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Articles 2491 - 2520 of 13875
Full-Text Articles in Entire DC Network
Indigenous Language Revitalization: Success, Sustainability, And The Future Of Human Culture, Grace Lewis
Indigenous Language Revitalization: Success, Sustainability, And The Future Of Human Culture, Grace Lewis
Capstone Showcase
This thesis looks at different styles of Indigenous language revitalization programs and seeks to delineate the three most successful characteristics seen across differing designs in an effort to promote the presence of these characteristics in existing programs. The literature analyzed outlines three main schools of thought: first, that language-based education is the most effective program design, second, that language-based education is only effective if it is directed and driven by the community it serves, and third, that culture-based education is the most effective design. The data rejects the idea that one design is superior to another, and instead presents three …
Understanding Public Support For Foreign Aid: A Cross-National Analysis, Erika Manning
Understanding Public Support For Foreign Aid: A Cross-National Analysis, Erika Manning
Mahurin Honors College Capstone Experience/Thesis Projects
This thesis examines how public support for bilateral foreign aid in democratic donor countries, namely the United States and South Korea, is influenced by various methods of policy framing. Despite the benefits of bilateral aid to both donor and recipient countries, public support for distributing it has been on the decline due to fears that aid is ineffective. However, this trend may also be the product of the publics’ perceptions of where aid is going and for what purpose. To determine the effects of type of aid and perceptions of recipient countries on support for foreign aid, I conducted a …
Let’S Get R.E.A.L.: Developing A Shared Definition Of Structural Racism Is The First Step Towards Health Equity, Deann Butler
Let’S Get R.E.A.L.: Developing A Shared Definition Of Structural Racism Is The First Step Towards Health Equity, Deann Butler
MUSC Theses and Dissertations
Recent events bought to the forefront the need to address structural racism in the US, specifically within the institution of healthcare. Organizations such as the American Public Health Association (APHA, 2021), American Medical Association (AMA) (O’Reilly, 2020), Center for Disease Control and Prevention (CDC) (Walensky, 2021) recognize racism as a fundamental driver of persistent health disparities in minority populations. Additionally, healthcare accreditation organizations such as National Council on Quality Assurance (NCQA, 2022) launched initiatives that strategically work to achieve health equity. More so, organizations across healthcare are creating roles such as Chief Health Equity Officer or Chief Diversity Officer to …
Revolution, Regime Change, And Rosewater: The United States’ Role In The Arab Spring, Grace Lewis
Revolution, Regime Change, And Rosewater: The United States’ Role In The Arab Spring, Grace Lewis
Capstone Showcase
This thesis seeks to determine which international relations theory best explains the United States involvement in the Arab Spring, and to ascertain if the goals set by those theories were met. Through the literature, I determine that two theories offer reasonable yet competing explanations of US involvement, and that these theories are first, defensive realism, and second, democratic peace theory. I employ the analytic method of pattern matching to compare each theory against the empirical record. In my analysis, I match empirical data from five affected countries to determine the strategic importance to the United States of the outcome of …
Racial Domination Through The Grey Areas: The Categorization Of Mixed-Race In The United States And Brazil, Arman Luczkow
Racial Domination Through The Grey Areas: The Categorization Of Mixed-Race In The United States And Brazil, Arman Luczkow
Honors Papers
A historical comparison of mixed-race categories in the United States and Brazil, analyzing the influence of governments and political groups.
12 U.S. Code § 1430 - Advances To Members, U.S. Congress
12 U.S. Code § 1430 - Advances To Members, U.S. Congress
Documents
No abstract provided.
Global Debt Database - Central Government Debt, International Monetary Fund (Imf)
Global Debt Database - Central Government Debt, International Monetary Fund (Imf)
Documents
No abstract provided.
