Dissertations
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Item Embargo FROM SCARS TO STRENGTH: UNVEILING THE INTERSECTION OF ACES, SOCIAL DETERMINANTS, AND RESILIENCE IN ADULT INPATIENT REHABILITATION(East Carolina University, December 2024) Kucukardali Cansever, BetulThis dissertation explores the complex relationship between adverse childhood experiences (ACEs), protective and compensatory experiences (PACEs), and their influence on resilience in primary care contexts and among adult inpatient rehabilitation patients. While ACEs are known to be linked with negative health outcomes, little attention has been given to the care for patients following a screening of ACEs in primary care, and protective factors are rarely if ever, considered in healthcare contexts. Furthermore, the role of ACEs, PACEs, social determinants of health (SDoH), and resilience in adult inpatient rehabilitation contexts are relatively unknown. The primary objective of this research is to deepen the scientific understanding of how ACEs, PACEs, and SDoH interact to shape resilience when individuals face medical conditions requiring inpatient rehabilitation. By examining this dynamic, this dissertation investigates clinical practices, research methodologies, and health equity policies, ultimately enhancing strategies for screening, triage, and intervention in rehabilitation units. The dissertation employs a dual approach, combining systematic reviews with original quantitative empirical analysis. It is organized into six chapters: the first chapter introduces the concept of resilience in rehabilitation and its relationship to ACEs and PACEs. The second chapter provides a systematic review of ACE screening practices in adult primary care settings, focusing on the types of clinical responses (e.g., resources, referrals, interventions) that follow positive ACE screenings. The third chapter systematically investigates additional psychosocial factors, both protective and adverse, that are assessed alongside ACE screenings in primary care, framed through a socio-ecological resilience model. The fourth chapter details the methodology of the original quantitative research. The fifth chapter presents the results of the empirical study, which examines the interaction between SDoH, protective factors, resilience, and behavioral health in adult inpatient rehabilitation patients with a history of ACEs; and the sixth chapter synthesizes the key findings and their contributions to the field, focusing on the integration of protective experiences in ACE screening interventions. It employs data visualization techniques to analyze health disparities across North Carolina counties based on the study participants' sample, offering recommendations for improving patient care and health equity. The research ultimately advances an understanding of the interplay between childhood adversity, protective factors, and health outcomes, offering strategies for improving resilience and health equity in diverse inpatient rehabilitation populations.Item Embargo Exploring Systemic Medical Traumatic Stress In Historically Marginalized Patients(East Carolina University, December 2024) Brown, Frandrea LatriceHistorically marginalized patients are at an increased risk for healthcare experiences that increase their risk for adverse health events, adverse health outcomes, and psychological distress related to medical trauma. These factors are exacerbated by experiences of structural violence through discrimination and microaggressions. However, research that describes the unique distress historically marginalized patients’ experience related to medical trauma, adverse health events, adverse health outcomes, and structural violence is sparse in healthcare literature. This study seeks to bridge this gap by exploring the interplay between factors and how they each contribute to patients’ experiences. This research is informed by the biopsychosocial-spiritual framework (BPSS) and historical trauma theory, which considers how collective trauma shared by historically marginalized patients spans multiple generations, affects the biopsychosocial-spiritual health of the group, and may result in trauma-related symptoms. Medical trauma, resulting from adverse health events and adverse health outcomes, is a critical yet understudied aspect of healthcare experiences, particularly among historically marginalized populations. This quantitative research, with a national sample, sheds light on the complexities of the relationship between the psychological distress resulting from medical trauma among such groups while recognizing the profound implications in shaping their healthcare. Through a comprehensive examination of the interplay between adverse health events, adverse health outcomes, social determinants of health, structural violence, internal stress, health care policies, practices and procedures, and medical trauma this study elucidates the mechanisms underlying a new concept explored within this dissertation described as systemic medical traumatic stress and its role within historically marginalized communities.Item Embargo EXPLORING THE LEADERSHIP ROUTES, BARRIERS, PRACTICES, AND LIVED EXPERIENCES OF NORTH CAROLINA CENTRAL UNIVERSITY SCHOOL OF LIBRARY AND INFORMATION SCIENCES BLACK ALUMNI LIBRARY LEADERS(East Carolina University, December 2024) Scott-Branch, JamillahThis study examined the leadership development pathways of Black library leaders who graduated from North Carolina Central University's School of Library and Information Sciences. Employing a narrative inquiry qualitative research approach, this research aimed to uncover the dynamics influencing these leaders' success and persistence in the predominantly White domain of library and information science. By integrating Social Cognitive Career Theory (SCCT) and Critical Race Theory (CRT), the study explored individual career development and examined the structural and societal factors impacting these leaders. Key findings revealed the pivotal roles of mentoring, professional development, and professional involvement in navigating library leadership. This work contributes to a deeper understanding of the challenges and triumphs of Black library leaders, offering valuable insights for librarians aspiring to leadership positions in libraries.Item Embargo CULTURALLY RESPONSIVE PRACTICES: INFLUENCING TEACHERS’ DISCIPLINARY AND INSTRUCTIONAL PRACTICES(East Carolina University, December 2024) Brown, Rashida VABSTRACT Rashida V. Brown, CULTURALLY RESPONSIVE PRACTICES: INFLUENCING TEACHERS’ DISCIPLINARY AND INSTRUCTIONAL PRACTICES (Under the direction of Dr. Matthew Militello). Department of Educational Leadership, December, 2024. All school students deserve an equitable, rigorous, and meaningful education experience. Too often, in classrooms, traditionally underachieving students do not have that experience. In the qualitative participatory action research project and study, I examined the degree to which culturally responsive practices (CRP) using equity-driven strategies influenced teachers’ disciplinary and pedagogical practices. The theory of action (ToA) posited: if teachers can identify culturally responsive practices and take intentional steps to analyze their current practices, then they can effectively implement CRP in their classrooms. In the participatory action research (PAR) project and study, based upon action research and equity-based protocols, the data sources included observations, post-observation conversations, field notes from meetings, community learning exchange (CLE) artifacts, and reflective memos. After analyzing data from two cycles of inquiry, the finding is: Connections between teachers and students through use of proximity, nonverbals, and effective discipline moves were uneven and largely ineffective; as a result, disciplinary practices dominated the classroom experience. The finding contributes to our knowledge and skill in shifting narratives and practices related to culturally responsive pedagogy. Teachers need to attend to students with a culturally responsive discipline stance (Hollie, 2018) that supports instructional outcomes. If teachers cannot engage students in content due being inundated with behavior issues, they cannot focus on student learning, a key determinant in the trajectory of students’ lives and well-being.Item Embargo Novel GPCR Mechanisms of Phenotypic Control in Vascular Smooth Muscle(East Carolina University, December 2024) Williams, Madison D.Cardiovascular disease (CVD) is a significant global health concern and the number one cause of morbidity and mortality in the US and worldwide. Ischemia and resulting tissue hypoxia and acidosis are important contributors to CVD development and progression. G protein-coupled receptors (GPCRs) are seven transmembrane receptors with established functions in cardiovascular (patho)physiology. Phenotypic switching of vascular smooth muscle (VSM) from a contractile, quiescent state to a noncontractile, proliferative state is a common feature of CVD. Two GPCRs, protease-activated receptor 2 (PAR2) and GPR68, have capacity to control cell proliferation in various tissues, but their role(s) in VSM cell proliferation and phenotypic control remain unclear. The purpose of this project was to determine how PAR2 and GPR68 independently control VSM cell growth and phenotype. Findings revealed that PAR2 controls VSM cell growth in a PKA/MEK1/2 and phenotype-dependent manner, while GPR68 inhibits VSM cell growth through Rap1A. Proteomics analysis revealed wide-ranging effects of GPR68 on VSM phenotype including modulation of extracellular matrix, actin-binding, and contractile proteins. Our findings highlight novel mechanisms of PAR2 and GPR68 in VSM cell growth and phenotypic control and offer evidence that they might be important targets for treatment of deleterious phenotypic switching of VSM in CVD.Item Embargo The Effects of Increased Oligomannose N-Glycan Expression on Neuroblastoma Progression and Epidermal Growth Factor Receptor Signaling(East Carolina University, December 2024) Burch, Adam PatrickN-glycosylation is an essential post-translational modification with known roles in cancer, including the pediatric cancer neuroblastoma (NB). The folding, stability, regulation, and trafficking of proteins are all dependent on proper N-glycosylation. There are three general classes of N-glycans: oligomannose, hybrid, and complex ranging from the least processed to the most respectively. Changes in metabolism, endoplasmic reticulum (ER) stress, and other cell signaling events can and do exert influence on the N-glycosylation processing pathway to ensure all glycoproteins are processed to fit the current needs of the cell. Pathological diseases are known to exert influence on the types of N-glycans produced. Regarding cancer biology, β1,6 complex N-glycans have often been attributed to the malignant transformation of cells. This work seeks to define the types of N-glycans (oligomannose, hybrid, or complex) that contribute to the progression of neuroblastoma. The link between N-glycosylation and the malignant transformation of cells has often been centered around more processed N-glycans (i.e., complex N-glycans). However, in the body of this work, we find that oligomannose N-glycans are responsible for aggressive neuroblastoma phenotypes, mainly increased invasiveness. By CRISPR/Cas9 knockout of MGAT1, MGAT2, or MGAT3 in human and rat neuroblastoma cell lines, we were able to generate cells with varying levels of N-glycan processing of proteins. MGAT1 encodes N-acetylglucosaminyltransferase-I (GnT-I), a critical glycosyltransferase that converts oligomannose N-glycans to hybrid N-glycans. By loss of GnT-I, cells have reduced synthesis of hybrid N-glycans and therefore also reduced production of complex N-glycans, resulting in cells with increases in oligomannose N-glycan content. MGAT2 encodes GnT-II, which converts hybrid N-glycans to complex N-glycans. Loss of GnT-II prevents the synthesis of complex N-glycans resulting in cells enriched with hybrid N-glycan structures. MGAT3 encodes GnT-III, which produces bisecting hybrid and complex N-glycans and is responsible for terminating N-glycan processing. By knockout of GnT-III, hybrid and complex N-glycans should be more susceptible to additional modifications (e.g., fucosylation, sialylation, galactosylation, etc.). With these various cell lines, we were able to explore how the reduced amounts of various N-glycan modifications influenced neuroblastoma growth, invasion, and cell-cell adhesion; ultimately revealing that increased expression of oligomannose N-glycans leads to neuroblastoma cells that are highly invasive but have decreased proliferation. Furthermore, we examined unmodified human neuroblastoma cells derived from a SK-N-BE(2) cells: BE(2)-C and BE(2)-M17. We found that BE(2)-M17 cells expressed more oligomannose N-glycans and were significantly more invasive but less proliferative relative to BE(2)-C cells, furthering the support that oligomannose N-glycans drive neuroblastoma