Populism in America: Anti-Elitism and Anti-Pluralism in the United States

Populism has become a defining force in the politics of democratic nations the world over in the early 21st century, and the United States is no exception. I define populism as the notion that the government has sold out the ``real” people of a nation in favor of some ``other” group. I define populist rhetoric as that which is both anti-elite -- targeting the government -- and anti-plural -- targeting some ``other.” I further identify three distinct strains of populist rhetoric – governmental, economic, and social – based on the group being assailed. I consider the place and prominence of populism in American politics across the nation’s history. In the late 19th century, both parties used anti-elite and anti-plural cues strategically. In most cases, the party out of power used more populist rhetoric in its efforts to disparage its rival. The party in power used much more populist rhetoric in moments of national crisis. Populism remained a feature of American politics across the 20th century. In the early 21st century, changing political cleavages and a global recession left an immense audience receptive to populist politics. I assess the ways in which Democratic and Republican Senate candidates across eight states used populist rhetoric in their primary campaign messaging in 2022. I find that Republicans used far more social populist rhetoric than Democrats, and that Democrats employed far more economic populist messaging than Republicans. I also find significant variation in how candidates of the same party used populist cues. Finally, I use survey data to consider whether primary voters might use candidates’ populist rhetoric as a heuristic. In primaries where populist rhetoric was a prominent part of the information environment and one candidate used substantially more populist messaging than the others, respondents with more populist views were substantively and significantly more likely to support the most populist candidate. This dissertation sheds light on a timely subject of superlative importance to contemporary American politics.Doctor of Philosoph

Mini Mart Study Location and Parking Guide

This Mini Mart study location and parking guide provides participants with driving directions and directions for arriving by bus to the study location.

IMPACT OF STAKEHOLDER ENGAGEMENT AND UNDERLYING FACTORS ON THE DESIGN, EVALUATION, AND KNOWLEDGE TRANSFER OF AUTOMATED QA TOOLS IN TWO RADIATION ONCOLOGY DEPARTMENTS PRIOR TO IMPLEMENTATION

The physics pre-treatment quality assurance (QA) step is the step mostly likely to detect potential safety events in the radiation therapy process. However, there is a need for improving the physics pre-treatment QA checklist with the process relying heavily on human inspection and evidence that errors still occur. The purpose of this study is to explore the impact of stakeholder engagement and underlying factors in the design and evaluation of an automated physics pre-treatment QA checklist. This work was done through knowledge transfer between two radiation oncology departments at the University of North Carolina (UNC) and the University of California-San Diego (UCSD) prior to implementation by first exploring factors underlying the design, use, and maintenance of the current physics pre-treatment QA checklists using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. An automated physics pre-treatment QA checklist (“PhyCheck”) prototype was developed at UNC, which demonstrated increased usability and decreased cognitive workload (CWL) compared to the current checklist. Safety events captured using the current physics pre-treatment QA checklist and qualitative data on automation and safety demonstrate the potential for automation to catch safety events and outline key barriers for automation. The engagement of stakeholders led to knowledge transfer between institutions and both institutions meeting the threshold for pre-implementation outcomes. This study highlights the importance of stakeholder involvement and engagement and outlines the underlying factors in the design, evaluation, and pre-implementation of health technology tools.Doctor of Philosoph

NAVIGATING THE TRIPLE BURDEN: UNDERSTANDING PREGNANCY, HIV, AND MENTAL WELL-BEING AMONG ADOLESCENT GIRLS AND YOUNG WOMEN IN ZAMBIA

Introduction: Adolescent girls and young women (AGYW) in Zambia face a triple burden of mental health challenges, pregnancy, and the complexities of living with or being at risk for HIV. High rates of anxiety and depression are compounded by stigma, socio-economic hardship, and limited mental health services. AGYW who become mothers often encounter health system constraints, financial insecurity, and competing responsibilities that hinder postnatal care (PNC) engagement. While social support and self-efficacy are recognized protective factors, their influence across age and HIV status remains underexplored. This dissertation examines the intersection of social support, self-efficacy, mental health, and maternal service engagement among AGYW in Zambia, focusing on mental health outcomes and experiences with facility-based delivery, breastfeeding, and PNC.Methods: This cross-sectional mixed-methods study draws on two datasets. Quantitative baseline data (N=1123) from the SHIELD/IWC trial were analyzed using logistic regression to assess associations between social support, self-efficacy, and mental health (anxiety and depression), stratified by HIV status and age group (10–15, 16–20, 21–25). Additionally, in a nested mixed-methods study, survey data on postnatal distress, PNC, and breastfeeding were collected from 40 AGYW. Qualitative data included in-depth interviews with these same 40 postpartum AGYW and focus group discussions with healthcare providers and caregivers.Results: Family support was associated with reduced anxiety, especially among AGYW aged 16–20, while friend support was linked to increased anxiety, particularly among AGYW living with HIV and those aged 21–25. Self-efficacy was not significantly associated with mental health overall but predicted higher depression among AGYW aged 10–15 and those living without HIV. Postnatal distress was common, shaped by concerns over newborn care, finances, and personal health. Despite all AGYW attending at least one PNC visit, barriers such as long waits, vaccine shortages, and stigma discouraged continued care. Social support aided PNC attendance and breastfeeding, though food insecurity and transportation challenges disrupted both.Conclusion: Findings highlight the interconnected burdens of mental health, maternal health, and HIV among AGYW. Addressing stigma, socio-economic disparities, and health system barriers is vital for improving outcomes. Future research should explore longitudinal trends and interventions to enhance resilience and youth-friendly care.Doctor of Philosoph