How Do Low-Income Single-Mothers Get By When Unemployment Strikes: Patterns Of Multiple Program Participation After Transition From Employment To Unemployment, Chi-Fang Wu, Yu-Ling Chang, Soohyun Yoon, Salma Musaad
How Do Low-Income Single-Mothers Get By When Unemployment Strikes: Patterns Of Multiple Program Participation After Transition From Employment To Unemployment, Chi-Fang Wu, Yu-Ling Chang, Soohyun Yoon, Salma Musaad
Children’s Nutrition Research Center Staff Publications
Little is known about longitudinal patterns of welfare program participation among single mothers after they transition from employment to unemployment. To better understand how utilization patterns of these welfare programs may change during the 12 months after a job loss, we used the 2008 Survey of Income and Program Participation to examine the patterns of participation in Medicaid, the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and unemployment insurance among 342 single mothers who transitioned from employment to unemployment during the Great Recession. Using sequence analysis and cluster analysis, this paper identified four distinct patterns of program participation: …
Signs Inscribed On A Gate: The Impact Of Van Buren V. United States On Civil Claims Under The Computer Fraud And Abuse Act, Scott T. Lashway, Matthew M.K. Stein
Signs Inscribed On A Gate: The Impact Of Van Buren V. United States On Civil Claims Under The Computer Fraud And Abuse Act, Scott T. Lashway, Matthew M.K. Stein
Western New England Law Review
This Article addresses the impact of the U.S. Supreme Court’s June 2021 decision in Van Buren v. United States on what constitutes“ authorization” to access a computer under the Federal Computer Fraud and Abuse Act (CFAA)—a law that imposes both criminal and private civil liability for violations—and concludes that, so far, the Van Buren decision has not rendered the CFAA toothless. The Introduction briefly explains the history of the CFAA, a summary of why it was enacted, how organizations have relied upon it as an important tool to protect themselves from computer hackers and increased cybersecurity risks, and a Circuit …
Prenatal And Pediatric Oral Health Education Among Dental Hygiene Programs In The United States, Denise M. Claiborne, Shillpa Naavaal
Prenatal And Pediatric Oral Health Education Among Dental Hygiene Programs In The United States, Denise M. Claiborne, Shillpa Naavaal
Dental Hygiene Faculty Publications
Purpose: Health care and dental providers must be prepared to address the oral health needs of mothers and children in order to reduce the burden of dental disease in these populations. The purpose of this study was to describe the curriculum and clinical experiences related to prenatal and pediatric oral health in the university and community college dental hygiene programs in the United States (US).
Methods: Dental hygiene program directors (PDs) from across the US were invited to participate in a cross-sectional electronic survey regarding the prenatal and pediatric oral health curriculum at their institution. In addition to program characteristics, …
The Role Of Inclusion In Climate Vulnerability Assessment And Equitable Adaptation Goals In Small American Municipalities, Elena Lioubimtseva
The Role Of Inclusion In Climate Vulnerability Assessment And Equitable Adaptation Goals In Small American Municipalities, Elena Lioubimtseva
Open Access Publishing Support Funded Articles
Equity and inclusion considerations are important prerequisites of effective climate adaptation planning, especially at a local scale. This study examines how climate adaptation plans of small American cities and counties consider equity in their climate vulnerability assessments and adaptation planning goals and how consideration of equity in existing adaptation plans relates to the inclusion of diverse categories of stakeholders. Data analysis is based on the content of 23 local climate adaptation plans of small urban and rural municipalities across the United States with populations of less than 300 thousand people. Correlations between conceptualization of vulnerability dimensions, inclusion of 9 categories …
Association Between Hospital Private Equity Acquisition And Outcomes Of Acute Medical Conditions Among Medicare Beneficiaries, Marcelo Cerullo, Kelly Yang, Karen E. Joynt Maddox, Ryan C. Mcdevitt, James M. Roberts, Anaeze C. Offodile
Association Between Hospital Private Equity Acquisition And Outcomes Of Acute Medical Conditions Among Medicare Beneficiaries, Marcelo Cerullo, Kelly Yang, Karen E. Joynt Maddox, Ryan C. Mcdevitt, James M. Roberts, Anaeze C. Offodile
Open Access Publications
Importance: As private equity (PE) acquisitions of short-term acute care hospitals (ACHs) continue, their impact on the care of medically vulnerable older adults remains largely unexplored.
Objective: To investigate the association between PE acquisition of ACHs and access to care, patient outcomes, and spending among Medicare beneficiaries hospitalized with acute medical conditions.
