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Food insecurity has emerged as a leading health care problem in the United States, impacting college students’ health, well-being, and academic performance. The aims of this study are: 1) to assess the prevalence of food insecurity at Mississippi State University, 2) to explore the coping mechanisms employed by students faced with food insecurity, and 3) to identify college students' perceptions about food access resources, 4) to identify ways in which a scenario that requires social distancing impacts food security in a college student population, and 5) to explore students' expressed needs from the university in improving food security status for all, whether they are learning on campus or in a distance environment. A mixed methods approach was used to assess the quantitative and qualitative aspects of the study aims. An online survey to gather demographic information and assess food security status using the 6-item version of the U.S. Household Food Security Scale Module (HFSSM) was administered. Next, qualitative focus groups with subsets of participants was conducted to gain further insight into the perceptions, coping mechanisms, and resource utilization issues related to food insecurity. Due to the impact of the COVID-19 pandemic on focus group data collection, an open-ended qualitative questionnaire was designed and sent to original survey participants to gather further data. This study found 34.1% of undergraduate college students to be food insecure. The strongest predictors of food insecurity were having received some type of food assistance in the past year and having received free- or reduced-lunches in elementary or secondary school. The data demonstrates that students with a meal plan are less likely to be food insecure. Qualitative data identified key influencers of food insecurity: 1) personal beliefs, 2) life skills, and 3) the university. The results of this study contribute to the literature focused on food insecurity prevalence in college students and help to fill in gaps in understanding food insecurity from the university student perspective. This will allow relevant interventions to be developed that are congruent with students’ needs, enhancing resource utilization to increase food security status among college students.

In recent decades, neurologists have been directing more of their research efforts to exploring the sources of health disparities in medical and surgical treatment of epilepsy. Many studies reveal that racial and ethnic minority patients continue to receive suboptimal care, which has some dire repercussions on their physical and mental health, as well as their social well-being because epilepsy is a chronic disease that tends to affect multiple aspects of the patient’s life. Although the earliest landmark studies emphasized the importance of mixed methodology research, the studies that followed tended to rely heavily on quantitative methods to unravel patterns of disparities with sparse use of qualitative methods to give voice to the patients concerned. In this work, I present a mixed methodology framework that is particularly suitable to investigating health disparities in epilepsy care, which affirms the complementary nature of quantitative and qualitative methods. I explore some of the challenges that clinicians face to utilizing qualitative methods, and introduce some of the validity criteria and techniques of qualitative research that make it a valuable methodology to understand disparities. I highlight some of the ethical concerns with recent studies in health disparities in epilepsy care which adopt only quantitative or qualitative methodology, and contribute very little to eliminating disparities compared to the potential contribution of mixed methodology research. This will be supported by various examples from research led by clinicians, public health professionals, and social scientists. / Urban Bioethics

We propose the generalized linear mixed model for finite normal mixtures (GLMFM), as well as the estimation procedures for the GLMFM model, which are widely applicable to the hierarchical dataset with small number of individual units and multi-modal distributions at the lowest level of clustering. The modeling task is two-fold: (a). to model the lowest level cluster as a finite mixtures of the normal distribution; and (b). to model the properly transformed mixture proportions, means and standard deviations of the lowest-level cluster as a linear hierarchical structure. We propose the robust generalized weighted likelihood estimators and the new cubic-inverse weight for the estimation of the finite mixture model (Zhan et al., 2011). We propose two robust methods for estimating the GLMFM model, which accommodate the contaminations on all clustering levels, the standard-two-stage approach (Chervoneva et al., 2011, co-authored) and a robust joint estimation. Our research was motivated by the data obtained from the tendon fibril experiment reported in Zhang et al. (2006). Our statistical methodology is quite general and has potential application in a variety of relatively complex statistical modeling situations. / Statistics

