Digital Commons Network^™

Exploring Factors Influencing Care And Outcome Among Stroke Patients In Tennessee, Omodele Agbejimi

Electronic Theses and Dissertations

Introduction: Stroke is the fifth leading cause of death in Tennessee. Socioeconomic variables influence the delivery of stroke treatment and its outcomes. Despite advances in acute stroke care, the burden of stroke keeps increasing. This study aimed to explore literature on factors contributing to stroke care and outcomes in the U.S., assess the determinants of stroke patients’ outcomes, and examine the geographical disparities in stroke hospitalization and stroke death rate and their association with stroke care accessibility in Tennessee.

Methods: A scoping review was conducted using socio-ecological models to explore literature on factors contributing to stroke care and outcomes. A …

In A Safe-Space Of Her Own: Alice's Journey Through A Traumatized Wonderland To Find Attunement And Recovery, Cheston A. Axton

Electronic Theses and Dissertations

Throughout Alice’s Adventures in Wonderland/Through the Looking-Glass’s 160-year existence, Lewis Carroll’s seven-year-old protagonist has experienced many changes and alterations. With an ever-growing pop culture interest, Alice’s original narrative has undergone numerous adaptations, with each new variation diving deeper into the impact of trauma on Wonderland.

This thesis continues this existing discourse by examining Wonderland’s capacity to facilitate recovery in the aftermath of severe trauma. Through this research, the traumatic experiences of Alice, from Christina Henry’s The Chronicles of Alice: Alice and American McGee’s Alice: Madness Returns, are examined concerning their effect(s) on her construction of Wonderland, as …

The Diversity Of Our Weightlifting Uniforms: A Qualitative Analysis Of The Experiences Of Gender And Sexual Minorities In Gyms, Rachel M. Schott

Electronic Theses and Dissertations

Gender and sexual minority (GSM) populations experience significant mental and physical health disparities compared to their cisgender, heterosexual counterparts. A particularly understudied modality that may contribute to these disproportionate health outcomes is decreased engagement in physical activity (PA). Gyms are a primary source for PA, yet understanding GSM experiences in these spaces is relatively understudied. The purpose of the present study is to better understand the experiences of GSMs in gym spaces with an emphasis on barriers and facilitators to their engagement. We conducted semi-structured phone interviews among self-identified gender and sexual minorities across the U.S. Thematic analysis was used …

Examining The Lived Experiences Of International Students At East Tennessee State University, John The Baptist Anodjo

Electronic Theses and Dissertations

This research investigates the lived experiences of international students at East Tennessee State University (ETSU), specifically examining how they navigate social, academic, and structural challenges. Through in-depth interviews with 20 international students from a variety of nationalities, I analyzed issues related to legal status, housing, food insecurity, healthcare, and social integration. I found that students encounter barriers due to immigration policies, financial constraints, and limited access to essential resources. Additionally, international students benefit significantly from support provided by campus services, community organizations, and their social networks, which play a vital role in their adjustment process. While institutional resources are beneficial …

The Intersection Of Appalachian Identity And Gambling Behavior, Noah S. Anderson

Electronic Theses and Dissertations

This study examined the relation between Appalachian identity and gambling behavior among students in central Appalachia (n = 395). One-way ANOVAs revealed no significant differences in engagement, F(2, 392) = 0.65, p = .523, or severity, F(2, 392) = 0.33, p = .718, across identification groups. Moderated regression showed that identity did not significantly moderate the engagement–severity relation (B = 0.073, p = .099), though engagement itself was a strong predictor of harm (B = 0.696, p < .001, R² = .521). Negative affect predicted both engagement (B = 0.074, p = .001) and severity (B = 0.069, p = .001), while identity remained non-significant. Logistic regression found that identity predicted gambling engagement (Exp(B) = 1.18, p = .034) only when controlling for severity. These findings relay the importance of empirical efforts in Appalachia and suggest that Appalachian identity may not be an independent risk factor in gambling behavior.

