Digital Commons Network^™

Plasma Proteins Associated With Psychosocial Factors And Heart Disease: The Jackson Heart Study, Daniel E Cruz, James S Floyd, Susan Hankinson, Daniel H Katz, Xiaojuan Liu, Michelle C Odden, Bruce M Psaty, Alexander P Reiner, Jerome I Rotter, Stephen S Rich, Robert E Gerszten, Amil Shah, Mario Sims, Usman A Tahir, Lesley F Tinker, Alexis C Wood, Bing Yu, Anthony S Zannas, Laura M Raffield, Láshauntá M Glover

Faculty, Staff and Students Publications

Background: Knowledge of proteomic mechanisms explaining the link between psychosocial stress and cardiovascular disease is limited. This study aimed to (1) identify plasma proteins associated with psychosocial factors and (2) assess associational pathways between psychosocial factors, identified proteins, and incident cardiovascular disease events in a discovery cohort, JHS (Jackson Heart Study), and 2 replication cohorts, the CHS (Cardiovascular Health Study), and the MESA (Multi-Ethnic Study of Atherosclerosis).

Methods: JHS participants from exam 1 (2000-2004) with SomaScan 1.3k platform proteomics data were included (n=2143, mean age=55.3). Depressive symptoms and perceived stress scores were measured via the 20-item Center for Epidemiological Studies …

Hepatopulmonary Syndrome As Presentation Of Pediatric Metabolic Dysfunction-Associated Steatohepatitis, Alexiss M Williams, Nhu Thao Galvan, John A Goss, Krupa R Mysore

Faculty, Staff and Students Publications

Childhood obesity is rising and leading to serious co-morbidities, among which is metabolic dysfunction-associated steatotic liver disease (MASLD) predisposing individuals to cirrhosis. We describe a young 11-year-old Hispanic male who presented with hepatopulmonary syndrome secondary to cirrhotic portal hypertension from metabolic dysfunction-associated steatohepatitis (MASH), necessitating liver transplantation. Despite lifestyle modifications post-transplantation, the patient experienced persistent weight gain and recurrence of steatosis, emphasizing challenges of managing pediatric MASLD. The burden of childhood obesity is increasing and impacting children significantly earlier than previously believed. Our case is one of the few to report the severe complications of MASH in a young, pre-teen …

Noncanonical Clock Regulators Control Stress Responses In Digestive Diseases, Dongyin Guan

Faculty, Staff and Students Publications

The digestive system is essential for nutrient absorption, processing, and waste elimination. The expression of many genes and physiological processes within this system exhibits a 24-h rhythmicity. However, modern lifestyle factors, such as jet lag, shift work, and irregular eating patterns, significantly disrupt these rhythms, triggering various stress responses and contributing to numerous digestive disorders. Here, we focus on emerging studies on noncanonical clock regulators involved in stress responses, integrate these novel findings into the established model of the core circadian clock, and highlight recent advances in the development of novel therapeutics targeting these 24-h regulators. In addition, we discuss …

Robot-Assisted Resection Of Diaphragmatic And Hepatorenal Recess Peritoneal Endometriosis: Two Cases And A Narrative Review, Chunhua Zhang

Faculty, Staff and Students Publications

In this report, we describe two cases of diaphragmatic endometriosis with concurrent hepatorenal recess peritoneal involvement managed using robotic-assisted laparoscopic surgery with the da Vinci Xi platform. In both patients, diaphragmatic implants and hepatorenal recess peritoneal lesions were excised en bloc, followed by resection of additional pelvic and abdominal lesions. Case 1 involved a 45-year-old woman whose pathology confirmed endometriosis in 28 of 46 sites, including the diaphragm, umbilicus, bowel, hepatorenal recess peritoneum, and pelvic peritoneum. Case 2 involved a 32-year-old woman with histopathologic evidence of endometriosis in 26 of 34 resected sites, including the appendix, diaphragm, hepatorenal recess peritoneum, …

Racial, Ethnic, And Neighborhood Disparities In Acute Kidney Injury In Pediatric Acute Leukemia, Kelly Getz, Lusha Cao, Edward Krause, Mark Ramos, Judy Lee, Maria Monica Gramatges, Karen R Rabin, Michael Scheurer, Richard Aplenc, Michelle Denburg

Faculty, Staff and Students Publications

Introduction: We sought to identify racial/ethnic and neighborhood disparities in acute kidney injury (AKI) in children with acute lymphoblastic or myeloid leukemia (ALL, AML).