An investigation of mixed convection in a rectangular enclosure is presented in which the velocity fields in the enclosure are determined using Particle Image Velocimetry (PIV). Basically, this technique records optical images of flow tracers within a flow field, and determines the velocity field by measuring the displacement of the flow tracers during short time intervals. The components which comprise the PIV system and its operation are described in detail to familiarize the reader with this relatively new technique. The main objective of this investigation is to determine the accuracy and applicability of the PIV technique as a velocity measurement tool. This is accomplished by comparing present experimental velocity results to those obtained by Nurnberg [2] using Laser Doppler Anemometry (LDA). LDA has been proven to be an accurate velocity measurement tool and provides data for evaluating PIV results. A second objective of this research is to use the PIV results to verify a numerical code written by Nurnberg [2] which predicts the velocity fields in the rectangular enclosure. However, the comparison of experimental results of the two measurement techniques revealed that the PIV results were too inaccurate to perform this function. The large amount of error present in this PIV system prompted the recommendation of an improved, more accurate system. Although this improved system is very expensive - approximately $40,000 - it will provide velocity measurements with an accuracy close to that of LDA, at half the cost of an LDA system and with far less time for data acquisition and analysis. / Thesis / Master of Engineering (ME)

Family/friend caregivers of persons with dementia often do not feel prepared for end-of-life, which contributes to high rates of complicated grief, depression and anxiety in bereavement. This mixed methods study used an exploratory sequential design to explore the core concepts and indicators of preparedness, develop and evaluate a multidimensional questionnaire aimed at measuring caregiver preparedness for end-of-life for persons with dementia. In Phase 1, a qualitative study with an interpretive descriptive design was used to explore the core concepts and indicators of preparedness with 16 bereaved family caregivers recruited from six long-term care homes located in Ontario, Canada. In Phase 2, a quantitative, cross-sectional Delphi-survey was conducted with 5 caregivers and 12 diverse professional experts to select preparedness indicators/items and develop the Caring Ahead questionnaire. Lastly in Phase 3, the self-report, paper format questionnaire was evaluated for evidence of validity and reliability using a quantitative cross-sectional design. In this final phase, the questionnaire was completed through the postal mail by 134 caregivers from over 50 long-term care homes/residential care facilities, primarily in Ontario, Canada. Evidence for internal structure and concurrent validity was generated along with reliability coefficients suggesting internal consistency and stability in a test-retest. Findings from this study contributed to the conceptualization and operationalization of preparedness and produced the new, multidimensional questionnaire titled Caring Ahead: Preparing for End-of-Life with Dementia with preliminary evidence for validity and reliability. This questionnaire aims to fill an existing gap expressed by researchers who aim to design and evaluate interventions promoting preparedness through a palliative approach. In addition, policy-makers should benefit from introduction of the Caring Ahead questionnaire as an outcome measure to monitor and evaluate the effectiveness of policies surrounding a palliative approach. / Thesis / Candidate in Philosophy / Providing care to a family member or friend with dementia can be very challenging and different than caring for persons with other disorders. Healthcare providers should provide a palliative approach to care which focuses on quality-of-life and helping family caregivers prepare for end-of-life. However, many family caregivers do not feel prepared for death and this can lead to serious mental health problems in bereavement. This thesis explores what feeling prepared for death means and describes the development and testing of a questionnaire to assess how prepared family caregivers feel for the end-of-life of someone with dementia. Through interviews and surveys with caregivers and professional experts, we developed and tested the Caring Ahead: Preparing for End-of-Life with Dementia questionnaire. Use of the new Caring Ahead questionnaire aims to help us understand how prepared family caregivers are feeling for end-of-life and what supports are needed.

