine And Theacrine Combination Improves Cognitive Performance In Tactical Personnel Under Physically Fatiguing Conditions, Blaine S. Lints, Adam T. Harrison, Sten O. Stray-Gundersen, Gianna F. Mastrofini, Riccardo F. Romersi, Noah K. Nakagawa, Mackenzie B. Yonder, Chimaobim E. Martin-Diala, Alexa J. Chandler, R. Davis Moore, Shawn M. Arent Ph.D., Cscs*D, Fissn, Facsm, Fnak

Faculty Publications

Background

Optimizing human performance under stressful physical and cognitive conditions is paramount during high-stakes military operations. As such, interventions to improve warfighter performance by mitigating task-induced cognitive performance deficits are necessary. While caffeine is the most widely consumed psychoactive substance in the world, common side effects (i.e. anxiousness, micro-saccades, irritability) may be detrimental to warfighter operations. Theacrine, a purine alkaloid similar in structure to caffeine but with a longer half-life, less habituation, and fewer side effects, is proposed as a caffeine-alternative to enhance cognitive resilience.

Methods

Tactically trained participants (n = 20; F = 5; M = 16; age …

Community And School Programs, Policies And Environments Related To Child Dietary Intake:The Healthy Communities Study, Gail Woodward-Lopez, Alexander C. Mclain, Edward A. Frongillo Jr., Natalie Colabianchi, Vicki Collie-Akers, Lorrene D. Ritchie

Faculty Publications

Background

To reverse the epidemic of unhealthy eating and related chronic disease in the United States, intervening early in life is essential.

Objective

Identify features of community- and school-based programmes, policies and environments related to child intake of fruits and vegetables (FV) and sugar-sweetened beverages (SSB).

Methods

Dietary intake of children 4–15 years old (n = 5138) from elementary and middle schools in 130 US communities was collected by survey (of parent and/or child) in 2013–2015. Features of community programs and policies (CPPs) and school environments were collected by staff surveys, direct observation, key informant interviews, and/or document review. …

The Effectiveness Of Medical Nutrition Therapy For People At Moderate To High Risk Of Cardiovascular Disease In An Australian Rural Primary Care Setting: 12-Month Results From A Pragmatic Cluster Randomised Controlled Trial, Tracy L. Schumacher, Anna Jansson, Jaimee Herbert, Erin D. Clarke, Carissa Alderton, Penny Milson, Christopher Oldmeadow, Leanne J. Brown, Megan E. Rollo, Annabelle Williams, M Com Nutr, Michelle Guppy, Andrew Boyle, Shanthi Ramanathan, Jennifer T. May Phd, Rn, Anp-Bc, John Attia, Clare E. Collins

Publications

PURPOSE: To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth. METHODS: The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient's general practitioner (GP). In addition to UC, the intervention group received two hours …

Effectiveness Of A Telephone-Delivered Walk With Ease Program On Arthritis-Related Symptoms, Function, And Activity: A Randomized Trial, Christine Pellegrini Ph.D., Sara Wilcox Phd, Yesil Kim, Scott Jamieson, Katherine Devivo, Daniel Heidtke

Faculty Publications

Objective

Walk With Ease (WWE) is a six-week arthritis-appropriate evidence-based physical activity program traditionally offered in a face-to-face format. Because many populations encounter participation barriers to in-person programs, WWE was modified for telephone delivery (WWE-T). The short- and long-term effects of this program on physical activity and arthritis-related outcomes were examined.

Methods

Participants (n = 267) with arthritis were randomized to WWE-T or a wait list control. WWE-T participants received two telephone calls per week (one group and one individual call) for six weeks. Group calls focused on arthritis education and social support. Individual calls focused on problem-solving and goal …

A Tailored Approach To Prep Screening For Awareness And Readiness, Keionda Crumblin Caldwell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Human immunodeficiency virus (HIV) is a serious health concern in the United States (U.S). Pre-Exposure Prophylaxis (PrEP) is a vital intervention in the prevention of HIV, yet its uptake and adherence are suboptimal due to barriers in identifying individuals who are most at risk and would benefit most from this preventive measure.

Purpose: This evidence-based project aimed to evaluate whether implementing a PrEP readiness tool at a walk-in clinic would identify at-risk adults and adolescents and lead to an increase in referrals for PrEP initiation.

