Digital Commons Network^™

Physical And Behavioral Health Diagnoses And Comorbidities Associated With Transition From Military Health System To Veterans Health Care Among Post-­ 9/11 Veterans, Nikki R. Wooten, Megan E. Amaun, Madeline Meyers, Prince Nii Ossah Addo, Jeffery Bowers, Felicia R. Carey, Rudolph P. Rull, Edward J. Boyko, Nathaniel Bell, Ana Defede-Lopéz, Mary Jo V. Pugh

Faculty and Staff Publications

Objective

To identify factors associated with transitioning from Military Health System (MHS) to Veterans Health Administration (VHA) care in post-9/11 veterans.

Study Setting and Design

Retrospective cohort study from the Long-Term Impact of Military-Relevant Brain Injury Consortium Phenotype Study.

Data Sources and Analytic Sample

Population-level data were analyzed from MHS and VHA electronic health data (FY2000-2020). Participants received ≥ 3 years of MHS care and separated from the military before October 1, 2016. The primary outcome was transition from MHS to VHA care after military separation. Covariates included demographic, military, and deployment characteristics at military separation; physical, mental, and substance …

Physical And Behavioral Health Diagnoses And Comorbidities Associated With Transition From Military Health System To Veterans Health Care Among Post-9/11 Veterans, Nikki R. Wooten, Megan E. Amaun, Madeleine Myers, Price N.O. Addo, Jeffrey Bowers, Felicia R. Carey, Rudolph P. Rull, Edward J. Boyko, Nathaniel Bell Ph.D., Ana Defede-Lopéz, Mary Jo V. Pugh

Publications

Objective

To identify factors associated with transitioning from Military Health System (MHS) to Veterans Health Administration (VHA) care in post-9/11 veterans.

Study Setting and Design

Retrospective cohort study from the Long-Term Impact of Military-Relevant Brain Injury Consortium Phenotype Study.

Data Sources and Analytic Sample

Population-level data were analyzed from MHS and VHA electronic health data (FY2000-2020). Participants received ≥ 3 years of MHS care and separated from the military before October 1, 2016. The primary outcome was transition from MHS to VHA care after military separation. Covariates included demographic, military, and deployment characteristics at military separation; physical, mental, and substance …

Factors Associated With Lapses In Care Among People Living With Hiv In South Carolina, Xueying Yang Ph.D., Fanghui Shi, Shujie Chen, Gavi Samuel, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Utilizing statewide electronic health records (EHR) data, this study aims to assess the factors determining the occurrence of lapses in HIV care among people with HIV (PWH) in South Carolina (SC). All adult (≥ 18 years old) PWH who were diagnosed with HIV between 2006 and 2018 with at least two HIV care encounters and at least 1-year follow-up record were included in the analysis. The outcome, a lapse in care, was defined as a repeated measure of HIV care encounter that occurs over a year following the previous visit. Generalized Estimation Equation models were employed. The study cohort had …

Inferring The Breakdown Scales Of The Chiral Expansions For GA And MN, Andreas Ekström, Daniel R. Phillips, Lucas Platter, Matthias Schindler

Faculty Publications

We apply Bayesian inference to the order-by-order chiral perturbation theory (χPT) expansions for the axial-vector coupling constant g_A and the nucleon mass m_N, and thereby infer the scales at which χPT breaks down for these two observables. Using a pointwise Bayesian analysis, we find that the inferred breakdown scales are notably different for the two observables. For the chiral expansion of g_A, we obtain 251⁺²⁰₋₅₀ MeV and 211⁺²⁰₋₃₀ MeV using two distinct sets of low-energy constants, while for the chiral expansion of m_N we infer a significantly …

Navigating Digital Margins: Folk Theories Of Content Moderation And The Information Practices Of Nonsuicidal Self-Injury Communities On Tiktok, Valerie Angela Vera

Theses and Dissertations

Content moderation can reinforce stigma and limit access to much-needed information, including information on nonsuicidal self-injury. Despite its prevalence, the behavior remains highly stigmatized, prompting individuals to turn to social media platforms like TikTok for social support and harm reduction information. However, as algorithms are known to disproportionately moderate stigmatized content, users must navigate a careful balance between visibility and concealment, altering their information practices to avoid detection. Using an explanatory sequential mixed methods design, this study explored how users navigate content moderation, negotiate visibility, and adapt their information practices in anticipation of and in response to moderation to create …

Implementation And Costs Of A Food Insecurity Resource Navigation Program For Primary Care Patients With Diabetes And Hypertension In South Carolina, Deeksha Gupta, Darin Thomas, Stella Coker Watson Self Ph.D., Ms, Edward A. Frongillo Jr. Ph.D., Alain H. Litwin, Joseph A. Ewing, Lynnette Ramos-Gonzalez, Lynnette Ramos-Gonzalez

Faculty Publications

Objective

To examine food insecurity resource navigation program costs and how navigation intensity relates to clinical outcomes, healthcare costs, and quality of life (QOL) for diabetes and/or hypertension patients.

