Digital Commons Network^™

Testing For Bleeding Disorders In Child Abuse: Aap Recommendation Adherence And Testing Results, Shannon L Carpenter, Angela Bachim, Caitlin R Mcnamara, Farah W Brink, Lori D Frasier, Nancy S Harper, Natalie Laub, Kristine A Campbell, Daniel M Lindberg, Joanne N Wood, James Anderst

Faculty, Staff and Students Publications

Objectives: Using a multicenter child abuse pediatrics research network (CAPNET), the study objectives were to characterize the adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification.

Methods: We performed a descriptive study of bleeding disorder evaluations among children younger than 10 years of age who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse from February 2021-May 2022 utilizing CAPNET. Cases were classified as bruising without ICH or ICH with or without bruising. Based on AAP guidance, testing was not recommended in cases with concomitant suspicious injuries, inflicted injury …

Generating Training Events For Building Cyber-Physical Security Skills, Avanthika Vineetha Harish, Kimberly Tam, Kevin Jones

School of Engineering, Computing and Mathematics

As the threat of cyber attacks increases, the cyber security sector continues to train professionals as one form of mitigation. Gamification and infrastructure like cyber ranges have been proven useful in training cyber security specialists to detect and react to cyber-attacks in information technology. However, a subset of all digital threats target cyber-physical systems, not just information systems, and these threats have been growing rapidly in recent years. While those threats are increasing, training specific to cyber-physical threats is not growing as quickly as information technology training solutions. While cyber ranges are useful for training and supporting events like cyber …

The Impact Of Dwell Time On The Contextual Effect Of Visual And Passive Lead-In Movements, Laura Alvarez-Hidalgo, David W. Franklin, Ian S. Howard

School of Engineering, Computing and Mathematics

Contextual cues arising from distinct movements are crucial in shaping control strategies for human movement. Here, we examine the impact of visual and passive lead-in movement cues on unimanual motor learning, focusing on the influence of “dwell time,” where two-part movements are separated by the interval between the end of the first movement and the start of the second. We used a robotic manipulandum to implement a point-to-point interference task with switching opposing viscous curl fields in male and female human participants. Consistent with prior research, in both visual and passive lead-in conditions, participants showed significant adaptation to opposing dynamics …

Simulation And Feasibility Assessment Of A Green Hydrogen Supply Chain: A Case Study In Oman, Mi Tian, Shuya Zhong, Muayad Ahmed Mohsin Al Ghassani, Lars Johanning, Voicu Ion Sucala

School of Engineering, Computing and Mathematics

The transition to sustainable energy is crucial for mitigating climate change impacts. This study addresses this imperative by simulating a green hydrogen supply chain tailored for residential cooking in Oman. The supply chain encompasses solar energy production, underground storage, pipeline transportation, and residential application, aiming to curtail greenhouse gas emissions and reduce the levelized cost of hydrogen (LCOH). The simulation results suggest leveraging a robust 7 GW solar plant. Oman achieves an impressive annual production of 9.78 TWh of green hydrogen, equivalent to 147,808 tonnes of H₂, perfectly aligning with the ambitious goals of Oman Vision 2040. The …

Social Anxiety Moderates The Association Between Adolescent Irritability And Bully Perpetration, Michael T Perino, Jennifer C Harper-Lednicky, Alecia C Vogel, Chad M Sylvester, Deanna M Barch, Joan L Luby

2020-Current year OA Pubs

BACKGROUND: Preliminary work suggests anxiety moderates the relationship between irritability and bullying. As anxiety increases, the link between irritability and perpetration decreases. We hypothesize that any moderation effect of anxiety is driven by social anxiety symptoms. We sought to explicate the moderating effect of anxiety, while clarifying relations to other aggressive behaviors.

METHODS: A sample of adolescents (

RESULTS: Irritability was significantly related to bullying (

CONCLUSIONS: Understanding how psychopathology interacts with social behaviors is of great importance. Higher social anxiety is linked to reduced relations between irritability and bullying; however, the link between irritability and other aggression remains positive. …

Combining Exercise Training And Testosterone Therapy In Older Women After Hip Fracture: The Step-Hi Randomized Clinical Trial, Ellen F Binder, Peter M Doré, Camelia Guild, Kelly M Monroe, Dominic Reeds, Kenneth B Schechtman, Et Al.

2020-Current year OA Pubs

IMPORTANCE: Despite receiving postacute rehabilitation services, many older women with a recent hip fracture repair are unable to return to their prefracture level of function. Whether testosterone therapy can enhance recovery after hip fracture in older women with persistent mobility impairments has not been fully examined.

