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Compromised Health: Examining Growth And Health In A Late Antique Roman Infant And Child Cemetery, Sierra Malis May 2023

Compromised Health: Examining Growth And Health In A Late Antique Roman Infant And Child Cemetery, Sierra Malis

Theses and Dissertations

This research examines the relationship between growth, growth disruption, and skeletal indicators stress amongst juveniles (n=60) interred at the Late Antique infant and child cemetery at Poggio Gramignano (PG) (ca. 5th century CE), associated with a rural agricultural community. Growth disruption – evidenced by decreased long bone length compared to dental age – and stress experience – evidenced by skeletal stress indicators – were compared to those within juveniles from two urban Roman-era cemeteries (n=66), Villa Rustica (VR) (0-400 CE) and Tragurium City Necropolis (TCN) (400-700 CE). Results indicate that the PG juveniles had significantly smaller femoral lengths-for-age than VR …


​​Evaluating The Utility Of Trial-Based Functional Analyses Of Inappropriate Mealtime Behavior: A Comparison Of Identified Functions Across Functional Analysis Methods, Meredith Huff Staggers May 2023

​​Evaluating The Utility Of Trial-Based Functional Analyses Of Inappropriate Mealtime Behavior: A Comparison Of Identified Functions Across Functional Analysis Methods, Meredith Huff Staggers

Theses and Dissertations

A critical first step in addressing problem behavior is to identify the function of the problem, or reason for engaging in the problem behavior, using systematic assessment procedures known as a functional analysis (FA). The literature consistently demonstrates the effectiveness of FAs, and variations of FAs (e.g., trial-based functional analysis [TBFA]) for assessing a variety of topographies of problem behaviors across populations, age groups, and settings; however, the use of TBFAs for assessing the function of inappropriate mealtime behavior (IMB) has been documented in the literature only once. The purpose of the current study was to contribute to the research …


Diy The Process Of Healing From Trauma Through Woodworking, And Living Off Grid, Rachel A. Pollock May 2023

Diy The Process Of Healing From Trauma Through Woodworking, And Living Off Grid, Rachel A. Pollock

Theses and Dissertations

DIY is a website and short hybrid documentary that explores off-grid living, the longing for authenticity and healing from trauma. It is also about clinging to memories, even ones that may be painful, and the desire to move on. The website, Bare Minimums explores healing through the written word, and the short documentary “Home Is Where You Park It” explores the processing of trauma through video. They are two different approaches that evoke completely different emotions and outcomes. Processing memories and trauma through these mediums shows a kind of nostalgia for what once was, mixed with uncomfortable feelings that anticipate …


Contrafreeloading In The Domestic Dog (Canis Lupus Familiaris), Liza Rothkoff May 2023

Contrafreeloading In The Domestic Dog (Canis Lupus Familiaris), Liza Rothkoff

Theses and Dissertations

Contrafreeloading is the behavior of working for food that requires effort to obtain when also provided with food that does not require effort to obtain. More specifically, contrafreeloading can be defined in multiple ways using various criterion such as 1) an animal’s preference and/or 2) an animal’s willingness to work for food when freely available food is offered. To date, multiple studies have evaluated contrafreeloading in various animal species, identifying that many non-domesticated species (e.g., maned wolves, red jungle fowl) and domesticated species (e.g., pigs, goats) demonstrate a preference and/or a willingness to work for food when readily available food …


An Investigative Study Of Potential Factors That Contribute To High Under-Five Mortality Rate In Africa, David Banahene May 2023

An Investigative Study Of Potential Factors That Contribute To High Under-Five Mortality Rate In Africa, David Banahene

Theses and Dissertations

Under-Five Mortality remains a significant challenge in developing countries, especially in Africa. The United Nations has implemented various measures, such as the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), to combat this issue. However, the success of these initiatives is uncertain. Our study investigates the social, economic, and environmental factors contributing to high Under-Five Mortality rates in African countries, using data from 1985 to 2020.We analyzed 53 African countries, partitioning them into training (45 countries) and testing data (8 countries). We conducted Multiple Linear Regression analysis and assessed the model performance using R-squared values and Root-Mean-Squared-Error (RMSE) values. …


Effect Of Elevated Temperature And Roundup Exposure On Oxidative Stress And Antioxidant Status In The American Oyster, Afsana Chowdhury May 2023

