Digital Commons Network^™

Functional Head Tremor: Contrasting Features With Other Tremor Etiologies, José Fidel Baizabal-Carvallo, Joseph Jankovic

Faculty, Staff and Students Publications

Background: Functional tremor (FT) is considered the most common phenomenology among patients with functional movement disorders (FMDs). Most patients have limb tremor, but they can also present with tremor involving the head and trunk.

Objectives and methods: We aimed to assess the clinical phenomenology of functional head tremor (FHT) and contrast it with features of HT observed in 125 patients with other tremor etiologies (OTE), including 71 patients with essential tremor (ET).

Results: There were 101 consecutive patients (68.3% females) with FT from which n = 36 (35.6%) had FHT. Yes-yes tremor was the most common directionality (47.2%). Functional trunk …

Feasibility Of Expiratory Muscle Strength Training In Individuals With Progressive Supranuclear Palsy, Katya Villarreal-Cavazos, James C Borders, James A Curtis, Jordanna S Sevitz, Nora Vanegas-Arroyave, Michelle S Troche

Faculty, Staff and Students Publications

Introduction: Dysphagia is common among individuals with Progressive Supranuclear Palsy (PSP). Expiratory muscle strength training (EMST) is a treatment used to increase expiratory muscle force production for airway protection deficits. To our knowledge, no studies have tested EMST in this population. The objective of this study was to determine the feasibility of EMST in individuals with PSP.

Methods: Twenty-nine participants completed baseline measures of maximum expiratory pressure and underwent a trial session of EMST. EMST was considered feasible if participants were able to complete at least 10 repetitions at 30% of their maximum expiratory pressure. Qualitative analyses were also completed …

A Multimodal Non-Invasive Approach For Intracranial Pressure Assessment: A Single-Center Study, Dana Klavansky, Helaina Lehrer, Aris Desai, Gabriela Keeton, Neha Dangayach, Alexandra Reynolds, Spyridoula Tsetsou

Faculty, Staff and Students Publications

Background: Intracranial pressure (ICP) monitoring is an integral part of acute brain injury management. While invasive ICP monitoring is the gold standard, there are several medical conditions that preclude its placement. The aim of the present study is to validate a multimodal approach for increasing ICP detection.

Material and methods: In this retrospective study, patients with acute brain injury who had an external ventricular drain (EVD) placement were included. We measured bilateral optic nerve sheath diameter (ONSD) and assessed for optic nerve disk elevation (ONDE) by using ocular ultrasound, bilateral middle cerebral artery pulsatility index (PI) by using transcranial Doppler, …

Cerebellar Purkinje Cell Stripe Patterns Reveal A Differential Vulnerability And Resistance To Cell Loss During Normal Aging In Mice, Sarah G Donofrio, Cheryl Brandenburg, Amanda M Brown, Tao Lin, Hsiang-Chih Lu, Roy V Sillitoe

Faculty, Staff and Students Publications

Age-related neurodegenerative diseases involve reduced cell numbers and impaired behavioral capacity. Neurodegeneration and behavioral deficits also occur during aging, and notably in the absence of disease. The cerebellum, which modulates movement and cognition, is susceptible to cell loss in both aging and disease. Here, we demonstrate that cerebellar Purkinje cell loss in aged mice is not spatially random but rather occurs in a pattern of parasagittal stripes. We also find that aged mice exhibit impaired motor coordination and more severe tremor compared to younger mice. However, the relationship between patterned Purkinje cell loss and motor dysfunction is not straightforward. Examination …

How Well Can Commonly Used Anxiety Scales Detect Treatment Outcomes In The Context Of Autism?, Huilin Chen, Jeffrey J Wood, Connor M Kerns, 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 …

Nortriptyline Inhibits Lysosomal Exocytosis-Mediated Sasp During Gastric Cancer Progression Via Targeting Hoxa1-Pitx2 Phase Separation, Yi Zhou, Chunhui Yang, Xinyue Li, Xiaojing Wang, Wanju Jiao, Xiaolin Wang, Jiaying Qu, Bosen Zhao, Shunchen Zhou, Qiangsong Tong, Liduan Zheng

