Digital Commons Network^™

Illness Terminable And Interminable: A Lacanian Exploration Of Medical Assistance In Dying, Matthew Devine

Electronic Theses and Dissertations

More and more people worldwide are requesting euthanasia, physician-assisted suicide (PAS), or medical assistance in dying (MAiD). Arguments in favor of expanding access to MAiD tend to prioritize the rational, competent, autonomous subject who has the right to make decisions about their body, including their death. Some have argued that this perspective – common in biomedical and bioethical literature – tends to neglect the fact that requests for assisted dying involve a relational structure: a relationship between the subject who requests an assisted death and the Other to whom this request is addressed. After reviewing relevant psychoanalytic approaches to suicide …

An Implementation Study Of Phonological Awareness Assessment Tasks For Literacy Development In D/Deaf And Hard Of Hearing Students, Sara Tuddenham

Electronic Theses and Dissertations

Minimal auditory input can impact phonological awareness skill acquisition in d/Deaf and hard of hearing (DHH) students. Teachers of the Deaf and speech-language pathologists can assess and instruct DHH students through methods tailored to their needs, but research on effective strategies is limited. This study explores the development and implementation of a linguistically and culturally inclusive set of phonological awareness tasks for DHH students at Western Pennsylvania School for the Deaf (WPSD). Tasks investigate phonological awareness in spoken English (i.e., rhyming, sound matching, blending, etc.) and American Sign Language (i.e., ASL parameters) for nine DHH students. Results indicate the feasibility …

Exploring The Self-Efficacy And Experiences Of Caregivers Using Thickened Liquids To Manage Pediatric Dysphagia, Jaimee E. Conmy

Electronic Theses and Dissertations

Pediatric dysphagia affects 1 in 37 typically developing children under five, with increased prevalence in at-risk populations. Thickened liquids are often used as an intervention despite limited evidence supporting their effectiveness in the pediatric population. Caregivers play a critical role in managing their child’s dysphagia, yet their experiences, self-efficacy, and challenges with thickened liquids remain underexplored. This mixed-methods study surveyed 57 caregivers of children on thickened liquid diets, to assess their self-efficacy, education, perceptions of effectiveness, and overall impact on their quality of life. Findings highlight gaps in caregiver training, concerns about preparation, and benefits and/or challenges experienced by caregivers. …

The Protective Role Of Resilience In Indirect Aggression Perpetration And Victimization, Amelia Klass

Electronic Theses and Dissertations

This study examines the relationship between resilience and indirect aggression, specifically relational and social aggression, utilizing a sample of 104 females aged 18–22. Indirect aggression, characterized by behaviors such as social exclusion, gossip, and manipulation, is associated with significant emotional and interpersonal difficulties. Using a theoretical basis that includes gender schema theory, social learning theory, and social information processing theory, this study investigates whether resilience has a significant relationship in both the perpetration of and victimization through the use of indirect aggression. Participants completed self-report measures, including the Adult Resilience Measure – Revised and the Young Adult Social Behavior Scales …

Collecting The Strands: A Psychoanalytic Study Of Hair-Pulling In Women, Jacklyn Corsitto

Electronic Theses and Dissertations

This dissertation investigated compulsive hair-pulling (i.e., trichotillomania) in women from a psychoanalytic perspective. The assumption, from a psychoanalytic viewpoint, is that the symptom of hair-pulling serves meaningful, and multiple, psychical purposes that should be analyzed rather than immediately removed, as would be the case in the current gold standard of treatment—behavioral therapy with habit reversal training. This behavioral modality leaves little to no room for exploring the historical, relational, symbolic, and emotional dimensions of hair-pulling. This dissertation fleshed out these dimensions and investigated what hair-pulling was doing for the individual, what its function or purpose was, and, indeed, what ideational …

Healthy And Successful Aging Outside The Closet: How Outness And Social Support Relate To Health And Aging Concerns, Jessica Segal

Electronic Theses and Dissertations

The ability to disclose an LGBTQ+ identity is a significant part of many queer lives. A person’s outness can often be tied into their social support whether through their network or available resources. This study investigated how outness, social network, and access to resources relate to older LGBTQ+ individuals’ concerns regarding their care and their aging. A secondary data analysis was conducted using survey data from the American Association of Retired Persons (AARP). The results showed that an increase in one’s social network indicated a decrease in aging-related care concerns; an increase in access to resources indicated a decrease in …