Effect Of Elevated Temperature And Roundup Exposure On Oxidative Stress And Antioxidant Status In The American Oyster, Afsana Chowdhury

Theses and Dissertations

Aquatic organisms are frequently exposed to various environmental stressors. In this study, we observed the short-term (1-week) combined dose-dependent effect of Roundup, a glyphosate-based herbicide, and high temperature (30°C) on the morphology of gills and digestive glands, expression of heat shock protein-70 (HSP70), dinitrophenyl protein (DNP), nitrotyrosine protein (NTP), antioxidant enzymes such as catalase (CAT) and superoxidase dismutase (SOD) in tissues of American oyster (Crassostrea virginica). Histological analyses showed an increase in mucous production in the gills and digestive glands, hemocyte aggregation in the connective tissues as well as structural change of the lumen in the digestive glands …


Analysis Of Post-Translational Modifications (Ptm) Crosstalk, Amit Das May 2023

Analysis Of Post-Translational Modifications (Ptm) Crosstalk, Amit Das

Theses and Dissertations

Mass spectrometry-based proteomics is a powerful tool for identifying post-translational modifications (PTMs) across the proteome. O-GlcNAcylation and phosphorylation are two PTMs that play crucial roles in regulating cellular processes, including cardiac contractile function. Dysregulation of these PTMs has been implicated in the development and progression of diabetic cardiomyopathy. In this study, we aimed to investigate the interplay between O-GlcNAcylation and phosphorylation in healthy and type 2 diabetic hearts, with a specific focus on the functional relationships between these PTMs and their potential therapeutic implications.

Utilizing mass spectrometry data, we identified and quantified specific PTMs on myofilament proteins, uncovering 1354 O-GlcNAcylated …


Sweet Potato In The Lower Rio Grande Valley: Evaluating Performance Across Several Cultivars, Jon Dale May 2023

Sweet Potato In The Lower Rio Grande Valley: Evaluating Performance Across Several Cultivars, Jon Dale

Theses and Dissertations

In Texas’ subtropical, semiarid Lower Rio Grande Valley (LRGV), citrus and sugarcane cultures have dominated specialty crop production for more than a half-century. However, the future of these high-dollar crops is becoming uncertain with increases in exotic pathogens, intensifying urbanization and the overarching complexities of both climate change and binational governance of Rio Grande Basin waters. For these reasons, the region’s specialty crop sector needs to be ready for alternatives that could benefit both market outlets and reduced input dependencies. Sweet potato (Ipomoea batatas), commercially grown in various similar climates worldwide with limited water resources, could be one …


Study Of Population Dynamics Of Sugarcane Aphid (Melanaphis Sacchari) In Rio Grande Valley, Texas, Neetu Khanal May 2023

Study Of Population Dynamics Of Sugarcane Aphid (Melanaphis Sacchari) In Rio Grande Valley, Texas, Neetu Khanal

Theses and Dissertations

Chapter 1: This chapter incorporates detailed information about the biotype concept, aphids, their types and their biotypes, importance of studying insect biotypes and their role in mediating host plant defenses.

Chapter 2: This chapter explains in detail about the biology, biotypes, feeding behavior, damage, and economic loss caused due to sugarcane aphid infestation. This chapter further elaborates on the need for studying population level differences and justifies the objectives and significance of this research study.

Chapter 3: This chapter provides information about the comprehensive work done on three different populations of sugarcane aphid collected from three different locations in Rio …


Anti-Doping Crisis In Sports, What's Next? Ion Mobility-Mass Spectrometry For The Study Of Anabolic Androgenic Steroids, Diana Constanza Velosa May 2023

Anti-Doping Crisis In Sports, What's Next? Ion Mobility-Mass Spectrometry For The Study Of Anabolic Androgenic Steroids, Diana Constanza Velosa

Theses and Dissertations

The main objective of this work is to augment both qualitative and quantitative measures of anabolic androgenic steroids (AAS) with ion mobility-mass spectrometry (IM-MS), laying the foundation for implementation into analytical drug testing laboratories. AAS testing requires high sensitivity and specificity. IM-MS is presented as an emerging technology workflow capable of targeted quantification of AAS and structural elucidation for potential unknowns, allowing ions to be separated and characterized based on their rotationally averaged collision cross section (CCS). Chapter 1 provides a background of the basic principles of IMS and the different types of analytical methods used for doping analysis currently …


