University of North Carolina Hospitals

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    REPLACING THE STATE: MARKET EXPANSION IN THE POSTINDUSTRIAL ERA

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    Understanding the boundaries that define states and markets has been a central focus in political-economy research. The nature of these relations has been linked to a myriad social phenomena including inequality, growth, electoral outcomes, etc. For all their theoretical differences, the common typologies used to describe the boundaries between states and markets in mature capitalist democracies generally arrive at a similar classification of states: Anglo-Saxon ‘liberal’ economies exhibit the most developed market arrangement and limited states, while the highly interventionist ‘coordinative’ or ‘social democratic’ states of northern Europe present the mirror image of the former. Over the past forty years, these historically entrenched arrangements have been pressured by the ongoing process of economic liberalization. As states unburdened themselves of their post-war economic responsibilities, market actors were empowered to exert greater influence in new areas. While the process unfolded differently in different contexts, it has transformed state and market boundaries in all post-industrial nations. I my dissertation, I focus on market expansion at the expense of the state, or marketization. This process involves states conceding decision-making capacities within a given domain by either eliminating regulation or by partially or fully exiting the market via privatization. I focus on two distinct ways in which marketization may elicit undesired social consequences; by erecting barriers for political action and by stratifying service quality. In the first paper, I explore whether marketization can hinder electoral accountability via a survey experiment focused on the privatization and deregulation of the utility sector. The second paper examines a similar issue but rather than focus on the effect on candidates, it asks whether privatization can expunge certain areas from the political arena. To test this, I use an observational design centering on the ‘Right to Buy’ reform in the UK. The third paper shifts the focus from the political consequences of marketization to the distributional effects. Using school-level data from Norway, I examine how state and market-based conditions determine the effects of private education systems on educational inequality.Doctor of Philosoph

    WITH GREETINGS FROM MOSCOW: THE ADOPTION OF RUSSIAN PROPAGANDA NARRATIVES IN THE PUBLIC COMMUNICATION OF GERMANY’S BÜNDNIS SAHRA WAGENKNECHT

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    This study investigates what the German newcomer party Bündnis Sahra Wagenknecht (BSW) publicly communicates concerning the war in Ukraine and to what extent this communication aligns with Russian propaganda. The analysis is guided by propaganda theory, emphasizing consistent, persuasive narratives aimed at shaping public attitudes. By applying the method of thematic content analysis, the study compares BSW leader Sahra Wagenknecht’s public communication with six Russian propaganda narratives extrapolated from existing literature. The analysis covers talk show appearances, debates, and speeches between the party’s founding in January 2024 and its first federal election in February 2025. The findings reveal that especially policy positions concerning peace negotiations and independence from the United States (US) closely align with Russian narratives. Additionally, the BSW utilizes four Russian propaganda narratives more directly in other communicative contexts than justifying its policy positions. The thesis concludes that the BSW fully aligns with Russian propaganda narratives, raising concerns about the role of Western democratic parties in the domestic amplification of foreign authoritarian propaganda.Master of Art

    NEURAL AND PSYCHOLOGICAL PREDICTORS OF DIGITAL STATUS SEEKING IN ADOLESCENCE

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    While the quantifiable nature of social media affords youths the opportunity to enhance their online status via the accumulation of likes, comments, followers, not all youths engage in digital status-seeking. We investigate how adolescents' social motivation such as their need for approval (NFA; approach & avoidance) moderate the links between neural sensitivity to peer status in the ventral striatum (VS) and amygdala and digital status seeking among 95 adolescents (Mage = 13.40 years, SD = 0.58, females = 50.5%). Adolescents perform an fMRI task where they were presented with images of their real-life classmates. Notably, we used peer-nominated sociometric ratings from 873 students across 3 middle-schools to select images of their peers based on who was most popular and least popular. We also assessed for NFA and assessed digital status seeking 2 years later. Results show that NFA moderated the links between neural sensitivity to low peer status and digital status seeking, such that sensitivity to low peer status in the VS predicted greater digital status seeking two years later, but only for adolescents with high avoidance NFA. Similarly, avoidance and approach NFA both moderated the links between amygdala sensitivity to low peer status and digital status seeking, such that sensitivity to low peer status in the amygdala significantly predicted greater digital status-seeking two years later, only for adolescents with high approach NFA, as well as adolescents with high avoidance NFA. Heightened neural sensitivity to low popular peers may be linked with greater digital status seeking, and these associations may be shaped by individual differences in adolescents' NFA.Master of Art

    INCORPORATING SOCIAL THEORY AND MISSING DATA APPROACHES TO BETTER INFORM AUTISM SPECTRUM DISORDER RESEARCH: APPLICATION TO THE ASSOCIATION BETWEEN LABOR EPIDURAL ANALGESIA AND ASD

