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Access status: Open Access ,
BRIDGING THE GAP IN CHRONIC PAIN CARE: THE ROLE OF INTEGRATED BEHAVIORAL HEALTH
(East Carolina University) Jose Hernandez Dominguez
Chronic pain remains predominantly managed through medication-centered approaches despite decades of biopsychosocial pain science supporting multimodal care. This dissertation investigates the integration of behavioral health within rural primary care as a strategy to address this gap. A retrospective chart review (n = 120) at a rural Federally Qualified Health Center reveals low rates of behavioral health referral (6.7%), minimal documentation of psychosocial contributors (6.8%), and infrequent mental health screening, alongside widespread pharmacological treatment. A subsequent randomized study (n = 103) found that a brief psychoeducation intervention delivered by a Medical Family Therapist was linked to patients’ intention to pursue behavioral health services and biopsychosocial pain beliefs, particularly when accompanied by provider endorsement. The final chapter translates these findings into policy recommendations designed to realign reimbursement, accreditation, and regulatory structures with contemporary pain science. Collectively, the findings suggest that medication-centered chronic pain management reflects structural policy misalignment rather than insufficient scientific evidence, highlighting the need for systems-level reform in primary care.
Access status: Embargo ,
Kinin B1 Receptor Antagonism Attenuates High Blood Pressure in Genetically Hypertensive Mice
(East Carolina University, 2026-05) Johnston, Alexandra
Cardiovascular disease (CVD) is the number one cause of death globally. Hypertension is the leading risk factor for the development of CVDs. There is ample evidence documenting the role of the kallikrein kinin system (KKS) in blood pressure regulation and the pathogenesis of hypertension. Kinins are vasoactive peptides that exert their regulatory effects through the activation of two receptor types, B1 and B2. The kinin B1 receptor (B1R) is an inducible G-protein coupled receptor that is markedly upregulated under inflammatory conditions. In the brain, we have shown that B1R is closely associated with microglia, the resident immune cells that mediate neuroinflammatory responses. Previously, we have reported that B1R expression is upregulated in cardiovascular regulatory regions of the brain in Angiotensin II-induced and deoxycorticosterone acetate (DOCA)-salt models of hypertension, suggesting a central role in blood pressure regulation. Due to its role in mediating inflammation and sympathetic activation, B1R may contribute to the elevated blood pressure seen in chronic neurogenic hypertension. Previous studies have reported that Schlager BPH/2J mice exhibit overactivation of the sympathetic nervous system, indicating they are a model of neurogenic hypertension. In this study, we hypothesized that pharmacological inhibition of B1R will reduce high blood pressure in the BPH/2J Schlager hypertensive mouse model by mitigating microglial activation. To investigate the role of B1R in chronic neurogenic hypertension, male BPH/2J hypertensive and BPN/3J normotensive mice were implanted with subcutaneous osmotic minipumps containing B1R antagonist, SSR240612 (5 mg/kg/day), or vehicle for 14 days. Mean arterial pressure (MAP) was measured by noninvasive tail-cuff plethysmography at baseline and following SSR240612 administration for 2 weeks. Tail-cuff recordings demonstrated a significant reduction in MAP in BPH/2J mice following SSR240612 treatment compared to baseline. Immunofluorescence staining revealed that microglia soma sizes increased in BPH/2J mice compared to BPN/3J, indicating an activated phenotype. Furthermore, B1R expression was colocalized with activated microglia in key cardiovascular regulatory regions. SSR240612 treatment attenuated this microglial activation, as indicated by reduced soma size and B1R immunoreactivity. Taken together, these findings suggest that central B1R contributes to persistent microglial activation and elevated blood pressure in chronic neurogenic hypertension. Our data provides novel evidence that blocking B1R can reduce chronic elevated blood pressure in genetically hypertensive mice, potentially through B1R mediated inflammatory mechanisms. This suggests that a B1R antagonist may serve as a potential therapeutic agent for the treatment of chronic neurogenic hypertension.
Access status: Open Access ,
CONSUMING INDIGENEITY: INTERDISCIPLINARY PERSPECTIVES ON THE ECONOMIC AND GEOPHAGIC CONSUMPTION OF TONALÁ BRUÑIDA WARE
(East Carolina University, 2026-05) Record, Dorian L.
Tonalá Bruñida, or “Tonalá Burnished,” ware is an Indigenous Mexican ceramic ware whose production has remained largely consistent from the late colonial period to today. As part of Spain’s extensive colonial maritime trade network, Tonalá Bruñida ware was a prolific luxury commodity among the upper socioeconomic classes of Spain during the colonial period. Today, the ware is produced mostly in forms that are marketable to tourists and collectors, marking a trend in the commodification of this Indigenous product by western audiences throughout time. This connection merits inquiry as it pertains to a broader understanding of colonialist oppression and the paradoxical fetishization of certain “New World” aesthetics which followed. Beyond its position as an object of economic consumption and aesthetic desire, Tonalá Bruñida ware was also an object of dietary consumption among wealthy colonial-period European women. This is an example of geophagy, or earth-eating, a nutritional practice that exists globally in both historic and modern contexts. The ware was shipped in both whole-vessel form and in bags of broken sherds from Mexico to Spain for this purpose. This resulted in its prevalence across 18th century commercial Spanish shipwreck contexts throughout the Caribbean and the Gulf of Mexico. Using a combination of oral history, pedestrian survey, archaeometric, and traditional ceramic analysis methods, this thesis investigates the nutritional and cultural values associated i with the intersection of Tonalá Bruñida ware as Spanish colonial material culture and as an object of geophagy. These efforts represent novel anthropological research on the ingestion of a finished ceramic product, illuminating an underexplored dimension of folk medicine. Taken with the understanding that Tonalá Bruñida ware geophagy was stigmatized in its discrete time and place, this thesis also aims to more fully grasp the methods by which upper class Spanish women consumed Tonalá Bruñida ware and their intentions in doing so in relation to its continued practice in Mexico today.