OBJECTIVE: To evaluate the effects of a supervised exercise program combined with topical testosterone therapy on functional outcomes in older women with a recent hip fracture.

DESIGN, SETTING, AND PARTICIPANTS: This phase 3 double-blind, placebo-controlled randomized clinical trial, Starting a Testosterone and Exercise Program After Hip Injury (STEP-HI), was conducted at 8 US sites …

Gdf15 Links Adipose Tissue Lipolysis With Anxiety, Logan K Townsend, Léa J Becker, Jordan G Mccall, Et Al.

2020-Current year OA Pubs

Psychological stress changes both behaviour and metabolism to protect organisms. Adrenaline is an important driver of this response. Anxiety correlates with circulating free fatty acid levels and can be alleviated by a peripherally restricted β-blocker, suggesting a peripheral signal linking metabolism with behaviour. Here we show that adrenaline, the β3 agonist CL316,243 and acute restraint stress induce growth differentiation factor 15 (GDF15) secretion in white adipose tissue of mice. Genetic inhibition of adipose triglyceride lipase or genetic deletion of β-adrenergic receptors blocks β-adrenergic-induced increases in GDF15. Increases in circulating GDF15 require lipolysis-induced free fatty acid stimulation of M2-like macrophages within …

Cdc’S Core Elements To Promote Diagnostic Excellence, Andrea Bradford, L Clifford Mcdonald, Preeta K Kutty

Faculty, Staff and Students Publications

Nearly a decade after the National Academy of Medicine released the "Improving Diagnosis in Health Care" report, diagnostic errors remain common, often leading to physical, psychological, emotional, and financial harm. Despite a robust body of research on potential solutions and next steps, the translation of these efforts to patient care has been limited. Improvement initiatives are still narrowly focused on selective themes such as diagnostic stewardship, preventing overdiagnosis, and enhancing clinical reasoning without comprehensively addressing vulnerable systems and processes surrounding diagnosis. To close this implementation gap, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of …

Association Between Food Insecurity And Chronic Eye Disease In The National Institutes Of Health's All Of Us Research Program, Ramin Talebi, Fei Yu, Victoria L. Tseng, Anne L. Coleman

SKMC Student Presentations and Publications

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Design

Participants

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Main Outcome Measure(s)

The Sonora Substellar Atmosphere Models. V. A Correction To The Disequilibrium Abundance Of Co2 For Sonora Elf Owl, Nicholas F. Wogan, James Mang, Natasha E. Batalha, Kevin Zahnle, Sagnick Mukherjee, Channon Visscher, Jonathan J. Fortney, Mark S. Marley, Caroline V. Morley

Faculty Work Comprehensive List

To aid the interpretation of observations of substellar atmospheres, S. Mukherjee et al. created the Sonora Elf Owl grid of model atmospheres, simulations that accounted for disequilibrium quench chemistry. However, Sonora Elf Owl did not accurately estimate CO₂ quenching because the models quenched the gas with respect to the full atmosphere equilibrium, but CO₂ should have instead been quenched with respect to the disequilibrium (i.e., quenched) abundance of CO. As a result, Sonora Elf Owl under-predicted the CO₂ abundance by several order of magnitude in some instances, an amount that JWST is sensitive to. Here, we release …

Administrative Law And The Pandemic, Gillian E. Metzger

Faculty Scholarship

American administrative law’s relationship to change is, as they say, compli­cated. On the one hand, continual evolution has been an endemic feature of American administrative law. Doctrines such as Chevron deference to agency statutory interpretations were born, grew, and declined in just the period from the 1980s to today. On the other, the United States (US) Supreme Court regularly rejects such common law development in administrative law as illegitimate and insists that federal judges must adhere to the original terms of the 1946 Administrative Procedure Act (APA) and other statutes, unless the Constitution requires otherwise. And to this day scholars …

Constraining The Family Regulation System: The Contribution Of The Restatement Of The Law, Children And The Law, Clare Huntington

Faculty Scholarship

Advocates, policymakers, and scholars have argued for years that the family regulation system (also known as the child welfare system) fails families. Critics rightly note that the system does far too little to support families proactively and does not address the poverty and structural racism underlying many allegations of child abuse and neglect. The overrepresentation of Black, Native American, and Native Alaskan children in foster care is a stark and disturbing manifestation of these failings.