Methods: Electronic health record data were retrospectively collected from patients treated for de novo pediatric ALL or AML in the multicenter Leukemia Electronic Abstraction of Records Network. AKI was defined by modified Kidney Disease Improving Global Outcomes criteria. Neighborhood-level resources were defined by the Child Opportunity Level (COL). Prevalence ratios (PRs) for AKI at diagnosis by race/ethnicity and COL were calculated using modified Poisson regression. Cox regression was used to calculate hazard ratios (HRs) of first …

Validation Of The German Version Of The Movement Disorder Society Non-Motor Scale (Mds-Nms), Kristof Wunderlich, David Geißler-Lösch, Isabel Wurster, Roswitha Kemmner, Kathrin Brockmann, Sheng Luo, Christopher G Goetz, Glenn T Stebbins, Pablo Martinez-Martin, Tiago A Mestre, Alvaro Sanchez-Ferro, Monica M Kurtis, Michelle H S Tosin, Roberta Balestrino, Chi-Ying R Lin, Carmen Gasca-Salas, Heinz Reichmann, Bjoern H Falkenburger

Faculty, Staff and Students Publications

No abstract provided.

Screening For Hypertension And Diabetes In Laundromats In The Largest Hispanic-Majority City In The U.S

Faculty, Staff and Student Publications

Purpose: This study aimed to assess the prevalence of hypertension and diabetes among laundromat users in San Antonio, Texas, and explore laundromats as a novel setting for health interventions regarding these 2 conditions.

Design: This descriptive, cross-sectional study involved demographic, blood pressure and HbA1c screenings to assess the health status of laundromat users.

Setting: The study took place in 7 laundromats in low-income areas of San Antonio.

Subjects: A total of 150 adults aged 18 and older who regularly used the laundromats and spoke either English or Spanish were eligible to participate.

>Measures: Hypertension was defined as a systolic BP …

An Integrated Framework For Early Detection And Transmissibility Assessment Of Emerging Variants In Wastewater, Steven F Rhode, Tsultrim Palden, Mats Leifels, Anna Gitter, Yang Kuang, Stefan Wuertz, Janelle Thompson, Kristina D Mena, Eric J Alm, Fuqing Wu

Faculty, Staff and Student Publications

Tracking the emergence of new viral variants is critical for epidemic preparedness, but remains challenging because variants typically circulate at low prevalence during the early phase of outbreaks. Here, we present an integrated framework that combines sensitive variant detection in wastewater with quantitative assessment of transmissibility through dynamic epidemic modeling. Using the SARS-CoV-2 Omicron variant as a proof of concept, we developed a novel nested allele-specific RT-qPCR assay (NAS-PCR) that achieved a thousand-fold increase in sensitivity compared with allele-specific RT-qPCR (limit of detection: 0.5 copies/μl). NAS-PCR detected Omicron in wastewater samples from the Greater Boston area starting in September 2021, …

Perceived Neighborhood Environment And Objectively Assessed, Habitual Physical Activity Among Us Adults: An All Of Us Research Program Study, Timothy J Walker

Faculty, Staff and Student Publications

Introduction: The purpose of this study was to assess the associations between perceived socioenvironmental neighborhood attributes and objectively assessed habitual physical activity among US adults as well as whether associations vary by sociodemographic characteristics.

