bluuebunny/crossref_metadata_2025 huggingface dataset:
Computational Modeling of a Geometrically Tunable Blood Shunt for Norwood Recipients
Authors:   , Garven Ellen Elizabeth , Throckmorton Amy
Published: July 2021

The low availability of suitable heart transplants requires the use of palliative treatments for infants with severe congenital heart defects. Out of every 10,000 live births, 2-4 infants have a severe form of congenital heart defect characterized by a single functional ventricle. In order to survive, these infants require the first of a series of palliative surgeries--the Norwood procedure--within hours or days after birth. The modified Blalock-Taussig shunt (MBTS) is one type of shunt used in the Norwood procedure to redirect blood flow. With this shunt, the single functional ventricle performs the work of two ventricles. The proper growth and development of the infant depends on a delicate balance of blood flow between the body and the lungs, the ratio of which is determined by the size, orientation, and conditions of the shunt. A model of the MBTS in a neonatal aortic arch is developed and evaluated using computational fluid dynamics. Parameters are modified individually to study their effect in steady-state, including multiple shunt geometries and a range of physiological conditions. Additionally, time-variant simulations are conducted to simulate the dynamics over the duration of a heartbeat. In comparison to a model of the healthy anatomy, the MBTS model creates more complex fluid patterns that have higher amounts of shear stress. These factors indicate less overall cardiac efficiency. Variations to the shunt diameter are used to validate the model against well-established concepts. Geometry variations with additional curvature and flaring had more pulmonary flow, which suggested more favorable uniform flow behaviors. Results of the physiological variations connect the significance of low cardiac output with blood oxygenation and poor clinical outcomes. The impact of moderate shunt dysfunction is found to be relatively minor. The inlet behavior of the time-variant simulations corresponds to a neonatal heartbeat, but the results do not mimic realistic fluid behavior over the entire duration because of limitations in the boundary conditions.
Synthesis of Two-Dimensional Transition Metal Nitrides
Authors:   , Urbankowski Patrick S. , Gogotsi Yury
Published: July 2021

The family of two-dimensional (2D) materials-solids with high aspect ratios and thicknesses consisting of a few atomic layers-has grown far beyond graphene. 2D transition metal carbides, nitrides and carbonitrides, known as MXenes, are one of the latest additions to this family. This rapidly growing class of 2D materials finds applications in fields ranging from energy storage to electromagnetic interference shielding and transparent conductive coatings. However, while over twenty carbide MXenes have been synthesized, very few transition metal nitrides (TMNs), and no nitride MXenes, had previously been reported. Two-dimensional TMNs, including nitride MXenes, have several potential advantages over their carbide analogs. They theoretically have higher values of electrical conductivity than carbide MXenes, which has implications on outperforming carbides in electrochemical and other applications. Compared to carbides, they are superior candidates for promising plasmonic devices and spintronic devices that incorporate magnetic 2D materials. Although there are theoretically as many nitride MXenes as carbide MXenes predicted, synthesizing nitride MXenes and 2D TMNs in general faces several challenges. Synthesis methods that have produced over two dozen 2D carbides MXenes have failed to yield 2D TMNs. The major focus of this dissertation is investigating routes of synthesizing 2D TMNs including, but not limited to, selective etching of layered bulk metal nitride precursors. Three promising routes of synthesis are explored, and their electronic and magnetic properties of the synthesized materials are also characterized. Discovering how to synthesize 2D TMNs will remove the barrier between merely studying their theoretically predicted properties and finally applying these outstanding properties in devices for energy storage, spintronics and beyond.
Using mindfulness and dance/movement therapy for emotion-focused coping with adolescents
Authors:   , Lewis Ja'Nae , Morningstar Dawn , Dougherty Abby
Published: July 2021