In response to these concerns, there is an active debate about abolishing or radically reforming the family regulation system to direct government funding to proactive …

Restating The Law Of Children And Youth: The Evolution Of Reform, Elizabeth S. Scott

Faculty Scholarship

A brief roadmap of this article may be helpful. Part I describes the emergence of the Child Wellbeing framework and its powerful role in shaping twenty-first-century youth justice reforms captured by the Restatement. Part II shows how this framework has begun to have a far broader influence on the law affecting children and how the framework and the developmental approach embodied in the Restatement can guide courts and shape the trajectory of the law in the future. Part III explores potential challenges to the Restatement’s effectiveness in attaining a fully integrated system based on the Child Wellbeing framework.

Multidisciplinary Team Care In Plastic Surgery: Vascular Anomalies, Tara L Rosenberg, Jessica A Ching

Faculty, Staff and Students Publications

Vascular anomalies consist of a wide range of diagnoses relating to abnormal vasculature. These lesions can affect a variety of anatomical structures, requiring the expertise of numerous specialists. Over the past few decades, the formation of multidisciplinary vascular anomalies clinics has allowed patients to meet multiple providers within the same clinic visit, leading to improved communication between patients and providers. Furthermore, diagnostic and treatment plans are discussed in multidisciplinary conferences allowing for enhanced diagnostic accuracy and more comprehensive management plans. The purpose of this article is to provide an overview of the multidisciplinary management of vascular anomalies, including descriptions of …

User Actions Within A Clinical Decision Support Alert For The Management Of Hypertension In Chronic Kidney Disease, Heather J Baer, John L Kilgallon, Michael Gannon, Ryan Dunk, Weng Ian Chay, Richard Fay, Michael Sainlaire, Chenxi Gao, Matthew Wien, Pamela M Garabedian, Edward Wu, Hojjat Salmasian, David W Bates, Patricia C Dykes, Adam Wright, Allison B Mccoy

Faculty, Staff and Students Publications

This study aimed to examine user actions within a clinical decision support (CDS) alert addressing hypertension (HTN) in chronic kidney disease (CKD).A pragmatic randomized controlled trial of a CDS alert for primary care patients with CKD and uncontrolled blood pressure included prechecked default orders for medication initiation or titration, basic metabolic panel (BMP), and nephrology electronic consult (e-consult). We examined each type of action and calculated percentages of placed and signed orders for subgroups of firings.There were firings for medication initiation (813) and medication titration (430), and every firing also included orders for nephrology e-consult (1,243) and BMP (1,243). High …

Emergency Department Patients With Para-Fluorofentanyl Overdose, Kim Aldy, Alex Krotulski, Jeffrey Brent, Sharan Campleman, Rachel Culbreth, Barry Logan, Paul Wax, Alexandra Amaducci, Bryan Judge, Michael Levine, Evan Schwarz, Diane P Calello, Christopher W Meaden, Joshua Shulman, Adrienne Hughes, Robert Hendrickson, Joseph Carpenter, Jennie Buchanan, Alex F Manini, Toxicology Investigators Consortium (Toxic) Fentalog Study Group

Faculty, Staff and Students Publications

Background: Fentanyl analogs, such as para-fluorofentanyl (PFF), are increasing in the illicit opioid supply.

Objectives: This study characterizes demographics, clinical effects, and sex differences for naloxone administration in emergency department (ED) patients with confirmed PFF overdose compared with fentanyl.

Methods: This prospective observational cohort is from the ToxIC Fentalog Study between 2020 and 2023 at 10 participating U.S. hospitals. Adult patients with suspected opioid overdose presenting to EDs were screened and eligible if waste serum samples were available for comprehensive toxicological analysis. Fentanyl-positive patients were included in this analysis examining associations between PFF and naloxone administration, with stratified analyses for …

Pilot Implementation Of Mom Power In The Appalachian Highlands: Acceptability And Effectiveness Of A Parenting Group For Mothers With High Psychosocial Need, Megan Wolff

Electronic Theses and Dissertations

Children need safe, stable, and nurturing relationships with a caregiver for optimal development. Maternal childhood adversity, traumatic life experiences, and mental health challenges can adversely impact parenting beliefs and behaviors in ways that compromise a caregiver’s ability to create and sustain a healthy caregiving environment for their child(ren). In the professional world of infant and early childhood mental health (IECMH), policies, providers, and programs work together to promote optimal child and family wellbeing to reduce the intergenerational transmission of risk and to empower resilience in families and communities. The present study investigated the feasibility, acceptability, and effectiveness of the pilot …

Adolescent Externalizing Symptoms And Parent Emotion Socialization: An Examination Of Longitudinal Effects And Differences By Adolescent Sex, Cheston West