Introduction Role identity theory explains that people derive a sense of purpose and meaning from holding social roles, which, in turn, is linked with health and well-being. Paramedics have a respected role in society but high rates of mental illness. I used role identity theory to explore what might be contributing to poor mental health among paramedics. Objectives My objectives were to estimate the prevalence of Post-Traumatic Stress Disorder (PTSD), depression, and anxiety; assess for relationships with a measure of paramedic role identity; and finally, explore how role identity conflict could lead to distress. Methods I used a mixed methods approach situated in a single paramedic service in Ontario, Canada, distributing a cross-sectional survey during the fall 2019/winter 2020 Continuing Medical Education (CMEs) sessions while also interviewing a purposively selected sample of 21 paramedics. The survey contained a demographic questionnaire, a battery of self-report measures, and an existing paramedic role identity scale. Each interview was transcribed verbatim and analyzed thematically with role identity theory as a conceptual framework. Results In total, 589 paramedics completed the survey (97% of CME attendees), with 11% screening positive for PTSD, 15% for major depressive disorder, 15% for generalized anxiety disorder, and 25% for any of the three. Full-time employees, women, those with ‘low’ self-reported resilience, and current or former members of the peer support team were more likely to screen positive. The dimensions of paramedic role identity were not associated with an increased risk; however, I defined a framework through the interviews wherein chronic, identity-relevant disruptive events contribute to psychological distress and disability. Conclusions Our prevalence estimates were lower than have been previously reported but point to a mental health crisis within the profession. Role identity theory provided a useful framework through which to reconceptualize stressors. / Dissertation / Doctor of Philosophy (PhD) / Role identity theory explains having a sense of purpose and meaning people from social roles (such as a parent or volunteer) is good for health and well-being. Paramedics are an important part of Canada’s public safety infrastructure and generally hold a respected position in society, but there is growing recognition of a mental health crisis within the profession. I used role identity theory to explore why and how role identity theory could contribute to poor mental health among paramedics. By surveying and interviewing paramedics from a single paramedic service in Ontario, Canada, I discovered that 25% of active-duty paramedics met the criteria for either post-traumatic stress disorder, depression, or anxiety. The risk varied across demographic categories, including gender. During the interviews, I discovered that role identity conflict – a discrepancy between what the paramedic thinks their role should be and what is achievable – can lead to significant psychological distress.

Background: An increasing number of mixed methods studies have been conducted across health care professions in recent years. However, little is known about the methodological reporting quality among mixed methods studies involving chiropractic research. Objective: To examine the methodological quality of published chiropractic mixed methods studies, provide recommendations for improving future chiropractic mixed methods research, and apply these recommendations in two mixed methods health services evaluations of chiropractic integration and prescription opioid use for spinal pain. Methods: We conducted a meta-epidemiological review of the chiropractic mixed methods literature and examined reporting quality using the Good Reporting of A Mixed Methods Study guideline and risk of bias using the Mixed Methods Appraisal Tool. We used generalized estimating equations to explore factors associated with higher methodological quality. We applied our findings in two sequential explanatory mixed methods investigations of the association between chiropractic care and opioid prescribing for non-cancer spinal pain. Results: Among eligible mixed methods studies, we found that many were both poorly reported and at risk of bias. Publication in journals with an impact factor and/or more recent publication were significantly associated with higher methodological quality. In our sequential explanatory analyses, we found that receipt of chiropractic care was associated with decreases in initial opioid prescribing and long-term opioid use, and our qualitative results suggested these relationships were multi-factorial. Conclusion: We identified areas for improvement in the methodological reporting quality of chiropractic mixed methods research. Our mixed methods studies suggest that integration of chiropractic services into primary care centres may reduce the use of opioids for spinal pain. / Thesis / Doctor of Philosophy (PhD) / We reviewed the literature to assess the methodological reporting quality of mixed methods studies involving chiropractic research and found that most studies had important omissions. We applied these results to optimize methodologic reporting of two mixed methods studies on the association between chiropractic care and opioid prescribing. We found that patients with non-cancer spinal pain were less likely to receive an initial prescription for opioids if they accessed chiropractic care. Further, among chronic pain patients receiving opioids, we found that providing access to chiropractic care reduced their chances of continuing to receive opioids. The qualitative aspect of our studies provided important context to inform how patients and their primary care providers felt access to chiropractic care had reduced reliance on prescription opioids. These findings will increase awareness among researchers for opportunities to improve reporting quality of mixed methods research and highlight the potential role of chiropractic care in helping to address the opioid crisis.

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