Methods: We used data from the All of Us research program, a longitudinal cohort study of a diverse sample of Americans. Perceived neighborhood social cohesion, physical and social disorder, walkability, and sociodemographic characteristics were self-reported. Habitual physical activity was ascertained using Fitbit-derived step counts over ≥24 weeks. Generalized additive mixed-effects models were used to test the associations between perceived socioenvironmental neighborhood attributes and daily step counts. …

Interplay Between Genetic Ancestry, Self-Reported Race And Ethnicity, And Clinical Factors In Pediatric Acute Lymphoblastic Leukemia: A Redial Consortium Report, Maria I Castellanos, Olga A Taylor, Veronica Garcia-Morales, Austin L Brown, Pagna Sok, Jeremy M Schraw, Van Huynh, Kathleen F Ludwig, Laura J Klesse, Sandi L Pruitt, Amy E Hughes, Kevin Tien, Kenneth M Heym, Timothy Griffin, Rodrigo Erana, Juan Carlos Bernini, Maria M Gramatges, Elizabeth G Atkinson, Philip J Lupo, Michael E Scheurer, Karen R Rabin

Faculty, Staff and Students Publications

Background: Pediatric acute lymphoblastic leukemia (ALL) is the most common cancer in children, and its incidence and outcomes vary by race and ethnicity.

Methods: The Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium has assembled a cohort of patients < 25 years at diagnosis to examine genetic and neighborhood-level factors influencing ALL. As the cohort is ongoing, for this report, we examined sociodemographic and cytogenetic factors that might be associated with ALL outcome disparities.

Results: Among 2,512 patients diagnosed between 2005 and 2020, we observed distinct patterns of genetic ancestry and residential characteristics across self-reported race and ethnicity. Latino children, who comprised 55.3% of the cohort, had a mean Amerindigenous ancestry proportion of 50.9%, whereas non-Latino White children exhibited a predominantly European ancestry (mean = 78%). Neighborhood-level analysis revealed significant socioeconomic and geographic differences by …

Exploring Bidirectionality In Global Health Partnerships: Perspectives From U.S. Pediatric Residency Programs, Ashley Combs, Adelaide Barnes, Kathy Ferrer, Heather Haq, Duncan K Hau, Lee Morris, Brittany Murray, Amy Rule, Reena P Tam, Lisa Umphrey, Megan S Mchenry

Faculty, Staff and Students Publications

Introduction Despite growing interest, little guidance exists to re-evaluate global health partnerships (GHPs) through promoting bidirectionality. This study aims to understand the perspectives of United States (U.S.) pediatric global health (GH) faculty on institutional bidirectional practices to inform future discussions with international collaborators. Methods An internally, iteratively developed REDCap-based online survey (REDCap, Vanderbilt University, Nashville, TN), by our diverse author group, collected qualitative data from January 18 to February 20, 2023. Free-text responses were reviewed and coded inductively, with findings framed to generate themes for subsequent engagement with international partners. Results Of the 88 U.S. programs that identify as having …

Clinical And Demographic Characteristics Of Hospitalized Patients With Xylazine-Related Wounds, Elizabeth Novick, Nikhil Seval, Dagan Coppock, Mollie Tucker, Daniel Taupin, John Zurlo, Carolyn Kramer

Department of Medicine Faculty Papers

OBJECTIVES: Little is known about the demographic and clinical features of patients with xylazine-related wounds. We sought to characterize hospitalized patients with substance use disorder (SUD) and xylazine-related wounds seen for infectious diseases consultation.

METHODS: We retrospectively reviewed the medical records of 193 patients diagnosed with SUD at 3 Philadelphia hospitals between October 2023 and January 2024. Patients were identified as either being diagnosed with (n=73) or without (n=120) xylazine-related wounds. We compared the demographic and clinical features between the 2 groups.

RESULTS: Patients diagnosed with wounds were younger ( P < 0.001), more likely to be White or Hispanic and less likely to be Black/AA ( P < 0.001), more likely to have tested positive for fentanyl ( P < 0.001), amphetamines ( P < 0.001), and cocaine ( P 0.001), more likely to acknowledge injection ( P < 0.001), and more likely to leave the hospital by patient-directed discharge (PDD) ( P < 0.001). Most patients had multiple wounds (75%), and more than half (53%) had at least one wound greater than 10 cm at its widest dimension. Although most patients diagnosed with wounds received antibiotics, many did not have symptoms or signs of infection.