Method: A PrEP Questionnaire from the Department of Wisconsin Public Health was given …

Investigating The Ecology Of The Homeless Court: The Promise Of Quasi-Experimental And Statistical Learning Methods, Dylan Wong

Theses and Dissertations

Interactions with the legal system are a crucial factor in maintaining homelessness. Difficulties in addressing legal issues are barriers to accessing services and finding employment and housing. Across the United States, the homeless court is an emerging legal program that has been developed to break this cycle, but they appear to face numerous capacity and coordination problems. Few empirical and systematic investigations have been conducted on homeless court programs. Further, previous studies of homeless courts focus their process and outcome measures on the priorities of the legal system. An investigation into the ecology, or environmental context, of homeless persons would …

Cultural Competency Of Teachers And Its Effect On Their Instructional Practices, Martin Sims

Theses and Dissertations

Core content teachers at S Middle School participate in a study that reveals how increased cultural competency levels among 7^th-grade core content teachers positively influences their instructional practices. The increased cultural competency led to a more inclusive and effective learning environment across all core content areas. Throughout the study, teachers reflected on their own cultural identities while also considering the diverse cultural backgrounds of their students in each class period. As a result, teachers gained a deeper understanding of how cultural factors shape students' learning experiences and needs. The participants adjusted their teaching strategies to better connect with …

Novel Approaches To Combat Neuro-Degradation: Investigations Of Two Supplemental Strategies Aimed At Improving Warfighter Performance, Blaine Lints

Theses and Dissertations

This dissertation examines the efficacy of two distinct nutritional supplementation strategies for improving physical and/or cognitive performance under stress. The first study investigated the effects of 150 mg caffeine plus 150 mg theacrine ingestion in tactically trained individuals. Results indicated that the combination of caffeine and theacrine was associated with significant improvements in reaction time, accuracy, and measures of ocular control following high-intensity interval (HII) exercise. The HII exercise protocol consisted of ten repetitions of 60s high-intensity intervals (≥90% maximal oxygen uptake [VO_2max]) followed by 120s low-intensity intervals (~40% VO_2max) on a treadmill. These benefits were …

Examining The Impact Of Teacher Participation In Pedagogical Content Knowledge Development Intervention On The Academic Achievement Of Culturally And Socioeconomically Diverse Students, Emelyne Viteve Baucicaut

Theses and Dissertations

This action research study examines the impact of a Pedagogical Content Knowledge (PCK) intervention on elementary teachers' instructional practices and student outcomes in Math and English Language Arts (ELA). The goal was to address student underperformance by enhancing teachers' PCK and exploring how improved content knowledge and pedagogical strategies influence classroom teaching and student achievement. Using a concurrent mixed-methods design, baseline data were collected through surveys, classroom observations, and student assessments. Over five weeks, teachers participated in professional development focused on lesson planning, student exemplars, and success criteria. Due to scheduling constraints, computer-based assessments were replaced by analyzing student work …

Camp In The Kitchen: Feminism And Craft In Liza Lou's Beaded Worlds, Aurora X. Bell

Theses and Dissertations

Kitchen (1991–96) was the first major work of art by American artist Liza Lou. It is an installation of a life-size kitchen in which every surface and object is covered in glass beads. Kitchen, which Lou refers to as a monument to women’s unsung domestic labor, received considerable critical attention and drew the artist into ongoing conversations around the relationship between “fine art” and “craft” and about the role of feminism in the art of the 1990s. In contemporary interviews, however, Lou expressed discomfort with the label of “craft” as well as with feminist art that she considered “didactic.” …

Multi-Dimensional Strategies Impacting Beginning Readers’ Word Solving And Engagement, Brooke Clayton

Theses and Dissertations

This dissertation studied the impact of reading instruction on beginner-level readers’ decoding skills and engagement among four first-grade students in Lexington, South Carolina. The following research question directed the study:

Will an instructional strategy foregrounded on direct, systematic phonics instruction in conjunction with multi-dimensional reading strategies improve beginner readers’ decoding skills and engagement?