invasiveness. These studies were instrumental in designating oligomannose N-glycans as perpetrators of aggressive neuroblastoma phenotypes. A primary focus of this work was to better understand how oligomannose N-glycans impacted neuroblastoma progression. Neuroblastoma cells expressing high amounts of oligomannose N-glycans exhibit increased invasiveness but decreased proliferation leading us to examine intracellular signaling, specifically the oncogenic receptor tyrosine kinase, epidermal growth factor receptor (EGFR). Knockout of MGAT1 is a powerful approach to enrich all N-glycosylated proteins of cells with oligomannose N-glycans, including EGFR. This investigation builds upon the towering literature surrounding N-glycosylation and EGFR, in particular how N-glycosylation modification of EGFR impacts the receptor’s ability to initiate downstream signaling. The 12-13 N-glycans of EGFR have been characterized as being mostly complex N-glycans and have been shown to be essential to both EGFR’s function and regulation; however, very few have attempted to examine how EGFR functions when decorated primarily with oligomannose N-glycans. Here we show BE(2)-C(-MGAT1) cells produce oligomannosylated EGFR (EGFR decorated with oligomannose N-glycans). Further characterization of oligomannosylated EGFR revealed that ligand independent phosphorylation and EGF stimulated phosphorylation are significantly increased in BE(2)-C(-MGAT1) cells. Furthermore, when observing proliferation in response to EGF stimulation in 3D conditions, BE(2)-C cells do not have a major proliferate response whereas BE(2)-C(-MGAT1) cells proliferate robustly likely due to the heightened EGFR phosphorylation of oligomannosylated EGFR. The increased autophosphorylation and sensitization of BE(2)-C to EGF stimulation when expressing oligomannosylated EGFR, due to loss of MGAT1, is novel and further details how changes in N-glycosylation, due to a pathogenic state, could alter a cellular phenotype without genetic mutation in EGFR. Here using both rat and human neuroblastoma cells with selective defects in the N-glycan processing of proteins we further define the role of N-glycosylation in the progression of neuroblastoma. By examining various N-glycosylation mutations as well as unmodified neuroblastoma cell lines we were able to establish that oligomannose N-glycans contribute to neuroblastoma progression through heightened invasiveness. Utilizing newly generated BE(2)-C(-MGAT1) cells we further explored the role of oligomannose N-glycans by examining EGFR signaling in BE(2)-C and BE(2)-C(-MGAT1) cells. Neuroblastoma cells bearing oligomannosylated EGFR respond intensely to EGF stimulation, leading to heightened autophosphorylation and EGF stimulated proliferation. Ultimately, we conclude that neuroblastoma cells with increased oligomannose N-glycan content is consistent with a highly invasive cancer that is readily able to undergo EGF stimulated proliferation.Item Embargo Characterizing the Epigenetic and Transcriptional Regulation of the Conjoined CHKB-CPT1B Locus(East Carolina University, December 2024) Berkuta, JonathanThe emergence of brown adipose tissue was an important event for vertebrate development; however, much is still unknown about this emergence. Previously, our lab showed that, in placental mammals, the Chkb and Cpt1b genes are conjoined and regulated by a singular upstream promoter region, whereas an intergenic CpG island prevents the conjunction of these genes in marsupials. Chkb encodes for choline kinase B (CHKB), which catalyzes the first step in phosphatidylcholine synthesis, while Cpt1b encodes for carnitine palmitoyltransferase 1B (CPT1B), which is the rate-limiting enzyme in fatty acid oxidation. We believe the loss of the marsupial intergenic CGI led to the conjunction of the Chkb-Cpt1b gene locus, and that CHKB is necessary for the brown adipocyte phenotype. In addition, we also believe lactylation, a novel form of epigenetic modification, is present across the Chkb-Cpt1b locus. In this dissertation, we show the intergenic CGI possesses enhancer and weak promoter activity and that CHKA, and not CHKB, is responsible for the majority of phosphatidylcholine synthesis in C2C12 and DE2.3 cells. We also show the presence of lactylation in these cells. We hope this data can be used to further our understanding of the emergence of brown adipocytes and provide future therapies to various diseases such as obesity.Item Embargo The Role of Complex Type N-Glycans in Neuronal Development(East Carolina University, December 2024) Hatchett, Cody JaredOligosaccharides are attached to up to 70% of human proteins. N-linked glycosylation is one of the predominant forms of co- and post-translational modifications in vertebrates. Discrepancies in glycan processing result in congenital disorders of glycosylation (CDGs), a group of rare genetic disorders characterized by impaired glycan synthesis or processing, leading to a wide range of clinical manifestations. CDGs are divided into two classes: type 1 and type 2. Regarding N-glycosylation, CDG type 1 disorders result from improper glycan synthesis or transfer of the precursor oligosaccharide, while CDG type 2 disorders result from disrupted processing of the precursor oligosaccharide linked to protein. Many identified CDG disorders are lethal within the first year of life, and those that survive often have neurological complications. Those who survive are impacted by epilepsy, locomotor skill deficiency, and slowed or stunted growth. N-linked oligosaccharides are processed by many enzymes, such as N-acetylglucosaminyltransferases (GnTs) and transporters. The three common types of N-glycans are oligomannose, hybrid, and complex. The first GnT to act is GnT-I, which is responsible for the processing of oligomannose to hybrid N-glycans via addition of a N-acetylglucosamine (GlcNaC) residue to the conserved core of N-glycans. The importance of glycan processing by GnT-I has been implicated in several studies using knockdown organismal and cell models. Global GnT-I knockout in mice was found to be lethal at the embryonic age of 8.5-10.5 days. This timeframe coincides with neurogenesis and the neural tube formation from the neural plate, which involves cell migration and proliferation. GnT-I was inactivated in developing neural tissue of mice, which perturbed neuron development. Further, these mice suffered from a shortened life span and reduced body size. These findings highlight the critical role of GnT-I in neurogenesis, growth, and