Identifying The Experiences And Perceptions Of School Psychologists On Racial Disparities In Autism Spectrum Disorderidentifying The Experiences And Perceptions Of School Psychologists On Racial Disparities In Autism Spectrum Disorder, Anna Marie Paolicelli

Electronic Theses and Dissertations

This paper investigates the experiences and perceptions of school psychologists who identify as experts in autism spectrum disorder (ASD) regarding racial and ethnic disparities in ASD identification. Utilizing a convergent embedded mixed-methods design grounded in Consensual Qualitative Research (CQR), the study explores how school psychology practices may have contributed to recent changes in ASD outreach and assessment, as well as persistent disparities, particularly for Black children with co-occurring intellectual disability (ID). Thirteen credentialed school psychologists with extensive experience in diverse educational and clinical settings participated in semi-structured interviews and binary survey items. Findings reveal perceived progress in ASD awareness and …

Centering The Medical Student Perspective In A Mixed-Methods Evaluation Of The Holistic Admissions Process At A Mission-Driven Institution, Brenda L. Liszka

Electronic Theses and Dissertations

This mixed-methods research explores the influence of a holistic admissions process on medical student enrollment at a mission-driven institution. The study quantitatively measured the impact of various admissions touchpoints on enrollment decisions and qualitatively investigated the experiences of students underrepresented in medicine based on their race or ethnicity, first-generation status, and medically underserved backgrounds. Individual interviews, guided by Maslow's Hierarchy of Needs, were used to understand participants' sense of belonging and esteem throughout the process. The findings inform an improvement agenda aimed at creating a responsive and inclusive admissions process that supports diverse student bodies and addresses national public health …

Narrative As Story And Ground: Toward A Dialogic Communication Theory Of Narrative Care, Preston Carmack

Electronic Theses and Dissertations

We live in a historical moment when a nuanced understanding of narrative as both ground and story is essential. In examining the work of two primary scholarly voices working with narrative and operating from a communicative lens, Walter R. Fisher and Ronald C. Arnett, this project lays a theoretical foundation for understanding the dialogic interplay of narrative as story and narrative as ground. Through tracing Fisher's and Arnett's contrasting interpretations of the work of Alasdair MacIntyre, a preeminent neo-Thomistic philosopher whose work has significantly contributed to the study of ethics and narrative construction of human rationality, coordinates related to telling …

Sociodemographic, Neighborhood-Level, And Health-Related Factors Associated With Progression To Bariatric Surgery: A Retrospective Chart Review., Angela Godwin

Electronic Theses and Dissertations

Background: Bariatric surgery is the most effective treatment for patients with Class 3 obesity. However, of individuals who start the bariatric surgical process, only about half undergo surgery. Factors associated with completion, including race, have been described; however, consistent evidence on obstacles remains to be identified.

Objectives: To explore variables based on the Social Ecological Model (SEM) that may be related to bariatric surgery completion.

Setting: A large, private hospital with a Bariatric Center of Excellence in New York City

Methods: This retrospective chart review utilized data from adults who established an initial bariatric surgery visit from April 1, 2012, …

Describing Latent Tuberculosis Infection And Treatment Completion In Virginia: A Social Determinants Of Health Approach, Amber N. Harmon

Electronic Theses and Dissertations

While the treatment of latent tuberculosis infection is a key strategy in tuberculosis elimination nationally and globally, there is a limited understanding of the general prevalence of latent tuberculosis as well as factors related to successful treatment. This dissertation describes the known landscape of latent tuberculosis in Virginia and explores possible factors related to latent tuberculosis infection treatment through three manuscripts. The first manuscript, Chapter 1, outlines the overall proposal for this dissertation research in the style of a National Institute of Health grant proposal. The second manuscript, Chapter 2, describes the current understanding of the factors related to latent …

Adding Varying Degrees Of Performance Feedback Components To The Taped Problems Intervention, Alyson C. Honaker

Electronic Theses and Dissertations

Math fact fluency, the ability to quickly and accurately solve one-digit by one-digit math problems, is a common challenge for many school-aged children. Difficulties with fluency often lead to reliance on inefficient strategies, hindering progress in more advanced math skills. Evidence-based interventions like Taped Problems Intervention (TPI) have demonstrated effectiveness in improving math fluency. However, research suggests incorporating behavioral components such as Performance feedback (PF) and goal setting/reinforcement (GS/R) may enhance its effectiveness. The present study used a multiple-probe across-task design to evaluate the effects of three variations of TPI on the subtraction fluency of five elementary students in a …

Exploration Of The Cultural Beliefs, Values, And Practices Of African American/Black Women Or Birthing Persons Regarding Postpartum Depression: A Focused Ethnography, Stephanie Jacobs

Electronic Theses and Dissertations

Introduction: Postpartum depression (PPD) is the most prevalent perinatal mental health illness in women, affecting approximately 10% to 20% of all women in the United States, and a disproportionately higher number of African American women. The aim of this study was to explore the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression.