A Multi-Level Comparison Of Increasing Training Modalities To Train Behavior Analysts To Conduct An Intensive Pediatric Feeding Intervention, Ronald Joseph Clark May 2023

A Multi-Level Comparison Of Increasing Training Modalities To Train Behavior Analysts To Conduct An Intensive Pediatric Feeding Intervention, Ronald Joseph Clark

Theses and Dissertations

A common focus within behavior analytic clinical practice is to incorporate training with caregivers to promote successful transition of clinical services. In the pediatric feeding literature, for example, training caregivers to ensure maintenance and generalization of the intervention is expected. However, training staff members to provide specific behavioral interventions has received less attention. The current study systematically implemented three levels of training to evaluate the level of intensity required to train behavior analytic staff (i.e., behavior technicians, Registered Behavior Technicians®, and Board-Certified Behavior Analysts®) to implement a feeding protocol with a role play partner. Only one participant met the mastery …


Estimating The Functional Consequences Of Intra-Specific Trichome Variation Of Tomato, Solanum Lycopersicum On The Specialist Herbivore, Manduca Sexta, Satinderpal Kaur May 2023

Estimating The Functional Consequences Of Intra-Specific Trichome Variation Of Tomato, Solanum Lycopersicum On The Specialist Herbivore, Manduca Sexta, Satinderpal Kaur

Theses and Dissertations

Chapter 1: Plants have a wide array of defenses against herbivores and hence they must confer trade-offs between growth and defense related traits. By using Solanum as a model genus, the major plant defense fitness trade-off hypotheses are reviewed in this chapter along with their assumptions and examples.

Chapter 2: This chapter provides an overview of the enormous intra-specific diversity in trichome morphology in tomato, Solanum lycopersicum. Also, the trichome sub-types are analyzed for the variations in density and dimensions in 10 varieties of tomato by using desktop scanning electron microscope.

Chapter 3: This chapter examines the functional consequences …


The Synthesis And Characterization Of Metal Oxide Nanomaterial-Based Composites And Their Use As Antibacterial Agents, Jo A. Sanchez May 2023

The Synthesis And Characterization Of Metal Oxide Nanomaterial-Based Composites And Their Use As Antibacterial Agents, Jo A. Sanchez

Theses and Dissertations

The work presented in this thesis discusses the antibacterial properties of various metal oxides and metal oxide/polymer composite fibers. Polyvinylpyrrolidone (PVP) fibers embedded with Zinc Oxide nanoparticles (ZnO NPs) were prepared by centrifugal spinning from PVP aqueous solutions) and ZnO NPs. The ZnO NPs were synthesized and coated with different surfactants, cetyltrimethylammonium bromide (CTAB) and hexadecyltrimethylammonium bromide (HTAB). The effect of surfactant coating on the antibacterial activity of ZnO NPs and PVP/ZnO nanocomposite fibers against escherichia coli (e. coli) and bacillus megaterium (b. megaterium) bacteria was systematically investigated. The results showed that coating the ZnO NPs …


Superabsorbent Polymer Use In Rangeland Restoration, Shannon V. Nelson Apr 2023

Superabsorbent Polymer Use In Rangeland Restoration, Shannon V. Nelson

Theses and Dissertations

Soil moisture deficits often hinder rangeland revegetation efforts. Due to sheer numbers and germination timing, invasive annual species can easily outcompete those of desired seeded species for resources, including water. One way to increase seedling establishment may be to increase the amount of water available to seeded species. Superabsorbent polymers (SAPs) can absorb and release hundreds of times their weight in water and slowly release it. Concentrated SAP bands at or near seedling rooting depth may act as a soil water reservoir for germinating seedlings and increase rangeland seedling establishment. The objective of these studies was to evaluate the effect …


Migration Of Elk (Cervus Canadensis) And Barriers To Movement, Levi Watkins Apr 2023

Migration Of Elk (Cervus Canadensis) And Barriers To Movement, Levi Watkins

Theses and Dissertations

Movement patterns of animals are varied, complex, and can be influenced by environmental and anthropogenic factors. One form of animal movement, migration, is influenced by environmental factors that alter the timing, duration, intensity, and likelihood of migration. Additionally, features of the landscape, both natural and anthropogenic, can alter how animals move through their seasonal and home ranges. Movement patterns can be impeded or prevented by features such as railroads, rivers, and roads. Here we explore characteristics of elk (Cervus canadensis) migration by evaluating the strategies of migration exhibited and the factors that influence migration of elk in central and eastern …