The Impact of Added Flavor on Consumption via Hedonic Eating

The role of added flavor in hedonic eating and overconsumption is of growing interest, particularly in ultra-processed foods (UPFs). This study examined whether added flavor influences intake through hedonic mechanisms and how liking and impulsivity affect consumption. Thirty-eight adults (50% female, 50% male) participated in a taste test and ad libitum intake phase with four snack types (potato chips, ice cream, gummy bears, soda) in flavored and unflavored conditions. A two-way repeated-measures ANOVA revealed significant effects of flavor and snack type on intake (p < 0.001). Unflavored chips and ice cream were consumed more than their flavored counterparts, whereas flavored gummy bears were consumed more than unflavored. Impulsivity had no effect. Findings suggest added flavor does not always increase intake but may enhance consumption of bland foods. Future research should refine unflavored control selection and examine the role of familiarity in added flavor-driven hedonic eating and consumption.Master of Scienc

IMPLEMENTATION OF A STANDARDIZED FOOD INSECURITY SCREENING AND REFERRAL PROTOCOL AT AN ENHANCED PRIMARY CARE CENTER

The Social Determinants of Health (SDOH) include the conditions where one is born, lives, works, worships, plays and ages that impact a person’s health status, quality of life and functioning (Gomez et al., 2021; Sand 2021; Stewart de Ramirez et al., 2022). When compared with those who have access to resources, those in low-resource households have increased stress, poor diets, decreased opportunities to exercise, poor access to healthcare and live in highly populated living conditions; all which increases incidence of acute and chronic illness (Al Abosy et a., 2022; Bonnell et al., 2021; Higginbotham et al., 2019). Studies show addressing the SDOH impacting one’s life has a greater impact on health outcomes compared to medical care alone (Lynch et al., 2024; O’Brien, 2019; Stewart de Ramirez et al., 2022; Yan et al., 2022). Food insecurity (FI) is a modifiable risk factor; therefore, it should be a priority to determine how primary care may improve health equity by addressing FI. At this enhanced primary care center, hereafter referred to as EPCC, FI was identified as an area for growth. Nationally, 12.8% of U.S. households experienced FI within the year 2022, which is a significantly higher value compared to the 2021 value of 10.2% (USDA, 2023). Specific to FI, North Carolina has the eighth highest rate of FI in the United States, with approximately one in five children living in food insecure households (North Carolina Department of Health and Human Services, n.d.). Research shows proper screening for FI improves not only health equity, but also health outcomes (De Marchis et al., 2020). Food insecurity screening increased patient access to food and improves the management of chronic health conditions (Berkowitz et al., 2019). To provide holistic patient-centered care, the SDOH must be addressed in the medical care setting. The inter-disciplinary medical team can screen, identify and address the SDOH for everyone who receives care. Development of a standardized food insecurity screening and referral protocol is a feasible way to identify and assist patients in meeting the basic needs and improving health equity.Doctor of Nursing Practic

IS HIV SUPPRESSION ENOUGH? IMPROVING QUALITY OF LIFE ASSESSMENT IN AGING HIV+ PATIENTS

As advancements in antiretroviral therapy (ART) have extended the lifespan of individuals living with HIV, addressing their quality of life (QoL) has become increasingly important, particularly in aging populations. This DNP project explored the use of the PozQoL screening tool in older HIV-positive patients at a HIV Primary Care Clinic (Clinic B) in Raleigh, North Carolina. A quality improvement project was designed utilizing a 13-item survey to collect data from 64 HIV+ patients aged 50+ years old. This survey highlighted 4 domains to determine a total QoL score – psychological, functional, social, and health concerns. The findings indicate that aging HIV-positive individuals score their mental health and functional health the lowest amongst the 4 identified domains across ages, genders, and ethnicities. This project highlights the importance of implementing routine QoL assessments in clinical practice to identify and address these challenges effectively.Results suggest that integrating QoL screening into HIV care can enhance patient-centered treatment approaches, improve communication between patient and provider and develop interventions specific to Clinic B patient needs. Key recommendations include implementing standardized QoL assessment tools in HIV care settings and providing targeted interventions for mental health, social support, and chronic disease management.While this project provides valuable insights, limitations include sample size constraints, duration of the project, and increased numbers of missed opportunities. Future work should include full roll-out to all patients at Clinic B, development of specific interventions and integration into the electronic medical records. By emphasizing the significance of QoL screening, this project contributes to the evolving landscape of HIV care, advocating for a holistic approach to improving the well-being of older individuals living with HIV.Doctor of Nursing Practic