Design, Setting, and Participants: This cross-sectional study used a generalized difference-in-differences approach to compare 21 091 222 patients admitted to PE-acquired vs non-PE-acquired short-term ACHs between January 1, 2001, and December 31, 2018, at least 3 years before to 3 years after PE acquisition. The analysis was conducted …
Association Of Body Mass Index In Midlife With Morbidity Burden In Older Adulthood And Longevity, Sadiya S. Khan, Amy E. Krefman, Lihui Zhao, Lei Liu, Anna Chorniy, Martha L. Daviglus, Cuiping Schiman, Kiang Liu, Tina Shih, Daniel Garside, Thanh-Huyen T. Vu, Donald M. Lloyd-Jones, Norrina B. Allen
Association Of Body Mass Index In Midlife With Morbidity Burden In Older Adulthood And Longevity, Sadiya S. Khan, Amy E. Krefman, Lihui Zhao, Lei Liu, Anna Chorniy, Martha L. Daviglus, Cuiping Schiman, Kiang Liu, Tina Shih, Daniel Garside, Thanh-Huyen T. Vu, Donald M. Lloyd-Jones, Norrina B. Allen
Open Access Publications
Importance: Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures.
Objective: To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older.
Design, Setting, and Participants: Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 …
Artificial Intelligence And National Security, Ryan Laverick
Artificial Intelligence And National Security, Ryan Laverick
Williams Honors College, Honors Research Projects
As technology advances at an exponential rate, it is becoming increasingly important to consider the ramifications of that technology in the geopolitical environment, and especially as it pertains to American national security. One of the most important categories of technological innovation that will likely disrupt the global balance of geopolitical power, especially along the US-China axis, is the advent and growing sophistication of artificial intelligence. In order to address the new and evolving national security challenges that will accompany this disruption, this paper seeks to define and explain the disparity in artificial intelligence capabilities between the United States and China. …
Big Screen Empire : What Foreign Films Reveal About The Perceptions Of U.S. Military Bases In Affected Host Nations, John Richard Walker
Big Screen Empire : What Foreign Films Reveal About The Perceptions Of U.S. Military Bases In Affected Host Nations, John Richard Walker
Browse all Theses and Dissertations
Existing scholarly literature on U.S. military bases in foreign nations does not adequately take films depicting such installations into account. This master’s thesis is a corrective for this oversight. Recognizing the utility of foreign films featuring American military bases or troop presences, this thesis examines them in light of scholarly work on these installations. Of particular importance in this analysis are the periodization of U.S. basing favored by Robert Kaplan and the categorization of varieties of antibase protest favored by Kent Calder. Using these two writers as an analytical framework, as well as histories of U.S. basing and military occupations, …
The Roots Of Collapse: Imposing Constitutional Governance, Catherine Baylin Duryea
The Roots Of Collapse: Imposing Constitutional Governance, Catherine Baylin Duryea
Faculty Publications
The foundational assumption of constitutional governance poses a conundrum for contemporary state-builders: a constitution heavily influenced by foreigners does not represent the views of the governed. Can a modern state-building effort foster democratic institutions when the new government reflects foreign? Nowhere was this tension more apparent than in Afghanistan, where the United States and the United Nations were heavily involved in drafting the 2004 Constitution. They shaped the process from the initial framework to the final, frenzied approval. Foreigners were engaged at both the procedural level—determining how the negotiations would occur and who would participate—and at the substantive level—providing input …
Analysis Of The Influence Of Cryptocurrency Regulation On Levels Of Financial Literacy, Kieran C. Yuen
Analysis Of The Influence Of Cryptocurrency Regulation On Levels Of Financial Literacy, Kieran C. Yuen
Dissertations and Theses
Using data collected by the National Financial Capability Study (NFCS), a survey by the Financial Industry Regulatory Authority (FINRA), this paper investigates the influence of passage of cryptocurrency regulation in U.S. states on levels of financial literacy. Results indicate that living in a state where cryptocurrency regulation was signed into law, a decrease was observed in the level of financial literacy. This finding supports the growing literature on factors that affect levels of financial literacy using a novel exogenous variable, cryptocurrency regulation.