The purpose of this capstone thesis was to create a method that incorporated mindfulness, body awareness, and movement to facilitate awareness and acceptance of emotions as they arise for adolescents in a school setting. Adolescents are at a complicated time in their development where their identities are beginning to form, they are often flooded with new and uncomfortable thoughts and emotions. Self-expression can be challenging for adolescents, for many reasons including lack of awareness of feelings and cultural stigma around the expression of emotions, especially those such as fear, hurt, anxiety, and sadness. The literature supported the use of dance/movement therapy as a beneficial intervention for adolescents to help with stress management, attending to the body, and emotional expression. Additionally, mindfulness was used as a tool to help the teenagers become more aware of thoughts and emotions as they relate to the felt experience of the body. Through an integration of dance/movement therapy and mindfulness the students who participated in this method became more aware of their thoughts and emotions and were able to pay attention to their bodily felt experience. Case vignettes were provided to illustrate the method in use within individual dance/movement and counseling therapy sessions.
The Experience of Body Image in Transgender, Nonbinary, and Gender Nonconforming Adults
Authors:   , Morrill Kimberly Lynn , McNamara Elizabeth , Barrington Erika
Published: July 2021

This critical review of the literature examines body-based experiences and body image in transgender, nonbinary, and gender nonconforming adults. This review surveys history, language, biopsychosocial factors, information, and research studies of body-based experiences of people not living as the gender assigned at birth. The review examines how body image affects the body, movement, and sense of self. The specific scope of interest for this literature review is body image, including gender dysphoria, in trans men, trans women, nonbinary persons, gender nonconforming persons, two-spirit persons, genderqueer persons, genderfluid persons, agender persons, bigender persons, persons with an intersex condition, and other genders that vary from the assignment at birth. The review examines how community-based therapy, psychotherapy, creative arts therapies, and dance/movement therapy currently approach clinically treating the trans community. The historical context of pathologizing the act of being transgender, continued advocacy within the community, the evolution of the language originating from within the community, and nationwide dialogue for improved care for transgender persons is examined. A goal for this critical review of the literature is to provide a starting point for continuing informed provider care by examining language, advocacy, and education.
Reviewing Efficacy of a New Central Line Bundle
Authors:   , Folarin Bolanle , Stover Sonya , Poyss Alicemarie R.
Published: July 2021

Introduction: Reviewing efficacy of a new central line bundle in reducing central line associated bloodstream infection (CLABSI) as compared to the old central line bundle. Using evidence-based research to develop a new bundle to include curos caps, povidone-iodine nasal swabs, and daily CHG wipes on all patients with central lines. Design: Retrospective chart review Methods: A microsystem assessment was conducted on a 32-bed transitional medical unit. Collaborated with the CLABSI value improvement team and the infection prevention team to review the data on CLABSI for 3 separate months in fiscal year 18 and fiscal year 19. A CLABSI safety analysis tool was used to screen infections to ensure they met the inclusion criteria for CLABSI. It was determined that the new bundle reduced CLABSI occurrence. Results: All the charts that indicated possible CLABSI were analyzed thoroughly using the CLABSI safety analysis tool. It was determined that there were two CLABSIs for the FY18 and zero for FY19 when compared month to month. The new bundle was estimated to increase cost by $34,382 for the entire year which is approximately $2,865 per month. At a cost of $18, 079 per CLABSI, that would have been $36,158 for the two cases. The unit spent about $8,595 on prevention for a potential net cost savings of $27,563. Conclusion: The new bundle adds to the operating expense of the unit but significantly reduces the overall cost. It also improved patient outcome by implementing evidence-based practice that reduced CLABSI occurrence. Keywords: new central line bundle, CLABSI, patient outcome, infection prevention, central line
Hedonic Hunger, Disinhibited Eating, and the Physiological Impact of Palatable Food
Authors:   , Muratore Alexandra F. , Lowe Michael R.
Published: July 2021