Research Question: What are the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression?

Methodology: A focused ethnography was chosen for this study and consisted of semi-structured interviews. Data was transcribed and analyzed …

The Application Of Macrophage-Targeted, Anti-Inflammatory Celecoxib Nanoemulgel For Nerve Regeneration In Peripheral Nerve Injury, Lu Liu

Electronic Theses and Dissertations

Peripheral nerve injury (PNI) refers to damage to the nerve located outside the brain and spinal cord. PNI is commonly caused by a physical accident (trauma) or medical operation^{1, 2}. The impact on the quality of life of PNI patients is directly correlated to neuropathic pain, resultant depression, and increased stress². Even after recovering from the PNI, patients still experience phantom pain and lose the ability to work due to the loss of tactile sensory or motor function^2-4. However, unlike damage to the central nervous system (CNS), peripheral nerves can regenerate because macrophages clean …

Effect Of Histidine Tag On The Enzymatic Activity Of Pseudolysin And Its Interaction With The Streptomyces Metalloprotease Inhibitor (Smpi) Protein, Adewale Adeboye Adewole

Electronic Theses and Dissertations

Pseudolysin (PLN) protein is a major virulent factor in Pseudomonas aeruginosa infection. PLN belongs to the family of zinc-dependent metalloproteases. It is naturally inhibited by a smaller protein called streptomyces metalloprotease inhibitor (SMPI), secreted by Streptomyces nigrescens. Previous and current studies demonstrate that the interaction between PLN and SMPI offers unique mechanistic insights for drug development against infections caused by P. aeruginosa. This study investigated the effect of N-terminal Histidine (His) tag on the enzymatic activity of PLN and its interaction with SMPI. His-tagged PLN and SMPI proteins were expressed in bacteria and purified by affinity chromatography …

"Driving Circles Around The Holler:" Liminality And The Grotesque In Donald Ray Pollock's Knockemstiff, Celia A. Ranniger

Electronic Theses and Dissertations

Donald Ray Pollock’s 2008 short story cycle, Knockemstiff, is a regionalist work of grotesque Grit Lit featuring characters from a small, rural holler community in southern Ohio. This work examines the form, narratives, and characters through close reading, illuminating the layers of different liminalities present in the cycle. These liminalities include narrative liminality of the form of the short story cycle, the social and economic liminal spaces inhabited by the characters, and the ways that the text comments on the liminal nature of storytelling itself. This thesis will argue that the geography of the cycle’s setting coupled with the subject …

Rural Roots, Academic Roads: Exploring College Persistence Among Rural Students, Misty Wilburn

Electronic Theses and Dissertations

This study examines the financial and social challenges faced by first-generation college students from rural backgrounds as they transition from K-12 to four-year regional institutions. Using quantitative analysis of secondary data from the class of 2024 at a selected institution, this study examines factors influencing graduation rates and financial aid needs. Key metrics include geographic origins, high school backgrounds, academic assistance, and financial support. By highlighting these challenges, this study contributes to a deeper understanding of the structural and social barriers that first-generation rural students encounter.

Enumerating Escherichia Coli (E. Coli) Concentrations And Evaluating Optical Brighteners As A Potential Indicator Of Human Wastewater Contamination In La Nana Bayou, Banita Creek, And Their Tributaries, Nacogdoches, Texas, Swastika Acharya, Matthew Mcbroom, Yuhui Weng, Yanli Zhang

Electronic Theses and Dissertations

La Nana Bayou was added to the Texas 303(d) list in 2000 after it failed to meet water quality standards set by the Texas Commission on Environmental Quality (TCEQ) for primary contact recreation due to elevated Escherichia coli (E. coli) levels. E. coli is a bacterial species commonly found in the intestines of humans and warm-blooded animals. It serves as an indicator of fecal contamination in freshwater, though its presence alone cannot identify the contamination source. Optical brighteners (OBs), chemicals found in laundry detergents, cleaning agents, toilet papers, and clothing, are unique to human wastewater. This study aimed …