CONCLUSIONS: Xylazine-related wounds are highly associated with illicitly manufactured …

Rationalizing Atrocity: Vindicatory Careerism And Mass Murder As A Career Path, 1939-1943, Bethany G. Bare

Electronic Theses and Dissertations

This study examines members of the Nazi Schutzstaffel from an occupational perspective, focusing on how professional roles shaped their participation in systematic mass murder. As National Socialism gained influence in interwar Germany, it coincided with the rise of a generation of ambitious and embittered men eager to distinguish themselves. The transition from the T4 Program (1939-1941), the involuntary euthanasia of disabled Germans, to Operation Reinhard (1942-1943), the extermination of Polish Jews, demonstrates how mass murder evolved into a career path, as each of the men examined served as T4 personnel before transferring to Poland to assume positions as extermination camp …

Perceptions Of Educators To Recognize And Respond To Suicidal Ideation Of Secondary Students, Clary Aaron

Electronic Theses and Dissertations

This qualitative phenomenological study explored how secondary teachers in East Tennessee perceive district-provided suicide prevention training and its role in supporting students experiencing suicidal ideation. Eleven middle and high school teachers who had previously made a crisis referral participated in semi-structured interviews. The study examined teachers’ experiences, perceived strengths and limitations of training, and needed resources. Findings revealed that teachers felt confident recognizing warning signs, especially behavioral changes, when strong student relationships existed. However, training was often described as repetitive, generic, and minimally engaging. Social media and limited support systems were seen as major stressors for students. Teachers emphasized relationship-centered …

Post-Vote Tampering In Nigerian Elections And The Role Of Blockchain-Enabled Electoral Systems, Ransome Chukwubuikem Enechukwu

Electronic Theses and Dissertations

Post-vote tampering during the collation and transmission of election results remains a persistent challenge in Nigerian elections, enabling manipulation of already-cast votes and weakening public trust in electoral outcomes. Existing technological interventions, including biometric voter accreditation and digital result transmission systems, improve voter authentication but do not adequately secure the post-vote result collation process. This thesis proposes a blockchain-enabled framework designed to protect the integrity of election results during the collation and transmission stages. Using a Design Science Research methodology, the study develops a permissioned blockchain framework based on Hyperledger Fabric that records polling-unit results as immutable ledger entries and …

Social Reading And #Booktok: Exploring Emotion, Community, And Book Promotion On Tiktok, Courtney B. Thompson

Electronic Theses and Dissertations

This study examines how BookTok, a subcommunity centered on reading, functions as a social and emotional domain that shapes contemporary reading culture. Discourse analysis of the most popular videos within the BookTok subspace revealed commonalities in how creators expressed their emotions through text, language, and audio. Patterns of emotional devastation were also present in the discourse, pointing to affective-discursive practices circulating the community. Moreover, a content analysis of the books being promoted across highly engaged BookTok videos uncovered significant themes of romance and an appreciation for modern fiction novels.

Findings suggest that reading functions as a social experience that is …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Feasibility Of Assessing Dietary Patterns And Anxiety In College Students: A Pilot Study Using Nutrition Questionnaires, Gad-7, And Asq, Kylie Ford

Electronic Theses and Dissertations

Anxiety is highly prevalent among college students representing a significant public health concern. Research indicates that dietary patterns may influence mental health outcomes; however, the practicality of collecting comprehensive dietary and psychological data in college populations remains unclear. This pilot study assessed the feasibility of evaluating dietary patterns and anxiety using self-report instruments. Participants completed the Nutrition and Eating Habit questionnaire, the Generalized Anxiety Disorder-7 (GAD-7), and the Anxiety Sensitivity Questionnaire (ASQ). Although twenty-one students were recruited, survey completion rates were low, with only seven participants completing the nutrition questionnaire necessary to calculate the Dietary Inflammatory Index (DII). Descriptive analyses …

Ethical Engagement In Global Missions: A Qualitative Inquiry Into Planner Motivations And Host Experiences, Harrison J. Ihrig