Evaluating Online Autism Information: A Content Analysis Of Language, Quality, And Interventions, Jada R. Beal

Electronic Theses and Dissertations

The internet is a widely used source of autism-related information, yet previous studies demonstrate that the quality, accuracy, and language used in such content remain inconsistent. This study conducted a content analysis of 356 autism-related internet sources obtained from top Google search results, examining their use of neurodiversity-affirming language, the quality of health-related information, and the inclusion of evidence-based interventions. Results showed that medical model language and person-first terminology were more common than neurodiversity-affirming language. Sources targeting caregivers were significantly more likely to use medical model language than those aimed at autistic adults. Only 12.92% of sources included quotes or …

Give Me A Break: Exploring The Use Of A Reset Room On Secondary School Students And Resilient Practices In Tennessee, Alex White

Electronic Theses and Dissertations

The culmination of toxic stress and social-emotional instability can result in significant challenges for students. Incorporating an appropriate response to address the social-emotional needs of students must be a priority if schools seek to see improvements in attendance, discipline, and ultimately academic success. Resilient middle and high schools recognized the need to create innovative spaces for students to learn how to self-regulate challenging emotions during the school day. The purpose of this quantitative research study was to investigate the relationship between chronic absenteeism, office disciplinary referrals, and the use of Resilient Schools Reset Rooms in middle and high schools from …

Role Of Cellular Proteins In The Regulation Of Herpes Simplex Virus Type 1 Gene Expression And Dna Replication, Joseph R. Heath

Electronic Theses and Dissertations

Herpes simplex virus type 1 (HSV-1) is a ubiquitous human pathogen that infects the majority of the human population. To facilitate infection, this virus relies on a combination of host and viral factors. Previous studies have revealed a number of host proteins that associate with the HSV-1 genome throughout infection but their putative role(s) in this process remain undefined. This study aims to examine two such proteins to determine their contributions to HSV-1 gene expression and DNA replication. The first of these factors is Ints3, a subunit of the Integrator complex. This protein complex functions in transcription regulation, and Ints3 …

Electronic Health Record Downtime, Grace R. Baldauf

Electronic Theses and Dissertations

Electronic health record (EHR) downtime presents significant challenges to patient safety and care quality in acute care settings, particularly regarding timely medication administration. This project addressed the problem of late or absent medication doses during planned or unplanned EHR downtime. The investigator aimed to evaluate the effectiveness of a structured downtime plan in improving nurses’ ability to administer medications on time during periods of EHR unavailability. The investigator used a quantitative design to implement a downtime plan evaluation paradigm. Data were collected using retrospective chart reviews of medication administration records pre-implementation and postimplementation of the downtime plan. The sample included …

Overcoming Second-Order Barriers To Teachers’ Technology Integration: A Study Of Positive Impacts, Crystal Ann Hume

Electronic Theses and Dissertations

This study explored K–12 public school teachers’ self-efficacy, value, and pedagogical beliefs about technology. The teachers worked in a medium-sized, semi-affluent public school district in North Texas. The study investigated second-order barriers to technology integration and what might positively impact teachers’ self-efficacy, value, and pedagogical beliefs. This study used a qualitative descriptive methodology to collect qualitative data about their beliefs by interviewing and observing K–12 classroom teachers who had completed a bachelor’s degree through a traditional teacher education program. Teachers with alternative certifications or noncertified classroom instructors were omitted. Findings revealed that external factors, failure, mistakes, confidence, and professional development …

Institutional Betrayal And Military Vaccine Mandates: An Inquiry Into Loss Of Health Autonomy Concerning Unlimited Liability Contractual Employment In The Covid-19 Era, Aaron G. Dehaven

Electronic Theses and Dissertations

The balance between government control and personal liberty is a growing concern in the modern world. Nowhere is this more evident than in discussions surrounding government policy in public health and individual health autonomy. The Covid-19 pandemic forced many institutions to change their standard operating procedures by adapting to rapidly changing health guidance instituted to protect public health. These changes highlighted the role of health autonomy and individuals’ rights to refuse medical treatments. The Department of Defense changed many aspects of how it operated during the pandemic, including the mandate of the Covid-19 vaccine for all service members. For various …