Associations Between Vascular Diseases And Alzheimer's Disease Or Related Dementias In A Large Cohort Of Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan
Associations Between Vascular Diseases And Alzheimer's Disease Or Related Dementias In A Large Cohort Of Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan
Faculty, Staff and Student Publications
BACKGROUND: Long term risk of Alzheimer's disease (AD) and related dementias (ADRD) associated with vascular diseases in people with colorectal cancer is unknown.
OBJECTIVE: to determine the risk of ADRD in association with cardiovascular diseases (CVD), stroke, hypertension, and diabetes in a cohort of patients with colorectal cancer.
METHODS: This retrospective cohort study consisted of 210,809 patients diagnosed with colorectal cancer at age≥65 years in 1991-2015 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database with follow-up from 1991-2016, who were free of any ADRD at the baseline (< 30 days after the date of cancer diagnosis).
RESULTS: The crude 26-year cumulative incidence of total ADRD in …
Characterizing Cancer And Covid-19 Outcomes Using Electronic Health Records, Youngran Kim, Liang Zhu, Huili Zhu, Xiaojin Li, Yan Huang, Chunhui Gu, Heather Bush, Caroline Chung, Guo-Qiang Zhang
Characterizing Cancer And Covid-19 Outcomes Using Electronic Health Records, Youngran Kim, Liang Zhu, Huili Zhu, Xiaojin Li, Yan Huang, Chunhui Gu, Heather Bush, Caroline Chung, Guo-Qiang Zhang
Faculty, Staff and Student Publications
PURPOSE: Patients with cancer often have compromised immune system which can lead to worse COVID-19 outcomes. The purpose of this study is to assess the association between COVID-19 outcomes and existing cancer-specific characteristics.
PATIENTS AND METHODS: Patients aged 18 or older with laboratory-confirmed COVID-19 between June 1, 2020, and December 31, 2020, were identified (n = 314 004) from the Optum® de-identified COVID-19 Electronic Health Record (EHR) derived from more than 700 hospitals and 7000 clinics in the United States. To allow sufficient observational time, patients with less than one year of medical history in the EHR dataset before their …
Risk Of Developing Alzheimer's Disease And Related Dementias In Association With Cardiovascular Disease, Stroke, Hypertension, And Diabetes In A Large Cohort Of Women With Breast Cancer And With Up To 26 Years Of Follow-Up, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan
Risk Of Developing Alzheimer's Disease And Related Dementias In Association With Cardiovascular Disease, Stroke, Hypertension, And Diabetes In A Large Cohort Of Women With Breast Cancer And With Up To 26 Years Of Follow-Up, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan
Faculty, Staff and Student Publications
BACKGROUND: No study on the long-term incidence of Alzheimer's disease (AD) and related dementias (ADRD) has been reported in women with breast cancer by vascular diseases.
OBJECTIVE: to determine the risk of ADRD in association with cardiovascular diseases (CVD), stroke, hypertension, and diabetes in women with breast cancer.
METHODS: Study identified 246,686 women diagnosed with breast cancer at age≥65 years in 1991-2015 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Women were free of ADRD at the time of cancer diagnosis and followed from 1991 to 2016.
RESULTS: Cumulative incidence of AD over 26 years of follow-up varied …
Determinants Of Social Distancing Adherence, Philip Gerretsen, Julia Kim, Eric E Brown, Lena C Quilty, Samantha Wells, Fernando Caravaggio, Jianmeng Song, Marcos Sanches, Branka Agic, Bruce G Pollock, Ariel Graff-Guerrero
Determinants Of Social Distancing Adherence, Philip Gerretsen, Julia Kim, Eric E Brown, Lena C Quilty, Samantha Wells, Fernando Caravaggio, Jianmeng Song, Marcos Sanches, Branka Agic, Bruce G Pollock, Ariel Graff-Guerrero
Faculty, Staff and Student Publications
Introduction: Governments and public health authorities across many jurisdictions implemented social (physical) distancing measures to contain the spread of the 2019 novel coronavirus disease (COVID-19). Adherence to these measures is variable and likely influenced by various factors. This study aimed to 1) identify the individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence, and 2) explore regional differences in social distancing adherence in the United States (U.S.) and English-speaking Canada based on each region's discrepant response to social distancing restrictions.