Methods

This retrospective study included patients receiving resource navigation (July 12, 2021-December 31, 2022 with twelve-month follow-up) across three primary care practices in South Carolina's largest health system. Participants were 18+ years old (from electronic medical records/Epic), had food insecurity (from Hunger Vital Sign™), and diabetes and/or hypertension (from Epic registries). Matched controls came from food insecurity screening-only practices. Patients in each group (n= 219) had diabetes (9.13%), hypertension …

Is Access Enough?: Toward A Blueprint For Prosocial Digital Interventions In Schools (A Case Study On The Implementation Of A Cmc-Based Gratitude Intervention), Carmen Latrice Landy

Theses and Dissertations

This organizational autoethnography examines the process by which a researcher-practitioner began implementing a CMC-based gratitude intervention for adolescents in a school setting. Too often, innovations are unable to reach full adoption within organizations because the real-world implications have not been fully considered. This study seeks to bring a deeper understanding of the facilitators of and barriers to school-based implementation. Through observations and critical reflection, this study highlights the importance of relationships, processes, and mutual agreements in any effort to introduce new practices to an organization. Weick’s (1988) findings on sensemaking combined with the constructs of the Consolidated Framework for Implementation …

The Eye: A Science-Fiction Screenplay Examining Space-Time, Meteorology, And Human Connection, Ella K. Lukowiak

Senior Theses

This thesis explores the nature of time, meteorology, and human interconnection to the universe through the lens of a science-fiction screenplay. The creative project spans a three-act, detailed outline, and a screenplay draft of Act I. It is based upon extensive scientific research regarding hurricane development, the inner workings of organizations such as the National Weather Service, Einstein’s Theory of Relativity, and the space-time continuum. I will delve into the various factors that shaped my science-fiction premise, including pivotal films such as Christopher Nolan’s INTERSTELLAR (2014) and Denis Villeneuve’s ARRIVAL (2016). Both of these filmmakers integrated complex science-fiction concepts into …

Long Term Effects Of Gestational Stress On Postpartum Cardiovascular Health In Female Rats, Arshaam Kordamiri

Senior Theses

Approximately 15% of women experience postpartum cardiovascular complications, including hypertension, cardiomyopathy, and heart failure. These conditions can impair maternal functioning and maternal-infant bonding, while increasing long-term health risks. Despite their severity, the underlying causes remain unclear. Stress is a known risk factor for cardiovascular disease (CVD), and gestation represents a period of heightened vulnerability. As CVD is a leading cause of maternal mortality, identifying contributing factors is critical.

Atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and troponin I are cardiac biomarkers involved in fluid regulation, blood pressure, and myocardial injury. We hypothesized that gestational stress alters cardiovascular function, geometry, …

Reevaluating Pediatric Concussion Recovery: The Need For Comprehensive Psychological Assessments, Jolie L. Slobodin

Senior Theses

Pediatric concussions represent a significant public health concern due to their complex and often long-lasting effects on the developing brain. Although concussion is classified as a mild traumatic brain injury (mTBI), growing evidence indicates that children and adolescents experience psychological, cognitive, and academic difficulties that extend beyond physical symptom resolution. While somatic and cognitive symptoms often predominate in the acute phase of recovery, emotional and behavioral concerns frequently emerge or persist later, yet remain inconsistently evaluated in standard concussion care. This thesis examines the psychological, cognitive, and academic outcomes of pediatric concussion and evaluates whether current assessment practices capture the …

Data Tracking And Analytics Within Inventory Management: Coffee Shop And Retail Store Optimization, Mateo J. Moyon

Senior Theses

This thesis examines the application of inventory management theory in the small and medium-sized business context, with a specific focus on the food and beverage industry. Drawing on the foundational academic literature spanning from Harris’s EOQ formula in 1913 through stochastic inventory theory, ABC analysis, and just-in-time strategy, this paper establishes the mathematical and operational bases for modern inventory management practice. Although there are proven value to these frameworks, research demonstrates that small to medium sized businesses adopt inventory management systems at lower rates citing cost and implementation as barriers. This thesis argues that the emergence of low-cost inventory and …