Development Of A Valid And Reliable Survey To Assess Personal, Behavioral, And Environmental Factors Surrounding Food Insecurity In A College Population, Jennette Kilgrow Apr 2023

Development Of A Valid And Reliable Survey To Assess Personal, Behavioral, And Environmental Factors Surrounding Food Insecurity In A College Population, Jennette Kilgrow

Theses and Dissertations

Objective: The aims of our present study were to develop a valid and reliable survey framed around the social cognitive theory, which would evaluate internal and external factors associated with food insecurity from the student's perspective, and to test the survey with a multi-state population. Design: The College Perspectives around Food Insecurity (CPFI) survey was developed through several revision and improvement steps using a mixed methods approach. In Phase 1 (2018-2019), data were translated into survey items and assigned to a theoretical concept (personal, behavioral, or environmental) in the social cognitive theory. In Phase 2 (2019-2020), content validity testing occurred …


Prevalence And Predictors Of Intern-Related Burnout In Dietetics Preceptors, Holly Hopkins Apr 2023

Prevalence And Predictors Of Intern-Related Burnout In Dietetics Preceptors, Holly Hopkins

Theses and Dissertations

Dietetics preceptors are at risk for abandoning the role of preceptor because of potential burnout. Quantifying the prevalence of burnout and identifying the predictors of burnout can help key stakeholders identify and implement strategies that prevent or mitigate burnout in dietetics preceptors. The purpose of this study was to determine the prevalence of intern-related burnout in dietetics preceptors and to identify the predictors of this burnout. This study used a cross-sectional study design. A survey instrument that included burnout and precepting measures, and items about the respondents’ personal and work characteristics was distributed to a random sample of 10,000 dietetics …


Forest Understory Plant Community Response To Prescribed Fire And Mechanical Thinning Treatments, Noelle V. Zenger Apr 2023

Forest Understory Plant Community Response To Prescribed Fire And Mechanical Thinning Treatments, Noelle V. Zenger

Theses and Dissertations

Much of the biodiversity in a forest comes from the understory vegetation. However, centuries of fire suppression in the western United States have made human-implemented disturbance necessary for reinstating natural disturbance cycles. However, the mechanical thinning and prescribed burning treatments used by land managers may differentially affect the response of the understory community. This study aimed to compare how prescribed fire and mechanical thinning treatments, with the size and severity of those treatments, affect understory plant communities in aspen-conifer forests over time. We sampled the understory community in burned, mechanically thinned, and untreated forest stands one, three, or five years …


A Comparison Of Kid Goat Lipase And Microbial Lipase On The Development Of Cheddar Cheese Flavor, Reece H. Larsen Apr 2023

A Comparison Of Kid Goat Lipase And Microbial Lipase On The Development Of Cheddar Cheese Flavor, Reece H. Larsen

Theses and Dissertations

Background: Manufacturers continue to look for methods to save time in aging cheese. Complex reactions occur during cheese ripening that produce characteristic flavors and aromas. The addition of exogenous lipase enzymes is one accelerated ripening method that has been studied. Our objective was to document and compare the flavor profiles of cheddar cheeses created with either microbial lipase or animal lipase. Materials and Methods: The experiment followed a conventional formulation to create experimental batches of cheddar cheese. Kid goat lipase and three microbial lipase treatments were compared against a control. Other animal lipases were evaluated in preliminary research but were …


Utilizing Isothermal Titration Calorimetry To Measure Β-Galactosidase Activity In Dairy Products, Tyler Ronald Jarrard Apr 2023

Utilizing Isothermal Titration Calorimetry To Measure Β-Galactosidase Activity In Dairy Products, Tyler Ronald Jarrard

Theses and Dissertations

The dairy industry uses enzymes to make cheese, alter product flavor, and eliminate lactose. The activities of these enzymes have been measured in clear buffered solutions, but because of the limitations of spectrophotometric methods, enzyme activities have not been measured in opaque or colored dairy products where they are used. Isothermal titration calorimetry (ITC) can be used to determine reaction kinetics in opaque and colored solutions by measuring the heat rate from enzyme-catalyzed reactions as a function of time. This study used ITC to measure β-galactosidase activity in opaque solutions of milk, sweet whey, sweet whey permeate, acid whey, and …