Origin Of Purpose, Career Satisfaction, And Life Satisfaction: A Quantitative Study On Early Career Professionals, Anne K. Hocking

Electronic Theses and Dissertations

Since the early 2000s, research has increased on purpose and how it correlates with fulfillment outcomes in life and career satisfaction. This research has been valuable in professional and academic fields and helped develop leadership practices and interventions for organizations to increase satisfaction levels among employees and students. This study focused on the general problem that research dedicated to purpose has not adequately addressed whether origin of purpose affect its outcomes on fulfillment levels, particularly those of life and career satisfaction. To address this consideration, the researcher conducted a quantitative associative correlation to measure if and to what extent origin …

Perceived Leadership Behaviors And Workplace Motivation: The Predictive Role Of Generational Cohorts In The U.S. Construction Industry, Leslie D. Klinegardner

Electronic Theses and Dissertations

The purpose of this study was to examine the extent to which perceived leadership behaviors predicted workplace motivation among construction workers across generational cohorts in the Greater Houston, Texas area. Grounded in self-determination theory, the research explored how transformational, transactional, and passive-avoidant leadership behaviors predicted the satisfaction and frustration of psychological needs for autonomy, competence, and relatedness. The analysis also considered whether leadership behaviors and generational cohort served as significant predictors of workplace motivation outcomes. The study followed a quantitative, predictive, cross-sectional design using survey methodology. Data were collected using the Multifactor Leadership Questionnaire (MLQ) and the Basic Psychological Need …

Deaf Faculty Members’ Experiences In Higher Education Institutions, Stephanie Proctor Horvath

Electronic Theses and Dissertations

Deaf faculty members bring diverse perspectives to higher education, yet their experiences remain underexplored in academic research. The critical first year of teaching can shape their career experiences, revealing both opportunities for growth and systemic barriers. The purpose of this study was to understand deaf faculty members’ experiences, focusing on their transition into academic roles, the accommodations provided in their workplaces, and the challenges they faced. This study employed a qualitative phenomenological design, utilizing semi-structured interviews with 15 Deaf faculty members, whose teaching experience ranges from 1 to 30 years. In the reflexive thematic analysis and AI-coding of this data, …

Principal Self-Efficacy: A Qualitative Study, Vance E. Self

Electronic Theses and Dissertations

This qualitative study explored elementary principals’ perspectives on the importance of selfefficacy in relation to management responsibilities, instructional leadership, and moral leadership as they impact student achievement measured by the STAAR in a Central Texas school district. The research addressed the growing challenges principals face in high-accountability environments, focusing on how their beliefs in their leadership abilities affect school performance and student outcomes. The purpose was to examine principals’ views on selfefficacy across three domains and to consider implications for leadership preparation, district support, and policy. The study was grounded in a constructivist paradigm and employed a qualitative case study …

Idiomatic Compositional Techniques In John Rutter's Requiem, Marguerite Walsh

Electronic Theses and Dissertations

John Rutter is an extremely significant figure in choral music, and his 1985 Requiem is one of his most widely performed works. Despite this popularity, it has yet to be analyzed in a rigorous academic capacity. Requiem is a harmonically rich and sophisticated work, and said lack of previous analysis represents a gap in theoretical research. This thesis analyzes Requiem for significant harmonic structures and idiomatic compositional techniques and applies those techniques in an original composition. Subtopics of note included harmonic non-functionality, modulations, and orchestration. The original work is comprised of two movements for choir and piano respectively titled “Requiem …

An Evaluation Of Key Components Of Natural Resource Camps, Undergraduate Persistence And Success In Natural Resources, Brandy Bishop

Electronic Theses and Dissertations

This study explores the key components that connect natural resource camps, undergraduate persistence, and overall success through gainful employment within the natural resource industry. The aim of this study was to assess early interest and attitudes towards natural resource career pathways and how education interventions shape students’ career outcomes thus leading to overall success. A longitudinal mixed method design was used combining Conservation Careers Camp survey data (n = 39) with institutional records for Forestry majors (n =655) in the Arthur Temple College of Forestry and Agriculture on the Stephen F. Austin State University campus. Quantitative data was analyzed through …