Hedonic hunger and disinhibited eating behaviors, such as loss of control eating and eating in the absence of hunger, represent increased motivation for food and susceptibility towards overeating and are associated with a range of adverse physical and psychological outcomes. The persisting prevalence of these symptoms suggests limited efficacy of current prevention efforts and establishes the need for the identification of additional risk and maintenance factors. Heart rate variability (HRV) has been established as a measure of biological responsiveness and psychological well-being and may function as a physiological marker of food responsivity. Preliminary evidence has identified associations between reduced HRV and eating disorder symptoms, suggesting that eating pathology may be associated with different physiological responses to food. The current study sought to replicate and extend previous findings by employing HRV as a measure of arousal in response to food presentation across different hunger conditions in healthy adults. We examined relationships between multiple indices of HRV (HF, LF, LF/HF) and measures of hedonic hunger, loss of control eating, and eating in the absence of hunger. Results found similar patterns of HRV in response to food exposure and intake as previous research in nonclinical samples, with reduced HF HRV during food exposure and food intake and increased HF HRV following food intake. Although there was a marginally significant interaction between hedonic hunger and PFS, subsequent analyses found no relationship between HRV and PFS, LOC or EAH. Limitations and implications of the study are discussed.
Kinematics of Locomotion in the Neonatally Spinalized Rat
Authors:   , VanLoozen Josephine L. , Giszter Simon F. , Dougherty Kimberly J.
Published: July 2021

Spinal cord injury (SCI) is a traumatic injury that disrupts motor control below the injury segmental level and the flow of sensory information from areas of the body below the injury to the brain. Restoring function after injury is a multifaceted problem involving treating the immunological, gene expression, neural control and anatomical aspects of the injury. Research aimed at restoring motor control after SCI often involves a locomotor training component aimed at reactivating silenced circuits and retraining the spinal cords response to sensory stimuli. In animals that are spinal cord injured as neonates (NTX) there is significant motor recovery without therapeutic intervention. Behavioral outcomes in untrained NTX animals range from uncoordinated limb movements to coordinated weight-supported stepping without therapeutic intervention. ~20% of neonatal injured rats can weight support without intervention. Following pelvis-based robot rehabilitative training, a further 20-30% of animals, that were previously unable to weight-support are able to take weight-supported steps while connected to the robotic system. Understanding how these NTX animals change their locomotor strategy and how circuits below the lesion are engaged as a result of the training could be used to target future rehabilitative strategies. We hypothesize that successful locomotor training influences pelvic rotation during walking to provide stability and this expands the task-space of the limb during walking. We expect that the interaction between spinally-controlled limb and cortically-controlled trunk/pelvis is necessary for the development of weight-supported stepping in the NTX rat. We believe this to be associated with changes in spinal cord excitability, which may be mediated by changes in expression of KCC2. Our findings highlight the importance of learned and plastic pelvic control via trunk musculature in rehabilitation of locomotion after neonatal SCI.
Discharge Opioid Prescribing Guideline Among the Urological Surgery Patient Population
Authors:   , Acebedo Christopher , Rundio Al , Hung Nancy
Published: July 2021

Background: Among the urological surgery patient population, the conventional opioid prescribing practice is arbitrary, provider preferential, and is not data-driven. The current prescribing practice can result in over-prescription, chronic opioid use, and surplus of opioid analgesics that can be a convenient source of diversion. Purpose: The purpose of the Doctor of Nursing Practice project is to develop and implement a discharge opioid prescribing guideline based on the procedure-specific inpatient opioid requirement. The primary outcome is the reduction of opioid prescription quantity at the time of discharge. The secondary outcome is the adequacy of pain control after discharge. Methods: The guideline was created by performing a retrospective analysis of the prospectively collected post-operative pain data and calculating the daily procedure-specific inpatient opioid requirement. A 5-day dose taper beginning on discharge day number one was incorporated, and the utilization of Prescription Drug Monitoring Programs was integrated into the guideline. Evaluation: Comparison of the pre- and post-implementation refill rates was performed. Data on pain control adequacy were collected using an electronic survey. The between-group difference in demographic data, mean inpatient opioid requirement, and mean discharge opioid prescription were analyzed using an independent samples t-test. Chi-square test was used to determine the between-group difference in the proportion of opioid refill. The percentage distribution of the post-discharge opioid surplus, readmission rate, and self-reported pain control adequacy was also calculated. Results: The Doctor of Nursing Practice project significantly decreased discharge opioid prescribing. Reduction in discharge opioid prescribing was associated with the expected increase in opioid refill that was negated by the favorable self-reported pain control rating, absence of readmission due to acute pain episode, and low opioid utilization after discharge. Clinical Implication: The Doctor of Nursing Practice project will minimize variability in prescribing practices, individualize opioid prescription by accounting for the procedure-specific pain burden, and reduce the rate of opioid prescription at discharge by providing a point of care procedure-specific prescribing guideline among the urological surgery patient population.
The Strategy of Fake News
Authors:   , Lewis Joshua R. , Tedesco Albert S.
Published: July 2021