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    Background: Many potential causes of autism spectrum disorder (ASD) have been reported in the literature; however, findings are often inconclusive due to issues like measurement error and selection bias, which are compounded by structural racism. Accurate identification of ASD risk factors requires understanding and addressing the ways in which structural racism contributes to bias in epidemiologic research. This dissertation used social theory to conceptualize how structural racism influences bias in the association between labor epidural analgesia and ASD, and incorporated missing data methods to address those biases.Methods: We used data from the Study to Explore Early Development, a U.S. multi-site, population-based case-control study of children aged 2–5 years with ASD and two control groups. Results: In Aim 1, we investigated the association between labor epidural analgesia and ASD and found no strong evidence to support an association, even after conducting several sensitivity analyses. Subtle associations emerged when the analysis was restricted to vaginal deliveries, however, they attenuated after adjustment for additional confounders (i.e., prolonged labor). We found no appreciable effect measure modification by the birthing person’s race and ethnicity. In Aim 2, we derived a validation cohort from children with multiple ASD measurements and used it to apply Multiple Imputation for Measurement Error to address missing outcome data due to loss to follow-up. We found that excluding those. lost to follow-up slightly underestimated the observed association reported in Aim 1, though not enough to alter conclusions Conclusions: We found no evidence to support an association between labor epidural analgesia and ASD. However, as we continue to investigate ASD risk factors, it's crucial to consider how variations in diagnostic practices, as well as systemic inequities, can influence systematic error and the associations we observe. Careful attention to these factors ensures that research conclusions are both valid and generalizable.Doctor of Philosoph

    Learning from Auto-Generated Data to Build Diverse Multi-Modal Models

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    High-quality data is crucial for training multi-modal models. However, human-annotated datasets are often costly, limited in scale, and constrained by existing data availability. To address these limitations, this thesis explores the use of auto-generated data for training diverse multi-modal models, highlighting the benefits in scalability, cost-effectiveness, and the ability to generalize to unseen scenarios. I investigate two primary research directions: diverse data generation and effective learning from auto-generated data. First, for diverse data generation, I explore generating data in different modalities, such as image, panorama, text, and text+image for multi-modal tasks, and investigate how the generated data can help with improving generalization, enhancing different skills, and building new application. This includes editing existing environments, scaling data by automatically annotating unannotated 3D environments and iteratively refining data with collaboration between two models, generating panoramic environments, and utilizing video data to enhance vision-and-language navigation tasks. Second, in learning from auto-generated data, I propose both discriminative and generative training objectives to better learn from the data, and introduce a mixture-of-experts framework to resolve conflicts among skill-specific text-to-image generation models. Together, these explorations demonstrate the effectiveness of leveraging auto-generated data in training robust, generalizable multi-modal models, and open new avenues for efficient, scalable, and innovative model training and application.Doctor of Philosoph

    Chronic ethanol exposure reduces resting state functional connectivity and regional synchrony in male rats

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    Rationale Alcohol use disorder (AUD) is a common mental health disorder affecting many individuals and their families in the United States. The effects of alcohol are not fully understood, particularly the effect of alcohol on baseline brain activity. Objectives We aimed to assess whether chronic ethanol exposure alters resting state functional connectivity between regions of interest (ROIs) previously associated with addiction in male rats. We also aimed to assess whether inhibition of histone deacetylases (HDAC) reduced or blocked the effects of chronic ethanol exposure. Finally, we aimed to investigate whether chronic ethanol exposure altered regional homogeneity (ReHo) and whether HDAC inhibition blocked the effects of ethanol on ReHo. Methods Male rats were administered water or ethanol (5 g/kg, 25% v/v) via intragastric gavage once daily during the light cycle for 14 days and allowed to withdraw for 24 h. Rats were additionally injected with either the HDAC inhibitor trichostatin A (TSA) (2 mg/kg, i.p.) or vehicle (10% DMSO in 0.9% saline) on the last two days of gavage and on the last day of withdrawal. Rats were scanned with magnetic resonance imaging (MRI) to obtain an anatomical scan as well as resting state functional connectivity (rs-fMRI). Results We found that chronic ethanol exposure decreased rs-fMRI in the following pairs of ROIs: caudate putamen-prelimbic cortex, caudate putamen-infralimbic cortex, caudate putamen-nucleus accumbens core as well as caudate putamen-insula, insula-prelimbic cortex, and insula-infralimbic cortex. Chronic ethanol exposure also decreased ReHo, particularly in the dorsal striatum. We did not find significant effects of inhibition of HDACs on rs-fMRI of ROIs or ReHo. Conclusions Chronic alcohol exposure and withdrawal decreases baseline functional connectivity and local synchrony in male rats which is not affected by HDAC inhibition. Future studies should examine the effects of alcohol on resting state connectivity in female rats as well as in voluntary alcohol consumption paradigms. Understanding baseline differences may open new therapeutic avenues in alcohol abuse and AUD to restore typical resting state connectivity