longevity. This study used zebrafish as an organismal model since embryonic and larval development stages are well-characterized, and the number of individual fish studied can be relatively large. Zebrafish, unlike mice, possess two gene copies of GnT-I referred to as mgat1a and mgat1b, resulting from multiple whole genome duplications. Inactivation of one of the two mgat1 genes, mgat1b, reduced the level of glycan processing from oligomannose to hybrid and complex N-glycans. Glycomics profiling supported this knockout with an increase in the Glc2Man5 structure acted upon by GnT-I. The GnT-Ib knockout fish had reduced complex N-glycans. Survivability was greatly reduced in the mutant fish line which began to drop around 10hpf. Developmental milestones were delayed when mgat1b was knocked out such as the presence of a heartbeat and swim bladder inflation. Sensory motor function was reduced in mutant line fish as indicated by reduced motor activity and slow touch or vibrational startle response as well as motor coordination and stamina. Muscle structure development of mgat1b knockout fish was delayed until up to 72 hpf via birefringence microscopy. Spinal cord caudal primary (CaP) primary motor neurons transiently expressing electric green fluorescent protein (EGFP) were examined using fluorescent microscopy with the mutant line having reduced collateral branching. These results indicate the importance of complex N-glycosylation on zebrafish development and motor function.Item Embargo EXAMINING A CULTURALLY INFORMED MODEL OF MENTAL HEALTH CARE UTILIZATION AMONG LATINX COLLEGE STUDENTS(East Carolina University, July 2025) Ruiz, Michelle IsabelDespite an elevated risk of mental health concerns among Latinx college students due to the unique stressors and challenges Latinx college students may face, including discrimination, cultural isolation, lack of representation, and low educational expectations, Latinx college students tend to underutilize mental health services. The behavioral model of health services utilization (BMHSU) has often been utilized to examine the individual characteristics that predispose individuals to use or not use health services, environmental factors that enable or impede health service use, and one’s need for health services as determined by symptoms, provider’s diagnoses, or other illness indicators. However, the BMHSU has been criticized for failing to consider the influence of specific cultural factors, and as such, may not fully account for disparities in mental health care utilization. The purpose of this study was to develop and examine a cultural adaptation of the BMHSU by including indicators of acculturation and related variables at each level (e.g., predisposing, enabling, and need factors) in hopes of creating a culturally informed model of mental health care utilization more applicable to Latinxs. The total sample was comprised of 126 Latinx undergraduate students, the majority of which were bilingual, second-generation immigrants of Catholic background. Results indicated that the culturally informed model of mental health care utilization more than doubled the predictive power of the BMHSU, accounting for 54% of the variance in utilization, whereas the traditional BMHSU only accounted for 24% of the variance in MHC utilization. Analysis of individual predictors revealed that mental health stigma and familism make help seeking behavior less likely. Meanwhile greater congruence between an individual’s perceived need for mental health care and a professional’s evaluation of need was found to promote help seeking behavior. Historically, cultural factors, including ethnic identity and familism, have been assumed to uniformly promote health and well-being among Latinxs, while acculturative stress and cultural beliefs such as machismo, have been associated with psychopathology. Findings of the current study emphasize the need to further understand the contexts in which cultural factors might be protective or function as a risk factor when tailoring research studies, and interventions that stem from such studies to Latinx populations.Item Embargo The Effects and Mechanisms of Lactate and Protons on the Human Umbilical Vein Endothelial (HUVEC) and Murine Melanoma (B16F10) Cells’ Migration, Adhesion, and Attachment.(East Carolina University, May 2025) Salem, Fatema BajesThe tumor microenvironment is often acidic due to the high metabolic activity of cancer cells, causing the production of excess lactic acid. This elevated acidity significantly impacts the behavior of both normal and cancer cells, including cell migration, attachment, and cell spreading. Under acidic conditions, normal and cancer cells experience delayed migration, attachment, and spreading. In this study, by using cancer cells (B16F10) and endothelial cell (HUVEC) models, it was observed that increased acidity reduced the collective and directional migration compared to treatment at physiological pH, resulting in slower wound closure . A further reduction in collective and directional migration occurred under the combined effect of acidity and elevated lactate concentrations. Furthermore, increased lactate concentrations at the physiological pH (pH 7.4) resulted in a similar reduction in cell migration. Interestingly, increasing the acidity caused opposite cellular responses in both models used in this project regarding random motility. The elevated levels of acidosis caused a significant increase in the random motility of B16F10 cells, marked by the uncoordinated movements of the migrating cells, which is the opposite of what was observed in HUVECs, where acidosis reduced random motility. Moreover, the random motility decreased in both cell models under the combined effect of the elevated acidity levels and lactate concentrations relative to the treatment with acidity alone. Furthermore, B16F10 and HUVEC cells adapted a higher polarization and elongated cell morphology (shape) in an acidic microenvironment due to difficulty in tail detachment. The same phenomenon was observed in the cells treated with lactate at a physiological pH. However, in both cell models, the combined effect of acidity and lactate had an insignificant impact on cell length compared to acidic treatment only. Moreover, HUVECs formed multiple leading edges of "Lamellipodia" when exposed to an acidic buffer, while the melanoma cells did not exhibit this trait. Also, the percentage of HUVECs with multiple leading edges decreased under the combined influence of lactate and acidity, aligning closer