Methods: A web-based repeated cross-sectional survey was conducted in 4,942 English-speaking participants from the four …
Women Of Faith Speak Up And Speak Out The Genesis And Philosophical Underpinnings Of Mormon Women For Ethical Government, Sharlee Mullins Glenn
Women Of Faith Speak Up And Speak Out The Genesis And Philosophical Underpinnings Of Mormon Women For Ethical Government, Sharlee Mullins Glenn
BYU Studies
Good government is ethical government. That is the premise upon which the nonprofit organization Mormon Women for Ethical Government (MWEG) was founded.
Like millions of people across the United States, I found myself growing increasingly alarmed during the 2016 U.S. election cycle as I watched the great rifts in our political landscape widen and deepen, abetted by the divisive and often vitriolic discourse on all sides. This division, combined with the flagrant flouting of basic human decency by some who were running for public office, awakened many of us to a sense of our duty as citizens.
A Distinguished U.S. Ambassador To Switzerland— Joseph B. Gildenhorn, C. Naseer Ahmad
A Distinguished U.S. Ambassador To Switzerland— Joseph B. Gildenhorn, C. Naseer Ahmad
Swiss American Historical Society Review
For over two hundred years, Switzerland and United States have enjoyed strong bilateral relationship. This relationship has endured so long due to the shared interests and common values. Leadership at governmental and business level in both countries have helped keep the bonds between Switzerland and United States strong and enduring.
Invisible Labors : Reviving Histories Of Women's Land Work In The Blue Island Ridge Communities, Chicago, Illinois, Susannah Papish, Mellissa H. Potter, Jacob Lindgren, 3arts Artists Projects, Columbia College, Special Collections, Fleet Library
Invisible Labors : Reviving Histories Of Women's Land Work In The Blue Island Ridge Communities, Chicago, Illinois, Susannah Papish, Mellissa H. Potter, Jacob Lindgren, 3arts Artists Projects, Columbia College, Special Collections, Fleet Library
Artists' Books
6 pages in folded accordion book : illustrations ; 4 postcards + 1 paper insert. "Invisible Labors was printed in a risograph edition of 50 as well as a deluxe edition of 50."--Colophon "To honor the little-known contributions of Chicago's early women agricultural and cultural workers, [Susannah Papish collaborated] on a new publication entitled Invisible Labors, inspired by a recent research and garden project in the Morgan Park and Beverly neighborhoods formerly known as The Ridge. This book [weaves] together historical archives, photographs, and original new artwork that creatively interprets the crucial role that women have played in working and …
Predictors Of E-Cigarette Initiation And Use Among Middle School Youth In A Low-Income Predominantly Hispanic Community, M Yvonne Gaddy, Denise Vasquez, Louis D Brown
Predictors Of E-Cigarette Initiation And Use Among Middle School Youth In A Low-Income Predominantly Hispanic Community, M Yvonne Gaddy, Denise Vasquez, Louis D Brown
Faculty, Staff and Student Publications
Introduction: E-cigarette use among middle and high school youth increased from 2. 5 million in 2014 to 9.2 million in 2019, becoming the most common tobacco product used among youth. Hispanic youth, the largest ethnic minority in the United States, have higher rates of tobacco use, including e-cigarettes, than non-Hispanics. Identifying factors that put youth at risk for future e-cigarette use is vital to focusing prevention efforts. Informed by social cognitive theory, this study identifies predictors of e-cigarette uptake among e-cigarette naïve youth in a predominantly low-income Hispanic community.
Methods: 1,249 students (6-8th grades) from two middle schools in El …
Racial Disparities In Treatments And Mortality Among A Large Population-Based Cohort Of Older Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song
Racial Disparities In Treatments And Mortality Among A Large Population-Based Cohort Of Older Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song
Faculty, Staff and Student Publications
BACKGROUND: There were racial disparities in treatment and mortality among patients with colorectal cancer, but few studies incorporated information on hypertension and diabetes and their treatment status.