    Impact of motivational interviewing on psychosocial and symptom outcomes during breast cancer endocrine therapy

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    Purpose Adjuvant endocrine therapy (ET) is recommended to women with hormone receptor-positive (HR +) breast cancer for 5–10 years to reduce recurrence risk and mortality, but adhering to ET for this full period is challenging due to the physical and psychosocial effects of treatment. We sought to understand how participation in a patient-centered counseling intervention affected anxiety and depression, recurrence worry, and treatment related symptoms. Methods We conducted a single-arm pilot study over a 12-month period, consisting of five counselor-led motivational interviewing (MI) counseling sessions. Eligible participants were over 18 years old, English speaking, and had stage I-III HR + breast cancer. Survey data collected at baseline and 12 months assessed anxiety and depression, and cancer recurrence worry. Endocrine symptoms were assessed at the 12-month time point, reported descriptively, and age-stratified to examine if symptom burden and age were related. Results Of the 42 women who initiated the intervention, 35 completed the baseline and 12-month surveys. Most participants were over 50 (63%), non-Black and non-Hispanic (63%; 97%). Overall patient-reported anxiety and depression decreased from baseline to 12 months, though only the change in anxiety was statistically significant, while cancer worry increased slightly. The most reported endocrine symptoms were hot flashes, night sweats, vaginal dryness, disinterest in sex, and joint pain; endocrine symptoms did not vary by age. Conclusion This study shows early promise in the efficacy of MI to improve anxiety, depression, recurrence worry, and treatment-related endocrine symptoms

    Control-Oriented and Escape-Oriented Coping: Links to Social Support and Mental Health in Early Adolescents

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    This study examined the factor structure of the Kidcope and its associations with social support, psychological symptoms, and mental wellbeing among early adolescents (ages 10–14) in Darjeeling, India. Confirmatory factor analysis supported a two-factor structure: control-oriented and escape-oriented coping. Multivariable regression and structural equation models indicated escape-oriented coping was associated with higher emotional symptoms (b = 3.19; p ≤ 0.001) and peer problems (b = 1.43; p ≤ 0.003), whereas control-oriented coping was linked with lower conduct problems (b = −1.11; p = 0.006), and hyperactivity (b = −1.28; p = 0.001). Control-oriented coping also correlated with higher mental wellbeing (b = 11.59; p = 0.004), prosocial behavior (b = 0.50; p ≤ 0.001), and resilience (b = 4.49; p ≤ 0.001). Results suggest control-oriented coping mediates 23% of the total effect of social support on psychological difficulties and 15% on resilience. Findings highlight early adolescence as a sensitive window for strengthening coping skills to protect mental health and enhance wellbeing in high-adversity settings

    Erratum: “Low-metallicity Nova Explosions: A Site for Weak rp-process Nucleosynthesis” (2025, ApJ, 987, 88)

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    Erratum to: "Low-metallicity Nova Explosions: A Site for Weak rp-process Nucleosynthesis

    Stimulating training and access to HIV research experiences (STAR program): a protocol for a crowdsourced, project-based, implementation science training program using mixed-methods design

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    Background HIV is more common among underrepresented minority adolescents and young adults (AYA, 13–24 years old) in the United States. Low uptake of HIV prevention services suggests a missed opportunity for implementing evidence-based interventions such as pre-exposure prophylaxis (PrEP) and sexually transmitted infection testing among this important population. Most research institutions in the United States also have limited opportunities for AYA training, mentorship, and capacity-building activities. Methods The “Stimulating Training and Access to HIV Research Experiences” (STAR) program brings together a highly qualified group of research mentors to achieve three specific aims: (1) identify and recruit underrepresented minority AYA interested in HIV research for STAR using crowdsourcing; (2) develop implementation science research and project-based design capacity for underrepresented trainees at participating US institutions; and (3) initiate and sustain enduring AYA research capacity through a digital participatory learning community. A three-stage approach is taken to increase the number of racial and ethnic minority trainees that: (1) learn about HIV prevention services; (2) lead the design of HIV prevention services; and (3) launch and evaluate HIV prevention services serving UREM AYAs at participating community sites. Furthermore, we create a Participatory Learning Community (PLC), with virtual opportunities for interaction, mentoring, and sharing of project-based designs so that rapid exchanges can occur and be documented among trainees, faculty, and invited scholars in the field. Discussion There is a substantial unmet need for adolescent and young adult (AYA) HIV implementation research training in the United States among underrepresented minority AYAs. STAR seeks to identify highly qualified trainees through open calls, build capacity for youth-led research using designathons and innovation bootcamps, and sustain these benefits through participatory learning communities. These approaches break new ground in HIV training using participatory methods that empower AYAs to become junior leaders while building institutional capacity for AYA HIV research

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