The Relationship Between Stress And Postpartum Depression-Related Behavior In Females And Its Potential Contribution To The Maternal Mortality Rate In The U.S., Sarah Chugh

Senior Theses

Stress, especially social stress, has been a leading cause of disruptive emotional behavior in humans, with pregnant and postpartum women being the most vulnerable to these effects. Our study aimed to investigate the effects of gestational social stress on postpartum behavioral outcomes. To accomplish this, we examined the following four key behaviors in female rats after being exposed to chronic witness stress (WS) during pregnancy: burying, freezing, rearing, and grooming. Burying behavior is used to assess a defensive response to threatening situations. Freezing responses are evaluated to show heightened fear or hypervigilance that follows stress. Rearing is measured as an …

Feeding The Mind: Dietary Consumption And Neural Aging, Bhavani Tuppale

Senior Theses

Neural aging is the process of physiological decline in the brain and increased vulnerability to neurodegenerative diseases. Neurodegenerative diseases such as Alzheimer’s disease are associated with aging and the interaction of genetics and lifestyle choices. Previous research studies have connected Alzheimer’s disease with dysfunction in the metabolic system. To combat age-associated dysfunctions in the metabolic system, research studies propose using the ketogenic diet, which utilizes ketone bodies as an energy source instead of glucose. The thesis analyzes literature on the effect of neural aging on various model organisms, how a ketogenic diet affects aging model organisms, and how aging and …

Identifying Factors Influencing Occupational Therapy Decision-Making Regarding Telehealth, In-Person, And Hybrid Care Within A Veterans Affairs Healthcare Setting In South Carolina, Christina R. Smith

Senior Theses

Telehealth has become an increasing part of healthcare service delivery, expanding client access to services across disciplines, including occupational therapy. Existing research suggests that telehealth occupational therapy can produce similar outcomes to in-person care in certain populations; however, variability in patient characteristics, technological readiness, intervention demands, and environmental contexts influences its suitability, and limited research examines how practitioners determine the appropriate service delivery model. The purpose of this qualitative study is to explore the factors that influence occupational therapy practitioners within a Veterans Affairs healthcare setting in South Carolina when determining the appropriateness of telehealth, in-person, or hybrid service delivery …

The Role Of Community Health Workers In Rural South Carolina, Sarah W. Haselden

Senior Theses

This paper aims to explore the role of Community Health Workers (CHWs) in rural South Carolina through a literature review as well as the data supplied from the Community Health Alignment Initiative (CHAI) and Community Health Workers Changing Outcomes in SC (CCOSC). Through reviewing the collection of materials and data, the effectiveness of CHWs can be studied. Community Health Workers (CHWs) provide a unique aspect to primary care within communities through their aid in prevention of health conditions. CCOSC and CHAI collected data throughout South Carolina to determine the needs of communities and how CHWs can work to address those …

The Effects Of Climate Change On Competition And Recovery From Disturbance In An Iconic Marine Community, Lauren Tibbits

Senior Theses

This paper explores how the recovery of populations of Semibalanus balanoides is affected by climate variation. In intertidal marine ecosystems, larval recruitment is important in shaping all ecological processes. S. balanoides is a cold-water barnacle species that is competitively dominant over Chthamalus montagui and C. stellatus, two warm-water species. This competitive interaction is well studied, though it is not understood how that competition influences the recovery of S. balanoides after a disturbance nor how this process varies over a temperature gradient. 19 sites were studied across the United Kingdom, spanning from northern Scotland to southwestern England. At each site, a …

The Impact Of Targeted Marketing On The Health Of Teenagers In America: Regulatory Safeguards And Implications, Katelyn Overbay

Senior Theses

The rise of digital marketing has transformed how companies engage with consumers, particularly those that fall within the adolescent age group. Teenagers represent a uniquely vulnerable demographic due to the developmental stage they are in, making them especially susceptible to targeted advertising strategies that leverage data analytics, social media algorithms, and behavioral tracking. The aim of this study is to examine the direct and indirect impacts of targeted marketing on the physical, mental, and social health of teenagers in the United States. Drawing on existing literature, case studies, recent lawsuits, and regulatory analysis, the research gathered explores how industries such …

Evaluating The Impact Of Social Determinants Of Health On Outcomes Of Type Ii Diabetes In South Carolina, Alexander G. Downs

