Scale 1 inch = 25 miles. Map of Kentucky and Tennessee from the early 1900s showing state and county borders, cities, and railroads. Geographic features include rivers, lakes, and mountains. An enlargement of Covington, Newport, and vicinity is inset at the top right. / https://dc.etsu.edu/rare-maps/1085/thumbnail.jpg

Scale 1 in = 40 miles. Drawn and engraved by J. Bartholomew via A. & C. Black, Edinburgh in 1856. Includes county borders and railways. / https://dc.etsu.edu/rare-maps/1086/thumbnail.jpg

Scale 1 inch = 22 miles. From Johnson's New Illustrated Family Atlas of the World, published in 1868 by A.J. Johnson. Johnson maps are characterized by hand coloring in red and green and distinctive borders. Details include the names of counties and important cities, rail lines, rivers and lakes. / https://dc.etsu.edu/rare-maps/1087/thumbnail.jpg

Scale 1 inch = 15 nautical miles (18 English statute miles). Includes mountain ranges, rivers, creeks, railroads, counties, cities, and towns. State borders are traced in color, counties are lightly tinted and relief is show by hachures. Insets include hypsometric map illustrating elevation relative to sea level, outline map of railroad systems, population density map and tables summarizing population growth over time. Printed below the title, "by Frank A. Gray." Printed below map frame, "Philadelphia: O. W. Gray and Son." According to the collector's notes, this map was copyrighted in 1876. / https://dc.etsu.edu/rare-maps/1088/thumbnail.jpg

Scale 1 inch = 22 miles. Hand-colorerd map showing counties and the railway system. Includes illustrations of the State House in Nashville, Memphis Navy Yard, and Entrance to the Mammoth Cave. Drawn by A.J. Johnson and published by Johnson and Ward in 1862. / https://dc.etsu.edu/rare-maps/1089/thumbnail.jpg

Scale 1 inch = 22 miles. Hand-colored map engraved by A.J. Johson and published by A.J. Johnson and Son in 1865. Shows state and county boundaries, capitals, towns, villages, roads, railroads, mountains and rivers. / https://dc.etsu.edu/rare-maps/1090/thumbnail.jpg

Scale 1 inch = 4 miles. Undated map drawn by Paul J. Bishop, highlighting areas of interest in Carter County and Elizabethton TN. / https://dc.etsu.edu/rare-maps/1117/thumbnail.jpg

No scale provided. Undated county map with key towns and churches plus a legend of important dates and events. / https://dc.etsu.edu/rare-maps/1119/thumbnail.jpg

INTRODUCTION: Nursing practice is continuously evolving in response to global health care need, sociopolitical culture, and advancing medical knowledge necessitating ongoing evaluation of professional practice. The purpose of this state of this science paper was to explore current perceptions of nursing and critique the depth of knowledge specific to nursing practice in the Appalachian region. METHODOLOGY: A review of the literature in multiple databases was conducted to explore perceptions of nursing in Appalachia. RESULTS: Categories of perception included the following: (a) perceptions of nurses and education leaders that practice in the Appalachian region, (b) perceptions of communities of Appalachia and Appalachian health care systems, and (c) perceptions of patients possessing inherent cultural characteristics of the Appalachian region. DISCUSSION: None of the literature specifically addressed perceptions of nursing. Much of the available literature was over 5 years old. A significant deficiency in understanding perceptions of nursing in Appalachia was identified.

Decades of research on parenting and emotion socialization have yielded consistent results that more supportive, warm, emotion-focused, and balanced parenting results in better long-term outcomes for children, particularly outcomes related to internalizing and externalizing symptoms. Further, in the context of childhood adversity, supportive and sensitive relationships and environment appear to protect against the development of internalizing symptomology. However, limited knowledge exists regarding these processes and their outcomes for children in rural Appalachia. The current project aimed to explore parenting, emotion socialization, adverse childhood experiences (ACEs), and internalizing and externalizing symptoms in college students raised in rural Appalachia. The sample consists of 591 students attending college in the Appalachian Highlands who completed self-report measures of retrospective parenting styles (i.e., how their parents parented them as a child), emotion socialization (i.e., emotion expression and environment in their home as a child), adverse childhood experiences (i.e., adverse experiences occurring for them prior to the age of 18), and religious support (i.e., experiences of being supported or unsupported by religious group as a child). Participants also completed self-report measures of current internalizing (i.e., depressive symptoms, anxiety symptoms) and externalizing (i.e., alcohol use, drug use) symptoms. To explore possible avenues of risk and resilience, simple moderation analyses were conducted in SPSS using Hayes’ PROCESS 4.0 Macro to explore if supportive or unsupportive environments moderate the relationship between ACEs and internalizing or externalizing symptoms. In both supportive and unsupportive emotional environment models for internalizing symptoms, the interactions were not significant, indicating no presence of moderation. However, in both supportive and unsupportive emotional environment models for externalizing symptoms, the interactions were significant, suggesting moderation. Further, authoritarian parenting also significantly moderated the relationship between ACEs and externalizing symptoms. Specifically, in a sample of students attending college in the Appalachian Highlands, in the context of high childhood adversity, growing up in a family marked by discouraging the displays of negative emotions and punitive parenting in childhood appear to be protective factors against substance use in adulthood, but not against depression or anxiety. Further, religious social support from childhood was not a protective factor in the context of ACEs and mental health outcomes. These results are inconsistent with much of the parenting and emotion socialization literature and suggest that Appalachian families may have different adaptive processes of parenting and emotion socialization. These results offer one piece of a much larger puzzle to understanding avenues for risk and resilience for children and families in Appalachia. As such, the results will be discussed in the context of Appalachian culture with a focus on further exploration of these processes and their implications.