Assessing Medical Decision-Making Capacity: The Importance Of Patient Values., Emilee M. Ertle

Electronic Theses and Dissertations

A medical decision-making capacity (MDC) assessment is the assessment of an individual to determine whether they can make their own medical decisions or if a proxy decision maker must make care decisions on their behalf. These assessments are necessary when individuals experience cognitive impairments which limit their ability to think through complex medical decisions. Best practice for MDC assessments is a growing area of research, with no standard approach to guide assessment planning. The current study builds upon the field’s knowledge of capacity assessments by investigating 1) what methods and measures clinicians utilize in capacity assessments, 2) what factors influence …

Effects Of Perfluorooctane Sulfonate In A Mouse Model Of Alcohol-Associated Liver Disease., Paxton Michelle Brizendine/Ames

Electronic Theses and Dissertations

Perfluorooctane sulfonate (PFOS), a pervasive environmental pollutant, has been increasingly associated with the development of metabolic dysfunction-associated steatotic liver disease (MASLD); nonetheless, its connections with alcohol-associated liver disease (ALD) have not been well studied. This study investigates the hypothesis that PFOS exposure alters hepatic metabolism, thereby leading to alterations in ALD severity. Male C57BL/6J mice were fed isocaloric control or 5% ethanol (EtOH) diet for 15 days. From day 6 of feeding, mice were concurrently gavaged with 1 mg/kg PFOS or 2% Tween-80 vehicle for 10 days, followed by a 5 g/kg EtOH binge dose. PFOS and ethanol co-exposure significantly …

Metabolic Regulation Of Cardiac Fibroblast Phenotype And Function., Collin Kleis Wells

Electronic Theses and Dissertations

Cardiac fibroblasts are central effectors of cardiac repair after myocardial infarction (MI). In response to signaling cues, they differentiate to a range of phenotypes with robust capacities to synthesize and secrete extracellular matrix (ECM) and signaling molecules. Although activated fibroblast phenotypes are associated with pronounced changes in metabolism, it remains unclear how the metabolic network upholds the effector functions of fibroblasts in the post-infarcted heart. Here, we identified that critical enzymes in the phosphoenolpyruvate (PEP) cycle, i.e. pyruvate kinase muscle-2 (PKM2) and phosphoenolpyruvate carboxykinase-2 (PCK2), are elevated in the heart after MI and examined their role in regulating post-MI remodeling …

Hybrid Geographies And Nature In The City: A Tale Of Two Greenspaces In Louisville, Ky., Rebecca Dixon

Electronic Theses and Dissertations

Many conservation initiatives position nature and the urban as opposing constructions, which means the possibilities where cities can work with nature are often overlooked. This study uses the lens of relational geographies to examine nature in the city by comparing two greenspaces in the Beargrass Creek watershed in Louisville, Kentucky: Waterfront Botanical Gardens and the Louisville Nature Center. The two organizations are compared by using a combination of content analysis, discourse analysis, and GIS flood analysis methods to determine how their geographical location and history affect the ways in which the dynamic between nature and culture is reproduced. Results show …

Estimation Methods For Bayesian Exponential Random Graph Models Under The Horseshoe Prior., Pamela Linares

Electronic Theses and Dissertations

Networks are powerful tools for modeling the complexity of social interactions, biological systems, and information spread. A leading statistical frameworks for analyzing network data are Exponential Random Graph Models (ERGMs), which provide a principled approach to capturing structural dependencies. However, ERGMs remain challenging to estimate, especially in sparse or high-dimensional settings where models suffer from degeneracy and unstable parameter inference. This paper proposes a penalized Bayesian approach to ERGMs that utilizes the horseshoe prior, a sparsity-inducing global-local shrinkage prior. This prior offers robust regularization while preserving important signals, improving estimation by shrinking irrelevant parameters and reducing the impact of extreme …

My Achilles Years., Ash William Bittner

Electronic Theses and Dissertations

This dissertation is a historically and rhetorically grounded creative project exploring the traumas of war. This project is divided into three broad chapters, each using a different (and relevant) approach to cover the content contained within that chapter. The first chapter relies on that historical grounding, exploring the history of PTSD as it is currently understood, before exploring ancient Greek poetry and theater and both the historical and military contexts for each, before finally discussing modern warfare and the “Forever War” of the American War on Terror that lasted for nineteen years. With the historical grounding set, it moves into …

