Digital Commons Network^™

From Awareness To Action: Improving Advanced Directives With The Five Wishes In College Aged Young Adults, Dina M. Giovanetti

Electronic Theses and Dissertations

This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of …

Avaren-Fc's Effects On Lymphoma Cells., Jacob Hahn

Electronic Theses and Dissertations

This thesis investigates the therapeutic potential of Avaren-Fc (AvFc), a novel lectin fusion protein that integrates the Fc region of human IgG1 with the engineered lectin Avaren, specifically targeting lymphoma. The study delineates the in vitro binding capabilities of Avaren-Fc with a human B-cell lymphoma cell line, a canine B-cell lymphoma cell line, healthy canine peripheral blood mononuclear cells (PBMCs), and healthy human PBMCs. AvFc was shown to exhibit significant binding to human lymphoma cells. Furthermore, the direct cytotoxicity of Avaren-Fc against canine lymphoma cells, canine lymphoma cells and healthy canine PBMCs was assessed. It was found that there is …

Examing Fear Conditioning/Extinction And The Role Of The Amygdala In Human Neuroimaging., Olivia Cook

Electronic Theses and Dissertations

Fear plays a crucial role in survival but can lead to psychological disorders when dysregulated. Fears can be innate due to evolutionary relevance or learned through associative processes, where predictive accuracy of threat is pivotal. Disruptions in fear neurocircuitry contribute to anxiety disorders, characterized by heightened activation and impaired learning. Fear conditioning and extinction paradigms based on classical Pavlovian conditioning have been used to study mechanisms underlying fear learning. Using this experimental model, fear networks in rodents have been described in detail with clear distinction between conditioning and extinction neural functioning. Yet, there is no consensus on the neurobiological processes …

Experiences Of Title Ix Hearing Panel Members., Amanda Gage Stonecipher

Electronic Theses and Dissertations

The number of allegations of sexual misconduct on college campuses has been increasing over the past decade and higher education institutions are charged with addressing the misconduct. Addressing student behavior on college campuses through a conduct process is woven into the fabric of higher education, and many institutions use a hearing panel model to determine if institutional policies were violated. My research aims to explore how student conduct hearing panel members process the tension between the emotional management required when hearing intimate and traumatic details of a sexual misconduct case. The data for this research were collected via semi structured …

The Role Of Law Enforcement In Sexual Assault Kit Submissions: A Statewide Analysis Of Decision-Making Processes & Focal Concerns In Kentucky., Rychelle Elizabeth Wilks

Electronic Theses and Dissertations

Sexual assault case attrition persists throughout the criminal justice system, partly due to inconsistent Sexual Assault Kit (SAK) submission decisions. This dissertation examines factors influencing police officers' decisions to submit SAKs for forensic testing, applying the focal concerns perspective to understand how legal and extra-legal characteristics shape these decisions. Using statewide Kentucky data from July 2007 to March 2018, this study analyzed 2,194 adult sexual assault cases from 192 law enforcement agencies. Of these cases, 1,520 (69.3%) resulted in SAK submission. Logistic regression analyses examined the full sample, as well as four subsamples. Results provide mixed support for focal concerns …

Characterizing The Ethanol Sensitivity Of The Planar Cell Polarity Pathway In Endoderm Morphogenesis And Jaw Development., Raéden Omneil C. C. Rolle Gray

Electronic Theses and Dissertations

Fetal Alcohol Spectrum Disorders (FASD) describes a large range of developmental defects due to prenatal alcohol exposure. It is characterized by neural and facial defects, including jaw hypoplasia. Many factors contribute to the susceptibility of ethanol-induced facial defects, including genetics, yet the genes involved, and the cell events they regulate, are poorly understood. Zebrafish have a large number of tools for genetic manipulation available, share 70% of genes with humans, are fertilized externally and are translucent during embryogenesis, making them great models to study FASD. Previous studies show that two members of the Planar Cell Polarity (PCP) pathway, zebrafish vangl2 …

Safety Evaluation Of Epicertin, An Oral Biotherapeutic Candidate For Treating Ulcerative Colitis: A 28-Day Repeated Dose Toxicity Study., Jimmy Fernando Cifuentes Jimenez