Senior Theses

Type II diabetes mellitus (T2DM) represents a significant public health burden in South Carolina, where 13.5% of adults are affected, surpassing the national rate of 12%. This integrative literature review examines the social determinants of health most strongly associated with T2DM morbidity and mortality in South Carolina, including race and ethnicity, socioeconomic status, rural or urban residence, educational attainment, healthcare access, and food insecurity. Evidence drawn from peer-reviewed studies, epidemiological reports, and state health data reveals that African American, rural, and low-income populations bear a disproportionate share of the diabetes burden in the state. These disparities arise through multilevel mechanisms …

Conservation Communication In Web 2.0: A Mixed Methods Analysis Of Alveus Sanctuary's Strategies On Twitch.Tv, Hope Denison

Senior Theses

This thesis examines how environmental creators can effectively transmit conservation messages in the evolving Web 2.0 media environment. The case of Alveus Sanctuary, a virtual sanctuary and education center on Twitch.TV, is used to explore the strategies currently used to engage audiences and raise ecological awareness online. Thematic analysis of interviews with the sanctuary’s founder revealed that Alveus combines traditional environmental education with an influencer business model to engage online audiences, leveraging parasocial behavior, interactivity, and collaboration to garner support. A quantitative content analysis of social media posts revealed that these strategies effectively induce parasocial engagement in online spaces. These …

Crystallization And Utility Of Brominated Phenylethynylene Bis-Urea Macrocycles, Paras Srivastava

Senior Theses

Macrocycles are large, cyclic molecules with central cavities that can encapsulate other molecules and that have uses in supramolecular chemistry. The Shimizu group has previously synthesized Macrocycle 1, a phenylethynylene bis-urea macrocycle that crystallizes in a columnar form, enabling its utility as a host in host-guest systems. Reactions within these systems can be used to modify stereospecificity, kinetics, and other physical properties. Previously, photodimerization reactions between coumarins and chromones have been studied in systems of Macrocycle 1, resulting in the improved specificity of photodimerization products. Herein, we apply a dynamic covalent chemistry (DCC) strategy to synthesize Macrocycle 1 and its …

America’S First Comic Role, “The Negro”: An Analysis Of Historical Caricatures And Their Influence On African American Characters And Archetypes, Skyla A. Praylow

Senior Theses

A stereotype is defined as “a set of ideas that people have about what someone or something is like, especially an idea that is wrong.”1 Even though stereotypes are understood to be harmful, “contributing to prejudice and discrimination,” they are still believed to have some “kernel of truth,” and are viewed as “overgeneralized beliefs about social groups in society.” These stereotypes are then used as propaganda to reinforce oppressive systems in the US.2 Stereotypes create the basis of opinions that are used to create caricatures. A caricature is “a picture, description, or imitation of a person in which certain striking …

(Un)Celebrated Women: Three Women Authors And Their Imprint On The Gullah Geechee Literary Tradition, Raven Mariah Gadsden

Theses and Dissertations

Three women authors, Laura Middleton, Julia Peterkin, and Zora Neale Hurston, are responsible for the creation of some of the most important Gullah Geechee literary images in the 1920s and 1930s. By examining the historical moments and movements which were active while these women were writing, it is obvious why these women are at the center of this conversation. Each of these women’s writing plants the seed for a Renaissance of Gullah Geechee representation. While Middleton's work never gets published, her documentation of black life in South Carolina for the Federal Writers' Project worked as a counter narrative to texts …

Comparing Stress Levels And Experiences Between Mothers And Fathers Of Children With Angelman Syndrome, Katherine Helen Fix

Theses and Dissertations

Angelman syndrome (AS) is a neurogenetic disorder characterized by significant developmental and cognitive impairments, disruptive behaviors, and a hallmark happy demeanor. Past studies have shown that certain features of AS contribute to increased parental stress. Other studies report that in general the stress of parents of children with disabilities is influenced by stereotypical gender roles surrounding factors including daily care taking tasks, financial responsibility, and medical care involvement. This study aimed to compare perspectives among mothers and fathers of individuals with AS to identify discrepancies and themes relating to stress, specific hardships, and caregiving roles. Parents of children with AS …

Weaponized Nostalgia And The Modern Woman: Patriarchal Insecurity In A Lost Lady And The Sound And The Fury, Grace Nicole Becker

Theses and Dissertations

This thesis analyzes the patriarchal nostalgia that resulted from men’s perceived feminization in modernity and how it manifests in the narrative framing of modern women in modernist literature. Niel Herbert from Willa Cather’s A Lost Lady and Jason Compson from William Faulkner’s The Sound and the Fury each embody contrasting masculine responses to the feminization of white manhood. Niel exemplifies the mourning of white masculinity that does not hinge on being antithetical to femininity, a sentiment which Greg Forter similarly identifies in Cather. Jason personifies an aggressive masculinity and repudiates women, blaming them, and other minority groups, for his own …