The study is grounded in several theoretical frameworks, including Scarborough’s Reading Rope (Appendix A), the Simple View of Reading, the Active View of Reading (Appendix C), Onset-Rime phonics instruction, and Self-Determination Theory. Interventions included the LETRS Science of Reading Phonics Small Group Plan (Moats & Tolman, 2019) …

Functional Time Transformation Model With Applications To Digital Health, Rahul Ghosal Ph.D., Marcos Matabuena, Sujit K. Ghosh

Faculty Publications

The advent of wearable and sensor technologies now leads to functional predictors which are intrinsically infinite dimensional. While the existing approaches for functional data and survival outcomes lean on the well-established Cox model, the proportional hazard (PH) assumption might not always be suitable in real-world applications. Motivated by physiological signals encountered in digital medicine, we develop a more general and flexible functional time-transformation model for estimating the conditional survival function with both functional and scalar covariates. A partially functional regression model is used to directly model the survival time on the covariates through an unknown monotone transformation and …

Deprivation And Threat As Predictors Of Executive Functioning And Emotion Regulation In Early Adolescence: The Protective Role Of School Support, Abigail Best De Arellano

Theses and Dissertations

Childhood adversity (CA) impacts a large proportion of US youth with far reaching consequences for development and subsequent health outcomes (McLaughlin et al., 2012). Given the widespread impact of CA, it is imperative to understand how these exposures impact development, as well as identify opportunities for intervention. McLaughlin and Sheridan (2016) proposed the Dimensional Model of Adversity of Psychopathology (DMAP), providing a framework for understanding the heterogeneity of outcomes related to exposure to CA. DMAP emphasizes that deprivation (i.e., lack of expected cognitive or social stimulation) and environmental threat (i.e., exposure to harm or the threat of harm) impacts youth …

Explainable Process Recommendation Through Multi-Contextual Grounding Of Dynamic Multimodal Process Knowledge Graphs, Revathy Venkataramanan

Theses and Dissertations

Can I eat this food or not? Is this food suitable for diabetes and why? Which AI pipeline is best suited for a given task and dataset? How should an end-to-end pipeline be constructed? These questions differ from factual question-answering tasks. Recipes and AI pipelines are processes consisting of several entities interacting with each other. A recipe consists of ingredients, cooking methods, and their interactions, while an AI pipeline includes datasets, preprocessing techniques, models, hyperparameters, tasks, and results. Each entity must be analyzed individually, and collective inferencing is performed to derive the final decision. This decision-making process, known as compositional …

I Belong Here And Am Thriving: Understanding Full-Time Graduate Student Well-Being And Belonging In An Msw Program, Lana Hart Elkins

Theses and Dissertations

Graduate-level social work students face high levels of stress that can impact their academic success and well-being. According to a national college health assessment, fulltime Master of Social Work (MSW) students at a southeastern university report significantly more academic, career-related, and financial stress than peers in other graduate programs. This study addressed the need to better understand full-time MSW student experiences and identify ways the program can mitigate stress, promote wellbeing, and foster a sense of belonging. Using a two-phase qualitative action research design, the study first analyzed responses to 12 open-ended questions from four student feedback surveys. These findings …

Academic Wellness In Health Professional Students: The Intersection Between Dietary Attitudes And Behaviors, Sleep Quality, And Mental Health, Kenya Shereece Moore

Theses and Dissertations

Academic success is strongly influenced by student well-being, with nutrition, sleep, and mental health emerging as critical and interconnected components. Health profession students often face significant mental and physical demands, as they navigate their educational training, which can challenge their ability to maintain healthy behaviors and access necessary support. Although these students are often trained to recognize, treat, and promote wellness in others, they may struggle to prioritize or seek care for themselves. This work aims to explore the health behaviors and care-seeking patterns of health profession students, with a focus on dietary habits, sleep, and barriers to mental health …

The Impact Of Adverse Childhood Experiences And Living With Hiv On Cardiovascular Health And Cardiometabolic Disorders In An African Population: An Analysis Of The Indepth Community In Rural South Africa, Samuel Gavi

Theses and Dissertations

Background: Adverse Childhood Experiences (ACEs) have been shown to be associated with cardiometabolic disorders (CMDs) and poor CVH; however, in Africa, this has not been well studied. Cardiovascular health (CVH) is an important measure of risk for cardiovascular diseases (CVD) developed by the American Heart Association (AHA). With the increasing prevalence of CVD in Africa, CVH is a potential upstream prevention approach. Africa also has the highest prevalence of HIV, and an increasing prevalence of comorbidities associated with it. Various mechanisms have been investigated to explain the relationship between CVD and chronic HIV infection. This study explores the potential relationship …

The Intersection Of Rurality And Wellness: A Multi-Manuscript Investigation Into Rural Well-Being, Lucas Perez