Electronic Theses and Dissertations

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic, relapsing inflammation of the colon and rectum with limited treatment options. Among them, immunosuppressive agents have a high rate of adverse side effects and do not cure the disease. EPICERTIN (EPT), a recombinant variant of the cholera toxin B subunit (CTB) with a C-terminal hexapeptide extension consisting of a KDEL endoplasmic reticulum (ER) retention motif, is a promising oral biotherapeutic candidate for the treatment of UC. EPT has demonstrated mucosal healing activity in mouse models of colitis and human colonic explants. EPT's mechanism of action involves binding to GM1 …

Congolese Mothers' Beliefs That Influence Health-Seeking Behaviors For Their Infants., Shawn Meiman

Electronic Theses and Dissertations

In 2024, approximately 100,000 refugees were admitted to the United States, with 20% coming from the DRC, while Kentucky continues to rank fourth in the country for refugee resettlement. The increasing number of Congolese refugee children in the United States and Kentucky necessitates a greater understanding of these beliefs and practices to ensure equitable, quality, and culturally informed health services. The purpose of this study was to explore Congolese refugee mothers’ culturally and socially situated beliefs, perceptions, practices, and resources related to health care that may influence their views and practices of preventive well-child health care for their infants in …

The Role Of Psychological Capital And Case Management Intensity In Patient Activation In Permanent Supportive Housing Residents., Sarah J. Carter

Electronic Theses and Dissertations

This dissertation explores patient engagement with health, or patient activation, in the formerly homeless population housed in Permanent Supportive Housing (PSH) and receiving case management support. Research is limited on patient activation in PSH residents; consequently, there is minimal understanding of factors contributing to one’s attitudes and behavior towards health care in this group. Psychological Capital refers to the components of hope, self-efficacy, resilience, and optimism. Research in other marginalized groups indicates increasing psychological capital may improve health behaviors. Case management provides support to PSH residents and forms of social support have been associated with improved health outcomes. Applying the …

The Relationship Between Forgiveness And Religiosity In Counseling In The Saudi Population, Salman Alqahtani

Electronic Theses and Dissertations

Forgiveness is an important psychological process associated with religiosity, with both having been shown to support mental health and promote personal growth. Forgiveness remains understudied in Arab and Islamic societies, specifically in Saudi Arabia, where religiosity is an important cultural value. The purpose of this study was to gain a better understanding of the relationship between forgiveness and religiosity among Saudi college students in a faith-oriented and collectivistic society. Data were collected from 106 Saudi college students using the Arabic variation of the Forgiveness and Reconciliation Inventory (A-FRI) and the Arabic Inventory of Religiosity (AIR). Results showed a statistically significant …

Postprocessing Gan-Generated Synthetic Time Series Using Dynamic Time Warping, Md Raisul Islam Roni

Electronic Theses and Dissertations

Generative Adversarial Networks (GANs) are a class of deep learning models capable of producing realistic synthetic data that preserve the statistical and temporal characteristics of real datasets. The DoppelGANger (DGAN) framework extends this approach to time series data by jointly modeling temporal dependencies and contextual metadata. However, synthetic sequences generated by GAN may show temporal misalignment, resulting in inconsistencies when compared with real data. This study presents a postprocessing framework based on Dynamic Time Warping (DTW) and its differentiable extension Soft-DTW to improve the temporal alignment of synthetic time series. The framework is evaluated using quantitative measures of alignment and …

Learning To Be Trauma-Informed: An Examination Of Individual-Level Factors Predicting Perceptions Of And Response To Trauma-Informed Practice Trainings, Kelly Daniel

Electronic Theses and Dissertations

Trauma is a substantial threat to public health. As such, significant effort has been exerted into developing interventions which mitigate the consequences of trauma. Trauma-informed practice (TIP) aims to alleviate the effects of trauma by building policies and practices focused on safety, trust, transparency, support, collaboration, and empowerment. This study investigated how individual-level factors, including readiness for organizational change, perceived benefit of TIP training, and personal trauma history affect one’s ability to apply a TIP lens in a sample (n =100) of members of a graduate-level college. Further, it explored if one’s perceptions of and response to trauma-informed practice training …

The People’S Medicine: Modern Perspectives On Folk Medicine In South Central Appalachia, Stacey M. Horton