Exploring The Impact Of Generative Ai To Mitigate Educator Burnout, Katie E. Acevedo

Electronic Theses and Dissertations

This qualitative case study examined how sixth–12th grade educators at a single-gender public school in West Texas perceived the role of generative AI in reducing workload, minimizing stress, and supporting professional autonomy. The study focused on concerns related to teacher burnout and the time demands of instructional and noninstructional responsibilities, exploring how emerging technologies might offer practical relief. The study aimed to understand how educators use generative AI tools and identify both the benefits and challenges associated with their integration. Framed by job demand-resource theory, connectivism, and heutagogy, the research explored how generative AI can function as a job resource, …

The Impact Of Mindfulness Therapy To Reduce Disruptive Behavior In High School, Wendy Nell Peters

Electronic Theses and Dissertations

The aim of this project was to determine the impact and effectiveness of Gina Biegel’s mindfulness techniques for stressed teens method on adolescent anxiety and the disruptive symptoms that lead to high school adolescents being assigned to detention. This project described a quantitative correlational design research project that investigated a small adolescent sample size, with a goal of decreasing the number of local high school adolescent students who are repeat detention offenders, by implementing Gina Biegel’s mindfulness techniques for stressed teens method on those high school adolescents who were assigned to detention. This was achieved by collecting demographic data from …

Examining Parent Accommodation Of Anxiety And Irritability In Preschool-Aged Children., Anna Olczyk

Electronic Theses and Dissertations

Anxiety and irritability are common developmentally normative emotions in early childhood, yet are also related to risk for psychopathology in childhood, adolescence, and adulthood. Parenting behaviors, including parent accommodation, may influence this risk. Parent accommodation is the parent modification of child/family routines and/or avoidance of activities to reduce child distress and has been documented widely in the anxiety literature. Although some research has examined parent accommodation of anxiety in preschool-aged children, most research has investigated accommodation of anxiety in clinical samples of school-aged children. Further, despite high rates of co-occurrence between child anxiety and irritability, research on parent accommodation of …

"No One Leaves For Free": A Media Analysis Of The Lived Experiences And Cumulative Impacts Of The Flint Water Crisis., Jordan Leigh Gatewood

Electronic Theses and Dissertations

In April 2014, the city of Flint, Michigan changed their municipal water source from Lake Huron to the Flint River. The effects of this change have been felt far and wide as news broke across the nation that this water was contaminated with lead and residents of Flint were getting sick. This research analyzes 170 news articles from three local and three national news outlets over a 10-year span, 2014 to 2024, to determine how community voice is presented in news media to portray the lived experiences and cumulative impacts of the Flint Water Crisis. Applying a Critical Environmental Justice …

Reclaiming Space: Unhoused Population And Their Use Of Public Libraries., Marcellos Desmond Jackson

Electronic Theses and Dissertations

This study explores how unhoused individuals navigate and utilize the spatial dynamics of public libraries, with a specific focus on how they assert agency into the public space. Public space is examined at the institutional level and through the influential roles of individual workers. Public libraries serve as both refuge and resources for unhoused individuals, and this study highlights the complex dynamics that arise within them. Drawing on observations and informational informal interviews, I examine how unhoused people utilize and navigate the physical space of a public library in a large metropolitan area. I find that unhoused people adapt to …

"That’S Not A Meal, Bestie”: Humor, Identity, & Feminized Consumption In “Girl Dinner”., Claire Tudor

Electronic Theses and Dissertations

This thesis examines the viral “Girl Dinner” trend as a case study in how gendered consumption, digital identity, and feminist humor intersect in digital spaces. Using “Girl Dinner” as a rhetorical artifact, this thesis explores how women use gendered trends to navigate visibility, labor, and autonomy in online spaces. Through thematic analysis of TikTok content, media coverage, and branded adaptations, the research traces the evolution of the trend from a lighthearted joke to a site of cultural negotiation. This study reveals that while “Girl Dinner” may appear empowering and relatable on the surface, it often reinforces traditional gender expectations under …