“Our Children Are in Trouble”: Integrating Therapeutic De-escalation Training to Youth Leaders

The behavioral health of pediatric populations has experienced a marked decline in recentyears, a trend significantly exacerbated by the adversity, trauma, and disruption brought on bythe COVID-19 pandemic (American Academy of Pediatrics, 2021). These challenges have led toincreased adverse behavioral incidents, which are associated with a 50% loss in instructionaltime, diminished academic performance, reduced motivation, heightened safety risks for youthand staff, and poor staff-youth relationships (Manasiev et al., 2019). This quality improvementstudy utilized the Institute for Healthcare Improvement’s Plan-Do-Study-Act (IHI PDSA)framework to examine the impact of training youth leaders at a local Boys and Girls Club inthree evidence-based de-escalation strategies: praise, choice, and goal setting with pre-correctionon the frequency and intensity of pediatric behavioral events.The researcher provided a didactic and interactive role-playing exercise training sessionto equip staff with the knowledge and skills to apply these techniques during routine youthinteractions. Quantitative data on behavioral incidents was collected pre- and post-intervention toassess the frequency and intensity of events. Post-intervention analysis revealed a 27.78%reduction in the frequency and a 59.4% decrease in the intensity of behavioral incidents. Theseoutcomes were determined through a comparative study of incident reports, using descriptivestatistics to evaluate the intervention’s effectiveness.ivFindings suggest integrating praise, choice, and goal setting with pre-correction into out of-school-time (OST) youth leader training can meaningfully reduce disruptive behavior inpediatric settings. The notable decline in the number and severity of incidents highlights thepotential for these strategies to promote a safer and more supportive environment, leading tolasting improvements in pediatric behavior and emotional regulation.Doctor of Nursing Practic

Windows into Planetary Evolution: the Detection and Characterization of Young Worlds

Young exoplanets -- those less than a billion years old -- offer a unique window into the early stages of planetary formation and evolution. Gaining insight into how these worlds acquire and lose their atmospheres, migrate within their systems, and evolve into the diverse populations we observe today is essential for refining models of planet formation. However, this phase remains poorly understood due to the rarity of known young transiting systems and observational challenges such as stellar activity. In this thesis, I investigate the atmospheres of several young exoplanets using a combination of ground- and space-based observations, including data from the Spitzer, Hubble, and James Webb Space Telescopes. Through transmission spectroscopy across optical and infrared wavelengths, I probe their atmospheric compositions, characterize aerosol properties and stellar spot contributions, and infer planetary masses using atmospheric scale height measurements. The findings of this work include the discovery of two transiting sub-Neptune-sized exoplanets orbiting the young M dwarf, TOI-1224, adding to the small, but growing sample of young multiplanet systems. I also present the first atmospheric analysis of K2-25b, K2-33b, and HIP 67522 b, which reveals significant diversity in their observed properties. These findings provide new constraints on atmospheric evolution in young systems and help connect early formation processes to the characteristics of mature exoplanets.Doctor of Philosoph

THE SPIKE IN STREAMING: ANALYZING THE RELATIONSHIP BETWEEN SUBSCRIPTION-BASED BROADCASTS AND IN-PERSON MATCH ATTENDANCE IN DIVISION I POWER 4 WOMEN’S COLLEGE VOLLEYBALL

Women’s college volleyball has seen significant growth in both attendance and broadcast viewership, as there are more eyes on the sport now than ever. With the expansion of streaming platforms, and more attention on college volleyball across social platforms, fans have an even more difficult decision in attending the match or watching from home. The following thesis examines the relationship between streaming college volleyball matches and in-person match attendance, to assist athletic departments in determining fan attendance behavior and explore if more broadcast options serve as a substitute or a complement to attending the match in-person. A linear regression model was run with match attendance as the dependent variable, while the broadcast variables, and a series of other control variables served as independent variables to predict fan attendance demand. The final regression model revealed the relationship between the various broadcast platforms and in-person attendance, while controlling for other variables that also impact attendance, and ultimately provide athletic departments and administrators with further insight on the value of broadcast production and ways to increase attendance as women’s college volleyball continues to garner more fan interest and attention in the media.Master of Art