Electronic Theses and Dissertations

The study addresses the critical need to document Appalachian folk medicine conventions and cultural practices from a modern perspective. In so doing, it addresses folk medicine research gaps in understudied places in South Central Appalachia, particularly in Southwestern Virginia and Northeast Tennessee. This research utilizes participant observation and oral history interviews to research modern Appalachian folk medicine practices among a select group of practitioners. Interviews focused on individuals who center their professional careers and subsequent lifestyles around herbalism, foraging, folk medicine, ethnobotany, and botanicals. By utilizing a critical praxis framework, the study seeks to move beyond lists of symptoms and …

Learning To Think, Thinking To Learn: A Qualitative Investigation Of Inquiry-Based Learning And Metacognition In Preschools, Jessica Carter

Electronic Theses and Dissertations

In response to an increased focus in the field of early childhood on inquiry-based practices and metacognition, this qualitative study was designed to investigate a variety of approaches to planning and facilitating classroom inquiry. Additionally, this research was designed to discover the ways in which metacognitive strategies are used in preschool classrooms to foster the learning process. Using teacher interviews, classroom observation, and analyses of teachers’ planning documents in a multiple case study design, this study focused on five Reggio-inspired classrooms to investigate the planning and teaching practices of preschool teachers related to inquiry-based learning. Of importance was their use …

Tennessee Reconnect And Adult Learner Retention, Brandon R. Dotson

Electronic Theses and Dissertations

This study examined the relationship between participation in the Tennessee Reconnect (TNReconnect) program and the retention of adult learners at two community colleges in northeast Tennessee. Grounded in Astin’s (1993) Input–Environment–Outcome (I-E-O) model, the study employed quantitative methods to investigate whether program duration, demographic characteristics, academic performance, and financial aid status predicted the likelihood of retention among adult learners.

Using institutional records of 2,355 students, binary logistic regression analyses were conducted across three models. The first model tested whether the duration of TNReconnect participation predicted retention. Results indicated that both program duration and GPA were significant predictors. Each additional semester …

Branding The Divide: Political Ideology And The Strategic Challenges Of Higher Education Marketing, Oscar J. Early Mr

Electronic Theses and Dissertations

The purpose of this qualitative study was to explore how first-year students experience and interpret institutional branding within the context of their personal and social identities, with particular attention to the role of political ideology. While previous research had examined general branding strategies and declining public trust in higher education, scholars have given little attention to the ways in which prospective students make meaning from institutional messaging during one of the most significant transitions of their lives.

I conducted interviews with 12 first-year students from four-year colleges and universities across South-Central Appalachia. The phenomenological analysis revealed that students’ interpretation of …

Behavioral Manifestations Of Childhood Abandonment: African-American Men's Reflections And Strategies To Support Teenage Boys In K-12 Education, Jarmel Bell

Electronic Theses and Dissertations

The purpose of this study was to explore the behavioral manifestations of childhood abandonment as reflected in the lived experiences of African-American men and to identify strategies that may support African-American boys in K–12 educational settings. Although there has been limited documentation regarding the direct connection between childhood abandonment and behavioral challenges in school environments, this study seeks to address that gap by capturing the reflections of African-American men who experienced abandonment during their formative years. These reflections provide insight into how abandonment may shape behavior in educational spaces and what types of interventions or supports might have made a …

Assessing Post-Pandemic Engagement In The Supplemental Nutrition Program For Women, Infants, And Children (Wic) In Northeast Tennessee, Christen Minnick

Electronic Theses and Dissertations

Since 1974, the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) has provided healthy food resources, nutrition education, and provider referrals for families at risk for poor nutrition. Public health professionals have consistently presented evidence that WIC engagement reduces premature births and infant mortality, improves child health and development, and increases specialized care access for participants. While average monthly participation in WIC has increased since the program’s inception, trends indicate that only around half of eligible families have consistently engaged with the program since 2011. Research has linked declining WIC participation to administrative burden, citing learning, psychological, compliance, …

Educator Perceptions Of Mindfulness Education In Rural Elementary Schools In Tennessee, Mary C. Shepherd-Mcgown

Electronic Theses and Dissertations

The purpose of this phenomenological study was to examine educator perceptions of mindfulness instruction and the alignment of school policies in rural elementary schools in Tennessee. Despite growing interest in mindfulness in education, few studies have investigated how these practices are experienced and implemented within under-resourced, rural contexts.