Fake news has found success in campaigns designed to attack the truth and reframe it to fit a specific agenda. As a result, combating fake news and standing up for the truth has become a staple of most mainstream television news outlets over the past three years (from 2016-2019). Fake news is not a new problem. It is modern-day propaganda made up of 21st-century media - tweets, headlines, and viral videos-created and distributed with the sole intent of causing disruption and confusion by selecting the points of interest deemed most favorable to the person or outlet making the claims. However, fake news and its offshoots, misinformation, and disinformation are symptoms of a bigger problem - the overall attack on science-backed truth. The mainstream media's responsibility is to stand up for factual truth, and they must take a more active role in defending the truth despite any notions of bias, politics or public outcry. This thesis will look at the media's role in defending the truth as the public is bombarded with too much information combined with the science of propaganda, which both manipulates the version of the truth the public sees as well as weakens their ability to be critical thinkers.
Connecting with the African American Community
Authors:   , Dennis Christina Eva , Brody Jean
Published: July 2021

This thesis research looks into the African American donor community and how arts organizations are connecting with that community. The researcher interviewed Development and Community Engagement representatives from five performing arts centers in New Jersey to understand how the organizations included in this research currently connect with the African American community and cultivate donors in that same community. A donor assessment survey completed by respondents, mainly residents of New Jersey, looked to see if people were donating to arts organizations and if they felt these arts organizations were connecting with them through the programming presented. The survey found the majority of respondents have donated money to an arts organization, many donating $1 to $100 in a year. The majority also felt that arts organizations were communicating with them in a way that connected with them and the organizations also presented exhibits, performances, etc. that connected with them. The research offers recommendations to the field on how to connect with a diverse community to grow a more diverse donor population. Community engagement is key in cultivating this relationship. The more the entire organization's staff is involved in connecting with the community, from the board and executive leadership down to the ushers and box office personnel, the more authentic the connection will be. After completing the research, the question arises if race and/or ethnicity should be a consideration for development teams when connecting to donors. This study also found that many arts organizations do not ask their donors their race and/or ethnicity, resulting in a lack of knowledge on this donor demographic. This knowledge is important to have to show accurate donor data and dispel the assumption that most, if not all, donors are white.
Supporting Interpersonal Interaction with Hospice Music Therapy
Authors:   , Clark Nicholas R. , Nolan Paul
Published: July 2021

The purpose of this capstone thesis was to develop a method of music therapy to support interpersonal interactions within the hospice setting, particularly those involving patients and their loved ones. This was accomplished through both a review of the relevant literature and clinical observations of the here-and-now effects of music therapy experiences on the responses of patients and their family members and close friends. These experiences and responses are illustrated in a clinical vignette describing the work done over several months with a hospice patient and his family. The method developed is a strength-based and resource-orientated approach to hospice music therapy that seeks to nurture that which is healthiest in patients and families rather than focus upon symptoms of illness when considering ways of supporting interpersonal interaction. This method relies upon mindful focus upon changes in physical status and interpersonal behaviors that occur during music therapy sessions. Some major themes emerged within the development of this method: resource-orientation, use of electronic devices, song recreation and improvisation, group dynamics, and musical communication. These will be discussed as this thesis concludes with suggestions for future practice and development of this methodology to music therapists and researchers interested in this topic.
A Hardware and Software Interfaced Microgrid Energy Management System
Authors:   , Halpin Thomas Joseph , Miu Karen Nan
Published: July 2021