A Deep Learning Approach For Semantic Segmentation And Its Application On Ctc., Samir Farag Harb

Electronic Theses and Dissertations

This dissertation explores the modeling and analysis of medical images, focusing on the intricate task of colon segmentation and subsequent 3D reconstruction, which are critical steps in Computed Tomography Colonography (CTC) systems. The primary objective of this research is to develop precise segmentation approaches to enhance the accuracy of colon identification and reconstruction from abdominal CT scans. Three distinct segmentation approaches are proposed and evaluated: a Markov Random Field (MRF)-based approach, a convolutional neural network (CNN)-based deep learning (DL) approach, and a sequential episodic training with dual contrastive learning Approach (G-SET-DCL) that has a flavor of few-shot learning (FSL). To …

Recent Studies On The Reactions And Synthesis Of Nitrogen And Sulfur - Containing Heterocyclic Pharmacophores., Bernard Louis Adjei

Electronic Theses and Dissertations

Nitrogen and sulfur-containing heterocycles remain significant classes of compounds in the field of medicinal and organic chemistry due to their unique structural features and diverse biological activities which make them of considerable interest for drug discovery and development. Notable examples of the nitrogen containing heterocycles include the phthalimide and glutarimide rings present in thalidomide. Thalidomide, a potent small-molecule therapeutic agent, precipitated a significant global drug crisis due to its teratogenicity, causing congenital malformations in phocomelia infants, which remains unrivaled over half a century ago. Currently, thalidomide derivatives are extensively utilized in the therapeutic management of various hematological malignancies. Recent investigations …

Opportunities For Mathematical Thinking (Omt) In Fourth Grade Mathematics Textbooks., Lucas Wayne Elliott

Electronic Theses and Dissertations

Mathematical thinking is essential not only for students’ academic achievement but also for their ability to compete in a global workforce (Schoenfeld, 1992; Mullis & Martin, 2017). However, students in the United States continue to lag behind their international peers on assessments that measure mathematical thinking (Mullis et al., 2020; van Davier et al., 2024). These gaps emerge as early as elementary school, where the foundation for future academic success is established (Aunola et al., 2004; Locuniak & Jordan, 2008). Given the importance of mathematical thinking and the persistent disparities in student performance, this study examined how mathematical thinking is …

Ecosystem Services Of Urban Green Spaces In Louisville, Ky., Julia Kachanova

Electronic Theses and Dissertations

Accelerating urbanization poses critical challenges to urban green spaces (UGS), vital for ecological balance and human health. Rapid development often results in fragmented habitats, biodiversity loss, and diminished ecosystem service delivery. There is an urgent need to explore and evaluate novel strategies capable of enhancing urban resilience, such as implementing urban orchards, and managing existing parks and gardens in sustainable ways. This dissertation explores how different forms of urban green spaces (UGS) contribute to the provision and maintenance of critical ecosystem services that support human well-being and urban biodiversity. By analyzing UGS impact on ecosystem service provisioning and long-term sustainability, …

Immunopathogenic Crosstalk Between Cancer And The Kidney: A Central Role For Macrophages As Potential Mediators., Dana Hammouri

Electronic Theses and Dissertations

Cisplatin remains a mainstay in the treatment of solid tumors, yet its therapeutic efficacy is frequently compromised by dose-limiting nephrotoxicity. Approximately 30% of patients receiving cisplatin develop acute kidney injury (AKI), which increases the risk of chronic kidney disease (CKD), a leading cause of morbidity and mortality. Despite extensive preclinical efforts, no FDA-approved therapy currently exists to prevent or treat cisplatin-induced nephrotoxicity (CIN). This in part is due to the reliance of preclinical studies on non-cancer animal models that fail to capture the complex physiological alterations associated with malignancy. To address this limitation, we developed a clinically relevant model in …

Teaching Out Of The Closet: A Qualitative Study To Examine How Queer Educators Navigate Their Professional Work Environments., Brent Braun

Electronic Theses and Dissertations

Queer educators across the nation have faced an onslaught of issues in recent years as they maneuver working in the heteronormative environments of public schools. With the passing of Senate Bill 150 in the Commonwealth of Kentucky in 2023, Kentucky educators became a part of the growing group of educators having to silence themselves within their classroom environments in order to protect their professional careers. This study sought to examine the ways in which queer educators navigate their professional environments in making decisions to either disclose or keep private their identity within the queer community. Semi-structured interviews were completed with …