Fuel Flexibility, Gas Turbine Combustion, Laser Diagnostics, Lean Blow-Out, Austin Thomas Shealy

Theses and Dissertations

To address increasing global energy consumption, energy industries seek to implement alternative fuels and increase energy generation efficiencies to meet energy demands. However, alternative and bioderived fuels present both chemical and physical properties significantly different from traditional hydrocarbon fuels typically used for gas turbine power generation. Consequently, they present unforeseen technical challenges. To address these challenges, ammonia has been suggested for use as a hydrogen carrier fuel in gas turbines. Ammonia presents many challenges by having a low overall reactivity as well as low energy density both by mass and volume. To address ammonia’s unique combustion characteristics, two strategies have …

From Adolescence To Adulthood: The Impact Of Parental Support, Resilience, Academic Motivation, And Mental Health In Black Women & Girls: A Multi-Manuscript Dissertation, Jessica Mikaja Barnes

Theses and Dissertations

Fatherlessness in the Black community is a growing phenomenon that has been widely studied. Although this has been widely studied, there is limited literature that focuses on Black adolescent girls and Black women in early adulthood, more specifically, high school age and college aged women. The literature that has been previously published presents an overwhelmingly negative connotation when connecting Black girls and absent fathers. This multi-manuscript dissertation consists of two studies, both of which explore the impact of fatherlessness on resilience, parental support, and academic motivation, and mental health of Black girls and women. For the first study, I employed …

A Connected Life: Functional Communication, Social Participation, And Real-World Outcomes In Chronic Post-Stroke Aphasia, Lauren Marie Hammond

Theses and Dissertations

This dissertation examines functional communication in persons with chronic post-stroke aphasia (PWA), with a focus on how communication ability is conceptualized, measured, and related to real-world participation. While traditional aphasia assessments primarily measure impairment-level language abilities, they often fail to capture the contextual, multimodal, and interactive nature of communication as it occurs in everyday life. Addressing this gap, the present work investigates functional communication from multiple perspectives, including measurement approaches, assessment development, and real-world communication outcomes.

Aim 1 presents a scoping review of functional communication assessments used in aphasia research and clinical practice. Studies were reviewed to identify formal and …

Politics And Intergenerational Conflict: Investigating The Impact Of Affective Polarization On Well-Being In The Vietnamese American Community, Van Phan

Theses and Dissertations

Vietnamese Americans are more likely than other Asian subgroups to identify as Republican. Despite this, Asian American youth, including Vietnamese Americans, still overwhelmingly identify with the Democratic Party. While political orientation could be a source of intergenerational conflict between Asian American generational groups, few studies assess these issues. The present study is an exploratory, hypothesis-generating study investigating the effect of affective polarization in politics on the relationship between intergenerational conflict and well-being for first-and-second-generation Vietnamese Americans. Results showed that affective polarization did act as a moderator for intergenerational conflict on perceived stress for both first-and-second-generation Vietnamese Americans. Specifically, Vietnamese Americans …

Assessing Hereditary Cancer Risk And Genetic Counseling Knowledge And Interest In Appalachian Kentuckians, Ashton Farmer

Theses and Dissertations

Appalachian Kentucky has the highest cancer incidence in the United States and about 5-10% of all cancer has a hereditary cause. Despite this, there are no board- certified genetic counselors located in the area, and few genomic studies have been done in this population. This study aimed to define Appalachian Kentuckians’ interest in cancer genetic counseling and knowledge of cancer risk factors. An original online survey including multiple choice, Likert scale, and open response items was utilized to assess interest in pursuing cancer genetic counseling and how knowledge of cancer causes impacts interest in cancer genetic counseling. A total of …

Quantum Spin-Like Behavior Of Elastic Guided Waves: Quantized Geometric Phase For Nde And Shm, Md Ebrahim Khalil Bhuiyan

Theses and Dissertations

Ultrasonic guided waves are widely used in nondestructive evaluation (NDE) and structural health monitoring (SHM) for detecting defects and damage in engineering materials and structures. Conventional diagnostic features, such as attenuation of wave amplitude, shifts in time-of-flight, and frequency variations are widely used for damage identification. However, these metrics are inherently sensitive to environmental and operational variations, including temperature, pressure, humidity, sensor coupling conditions, boundary constraints, and external loading. Such sensitivities introduce significant uncertainty in signal interpretation, often obscuring damage-related signatures. Recent advances in wave physics have revealed that elastic guided waves exhibit intrinsic spin angular momentum (SAM), arising from …