Faculty, Staff and Students Publications

Lysosomal exocytosis, a calcium-dependent secretory process, facilitates extracellular release of cargos that promote cancer progression, though its regulatory pathways and therapeutic strategies are poorly understood. Herein, using combined transcriptomic and proteomic approaches, we identify homeobox A1 (HOXA1) as a functional partner of paired like homeodomain 2 (PITX2) within biomolecular condensates forming via liquid-liquid phase separation. Mechanistically, HOXA1-PITX2 complex facilitates the expression of mucolipin 1 (MCOLN1) and RAS-related protein Rab-3A (RAB3A), which drive lysosomal exocytosis of galectin-1 (LGALS1) and insulin like growth factor binding protein 7 (IGFBP7) from senescent gastric cancer cells. This process potentiates AKT activation and epithelial-mesenchymal transition, accelerating …

Racial And Ethnic Disparities In Pediatric Autoimmune Encephalitis: A Systematic Review, Jennifer H Yang, Kristen S Fisher, Julia Dumcum, Sophie Zacharek, Alexandra B Kornbluh, Kelsey Poisson, Mary C Karalius, Leigh Sepeta

Faculty, Staff and Students Publications

Objectives: Health disparities and social determinants of health are increasingly recognized as important predictors for clinical outcomes in autoimmune disease. However, this is poorly studied in pediatric autoimmune encephalitis (AE).

Methods: We conducted a systematic literature review in accordance with PRISMA guidelines. Searches included Medline (Pubmed), EMBASE, and Web of Science databases from inception years to October 4, 2024. Inclusion criteria were: 1) Patients diagnosed with AE ≤ 18 years old; 2) any report of race and/or ethnicity, 3) report of specific diagnostics and disease outcomes, 4) observational cohort studies, epidemiological studies or case series/ cohort studies of n ≥ …

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 …

Plasma Metabolomic And Proteomic Signatures Of Blood Pressure Management After Bariatric Surgery Among Adolescents, Shudi Pan, Zhenjiang Li, Juan Pablo Lewinger, Jesse A Goodrich, Hongxu Wang, Sarah Rock, Carmen Chen, Todd M Jenkins, Stephanie Sisley, Stephen R Daniels, Douglas I Walker, Max T Aung, Erika Garcia, Rob Mcconnell, Sandrah P Eckel, Michele A La Merrill, Tanya L Alderete, Zhuanghua Chen, Frank D Gilliland, Thomas H Inge, David V Conti, Justin R Ryder, Lida Chatzi

Faculty, Staff and Students Publications

Background: Emerging omics approaches, including metabolomics and proteomics, can be integrated into obesity treatment for better blood pressure management. We tested whether preoperative metabolomic and proteomic profiles predict long-term elevated blood pressure (EBP) changes better than known risk factors in adolescents undergoing bariatric surgery.

Methods: We included 108 participants from the Teen-LABS (Teen-Longitudinal Assessment of Bariatric Surgery). Plasma untargeted metabolomics (via liquid chromatography with high-resolution mass spectrometry) and Olink proteomics were assessed pre surgery. An elastic net model with stability selection was used to identify features predictive of EBP reductions 5 years post surgery. Models including identified metabolites, proteins, and …

Synthesis Of Phenyl-Substituted Zinc Dipyrrin Photosensitizer For Carbon Dioxide Reduction, Stephen Ankomah

Electronic Theses and Dissertations

The release of CO₂ from fossil fuel combustion drives the need for its conversion into more sustainable options like CO and CH₄ via photocatalytic reduction. This process requires a catalyst, sensitizer, and electron donor. Zinc dipyrrin-based complexes are promising photosensitizers, offering an alternative to expensive, rare-metal-based systems. Most first-row transition metal dipyrrin compounds have short excited-state lifetimes due to rapid nonradiative decay, but Zn(II) dipyrrin complexes stand out. With a d¹⁰ configuration, they lack deactivating ligand field states and can access long-lived triplet states through a charge-separated intermediate. A phenyl-substituted Zn(II) dipyrrin complex was synthesized and studied using NMR to …

