Digital Commons Network^™

How Well Can Commonly Used Anxiety Scales Detect Treatment Outcomes In The Context Of Autism?, Eric A Storch, Philip C Kendall, Gaia Scerif, Cathy Creswell

Faculty, Staff and Students Publications

Anxiety is one of the most prevalent mental health challenges in autistic children, yet there is limited evidence on effective tools to measure treatment outcomes. Previous research with non-autistic children has found that the Child Anxiety Impact Scale, Parent Version achieved good diagnostic accuracy when measuring treatment outcomes and performed better than a commonly used symptom measure. However, this has not been evaluated for autistic children. The present study examined the psychometric properties of the Child Anxiety Impact Scale, Parent Version in autistic children and compared its utility against other anxiety symptom measures, to detect treatment outcomes as assessed by …

Adenovirus Types In Us Children Hospitalized Or Seen In The Emergency Department With Acute Respiratory Illness, 2016-2019, Justin Z Amarin, Olla Hamdan, Haya Hayek, Laura S Stewart, Herdi K Rahman, Rangaraj Selvarangan, Jennifer E Schuster, Christopher J Harrison, Mary E Moffatt, Marian G Michaels, John V Williams, Julie A Boom, Leila C Sahni, Vasanthi Avadhanula, Mary Allen Staat, Elizabeth P Schlaudecker, Christina Quigley, Geoffrey A Weinberg, Peter G Szilagyi, Janet A Englund, Eileen J Klein, Aaron T Curns, Heidi L Moline, Ariana P Toepfer, James D Chappell, Andrew J Spieker, Natasha B Halasa

Faculty, Staff and Students Publications

Background: Human adenovirus (HAdV) is a common cause of pediatric acute respiratory illness (ARI), contributing to 5-13% of cases worldwide. Clinical manifestations vary by HAdV species and type; therefore, delineating type-specific disease presentations and understanding severity of specific HAdV types' disease may help develop targeted interventions.

Methods: We conducted a multicenter, prospective study within the New Vaccine Surveillance Network to characterize HAdV types. Children < 18 years old with ARI were enrolled in the emergency department or inpatient setting at 7 US children's hospitals from 1 December 2016 to 30 November 2019. Respiratory specimens were collected and tested for HAdV and other viruses. Subsequently, typing was conducted on HAdV specimens using single-plex real-time PCR assays targeting sequences in the hexon gene. Comparisons between HAdV types were performed to determine differences in characteristics and outcomes. Generalized linear mixed effects models were used to evaluate severity.

Results: Among the 1843 HAdV-positive cases, 1402 specimens (76%) were typed. The most common types detected were HAdV-C1 (n = 439), HAdV-C2 (n = 393), and HAdV-B3 (n = 221). Children with HAdV-B7 (n = 78) …

Difficult Conversation Case: Death Notification, Amrita Vempati, David Fernandez, Daniela Ortiz, Anita Rohra, Stephanie Stapleton, Hillary Moss

Faculty, Staff and Students Publications

Audience: This case is meant for senior emergency medicine (EM) resident physicians as a preparatory tool for the American Board of Emergency Medicine Certifying Exam. However, it is applicable for EM residents at all levels of training.

Introduction: Difficult conversations are an integral part of the practice of emergency medicine. Competent EM physicians routinely engage in challenging conversations with patients and their families (eg, delivering bad news, disclosing medical errors, providing death notifications).1 Despite their importance, communication skills are often not formally taught in residency training.2 Instead, learners frequently rely on role modeling to develop the skills necessary to navigate …

Modeling Reemergence Of Vaccine-Eliminated Infectious Diseases Under Declining Vaccination In The United States, Peter J Hotez, Nathan C Lo

Faculty, Staff and Students Publications

(Abstracted from JAMA 2025;333(24):2176-2187) The development of childhood vaccine protocols has led to the elimination of many infectious diseases from the United States, including measles, rubella, diphtheria, and polio, by maintaining herd immunity. In recent years, especially since the COVID-19 pandemic, vaccination rates have declined due to policy changes, misinformation, distrust, and broader societal shifts.

Hes V20 Surpasses Galad For Hcc Detection: A Review Of Multi-Dimensional Biomarker Scores And Studies

Faculty, Staff and Students Publications

This was a narrative review of select studies published through September of 2024. We review the shift toward multi-dimensional scores such as HCC early detection screening (HES), GALAD, ASAP, and mt-HBT represents a significant advancement in biomarker research for hepatocellular carcinoma (HCC) detection. Unlike single biomarker approaches, these scores integrate various clinical and biochemical factors to enhance predictive accuracy by reflecting different complementary aspects of disease progression and HCC oncogenesis. Proper testing and validation of biomarker scores in phase 3 biomarker studies is essential before wide use can be recommended. We also review the comparative performance of biomarker scores in …

Gender Matters: A State-Of-The-Art Review Of Transcatheter Structural Interventions In Older Women Vs Men, Jina Chung, Puja Kiran Mehta, Simrat Kaur, Abdulla Al Damluji, Vasilis Babaliaros, Leslie Cho

Faculty, Staff and Students Publications

With rising life expectancy, the population of older adults over the age of 65 is rapidly expanding, with women comprising the majority. Structural heart disease is common in this group, and transcatheter interventions have transformed its management. Optimal outcomes require careful consideration of sex-specific differences. This review examines transcatheter structural heart interventions in older adults with a focus on sex-based outcomes, procedural planning, and current knowledge gaps.