Electronic Theses and Dissertations

Short-term mission (STM) trips are limited duration service experiences, commonly organized by faith-based organizations (FBO), in which volunteers travel domestically or international to provide ministry, community outreach, and/or health-related services. In recent decades, the number of these trips organized by organizations in the United States has increased exponentially, but the phenomenon is difficult to accurately measure due to its decentralized nature and the lack of standardized terminology. Despite their prominence, limited research has been conducted to examine planning, implementation, and evaluation processes of international STMs organized by FBO, particularly through a public health lens. The purpose of this study was …

Extreme Precipitation Events And Population Exposure: Site Recommendations For The Future Tennessee Mesonet, Victoria G. Redlund

Electronic Theses and Dissertations

This study examines frequency of and population exposure to extreme rainfall events in Tennessee to guide the placement of future mesonet weather stations. Using 1991-2021 daily nClimGrid precipitation records, extreme events were defined as events of rainfall ≥50 mm. These events were collated on an annual scale and normalized alongside square-root-scaled population densities derived from Landscan to develop extreme rainfall vulnerability maps. Results highlight where extreme rainfall is most frequent relative to population densities in each county. The findings were compared with models of mesonet suitability and feasibility to determine how meteorological needs correlate with siting needs such as land …

“The Distance And Time Difference Aren’T Helping”: Family Communication Practices Of African Graduate Students Adapting To A New Country, Hummuh Abubakar

Electronic Theses and Dissertations

This qualitative study examined how international graduate students maintained long-distance communication with family members while adapting to life in the United States. Drawing on semi-structured interviews with seven international students, the research explored how participants sustained emotional closeness, manage disclosure, and select communication media across geographic distance. Guided by Communication Privacy Management Theory and Media Richness Theory, the study analyzed how students regulated private information and strategically used video calls, voice calls, and messaging platforms to meet relational and emotional needs. Findings revealed four primary themes: reliance on digital communication technologies; the emotional and psychological functions of family communication; structural …

Utilizing Physics Informed Neural Networks For Disrupted Signal Dynamics, Nicholas J. Joyner

Electronic Theses and Dissertations

Physics-informed neural networks (PINNs) have been used in many applications including engineering and physical sciences. PINNs allow the incorporation of a priori understanding of a process’ structure into the modeling. We attempt to leverage the PINN structure toward the evaluation of disruptions to classical dynamical models by combining elements of ordinary differential equations into our loss function with sigmoidal gating to balance the penalties for deviations from the data with those for structural deviations. This enables the identification of the signal structure and the limits of disruption influence. As a use case, we consider stock value from 2019-2021, which expresses …

The Influence Of Intervention Strategies On Students With Disabilities Who Exhibit Challenging Behaviors In Rural Public Schools: Teacher Perceptions, Ben B. Robertson

Electronic Theses and Dissertations

This phenomenological qualitative study addressed rural teachers' perceptions of the influence of intervention strategies on students with disabilities who exhibit challenging behaviors. The purpose of this study was to examine teachers’ perceptions of the effect of intervention strategies on academic achievement, student behavior outcomes, and teacher self-efficacy through the lens of Bandura’s Social Cognitive Theory. This theory is a complex, dynamic interaction among people, their behaviors, and their environments. Data collection included 14 individual interviews, conducted on Zoom with educators from one school district in Southern Virginia, including seven general education teachers and seven special education teachers. Data analysis strategies …

Media Portrayal Of High-Profile Female Victims Of Sexual Harassment, Chinenye Nwaneri

Electronic Theses and Dissertations

This rhetorical study investigated how the Nigerian media portray high-profile female victims of sexual harassment. The research was undertaken in response to concerns that media narratives often reinforce gender stereotypes and influence public perceptions of victims. Focusing on the sexual harassment allegations made by senator Natasha Akpoti-Uduaghan against Senate president Godswill Akpabio, the study analyzed newspaper coverage from Daily Trust and Vanguard between February and December 2025. Using Critical Discourse Analysis within the framework of Feminist Media Theory, the research examined how language and framing shaped the representation of the female accuser. The findings reveal that media coverage constructed the …