to the levels seen with physiological pH. The interconnection between cell attachment, spreading, and cell migration was intensively studied. Cell attachment and spreading are the main primary stages in cell migration. They establish the initial contact and provide a correct mechanical force initiation and cellular signaling for the cell to migrate. In both cell models, the attachment and spreading delay was observed in acidic microenvironment, whereas the addition of lactate to the acidic treatment reversed these effects by reducing the negative impact of acidity in this assay. In this assay context, it was observed in both cell models that acidity blocked the transition of spreading cells to the polarized phase, and the combination effect of acidity and lactate reduced this transition blocking. Actin fibers play a crucial role in cell migration by providing structural support, enabling force generation, and coordinating signaling pathways. In both cell models, significantly high actin stress fibers were observed in an acidic microenvironment compared to physiological microenvironment. A similar situation was observed in HUVEC treated with high levels of lactate at physiological microenvironment, but not in B16F10 cells. The combined effect of lactate and acidity has an impact on reducing actin stress fibers in HUVECs, but this effect was not observed in the transformed cells. Changes in the location of focal adhesions and phosphorylation levels of focal adhesion kinase (FAK) and phosphorylated paxillin (pPAX) may significantly impact cell migration, attachment, and spreading. The acidic microenvironment caused alteration in the location and cluster size of phosphorylated pPAX (pPAX, Y118) and phosphorylated FAK (pFAK, Y397) during migration, attachment, and spreading in both cell models, displaying localization to the spreading cell periphery instead of the spreading cell body where dynamic focal adhesions are located compared to physiological pH-treated cells. Acidic treatment combined with lactate reduced the cluster size of pPAX (Y118) and pFAK (Y397) alongside alteration in their localization compared to acidic treatment without lactate. An additional measure was taken to evaluate the effects of acidic treatments on the phosphorylation levels of paxillin and focal adhesion kinase. The acidic microenvironment caused a decrease in FAK and PAX phosphorylation levels in both cell models and enhancement upon the addition of lactate to the acidic buffer in HUVEC but not the transformed cells.Item Open Access EVALUATING THE CORE OF CORE SELF-EVALUATION: A REVIEW OF THE CONCEPTUALIZATION OF THE CONSTRUCT(East Carolina University, December 2024) Board, Toby EmanuelThis dissertation examined the conceptualization, measurement, and predictive validity of Core Self-Evaluations (CSE) as a higher-order construct in relation to job and life satisfaction. Through analyses including usefulness analysis, relative weights analysis, and structural equation modeling, the study demonstrated that CSE provides incremental and relative importance over its components—self-esteem, generalized self-efficacy, locus of control, and neuroticism—when predicting satisfaction outcomes. Structural comparisons supported an aggregate, formative model where each component contributes uniquely, challenging traditional reflective approaches and advancing our understanding of personality and self-concept. These findings have important implications for theory and practice, offering a refined framework for assessing and applying CSE to predict satisfaction and well-being. By conceptualizing CSE as an aggregate construct, future research can focus on improving its measurement by expanding item content, addressing compensatory scoring, and ensuring its validity across cultures and diverse settings, such as remote work environments and broader life domains beyond the workplace.Item Open Access UNDERAPPRECIATED AND OVERWHELMED: ADDRESSING TEACHER BURNOUT AND SELF-EFFICACY THROUGH THE USE OF A SOCIAL AND EMOTIONAL PROFESSIONAL LEARNING FRAMEWORK.(East Carolina University, December 2024) Etchison, Christin A.Recognizing that feelings of being overworked, undervalued, and isolated contribute significantly to teacher burnout—leading to increased absenteeism and attrition—this inquiry explored the implementation of a teacher-focused SEL professional learning framework to help mitigate these negative effects. By fostering social-emotional competence through consistent training and support, teachers can create a more positive classroom climate that enhances student outcomes. Utilizing an explanatory sequential mixed methods research design grounded in improvement science, this inquiry measured teacher absences and self-efficacy following the professional learning program’s implementation. Additionally, qualitative insights were gathered from teachers’ experiences regarding job satisfaction and retention. The findings reveal that while the SEL framework positively impacted teachers' sense of belonging and support, contributing to a slight reduction in burnout levels and absenteeism, deeper structural issues persist. Teachers reported ongoing challenges related to work-life balance and low self-efficacy in critical areas, such as classroom management and parent engagement. The findings also underscore the complexity of addressing teacher burnout and highlight the need for a multifaceted approach that combines social-emotional interventions with targeted professional development. Educational leaders are urged to develop strategies that specifically enhance teachers’ confidence and competencies, ultimately fostering a more supportive and effective learning environment. This inquiry provides critical insights into the dynamics of teacher well-being and offers a foundation for future research and practice aimed at improving teacher retention and student outcomes. Lastly, the findings highlight the interplay between teacher well-being and student outcomes, emphasizing that addressing teacher burnout through SEL not only enhances teachers' emotional health but also fosters a positive classroom environment conducive to student learning. For practitioners, implications of this inquiry include the need for implementing comprehensive support systems and targeted professional development to sustain teacher efficacy and retention, ultimately leading to improved educational experiences for both teachers and students.Item Open Access RESTORATION AT THE BOUNDARY: A SOCIO-ECOLOGICAL PERSPECTIVE ON MANAGEMENT IN