Guided by Bandura’s Social Learning Theory (SLT) and framed conceptually by the Whole-School Mindfulness (WSM) model, the study explored how social, organizational, and policy factors influence the adoption of mindfulness practices. SLT provided a theoretical lens for understanding how educator behaviors are shaped through observation, modeling, and reinforcement, while the WSM framework …

A Comparative-Correlational Study On The Mental Health And Well-Being Of First-Generation Students At A Historically Black College And University, Shedred Jackson

Electronic Theses and Dissertations

The purpose of this study was to investigate the mental health and well-being of first-generation college students (FGCS) in comparison to non-first-generation college students (NFGCS) at a private Historically Black College and University (HBCU) in the Southeast. This study was undertaken to investigate students' mental health and well-being, as well as their use of, access to, and the availability of mental health services. A comparative-correlational research design was employed to collect and analyze the data. The study used a sample size of 388 responses from undergraduate college students enrolled at the private HBCU. Of the 388 students in the sample, …

Teacher Perceptions Of The Effectiveness Of Voluntary Pre-Kindergarten Attendance, Kimberly Taylor

Electronic Theses and Dissertations

The purpose of this study was to identify the perceptions of educators with respect to student enrollment in voluntary pre-kindergarten classes provided through the Tennessee Department of Education in public schools. The data collection strategy used to gain teacher perspectives was through conducting one-on-one interviews with 15 educators in three Tennessee school districts. To qualify for the study, teachers must have been teaching in kindergarten classrooms that receive students who had previously been enrolled in the school’s pre-kindergarten program. Data collection and analysis were based on the Grounded Theory approach which uses data that is systematically gained and analyzed to …

Bud On The Ballot: A County-Level Analysis Of Citizen Support For Cannabis Legalization, Amelia G. Jennings

Electronic Theses and Dissertations

Cannabis research has often emphasized usage rates among certain groups of citizens, focusing mostly on demographic factors. A less studied topic within the cannabis literature pertains to the predictors of voting patterns of legalization referendums. Past research on this topic has examined states with similar characteristics, which calls into question the generalizability of results. The current study attempts to broaden the scope of knowledge in this area by partially replicating a previous study that explored county-level voting patterns, while also exploring the potential influence of the declining agricultural industry in predicting support for cannabis legalization. This was accomplished by analyzing …

Undergraduate Students' Perceptions Of Sense Of Belonging And Engagement Opportunities In The Campus Community, Shelby Jo Akers

Electronic Theses and Dissertations

This non-experimental, correlational, quantitative study examined the relationship between undergraduate students’ perceptions of sense of belonging and their participation in university programming and engagement opportunities at a medium-sized public institution in the Southeastern United States. Guided by the Integrative Framework for Belonging (Allen et al., 2021), the study explored how specific student factors including academic major, campus residency status, class standing, primary mode of instruction, and employment status intersect with engagement to shape students’ sense of belonging. Engagement opportunities that were measured included dimensions of campus facility use and participation in clubs and organizations. Questions related to perceptions of the …

"That Was Something I Had To Get Used To”: Communication Challenges Of African Graduate Teaching Assistants, Mohammed Hafiz Nabila

Electronic Theses and Dissertations

This qualitative study examined the communication challenges and adaptive strategies of African Graduate Teaching Assistants (AGTAs) in U.S. higher education, focusing on East Tennessee State University. The study aimed to understand how AGTAs navigate linguistic, cultural, and institutional barriers in their teaching roles. Using semi-structured interviews with seven participants, data were analyzed through thematic analysis to identify key patterns and meanings. Findings revealed challenges related to accents, cultural adjustment, and limited institutional preparation. Faculty mentorship played a vital role in shaping AGTAs’ confidence, interpretation of challenges, and professional growth. However, lack of support often led to isolation and self-doubt. The …

A Leslie System For A Demographic Simulation: From An Actuarial Point Of View, David Kings