PATIENTS AND METHODS: The study identified 101,250 patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in the United States who were diagnosed with colorectal cancer at age ≥65 years between 2007 and 2015 with follow-up to December 2016.
RESULTS: There were substantial racial and ethnic disparities in the prevalence of hypertension and diabetes in patients with colorectal cancer, in receiving chemotherapy and radiation therapy, and in receiving antihypertensive and antidiabetic treatment. …
Using Implementation Mapping For The Adoption And Implementation Of Target:Bp In Community Health Centers, Melissa A Valerio-Shewmaker, Natalia I Heredia, Catherine Pulicken, Patenne D Mathews, Roshanda Chenier, Tracy L Swoboda, Ella R Garza, Fernanda Velasco-Huerta, Maria E Fernandez
Using Implementation Mapping For The Adoption And Implementation Of Target:Bp In Community Health Centers, Melissa A Valerio-Shewmaker, Natalia I Heredia, Catherine Pulicken, Patenne D Mathews, Roshanda Chenier, Tracy L Swoboda, Ella R Garza, Fernanda Velasco-Huerta, Maria E Fernandez
Faculty, Staff and Student Publications
BACKGROUND: Despite the availability of multilevel evidence-based interventions for blood pressure management, poor hypertension control is common among community health center patient populations across the state of Texas and the United States.
METHODS: We used Implementation Mapping (IM) to identify barriers and facilitators influencing the adoption and implementation of the
RESULTS: As part of the needs and capacity assessment, we collected data through interviews with CHC staff, examining gaps in needs and services (e.g., what do clinics need to implement
DISCUSSION: This paper provides an example of using Implementation Mapping to develop strategies to increase the adoption and implementation of …
Impacts Of Immigration Detention On Sub-Saharan Africa Asylum Seekers In The United States, Felix Vescovi Ogunsuyi
Impacts Of Immigration Detention On Sub-Saharan Africa Asylum Seekers In The United States, Felix Vescovi Ogunsuyi
Walden Dissertations and Doctoral Studies
Detaining asylum seekers has become an established practice in many countries. There is a large body of research suggesting that immigration detention causes asylum seekers harm. However, the focus of these studies has been on diagnosable disorders and mental health, with no descriptive understanding of how detention and resettlement are experienced and conceptualized by asylum seekers. The purpose of this phenomenological study was to examine how formerly detained asylum seekers from sub-Saharan African countries perceive the impact of detention on their resettlement experience in the United States. Ager and Strang’s conceptual framework of refugee integration was used as the study’s …
Motivations Of Youth Engaged In International Drug Smuggling Through The Perceptions Of Law Enforcement In San Diego County, Gabrielle Suzanne Smyth
Motivations Of Youth Engaged In International Drug Smuggling Through The Perceptions Of Law Enforcement In San Diego County, Gabrielle Suzanne Smyth
Walden Dissertations and Doctoral Studies
The use of illegal narcotics in the United States is an epidemic that requires significant and measurable results. Not only are illegal drugs crossing from Mexico into the United States a threat to public safety, but the involvement of juveniles is also becoming increasingly dangerous. Since early 2018, the Drug Enforcement Administration’s (DEA’s) San Diego Field Division has seen a disturbing trend of Mexican cartels increasingly recruiting juveniles from high schools in southern San Diego County to smuggle drugs through the ports of entry. The theoretical framework utilized in this study was social learning theory. The logical connection between social …
‘I Went To The One Game In Town’: Obstetric And Maternity Unit Closures, Dwindling Birth Choices, And Resilience In Rural Appalachia, Sia Beasley
Theses and Dissertations--Anthropology
Obstetric and maternity health services are being rapidly eliminated in the rural United States, making maternal care more difficult to access and causing negative birth outcomes. Service closures have a magnified impact in Appalachia due to histories of systemic regional and state policy practices which devalue the lives of people living rural areas, local economic marginalization, geographic barriers, and insufficient health infrastructures. This research investigates how women living in rural Appalachia navigate pregnancy and birth amidst constant care closures. The Sunflower Mountain Region is a seven-county area in rural Southern Appalachia. The region has experienced ongoing obstetric closures over the …