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 …

Strategic Enhancement Of Biofuel Production Using Bacillus Subtilis As A Model Organism: A Dual Approach Of Gene Essentiality Mapping And Optimization, Angela A. Zebede

Electronic Theses and Dissertations

With rising global demand for renewable energy, enhancing microbial platforms for biofuel production is vital. This study engineered Bacillus subtilis to improve resilience to solvent stress by targeting membrane lipid biosynthesis pathways essential for integrity. Growth curve analysis (OD₆₀₀) showed that phosphatidylserine (PS) and phosphatidylethanolamine (PE) knockout strains grew significantly slower than wild type (168), indicating the importance of these lipids under stress. Laurdan fluorescence spectroscopy was used to assess membrane properties. Generalized polarization (GP) analysis revealed a concentration-dependent reduction in membrane order upon 1%–2% 1-butanol exposure. GP values declined progressively from control to 2% treatment, reflecting increased membrane fluidity …

Divergent Responses Of Branched-Chain And Straight-Chain Lipid Membranes To Butanol Stress Revealed By All-Atom Molecular Dynamics Simulations, Joshua Olaf Aggrey

Electronic Theses and Dissertations

Membrane integrity under chemical stress is critical to cellular survival and industrial microbial bioproduction, yet the molecular basis of bilayer resilience remains poorly understood. Using all-atom molecular dynamics simulation, we compare the effect of increasing concentrations of 1‑butanol on membranes composed of straight-chain (1,2-dipalmitoyl-sn-glycero-3-phosphocholine, DPPC) and branched-chain (1-anteiso-palmitoyl-2-palmitoyl-sn-glycero-3-phosphocholine, APPC) lipids, which differ in the point of attachment of a single methyl group. In the absence of butanol, both membranes exhibit well-ordered architectures consistent with experimental benchmarks; however, under increasing solvent stress, their behaviors diverge markedly. DPPC membranes display gradual thinning, modest area per lipid …

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 …

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

Electronic Theses and Dissertations

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

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

Electronic Theses and Dissertations

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

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

Electronic Theses and Dissertations

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

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

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

Electronic Theses and Dissertations

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

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 …

The Food Truck: A Multi-Product Newsvendor With Expectile Risk, Sekyiwaah Nuamah

Electronic Theses and Dissertations

The Newsvendor Problem is a fundamental model in Operation Research and Supply Chain Management used to determine the optimal order quantity under uncertain demand to minimize expected costs.
This research extends the classical Newsvendor problem to a multi--product setting, addressing the risk of asymmetric cost structures faced by a food truck. This thesis introduces expectile risk measures to quantify and manage uncertainty in demand, moving beyond traditional risk metrics. To evaluate the impact of expectile-based decision-making, we analyze three types of demand distributions--simple, symmetric, and skewed. For skewed distributions, we apply linear spline inverse interpolation to derive expectile values from …

Deep Learning With Kalman Filter, Rexford Julius Quaye

Electronic Theses and Dissertations

This thesis presents an extension of the Kalman filter to handle nonlinear and non-Gaussian systems. The standard Kalman filter is optimal under Gaussian assumptions but struggles with more complex noise models. This work introduces a novel loss function based on the Mahalanobis distance, which incorporates the covariance structure of measurement errors, enabling the filter to adapt to non-Gaussian scenarios. The neural network framework is applied to predict the system’s process model, while retaining the classical Kalman measurement update. The proposed methodology is demonstrated through examples of car position and rocket altitude tracking. The results show that the new approach performs …

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 …

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 …

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

Electronic Theses and Dissertations

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

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

The research explores the devastating impact of the Russian …

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

Electronic Theses and Dissertations

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