THE GREATER EVERGLADES ECOSYSTEM(East Carolina University, December 2024) Sabin, John EdwardHow will conservation areas in South Florida continue to change because of ongoing restoration efforts? Ecosystem restoration practitioners in the Global North aim for adaptive management during a time of increasing uncertainty. To reconcile competing socio-ecological futures in South Florida, this project integrates discursive narrative analysis, spatial modeling, and intuitive data visualization to guide a holistic monitoring approach during the restoration of the Florida Everglades. Projects like the East Coast Buffer (ECB) and the Western Everglades Restoration Project (WERP) represent ongoing attempts in Everglades restoration to acquire and protect degraded landscapes adjacent to protected areas, such as Everglades National Park and the Big Cypress Preserve. This interdisciplinary framework seeks to build a socio-ecological model to monitor ecosystem restoration and holistically track affected cultural landscapes at the periphery of the built environment. Insights provided through this research suggest that panarchy as a conceptual tool best facilitates the co-production of knowledge in large-scale restoration projects threatened by environmental amnesia. I developed a landcover change ranking system through expert knowledge consultation, remote sensing, and GIS to understand the shifting physiognomic structure of landscapes affected by restoration activities in the ECB. I bridge this modeling framework into the content of WERP to showcase how the restoration game progresses under new challenges to the role of wilderness in South Florida. The insights provided through this investigation also guide the ongoing development an ArcGIS Story Map that accompanies this research. This online spatial presentation platform integrates the research components of the greater project into a place-based narrative intended to assist with collaboration, education, and planning.Item Open Access Assessing the current status of and developing best practices in the delivery of sexual and gender minority content in PA education: a mixed methods approach(East Carolina University, December 2024) Jones, Quinnette BrookeBackground: A strategy aimed at reducing the health disparities experienced by sexual and gender minority (SGM) populations is to ensure health care providers are well equipped to care for them. There is a gap in the health professions literature addressing best practices for delivering this content in training. This research aims to assess the current status of and to identify PA educator beliefs about best practices in the delivery of SGM content in PA education. Methods: This mixed methods study was guided by queer theory and curricular development practices. Quantitative data was obtained through a survey sent to all US PA programs in 2021. Questions addressed amount, delivery, and importance of lesbian, gay, bisexual, transgender, queer, (LGBTQ) content and how well students are prepared to care for LGBTQ patients. Data was analyzed with bivariate and multivariate methods. Qualitative data was obtained through 5 focus groups with expert PA educators exploring their perceptions about best practices in the delivery of SGM content in PA education. Focus groups were conducted from April to May 2024. Content analysis was completed by 2 coders using both inductive and deductive methods. A comparison of results from quantitative and qualitative analyses was conducted to evaluate for convergence. Results: The questionnaire had a 71.8% response rate (204 out of 284 responded) and showed that the majority of PA programs teach between 1 to 3 hours on each LGBTQ content area and integrate the content throughout their curricula. Multivariate analyses showed increased odds of having adequately or well-prepared students with knowledgeable faculty members (AOR=6.16; 95% CI 2.97, 12.78) and teaching more than 3 hours of LGBTQ+ content (AOR=5.20; 95% CI 95% 1.60, 16.82). Qualitative analyses revealed expert PA educator beliefs about best practices including topics to include in the curricula, ideal teaching approaches, necessary student competencies, and barriers and facilitators to inclusion of SGM content. Conclusion: Convergence of findings resulted in 8 consensus best practices for the inclusion of SGM content in PA education. PA education accreditation standards require the inclusion of SGM content in PA education and findings from this study may serve as a guide for evaluating and integrating content.Item Open Access OF PASSING AND FAILING: THE INTERPLAY OF CLASSROOM TEACHING AND TUTORING IN HIGH SCHOOL(East Carolina University, December 2024) Custy, Cameron KinseyAs asserted by Bowers and Sprott (2012) and confirmed by Hart (2019) and Vatterott (2019), academic success can be achieved by students when given proper assistance and guidance during the learning process. Students at Carolina High School (CHS) were given the opportunity to attend tutoring activities during the school day, called PowerHour, to eliminate barriers students can face with attending after-school tutoring. The purpose of this study was to evaluate the effectiveness of Power Hour on improving student academic achievement. The results of this study were used to further refine the PowerHour program to provide the greatest benefit to the students attending CHS. This research focus motivated three research questions: (1) How have teachers’ perceptions of tutoring changed? (2) How have students’ perceptions of tutoring changed? (3) How have students’ academic outcomes changed? To address the research questions, I gathered student engagement data both before and after my intervention to discern if there were any changes in the level of student engagement in the courses the students were studying. I also collected data on teacher and student perceptions using open-ended surveys followed by focus group discussions with the participants. I used student achievement data to gauge any change in students’ academic outcomes. I analyzed and theorized the data I collected to help improve the overall PowerHour program so that it would provide students with a high-quality tutoring program that has the potential to positively impact their learning outcomes and ultimately set them on a path to future success.Item Open Access UNDERSTANDING BARRIERS IN RESPIRATORY EQUIPMENT IMPLEMENTATION AMONG WILDLAND FIREFIGHTERS(East Carolina University, December 2024) Rodriguez, Aida ChristineBackground: Over the past decade, awareness