Electronic Theses and Dissertations

Adolescence is an important developmental context with several changes in social and emotional functioning. Though adolescents are gaining independence from their caregivers, they still engage in dynamic interactions with their caregivers who remain key figures in their lives. When adolescents express emotions, caregivers engage in various behaviors in response to these expressions, a process known as emotion socialization. This process has mostly been examined as a parent-driven construct in which parent emotion socialization impacts child-level outcomes, namely internalizing symptoms, with limited research on externalizing symptoms. However, available literature demonstrates that child-level characteristics (e.g., externalizing symptoms) are linked to differences in …

Rural High-School Principals’ Perceptions Of Their Understanding Of Special Education Law, Tiffany Jenkins

Electronic Theses and Dissertations

This phenomenological study aimed to determine rural high school principals’ perceptions of their understanding of special education law. Although there is some literature regarding administrators' perceptions of their understanding of special education policies and procedures, this study focused specifically on special education law and perceived versus actual levels of understanding.

Data Collection strategies include voluntary, focused interviews of rural high school principals via Zoom. Data analysis included transcriptions of interviews, member checking, open coding, identifying themes and content analysis, and finally, interpretation and triangulation of the data. The analysis of this study was based on the theoretical proposition of andragogy. …

College Readiness In Mathematics Related To Student Academic And Belonging Mindsets, Tabitha Sherrell

Electronic Theses and Dissertations

My quantitative study investigated the differences and correlations between students’ academic (growth vs. fixed) mindsets and belonging mindsets when enrolled in a college-level mathematics course or enrolled in both the college-level mathematics and learning support mathematics courses. The study was conducted at a Tennessee community college in the Fall 2021 semester. Sixty-two students completed the paper survey, which consisted of 17 items that measured academic (growth vs. fixed) and belonging mindsets and included demographic items (age and gender) and ACT mathematics scores. I conducted independent t-tests to find any significant differences between academic (growth vs. fixed) mindset scores and belonging …

Knowledge And Perceptions About Feeding And Growth In Infants And Young Children Among Early Interventionists, Kayla Chambers

Electronic Theses and Dissertations

Nutrition plays a vital role in early childhood, where rapid growth and development occur. This study investigates Early Interventionists’ (EIs) nutrition knowledge and perceptions of nutrition-related concerns in children receiving services through the Tennessee Early Intervention System (TEIS). An electronic survey was distributed to EIs in Tennessee to assess their nutrition knowledge and perceptions and to identify nutrition concerns. Findings revealed that most EIs have never received any nutrition education, despite being asked for nutrition guidance by families and being open to nutrition-related training. The EIs reported seeing nutrition concerns such as growth delays, food refusal, and picky eating, but …

Finding An Effective Measure Of Religiosity And Substance Use Levels For The Deaf: An Attempted Pilot Study, Angela Masiello

Electronic Theses and Dissertations

The Deaf often lack access to health-promoting services (Meador & Zazove, 2005), though they have an increased risk of developing substance use disorders (Hommes et al., 2018). Communication has been a prominent barrier to the accessibility of healthcare services and participation in research for the Deaf (McKee et al., 2012). Literature has shown multiple methodological challenges when conducting research with the Deaf (Napier et al., 2018). This pilot study used Jones et al.’s (2001) cross-cultural translation model to translate two measures into American Sign Language (ASL). Six bilingual experts in ASL and English translated the RSAS-5 and the TAPS into …

The Moderating Effects Of Duration On The Relationships Among Adverse Childhood Experiences, Perceived Social Support, And Adult Mental Health, Jessica M. Templeton

Electronic Theses and Dissertations

Childhood adversity is a significant predictor of negative mental health outcomes, with prior research primarily focusing on cumulative risk models of adverse childhood experiences (ACEs). This study examines whether the duration of ACE exposure moderates the mediating effect of perceived social support on the relationship between ACEs and adult mental health outcomes, specifically anxiety and depression symptomatology. Using archival data from the Correlates of Adversity and Temperament in Childhood (CATCH) dataset, responses from 230 participants were analyzed. Mediation analyses revealed that perceived social support mediates the relationship between ACEs and both anxiety and depression. Moderated mediation analyses further indicated that …

Brand Media And Health Perceptions: A Thematic Analysis Of Generational Differences, Julie Irene Diaz