Mental Health Service Utilization Among Arab/Middle Eastern In The Us: Structural Disparities, Digital Access, And Stigma-Related Barriers., Fatima M. Aldarweesh

Electronic Theses and Dissertations

Arab Middle Eastern (AME) United States (US) college-attending students are more susceptible to disproportionate mental health problems and underutilization of mental healthcare services due to cultural, structural, and psychosocial barriers. The study examines mental health service utilization and mental health outcomes among AME, particularly focusing on the impact of structural, cultural, and psychosocial determinants grounded in Andersen and Aday’s Health Services research model and Corrigan’s stigma framework. The three interconnected aims use secondary nationally representative data from the Healthy Minds Study (HMS) 2019-2024. The study was analyzed using logistic regression and generalized structural equation modeling across three aims to identify …

The Influence Of Psychological, Biological, And Social Determinants On Disordered Eating Behaviors Among U.S. Young Adults: Evidence From Nhanes 2015-2018., Samantha Kaye Gerbine

Electronic Theses and Dissertations

Disordered eating behaviors (DEBs) are influenced by biological, social, and psychological factors, yet research often narrowly focuses on White, college-aged women. This study assessed the predictors and prevalence of DEBs in a nationally representative sample of U.S. young adults using data from the 2015–2018 National Health and Nutrition Examination Survey (NHANES). Survey weights were applied to generate national estimates. Descriptive statistics characterized the sample, and logistic regressions tested biological, social, and psychological predictors of DEBs. A composite risk score was developed using variables retained in the final model. The unweighted sample (n = 1,062) represented 64 million U.S. young adults. …

Engaging In Movement At Work: Exploring Engagement And Physical Activity., Spencer A. Cavan

Electronic Theses and Dissertations

High levels of employee engagement provide organizations competitive advantages such as increased customer satisfaction, profits, and employee productivity. Despite potential benefits, the number of engaged employees is declining and organizations need to find innovative ways to enhance engagement. Emerging evidence suggests workplace physical activity may generate organizational benefits extending beyond health improvement. Therefore, the purpose of this study was to investigate perceptions of engagement among employees participating in a physical activity intervention at work. A qualitative design, guided by phenomenology, examined perceptions of workplace physical activity and perceived levels of engagement, as well as constraints related to involvement among university …

The Effects Of Off-Season Evidence-Based Training Block Periodization Program On The Performance Of Soccer Athletes In A Di School: An Exploratory Study, Ibrahim F. Almughathawi

Electronic Theses and Dissertations

The investigators explored the effects of a two-year evidence-based block periodization strength training program on performance outcomes in NCAA Division I male soccer athletes. The investigators aimed to examine longitudinal changes in body composition, explosive strength, and match-play physical demands, as well as the associations between field-based performance assessment and GPS-derived metrics. Using a retrospective design, data were drawn from a research data repository for athletes who participated in a long-term sport science monitoring program under the same head coach and training conditions. Performance measures included vertical jump assessments (static and counter movement jumps under bodyweight and external load), isometric …

Preschool Teachers’ Perspectives On Conceptual Movement In Academic Instruction: A Mixed- Methods Study With Implications For Early Math, Kehinde H. Orimaye

Electronic Theses and Dissertations

This convergent mixed-methods study investigated Missouri preschool teachers’ familiarity, implementation, and perceptions of conceptual movement (CM), the purposeful integration of bodily actions to support young children’s understanding of abstract academic concepts, particularly in early mathematics instruction. Grounded in embodied cognition and informed by enactivism and the theory of event coding (TEC), the study explored: (a) preschool teachers’ awareness and frequency of CM use; (b) how teacher characteristics such as experience, age group taught, and math anxiety relate to CM implementation; and (c) teachers’ perceptions of CM’s instructional value, implementation challenges, and professional development needs.

Quantitative data were collected through a …

Reentry For Formerly Incarcerated Individuals: A Focus On Workforce Reentry And Recidivism In Appalachia, Margaret E. Francisco

Electronic Theses and Dissertations

Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.

This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted …

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 …