has grown among wildland firefighters about the health risks associated with smoke exposure and cancer. In June 2022 the International Agency for Research on Cancer (IARC) reclassified occupational exposure for firefighters as Group 1, carcinogenic to humans. However, limited data exist on respiratory protection practices, perceived barriers to adopting protective equipment, and chemical risk knowledge among firefighters. Understanding these gaps and barriers is essential for developing effective protection protocols and education programs. Specific Aims: This study aimed to evaluate firefighters’ chemical risk knowledge of smoke produced in wildland/Wildland Urban Interface (WUI) fire incidents, identify knowledge and perception gaps between leadership and non-leadership levels, and explore attitudes, barriers and motivators to respiratory protection across leadership roles. Methods: A mixed-methods approach was employed using The Wildfire Conservancy Respiratory Protection Survey (n=766) and key informant interviews with non-leadership and leadership firefighters (n=27). In the quantitative analysis, data were analyzed using RStudio (version 2024.04.2+764) and the qualitative thematic analyses were conducted using Dedoose (version 9.2.012). The study applied Social Cognitive Theory to investigate cognitive, behavioral, and environmental factors influencing the use of respiratory protection among wildland firefighters. Results: The Wildfire Conservancy Survey revealed that 85.9% of firefighters do not use respiratory protection during wildland/WUI incidents, with cloth masks being the most commonly used form of respiratory protection (67.8). Significant knowledge gaps were found regarding hazardous chemical produced by smoke. No significant differences in chemical knowledge were observed between firefighters in leadership versus non-leadership (p-value=0.646). Impaired breathing (64.2%) emerged as a major barrier in respiratory protection. Leadership exhibited significantly more concern about the size of the respiratory equipment (p-value=0.004), whereas non-leadership firefighters placed greater importance on the appearance of the equipment (p-value=0.004). Cancer risk reduction (74.8%) was the strongest health motivator for respiratory protection use for both leadership and non-leadership. Key informant interviews highlighted leadership’s influence on respiratory protection adoption, with non-leadership firefighters being less likely to adopt protection due to cultural norms and perceived feasibility. Discussion: Significant knowledge gaps regarding smoke exposure risks and respiratory protection exist among wildland firefighters. Targeted training across all ranks is needed to raise awareness, and leadership must model protective behavior to improve equipment adoption. Current respiratory methods are inadequate, underscoring the need for effective, practical solutions. Addressing cultural norms that discourage safety measures and creating a national standard for respiratory protection are essential for fostering safer wildland firefighting practices.Item Embargo Using A Sexual & Gender Minority Health Disparities Framework To Examine Multi-level Influences On Bisexual College Women’s Sexual Health Communication About HIV(East Carolina University, July 2024) Muscari, EmmaPrior studies have consistently revealed that bisexual+ women are at an increased risk for numerous mental and sexual health disparities compared to individuals with differing sexual orientations, in part due to bierasure and binegativity—yet less is known about bisexual+ women’s approaches to obtaining information about partner sexual health and HIV status. My dissertation employed a mixed-methods approach to investigate sexual health communication strategies (i.e., requesting partner sexual health history) as a means of HIV prevention, and the multi-level psychosocial factors that underlie sexual health communication related to HIV. Specifically, I assessed the individual, interpersonal, community, and societal factors—informed by the Sexual & Gender Minority (SGM) Health Disparities Research Framework and the Theory of Planned Behavior (TPB)—that guide sexual health communication in bisexual+ college women. A total of 258 bisexual+ college women completed an online survey that assessed for multi-level factors that affect HIV-related sexual health disparities and HIV prevention behaviors. Across levels of influence in the SGM ecological framework, community level influence in the form of LGBTQ community connectedness predicted bisexual women's individual level experience of sexual identity outness (i.e., more LGBTQ community connectedness predicted more sexual identity outness). Societal level influence in the form of bierasure predicted medical mistrust on the interpersonal level (i.e., less bierasure predicted less medical mistrust). When examining ecological influences on variables associated with the TPB, more LGBTQ community connectedness and less internalized heterosexism predicted more favorable attitudes around having a shared sexual conversation. More LGBTQ community connectedness also predicted more perceived social pressure around having a shared sexual conversation. Examining TPB variables more focally, the TPB intermediate variable of intention was not only influenced by upstream TPB variables (more attitudes, norms, and self-efficacy predicted greater intention) but also predictive of TPB outcome variables of sexual safety strategies and request for partner sexual health history. A qualitative analysis of HIV prevention behavior (request for partner sexual health history) yielded three themes across participants who reported requesting history: 1) Style, 2) Content, and 3) Timing, and one theme across participants who did not request history: 1) Barriers. The Barrier theme had seven subthemes: Discomfort, Unaware, Managing Partner Reactions, Perceived Minimal Risk, Partner Initiated, Social Norms, and Perceived Lack of Relevance. Qualitative responses provided context for upstream TPB variables and elucidated specific attitudes, norms, and efficacy factors that are involved in shared sexual health conversations. Future research should continue to take a multi-level approach in capturing the numerous factors that influence HIV-related sexual health outcomes for bisexual+ women. HIV prevention programs should consider how fostering positive attitudes, favorable social norms, and self-efficacy influences request for partner sexual health history.Item Embargo Use of