Electronic Theses and Dissertations

This thesis explores the influence of brand identity and media on shaping evolving perceptions of health across generations. The three generations considered are Generation X, Millennials, and Generation Z. The initial hypothesis predicted the popular media and brands that each generation interacts with are most likely to influence their perception. Additionally, the health brands most popular with each generation would influence their overall health perception, based on the identity and values of the brand. A qualitative study was conducted using focus groups to gather data about health perceptions, brand identity, media influence, and holistic health. The findings suggest that individuals …

Disability Inclusion In Local Public Health Community Health Assessments And Community Health Improvement Plans, Haleigh Leslie

Electronic Theses and Dissertations

Introduction: Local health departments (LHDs) use community health assessments (CHAs) and community health improvement plans (CHIPs) to identify and address health needs of the populations they serve. People with disabilities experience health disparities, and there is limited information about how the health needs of people with disabilities are included in CHAs and CHIPs. The purpose of this study was to describe and quantify disability inclusion in LHD CHAs and CHIPs.

Methods: This cross-sectional, mixed methods study used the CHAs and CHIPs of accredited local health departments, data about LHDs and populations served, and interviews with LHD staff and community partners …

Digital Revival: The Role Of Social And Streaming Media In The Resurgence Of Appalachian Country Music, Jacob Cody Powers

Electronic Theses and Dissertations

This study investigates the role of digital media, specifically social media, and streaming platforms, in the resurgence of Appalachian country music. In recent years, niche music genres have found new life through online platforms, which offer unique avenues for discovery, engagement, and community building. Using a mixed methods approach, this research combines quantitative survey data and qualitative thematic analysis to explore how audiences discover Appalachian country music on platforms such as TikTok, YouTube, and Spotify. A cross-sectional survey was distributed to college students and social media users, collecting responses on participants' digital engagement habits, platform preferences, and motivations for exploring …

Inferring Feeding Biology In Extinct Shrews (Soricidae: Mammalia): Application Of A Linear Morphometric Approach, Derek J. Den Ouden

Electronic Theses and Dissertations

Linear morphometrics have been used extensively to infer the ecology of fossil organisms, but shrews have not yet been thoroughly explored using this technique. Often considered to have a homogenous insectivorous diet, direct dietary observation suggests shrew dietary diversity is substantial. Diversity of this nature is well established to have influenced skull morphology in other mammal clades, so similar patterns are hypothesized to be detectable in shrews. To test this, I examined the link between known diet and morphological disparity in extant shrews using linear morphometrics and then utilized that framework to infer the dietary ecology of several fossil taxa. …

The Importance Of The Relationship Between General And Special Education Co-Teachers In Inclusive Preschool Programs, Ruth Copeland, Ruth B. Copeland

Electronic Theses and Dissertations

A qualitative case study was designed to examine the importance of the relationship between general and special education co-teachers in inclusive preschool programs. The holistic strengths-based portraiture method will be used to study the positive aspects of the relationships of two co-teaching teams. In-depth interviews with individual teachers, co-teaching teams, and administrators combined with a questionnaire and classroom environmental rating scales were used to examine the culture and community that build positive relationships between general educators and special educators who co-teach in an inclusive preschool setting. The main goal of this research was to identify critical elements that contribute to …

Revealing Hidden Histories: A Multi-Sensor Aerial Survey For Detecting Unmarked Burials At Sinking Spring Cemetery, Abingdon, Va, Noah Hall

Electronic Theses and Dissertations

The Sinking Spring Cemetery, established in 1773 in Abingdon, Virginia, spans 11 acres and is divided by a road. The 9-acre southern section was reserved for white church members. Enslaved individuals and free people of color were buried in the smaller northern section, where few headstones remain today. This study aimed to map the unmarked graves using thermal, multispectral, and Light Detection and Ranging (LiDAR) sensors deployed on unmanned aerial systems. Graves were characterized by subtle topographic depressions mapped by LiDAR and cooler radiant temperature anomalies in thermal imagery. Thermal data collected at different times of the day and year …

Investigating Stress Hormone Variations In Green Frogs (Lithobates Clamitans) During The Mating Season, Abby Mciver

Electronic Theses and Dissertations

Monitoring stress hormones in wildlife populations is increasingly used to understand how human activities may impact the environment. The goal of this study was to quantify corticosterone in green frogs (Lithobates clamitans) at baseline levels and in response to an acute stressor throughout the mating season. The project was conducted from May to September of 2024 at Bays Mountain Park in Kingsport, Tennessee. Corticosterone levels were determined over six consecutive days each month from May to September using a non-invasive dermal swab technique. Additionally, body metrics, water chemistry, and weather and habitat conditions were evaluated on each sampling …