Road Surface And Subsurface Monitoring Using Machine Learning, Koduah Amoako

Theses and Dissertations

This thesis presents a comprehensive, non-invasive framework for real-time monitoring of road surface and subgrade conditions using acoustic sensing and machine learning. Traditional Tire-Road Coefficient of Friction (TRCF) estimation techniques often rely on intrusive sensors, offline data analysis, or laboratory measurements, making them impractical for real-time applications. The present research introduces an alternative approach that utilizes the acoustic emissions generated by tire-road interaction to infer both surface friction and subsurface integrity dynamically.Measurement microphones were mounted beneath a test vehicle to record tire-road noise signatures across different pavement textures and vehicle speeds. The collected acoustic signals were processed using Fast Fourier …

The Role Of C-X-C Chemokine Receptor Type 5 (Cxcr5) On Sex-Dependent Neurobehavioral Changes In The Sub Clinically Sensitized Individuals With Repeated Allergen Exposure, Dilini Vimarshani Ekanayake Ekanayake Mudiyanselage

Theses and Dissertations

Food allergen consumption has been suspected to influence mood and behavior in individuals who are sensitized but tolerant to the food. Using a mouse model of subclinical cow’s milk allergy (CMA), we previously showed that C57BL/6J mice sensitized to β-lactoglobulin (BLG, Bos d 5) exhibited elevated BLG-specific IgE levels even without observable allergic reactions, suggest developing immune responses towards the allergen. We also observed elevated cytokine and chemokine levels, astrogliosis and cortical demyelination along with behavioral changes such as anxiety-like and depression-like behavior after consuming a whey-containing diet for two weeks. Furthermore, we demonstrated the possible immune cell infiltration and …

Resistance Through Policy: Documenting Lgbtq+ Advocacy In Public Education, Rhys Mitchell Fryar

Theses and Dissertations

This research examines how educational policies related to LGBTQ+ students are constructed, interpreted, and implemented across federal, state, and district-levels. It asks whether institutional intent reflects authentic commitment to equity or functions as symbolic compliance in politically contested environments. Using Portland Public Schools (PPS) as a case study, the analysis situates the district within Oregon’s affirming policy landscape and the Trump administration’s restrictive federal mandates. PPS has adopted policies, such as Administrative Directive 4.30.061 AD (2023b) and the Gender Identity Support Guide (2023a), to support queer and gender-expansive students; however, it faces a federal investigation (U.S. Department of Education, 2025b, …

Black Women’S Experiences Accessing Health Care And Law Enforcement After Intimate Partner Violence: A Qualitative Pilot Study, Kaylen M. Moore, Linda M. Wesp, Jeneile Luebke, Peninnah M. Kako

College of Nursing Faculty Research and Publications

Background:

Intimate partner violence (IPV) is a global public health issue impacting millions of people each year. Black women constitute 14% of the US population but alarmingly comprise 31% of homicides resulting from IPV. African American women survivors of IPV experience intersecting impacts of racism, sexism, and historical mistrust. This research aimed to raise awareness about their experiences of violence and perceptions of institutional support.

Objective:

This study sought to explore African American women’s experiences with IPV and navigation of health care and law enforcement after experiences of violence.

Method:

Critical ethnography was used as an approach for this qualitative …

Presenteeism Among Health Care Personnel With Covid-19, James C. Crosby, Eliezer Santos Leon, Brian Chinnock, Karisa K. Harland, Anusha Krishnadasan, Nicholas M. Mohr, Ian D. Plumb, Melissa Briggs Hagen, Kelli Wallace, David A. Talan, Anne Zepeski, Tracy Young, Howard A. Smithline, Lilly C. Lee, Stephen C. Lim, Gregory J. Moran, Mark T. Steele, David G. Beiser, John P. Haran, Peter C. Hou, Brett Faine, Utsav Nandi, Walter A. Schrading, Anne Chipman, Frank Lovecchio, Alysia Powers, Lisandra Uribe, Kavitha Pathmarajah, Dean M. Hashimoto, Chloe Namias, Efrat Kean, Elizabeth Krebs, Amy Stubbs, Sara Roy, Lucia Solis, Mary Mulrow, Nathan Graff, Jillian M Tozloski, William Mower, Jacqueline Caldera, Michelle Huber, Jacob Hampton, Abigail Lopes, Katherine Elkort, Stephanie A. Eucker, Carla Kingsbury, Jonathan Femling, Silas Bussmann, Jane Yee, Joseph Stuppy, Richard E. Rothman, Gaby Dashler, Marcel E. Curlin, Mastura Wahedi, Laurie Kemble