Modular Therapy to Treat Anxiety for School Age Students with Autism(East Carolina University, July 2024) Glenn, Melissa RegineAutism spectrum disorder (ASD) is a neurological disorder characterized by challenges with social communication, interpersonal skills, sensory stimulation, and restricted and repetitive behaviors. Because of these challenges, the social demands of school can produce anxiety in some children with ASD. Although practitioners use several evidence-based interventions to treat autism, there are few evidence-based treatments to address the anxiety symptoms commonly associated with individuals with ASD. This study aims to determine the extent to which perceived anxiety levels decrease for school-age children with autism who also present with anxiety-related concerns, the extent to which children with ASD rate the usefulness of the intervention, and measure parent and teacher satisfaction with the intervention and perceived behavioral outcomes. The school psychology researcher will use a modified version of the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, and Conduct Disorders (MATCH-ADTC) to include more visuals, schedules, and social stories. In addition, the researcher intends to determine the effectiveness of the intervention by collecting data on the students’ engagement (determined by the practitioner) and feedback on the students’ experience (determined by the student).Item Embargo Feasibility and Acceptability of a Behavioral Intervention Program Among Patients with Atrial Fibrillation to Promote Engagement in Physical Activity(East Carolina University, July 2024) Anthony, Scarlett LeighContemporary AF management includes rate control, rhythm control, anticoagulation, and lifestyle management. Lifestyle management remains aspirational for most clinical settings around the world. Achieving regular physical activity (PA) is daunting for patients and programs such as cardiac rehabilitation are often not available, or not covered as in the USA, leaving few treatment options for patients. This study employed a behavioral PA intervention focused on psychoeducation, aerobic exercise, and problem solving to examine the feasibility and acceptability of a brief PA intervention among patients with AF in a rural-serving clinic. 128 patients were approached in clinic and a total of 24 participated in the study. Accelerometer data revealed an average of 255 minutes of moderate and vigorous PA per week (36.4 min/day) at baseline and 298 minutes of moderate and vigorous PA per week (42.6 min/day) at the end of program. Accelerometer data showed an average of 18.24 hours per day of sedentary time at baseline compared to 17.18 hours per day at the end of the program. Despite increases in PA, overall symptom burden and quality of life scores remained consistent. The average rating of patient satisfaction of the program was 21.8 out of 25 indicating high satisfaction. High attendance rates and patient satisfaction ratings provide preliminary evidence of the feasibility and acceptability of a PA behavioral intervention for patients with AF. Findings suggest that programs have the potential to improve PA levels in rural-serving clinics.Item Embargo MICROBES AND AIRPLANES: INVESTIGATING MICROBIOLOGICALLY-INFLUENCED CORROSION OF SUBMERGED WORLD WAR II AIRCRAFT WRECK SITES(East Carolina University, July 2024) Bush, Dominic W.There is perhaps no better symbol of the destruction, technological advancement, and geographical scale of World War II than aircraft. Today, thousands of these wartime vestiges are located beneath the ocean’s surface, serving as a highly sought after form of material culture. While archaeologists tend to opt for in situ preservation strategies, there are those who have advocated for a different ‘preferred’ option, instead promoting recovery. Proponents of the latter perspective have levied charges of inaction against archaeologists, citing unchecked degradation as the impetus for salvaging submerged aircraft wreck sites. To counter these claims, and better understand the degradative forces that place these sites at risk, the totality of environmental factors needs to be comprehensively assessed. This includes a site’s microbiome, as previous research has indicated that colonizing microorganisms have the potential to detrimentally impact steel shipwreck sites and other forms of underwater cultural heritage. However, aluminum aircraft of World War II have yet to be the focus of similar investigations, leaving a void in the field’s understanding regarding in situ preservation threats. Thus, this dissertation is the first attempt to extend this line of research to submerged aircraft wreck sites, using four sites in Hawaiʻi. The first step involves characterizing the microbes present, which necessitated sound collection protocols for obtaining microbial samples. The methodology developed for this project was designed to be practical, affordable, and amenable to a variety of uses. The successful collection of biofilm, the main form of biofouling on submerged aircraft wreck sites, enabled DNA sequencing of the material from these samples. The sequencing results allowed for an interpretation of the microbial assemblages associated with corroded and non-corroded wreck surfaces. While no significant taxonomic differences were identified between corroded and non-corroded samples, the study succeeded in defining the microbial communities of submerged aircraft wreck site biofilm, which appeared compositionally-distinct from those of the surrounding seawater and sediment. In addition to identifying key constituents, the data indicated that environmental factors, including the background microbiome and sedimentary interactions, play a prominent role in shaping submerged aircraft wreck site biofilms. Ultimately, evidence of microbiologically-influenced corrosion of submerged aircraft wreck sites remains inconclusive, although significant strides were made in understanding the microbial communities associated with these sites. For archaeological management, the study provides a sound methodology for future collections, baseline data, and the identification of necessary approaches and additional lines of evidence. There is an inherent value in being the first to attempt to see what works, thus serving as a launching point for future, more sophisticated forms of analyses that strive towards developing definitive statements on the relevancy of microbiologically-influenced corrosion to the in situ preservation of submerged aircraft wreck sites.