Access status: Open Access ,
HOLY WHAT?: REINTERPRETING THE JOHN’S ISLAND WRECK IN EDENTON, NORTH CAROLINA
(East Carolina University, 2026-05) Costa, Addison W.
From 1775 to 1783, the Revolutionary War raged across the 13 British North American colonies. To exert greater pressure on the rebellion, the Royal Navy blockaded harbors throughout New England, and British authorities encouraged harassment and raiding of colonial ports. For the purpose of coastal defense, North Carolina and Virgina worked together to construct two galleys: Washington and Caswell. Both galleys used Edenton, North Carolina, as a home port, and Caswell sank there in 1779 due to structural issues. Washington was summarily deployed for action and vanished from the historical record in late 1780. Roughly a year after Washington left Edenton, a ship-rigged row galley named General Arnold attacked the town. Targeting economic infrastructure, General Arnold burned plantations and warehouses, stole a merchant sloop, and disabled a local schooner before being seized by the townspeople of Edenton. After its capture, the fate of General Arnold is relatively ambiguous. Some stories indicate that it was used as communal property by the merchants of Edenton, while others suggest it was renamed as the privateer galley Tartar, reportedly launched at Edenton in 1782 (Babits and Howard 2008:20). The John’s Island Wreck is located at the mouth of Pembroke Creek near Edenton. The site was the subject of archaeological investigations in 1980 and 1993, which resulted in speculation that the remains represent the merchant ship Holy Heart of Jesus. Helmed by Swedish captain and gun smuggler William Borritz, that vessel was reported to have unexpectedly arrived at Edenton in 1778 with a cargo of 45 cannon. Though archaeological evidence found in both investigations did not explicitly rule out this interpretation, the vessel’s identity was never confirmed. The proposed thesis seeks to reassess the interpretation of the John’s Island Wreck by comparing legacy archaeological data with that recorded in 2024, as well as recently available archival data, to determine whether it could be the remains of a row galley dating to the Revolutionary War.
Access status: Open Access ,
Congruence of Efficacy Beliefs and the Prediction of Performance in Military Teams
(2026-05) Green, Mary Elizabeth
Military teams work together in high-pressure environments where performance is an overall evaluation of success. The Army remains committed to improving team effectiveness in the military and this study supports how psychological factors that may impact team performance may support this aim. Bandura (1986) developed Social Cognitive Theory to better understand why individuals behave the way that they do. Stemming from this research self-efficacy was introduced as a key psychological predictor of performance. Later on, the Estimation of Other’s Self-Efficacy (EOSE) was developed as an extension, to better understand how one individual may perceive another’s self-efficacy (Lent & Lopez, 2002). While both of these efficacy beliefs are individually relevant to group performance, understanding how they align within teams may optimize team performance. Therefore, the purpose of this study is to examine how the congruence of self-efficacy and EOSE predict performance in military teams. It was hypothesized that pairs with congruence of self-efficacy and EOSE at a moderate-to-high level would perform better compared to dyads who are congruent at low levels or not congruent at all. Participants of this study included 80 members of a Reserve Officers’ Training Corps (ROTC) program performing in 40 pairs consisting of one higher rank and one lower ranked cadet. Pairs worked together to complete a rope-pull task where they were instructed to pull as hard as they could for 5 seconds against an anchored column. Efficacy was measured directly before each pull; self-efficacy was reported by the lower ranked cadet and EOSE was reported by the higher ranked cadet. After each pull, subjective performance was reported by both cadets. Objective performance (i.e., Force; n/kg) was also recorded by a dynamometer attached to the rope. In line with previous research (Stephen et al., 2022; Habeeb et al., 2024; Shanock et al., 2010) a five- phase analysis was used, mainly focusing on a polynomial regression and surface response plots of interaction, utilizing force, collective performance of the higher ranked cadet, and collective performance of the lower ranked cadet as performance outcomes. For all three performance outcomes, performance was greatest when dyads were incongruent compared to when they were congruent. It was observed that subjective and objective performance was highest when EOSE was reported higher than self-efficacy, meaning that EOSE was observed as an over estimator of self-efficacy. Previous research has demonstrated that congruence of efficacy beliefs is better for performance in trained pairs. In the current study incongruence was associated with greater performance. Such findings suggest that approaches to optimizing team assignment may require different strategy and consideration for teams are untrained versus when they are trained teams.