Department of Medicine Faculty Papers

IMPORTANCE: Presenteeism-defined as continuing to work during an illness-poses a public health risk in the workplace and is especially hazardous within health care institutions where vulnerable patients may be exposed to nosocomial infections. Understanding the frequency and characteristics of health care personnel (HCP) who report presenteeism while ill with COVID-19 may help mitigate SARS-CoV-2 spread in hospitals and other health care institutions.

OBJECTIVES: To determine the frequency of presenteeism among HCP with symptomatic COVID-19, and to evaluate the demographic, occupational, and clinical factors associated with it.

DESIGN, SETTING, AND PARTICIPANTS: This is an observational cohort study that uses data from …

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 …

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 …

How Fundraisers Met Goals During The Covid-19 Pandemic, Cody C. Greene

Electronic Theses and Dissertations

The COVID-19 pandemic disrupted nearly every aspect of higher education operations, including fundraising and donor engagement. This qualitative study explored how Vice Presidents for Advancement and other senior fundraising leaders in higher education adapted their practices to meet fundraising goals during the pandemic. Using a narrative design, in-depth interviews were conducted with nine participants representing diverse institutions in the southeastern United States. Braun and Clarke’s (2006) six-phase thematic analysis was used to code and interpret the data.

Seven major themes emerged: communications, technology, donor relations, managing a fundraising team, overall giving impact, successful strategies, and the future. Participants described how …

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, …

From Policy To Practice: How Institutional Interpretations Of Ferpa Shape The Campus Safety Conversation, Britney Deaver

Electronic Theses and Dissertations

The Family Educational Rights and Privacy Act (FERPA) is a foundational federal law designed to protect the privacy of student education records. FERPA includes exceptions—such as for health and safety emergencies—that institutions may interpret and apply in varied ways. This qualitative study explores how higher education professionals across diverse institutional contexts conceptualize and apply the health or safety exception, and how those interpretations influence campus safety practices and policy-making. Through semi-structured interviews with compliance officers and administrators, the research examines the intersection of federal policy, institutional culture, and individual judgment.

Findings reveal a range of interpretations shaped by institutional risk …

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, …

Stochastic Functional Data-Driven Models For Real-Time Battery Health Forecasting Under Dynamic Operating Conditions, Joshua Owusu

Electronic Theses and Dissertations

This thesis provides an effective statistical model to predict the real-time state of lithium-ion batteries for reliable Battery Management Systems (BMS). It highlights battery data (voltage, current, temperature) as smooth functional curves. The principal method demonstrates diminishing trends to health outcomes like State of Health (SoH) and Remaining Useful Life (RUL) by employing Functional Principal Component Analysis (FPCA) and Bayesian Functional Linear Models (FLMs). The primary objective is to figure out how uncertain forecasts are. Simulations demonstrate that the highest accuracy (lowest MSE) is achieved through low noise levels along with large sample sizes. The final system provides a highly …

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 …

Exploring The Impacts Of Medical Invalidation On Postpartum Parents With Pcos, Shalini Venkat

Electronic Theses and Dissertations

Individuals with polycystic ovary syndrome (PCOS) face an increased risk of poor perinatal health, yet little is known about whether negative healthcare experiences contribute toward these outcomes. Patients with PCOS have reported experiencing invalidation by healthcare providers; however, the effects of these encounters in postpartum populations remain unclear. Using data from an online survey, the current study investigated whether PCOS status moderated the relationships between invalidating communication by healthcare providers, pregnancy and birth complications, postpartum depression, and postpartum anxiety. While experiences of invalidating communication by healthcare providers predicted worse perinatal health, those with PCOS solely experienced an increased risk of …

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 …

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 …

The Development Of Teacher-Student Relationships In The Elementary School Setting And Their Influence On The Whole Child, Jana H. Kline

Electronic Theses and Dissertations

The relationship students have with teachers can influence their social development, behavior, and academic performance. Some teachers naturally build positive relationships with students while others may not realize the importance or know how to build them unless specific strategies are given. The purpose of this phenomenological, qualitative research study was to examine teacher perceptions of the development of relationships with students in the elementary school setting and their influence on the whole child.

To address this purpose, data collection strategies included individual interviews with elementary school teachers. Analysis of data involved transcribing interviews and line-by-line coding. Themes regarding teacher-student relationships …

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 …

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: …

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 …

"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 …