Parent Engagement And Advocacy In Individualized Education Programs In Rural Appalachian School Districts, Mollie Rutledge

Electronic Theses and Dissertations

The purpose of this phenomenological study was to explore parent engagement and parent advocacy in the Individualized Education Program (IEP) development and implementation in rural Appalachian school districts. Parent engagement and parent advocacy in Individualized Education Program (IEP) development and implementation are persistent challenges in special education. By intentionally grounding this research in rural Appalachia, the researcher responded to calls for education research that is attentive to the complexity and diversity of rural communities. Parents in rural areas face unique challenges related to poverty, isolation, and limited resources that can influence their engagement and advocacy in the IEP process. The …

Men’S Preconception Diet Quality Patterns Predict Supportive Food Parenting Practices: Evidence From A Longitudinal Cohort Study, Mariane H. De Oliveira, Brian K. Lo, Matthew M. Lee, Stephanie Armbruster, Natalie Grafft, In Young Park, Alejandra Cantu-Aldana, Katherine W. Bauer, Rebekah Levine Coley, Sebastien Haneuse, Kirsten Davison, Jess Haines

Human Genetics Publications

Background: Food parenting practices play a vital role in shaping children's food intake, yet evidence linking fathers' earlier diet patterns to later parenting is limited. This study examined the association between fathers' diet quality patterns during their adolescence and food parenting practices during fatherhood.

Methods: Data were drawn from Fathers & Families (F&F), a father-based cohort that recruited participants from an ongoing cohort in the United States that has followed participants since adolescence. Participants (n = 584) reported their dietary intake during adolescence (ages 10-18) using a Youth/Adolescent Food Frequency Questionnaire across multiple survey waves (1996-2011), and reported their food …

How Ai Destroys Institutions, Woodrow Hartzog, Jessica Silbey

Faculty Scholarship

Civic institutions—the rule of law, universities, and a free press—are the backbone of democratic life. They are the mechanisms through which complex societies encourage cooperation and stability, while also adapting to changing circumstances. The real superpower of institutions is their ability to evolve and adapt within a hierarchy of authority and a framework for roles and rules, while maintaining legitimacy for the knowledge produced and the actions taken. Purpose-driven institutions built around transparency, cooperation, and accountability empower individuals to take intellectual risks and challenge the status quo. This happens through the machinations of interpersonal relationships within those institutions, which broaden …

Metrics Not Thresholds: How To Regulate Ai And Other Expert Methods For Use In Criminal Investigations And Proceedings, Rebecca Wexler

Faculty Scholarship

Should regulators set performance thresholds for AI tools used in the criminal legal system? This Article draws on U.S. evidence law for guidance. Its answer is ... don’t. Instead of gatekeeping with ex ante performance thresholds, regulators should require or incentivize metrics of reliability that can be clearly communicated to end-user decisionmakers.

U.S. Shareholder Activism: Convergence With Japan, Nobuhisa Ishizuka

Faculty Scholarship

To many observers long accustomed to slow, incremental change, the current boom in shareholder activism in Japan comes as a surprise. The opening for U.S.-style activists was created by market conditions that eventually resulted in policy changes that attracted significant numbers of foreign investors. However, even the current market would not have emerged without a parallel evolution in U.S. hedge-fund tactics, which gradually shifted over a number of years to a sophisticated and more nuanced approach, one based on partnership and dialogue with target companies, in contrast to adversarial relationships and public campaigns. This article attempts to place current trends …

The Federal Reserve’S Fiscal Agent Mandate And The Problem For Central Bank Independence, Lev Menand, Joshua Younger

Faculty Scholarship

The Federal Reserve is among the most powerful organs of government. It is tasked primarily with maintaining the growth of monetary and credit aggregates consistent with long-run maximum employment and price stability. This mandate is widely known and the subject of extensive public debate. But another mandate lies within the statute that is largely overlooked — to serve as fiscal agent of the United States. This distinct responsibility is older, and also important. This Article offers a comprehensive assessment of where the Fed’s two mandates overlap and occasionally sharply conflict: in the market for U.S. government debt. First, it identifies …