Development And Validation Of A Spanish Nutrition Screening Tool For Hispanic American 3 To 5-Year-Olds, Denisse Arias Olivas Apr 2023

Development And Validation Of A Spanish Nutrition Screening Tool For Hispanic American 3 To 5-Year-Olds, Denisse Arias Olivas

Theses and Dissertations

Latinos comprise 18.9% of the population in the United States and are the largest and fastest growing minority group. Obesity prevalence was 26.2% among Hispanic children compared to 16.6% among non-Hispanic White children. The obesity epidemic among Latino children has been growing rapidly over the past three decades. Multiple barriers, such as lack of culturally appropriate screening tools, language, and lack of access to nutritional assessment and expert consultation, prevents screening of Latino children and further nutritional guidance. For this reason, prevention efforts such as the use of nutritional screening tools is required for early intervention, more so with populations …


A Causal Comparative Study Of The Effects Of Physical Activity Course Enrollment On College Students’ Perceived Wellness, Mental Health, And Basic Psychological Needs, Genee’ Regina Glascoe Apr 2023

A Causal Comparative Study Of The Effects Of Physical Activity Course Enrollment On College Students’ Perceived Wellness, Mental Health, And Basic Psychological Needs, Genee’ Regina Glascoe

Theses and Dissertations

On college campuses, there has been an increase in mental health needs among students. In 2019, 56% of students attended counseling for mental health concerns compared to 46% of students who attended in 2010 (The Center for Collegiate Mental Health, 2019). Colleges have begun focusing on student wellness to assist their students with the capability to thrive during their college years and beyond (LaFountaine et al., 2006). Basic psychological needs must be met to achieve psychological growth and wellbeing (Ryan & Deci, 2000b; Zhang et al., 2012). Taliaferro et al. (2009) found evidence of an association between physical activity and …


Ciento Ochenta Grados: South Carolina Promotores De Salud And The Covid-19 Pandemic, Richard Lyle Strater Apr 2023

Ciento Ochenta Grados: South Carolina Promotores De Salud And The Covid-19 Pandemic, Richard Lyle Strater

Theses and Dissertations

This research engages with promotores de salud in South Carolina to examine sustainability challenges in their work to support Hispanic and Latino communities through advocacy-as-care approaches. This thesis contributes to scholarly literature on CHWs in the United States at a time when the profession is working to legitimize itself through professional advocacy, which includes the organization of state CHW associations, regional CHW networks, and the National Association of Community Health Workers (NACHW). Their work to support communities is, at times, made more difficult because of their positioning within formalized neoliberal systems of care, while also being marginalized by their lack …


An Exploration Of Perinatal Stress And Associated Mental Health Of Transitioning First-Time Fathers, Timothy Reed Burkhalter Apr 2023

An Exploration Of Perinatal Stress And Associated Mental Health Of Transitioning First-Time Fathers, Timothy Reed Burkhalter

Theses and Dissertations

Becoming a first-time parent is a stage in life that can be full of excitement but also trepidation. Much common knowledge and research focus on the maternal experience. To add to this established knowledge, this phenomenological study will explore the perinatal stress experiences of transitioning first-time fathers in the U.S.


An Examination Of Inter-Limb Functional Asymmetry After A Fatiguing Bout Of Exercise In High Level Soccer Players, Nestor Urrea Apr 2023

An Examination Of Inter-Limb Functional Asymmetry After A Fatiguing Bout Of Exercise In High Level Soccer Players, Nestor Urrea

Theses and Dissertations

INTRODUCTION: Inter-limb functional asymmetries greater than 15% have been linked to a greater incidence of injury. Moreover, asymmetries greater than 10% have shown greater risk of injury and worsened sport performance, especially for strength and power capabilities, in athletes of multiple sports. Fatigue and sex are factors that seem to influence injury rates as well as greater asymmetries between limbs. This research project aims to investigate the effects of a fatiguing bout of exercise in strength and power inter-limb functional asymmetries in male and female soccer players. It was hypothesized that strength and power asymmetries are negatively affected after a …