Theses and Dissertations

Rural communities face unique mental health and wellness challenges, including geographic isolation, provider shortages, and stigma surrounding help-seeking. This dissertation explores rural wellness through three interrelated studies, utilizing both qualitative and quantitative methods to examine disparities, perceptions of rurality, and demographic influences on well-being. The first study utilized the Five Factor Wellness Inventory (5F-WEL) to compare wellness scores between rural and non-rural individuals. The second study employed Interpretative Phenomenological Analysis (IPA) to explore rural definitions of wellness, as well as barriers and strengths related to mental health. The third study examined how perceptions of rurality and demographic factors predict wellness …

Exploring The Holistic Wellness Of Black Women Counselors, Shanta A. Jerideau

Theses and Dissertations

Counselor wellness is crucial for clinician longevity and ethical practice. However, there is limited literature on the holistic wellness of Black women counselors. This manuscript probes into the lived experiences of Black women counselors, particularly in relation to the sociopolitical climate and racial injustices in the United States. Utilizing Consensual Qualitative Research, we examine the experiences of 15 Black women counselors working in counselor education, private practice, and community agencies within the Southeast Region of the United States. We anticipate this approach will enhance counselor education literature and foster increased peer support.

Investigating Mechanisms And Day-Level Factors That Influence Children’S 24-Hour Movement Behaviors, Hannah Parker

Theses and Dissertations

Twenty-four hour movement behaviors (i.e., physical activity (PA), screen time (ST), and sleep) are associated with health outcomes, chronic disease (obesity, type 2 diabetes), and mortality. Most literature evaluating children’s 24-hour movement behaviors has focused on static person-level demographic information such as age or biological sex. Relatively less work has examined the variable factors that change day to day, such as environment or context. The Structured Days Hypothesis (SDH) suggests that when children are in structured environments, they have healthier movement behaviors compared to less structured environments where children have more discretionary time to engage in obesogenic behaviors. Besides school/childcare, …

Hypertensive Disorders Of Pregnancy And Perinatal Outcomes: Two Prospective Cohort Studies Of Nulliparous Women In India And Tanzania, Andrea B. Pembe, Pratibha Dwarkanath, Amani Kikula, John Michael Raj, Nandita Perumal Phd, Heavenlight A. Paulo, Rajalakshmi M, Christopher P. Duggan, Honorati M. Masanja, Nandini Chopra, Mary M. Sando, Tinku Thomas, Cara A. Yelverton, Alfa Muhihi, Anura V. Kurpad, Wafaie E. Fawzi, Blair J. Wylie, Christopher R. Sudfeld

Faculty Publications

Introduction Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings. However, in resource-limited settings, studies with robust measurement of HDP, including severity and timing, and perinatal outcomes are limited.

Methods We analysed data from two prospective cohorts of nulliparous women in India (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) who were enrolled in calcium supplementation trials and had blood pressure and proteinuria assessments throughout pregnancy and at the time of labour and delivery. Generalised estimating equations were used to assess the relationship between HDP severity categories (gestational hypertension, preeclampsia …

Associations Between 24-Hour Movement Compositions And Cardiometabolic Health In Children And Adolescents: A Five-Part Compositional Analysis Using Data From The International Children’S Accelerometery Database (Icad), Zoë A. Marshall, Adam Runacres, Pedro Curi Hallal, Russ Jago, Soyang Kwon, Kate Northstone, Russell R. Pate, Jardena Puder, John J. Reilly, Luis B. Sardinha, Niels Wedderkopp, Ester Van Slujis

Faculty Publications

Objectives The benefits of physical activity (PA) and the negative impacts of sedentary time (SED) on health in youth are well established. However, uncertainty remains surrounding how PA and SED jointly influence cardiometabolic risk (CMR) factors. The aim of this study was to determine the joint influence of SED, light-, moderate- and vigorous-intensity PA (LPA, MPA and VPA), and sleep on CMR factors using five-part compositional analyses.