Electronic Theses and Dissertations

This thesis develops a discrete stochastic linear systems interpretation of age–stage demographic evolution grounded in Leslie operators and realized in a discrete-event simulation implemented with salabim. The central claim is that one annual cycle of the simulation constitutes a cone-preserving, stochastic affine transformation on a high- dimensional population state vector indexed by age, sex, marital status, household type, employment, and education, and that the composition of yearly operators yields a random matrix product whose top Lyapunov exponent is the stochastic counterpart of the Perron–Frobenius growth rate (Caswell, 2001; Tuljapurkar, 1997)[1, 2]. The actuarial bridge is constructed by mapping simulated survival …

Perceptions Of Choral Teachers On The Characteristics Of A Secondary Choral Program, Nathan Dale Rhea

Electronic Theses and Dissertations

The purpose of this study was to examine the perceptions of choral teachers on the characteristics of a successful secondary choral program. The study focused on the main characteristics of excellence, success, and sustainability. The literature showed that there was a significant amount of research on the music curriculum, standards, and various assessment strategies but minimal research on perceptions on the characteristics of excellence, success, and sustainability of a choral music program at the secondary level.

Data collection strategies included individual interviews of eight participants who were choral music educators. The analysis of data occurred through the lens of the …

Isolation, Chemical Characterization, And In-Vitro Cytotoxic Evaluation Of Novel Polar Flavonoids From Chromolaena Leivensis, Matthew Tohatsu Tetteh

Electronic Theses and Dissertations

This study focuses on isolation, chemical characterization, and in-vitro cytotoxic evaluation of novel polar flavonoids from chromolaena leivensis. A 95% ethanolic extract of c. leivensis shipped by Prof. Ruben Torrenegra from University of Applied and Environmental Sciences, Bogota, Colombia, was dissolved in 1:1 methanol/chloroform mixture and its purity analyzed by TLC. The sample was eluted with toluene/methanol in an increasing order of polarity on silica gel, resulting in 49 fractions labelled CLA1 to CLA49. Among these fractions, CLA10 (1) and CLA19 (2) obtained yellow and white crystals. They were analyzed by GCMS, IR, and …

An Income Subsystem As A Discrete Stochastic Leslie System: A Simulation-Based Approach, Fahd Nii Okantah Cobblah

Electronic Theses and Dissertations

This thesis formulates the household-income engine of an integrated population sim- ulator as a Discrete Stochastic Leslie System (DSLS). The nonnegative state vector nt ∈ Rk + aggregates income, savings, debt, employment, and transfers. (Here, the subscript + denotes the positive cone, i.e., vectors with nonnegative components). Annual evolution is linear in state, stochastic in coefficients: nt+1 = Ttnt + εt, with Tt : Rk + → Rk + cone-preserving. Exogenous macro drivers (inflation, employment, tax, salary inflation, mortgage) are forecast via ARIMA; forecasts multiply entries of Tt, preserving linearity in expectation while introducing realistic temporal correlation. The discrete-event implemented …

Mountain Communities During A Time Of War: A Case Study Of The Hutsul Region In The Carpathian Mountains Of Ukraine, Pavlo Rybaruk

Electronic Theses and Dissertations

This thesis investigates the ethno-ecological technologies employed by the Hutsul people within the highland agrarian economy of the Carpathian Mountains. Over centuries, the Hutsuls have developed ethno-ecological technologies that maintain ecological integrity while supporting community livelihoods.

The study addresses three primary research questions: What are the most important ethno-ecological technologies of the Hutsul highland economy? How might these traditional ethno-ecological practices be applied to economic, agricultural, and tourism development in the Hutsul region? How might these traditional ethno-ecological practices be combined with contemporary approaches to encourage sustainable development in the region?

The research explores the devastating impact of the Russian …

Perceptions Of Practitioners: An Examination Of Practices For Retention And Support Of Special Education Teachers, Megan L. O'Dell

Electronic Theses and Dissertations

Teacher attrition remains a critical challenge in public education, particularly among special education teachers who face unique legal, instructional, and emotional demands. This phenomenological study explored the lived experiences of current and former K–5 special education teachers to better understand the practices and resources that influence their decision to remain in or leave the profession. The central research question investigated how leadership, professional learning, and working conditions shape teacher sustainability in special education roles. Twelve participants, including six currently employed special education teachers and six who had exited the profession, participated in semi-structured interviews. Data analysis revealed five major themes: …