Gluten Free Diet Ameliorates Si Enteropathy In Iga Deficient Mice, Ryan Albert William Ball Apr 2023

Gluten Free Diet Ameliorates Si Enteropathy In Iga Deficient Mice, Ryan Albert William Ball

Theses and Dissertations

Secretory IgA is the most abundant antibody in the intestinal mucosal and functions as the first line of defense against pathogens and micro-organisms in the gut. Selective IgA deficiency is the most common form of antibody deficiency. Clinically, IgA deficient patients are largely asymptomatic, they are however at a higher risk of developing certain inflammatory conditions like Celiac disease; an SI-specific enteropathy triggered by exposure to dietary gluten. Interestingly, celiac patients are 10-15 times more likely to have an IgA deficiency. Recent studies have shown that IgA-/- mice develop enteropathy specifically in the ileum. We confirmed this phenotype in …


Examining Associations Between Social Needs And Mental Health Among Youth And Young Adults With Diabetes, Andrea Danielle Brown Apr 2023

Examining Associations Between Social Needs And Mental Health Among Youth And Young Adults With Diabetes, Andrea Danielle Brown

Theses and Dissertations

Household food insecurity (HFI) disproportionally affects people with diabetes living in the United States and is more likely to occur in households with children and in minority race/ethnicity households. Food insecure people with youth-onset diabetes likely have increased risk for poor mental health due to dealing with stress and cost related to diabetes management, especially if facing additional health-related social needs that intersect with HFI. If left untreated, poor mental health among youth and young adults (YYA) with diabetes can lead to diabetes-related complications, increased health care costs, and mortality. Yet few studies have examined associations between HFI and mental …


Ultra-Processed Food Consumption And Risk Of Liver Cancer, Longgang Zhao Apr 2023

Ultra-Processed Food Consumption And Risk Of Liver Cancer, Longgang Zhao

Theses and Dissertations

Background: Studies have shown positive associations between ultra-processed food (UPF) intake and obesity and type 2 diabetes, two risk factors for liver cancer. However, the relationship between UPF intake and liver cancer has scarcely been studied. We aimed to evaluate the association between UPF intake and the risk of liver cancer in three prospective cohorts and further explore the role of genetic predisposition to fatty liver diseases and biomarkers of liver health on modifying the association.

Methods: We used data from the Nurses’ Health Study (1986-2012), the Health Professionals Follow-up Study (1986-2012), and UK Biobank (2006-2020). Diet was assessed with …


Multilevel Description Of Spotted Fever Group Rickettsia Among Humans, Animals, And The Environment In Miraflores, Colombia, And South Carolina, Usa, Lidia Gual Gonzalez Apr 2023

Multilevel Description Of Spotted Fever Group Rickettsia Among Humans, Animals, And The Environment In Miraflores, Colombia, And South Carolina, Usa, Lidia Gual Gonzalez

Theses and Dissertations

Tick-borne diseases are emerging worldwide due to environmental shifts caused by land fragmentation and climate change. Among the most important ones spotted fever group rickettsioses (SFGRs) are of particular interest due to their wide species variety and high pathogenicity. Given the global spotted fever group rickettsia (SFGR) distribution, evaluation and comparison of different populations is critical to better understand these pathogens' epidemiology and unravel the risk factors affecting disease occurrence. Consequently, this dissertation investigates SFGR highlighting the One Health framework, assessing animals, humans, and the environment. The first part includes an evaluation at the household level using human and canine …


Female Infertility And Maternal And Infant Outcomes In South Carolina – The Role Of Insurance Type, Chelsea Mencio Norregaard Apr 2023

Female Infertility And Maternal And Infant Outcomes In South Carolina – The Role Of Insurance Type, Chelsea Mencio Norregaard

Theses and Dissertations

The overall objective of this research study was to examine the association between fertility treatments and maternal and infant birth outcomes, and to understand what role insurance type plays in these associations.

This retrospective statewide cohort study utilized population-based birth certificate data from January 2018 – December 2021in South Carolina, linked to all-payer claims data for outpatient services, inpatient admissions/discharges, and emergency department visits. Key exposure variables included insurance type and fertility treatment, depending on Aim. Key outcomes of interest included fertility treatment (Aim 1); maternal outcomes (Aim 2) including severe maternal morbidity, cesarean delivery without medical indication, elective labor …