Methods Data were pooled from 16 cohort studies comprising 22 474 children and adolescents from the International Children’s Accelerometery Database. PA was measured using hip-mounted accelerometers with sleep self-reported. CMRs included body mass …

Implementation Outcomes And Associated Constructs From The Consolidated Framework For Implementation Research Among Churches Trained Online To Implement Faith, Activity, And Nutrition In A National Implementation Study, Sara Wilcox Phd, Ruth P. Saunders Phd, Andrew T. Kaczynski Ph.D., Caroline Rudisill Ph.D., Msc, Ye Sil Kim Phd, Jasmin Parker-Brown, Kelsey R. Day

Faculty Publications

Churches hold promise for reaching populations with high rates of chronic disease, yet few faith-based large-scale implementation studies exist. The study purpose was to examine 12-month implementation outcomes and associated Consolidated Framework for Implementation Research (CFIR) constructs after converting in-person training to online for an evidence-based intervention designed to improve church organizational practices related to physical activity (PA) and healthy eating (HE). US churches recruited from 2020 to 2022 participated in eight online lessons prior to implementation. Each church’s coordinator completed an online baseline and 12-month survey assessing church practices for PA/HE components targeted in the Faith, Activity, and Nutrition …

Integrating Community Assets, Place-Based Learning, And Career Development Through Project-Based Learning In Rural Settings, Denae Kizys, Christine Lotter Ph.D., Lucas Perez, Rachel Gilreath, Dodie Limberg

Faculty Publications

Our study investigates the first year of a two-year place-based education (PBE) professional development model that focuses on career development in rural middle schools through project-based learning (PBL) units. Rural science, technology, engineering, and mathematics (STEM) educators face unique challenges, including geographic isolation, limited resources, and reduced access to professional development opportunities, which can hinder the effective integration of career-oriented learning in the classroom. We addressed these challenges by implementing professional development in which school counselors and teachers collaborate to design PBL units aligned with rural community local needs and STEM careers. Using a descriptive multiple-case study methodology to document …

Multiagent Copilot In Industrial Ai Applications, Chathurangi Shyalika, Renjith Prasad, Utkarshani Jaimini, Cory Henson, Fadi El Kalach, Amit Sheth

Publications

In the era of smart automation and digital transformation, achieving efficiency, precision, and adaptability is essential for industries to remain competitive. Sectors, including manufacturing, supply chain and logistics, healthcare, finance, and retail, face significant challenges in deploying Artificial Intelligence (AI) solutions tailored to their unique needs, particularly in critical, resource-constrained applications. According to Gartner’s 2024 Hype Cycle for Artificial Intelligence, composite AI, which integrates techniques like machine learning, knowledge graphs, and rule-based systems, is becoming foundational for industries, enhancing predictions, decisions, and scalability across complex environments.

The complexity of real-world systems requires Industrial AI solutions to be customizable to business …

Pulse Pressure, White Matter Hyperintensities, And Cognition: Mediating Effects Across The Adult Lifespan, Jade Hannan, Sarah Newman-Norlund, Natalie Busby, Sarah C. Wilson, Roger Newman-Norlund, Chris Rorden, Julius Fridriksson Ph.D., Leonardo Bonilha

Faculty Publications

Objectives: To investigate whether pulse pressure or mean arterial pressure mediates the relationship between age and white matter hyperintensity load and to examine the mediating effect of white matter hyperintensities on cognition.

Methods: Demographic information, blood pressure, current medication lists, and Montreal Cognitive Assessment scores for231 stroke- and dementia-free adults were retrospectively obtained from the Aging Brain Cohort study. Total WMH load was determined from T2-FLAIR magnetic resonance scans using the TrUE-Net deep learning tool for white matter segmentation. In separate models, we used mediation analysis to assess whether pulse pressure or MAP mediates the relationship between age and total …

Pulse Pressure, White Matter Hyperintensities, Andcognition: Mediating Effects Across The Adult Lifespan, Jade Hannan, Sarah Newman-Norlund, Natalie Busby, Sarah C. Wilson, Roger Newman-Norlund, Chris Rorden, Julius Fridriksson, Leonardo Bon, Nicholas Riccardi

Faculty Publications

Objectives: To investigate whether pulse pressure or mean arterial pressure mediates the relationship between age and white matter hyperintensity load and to examine the mediating effect of white matter hyperintensities on cognition.

Methods: Demographic information, blood pressure, current medication lists, and Montreal Cognitive Assessment scores for231 stroke- and dementia-free adults were retrospectively obtained from the Aging Brain Cohort study. Total WMH load was determined from T2-FLAIR magnetic resonance scans using the TrUE-Net deep learning tool for white matter segmentation. In separate models, we used mediation analysis to assess whether pulse pressure or MAP mediates the relationship between age and total …