Intelligent, networked microgrids are becoming increasingly desired for land, sea, and space applications. These self-contained power systems contain limited power availability, but feature two-way communication infrastructure allowing for detailed power measurements and discrete control. Thus, control of individual loads is essential to maintain acceptable system operating conditions. Furthermore, the ability to remotely control these power systems is invaluable when locally enacted control is infeasible. Therefore, developing a system that represents an intelligent microgrid with remote controllability can represent these capabilities, and can be used as tool to test and evaluate ways to address measurement, control, and communication challenges. In order to study the behavior of these systems, a reconfigurable laboratory-based hardware and software microgrid power system was developed, presented, and tested. This system allows for measurement collection and centralized control of remote devices, through an Energy Management System. In the Energy Management System software, collected data is processed using state estimation, which allows for mathematical determination of unknown parameters using a select set of known data. Multiple cases were studied with varying sets of measurement data provided to the estimator. Additionally, two system control cases, composed of remedial voltage control actions, and control actions to meet power demands of critical loads, are presented. During each control action case, the system response is analyzed. Overall, both the measurement and control cases presented successfully demonstrate the system and software capabilities.
On the Detection of Malware on Virtual Assistants Based on Behavioral Anomalies
Authors:   , Noorani Mahshid , Weber Steven P. , Mancoridis Spiros
Published: July 2021

The Internet of Things (IoT) refers to the growing network of "smart objects." The increase in popularity of IoT devices, due to their efficiency and convenience, has given rise to new security concerns. The variety and novelty of IoT devices provide a corpus of malware that is of insufficient size to employ classic machine learning algorithms. This makes anomaly detection methods for IoT device security more attractive, especially in the short term, until there are enough behavioral signatures for malware to train more sophisticated machine learning detection models for these devices. This thesis explores some of the security concerns pertaining to running software similar to Amazon Alexa home assistant on IoT-like platforms. We implement a behavioral-based malware detector and compare the effectiveness of different system attributes that are used in detecting malware, i.e., system calls, network traffic, and the integration of system call and network traffic features. Given the small number of malware samples for IoT devices, we create a parameterizable malware sample that mimics Alexa behavior in varying degrees, while exfiltrating data from the device to a remote host. The performance of our anomaly detector is evaluated based on how well it determines the presence of our parameterized malware on an Alexa-enabled IoT device.
Delirium Assessment of the Elderly in the Intensive Care Unit
Authors:   , Clyne Timothy , Ankrah Lucy , Zuzelo Patti Rager
Published: July 2021

Objective: To improve delirium identification by nurses of elderly patients over the age of 65 in an intensive care unit through the implementation of the CAM-ICU. Design: Evidence-Based Practice (EBP) quality improvement project framed with in the Iowa model of EBP. Inter rater reliability was established in the use of the CHART-DEL tool in accordance with the guidance from the CHART-DEL manual. The CHART-DEL was then used as a monitor for concurrent validity for the CAM-ICU performed by the intensive care nurse. Finally, to ensure rigor in the findings a randomly selected sample of the CHART-DEL was re-validated by an expert rater. Participants: Intensive Care Unit (ICU) Registered Nurses. Intervention: Education and implementation of the CAM-ICU for delirium screening. Patients over the age of 65 admitted to the ICU will be screened for delirium using the instrument. Results: The result of implementation of this evidenced based practice will improve the identification of delirium by nurses and increase the adherence to delirium screening through the use of the CAM-ICU. All nurses receiving CAM-ICU education were found to use the tool with accuracy as validated by the CHART-DEL abstraction tool. Adherence to the use of the embedded CAM-ICU was 100 percent for intensive care nurses receiving education on the proper use of the tool.
The Impact of Safety Huddles on Staff Perception of Safety
Authors:   , McTigue Mary , Gallagher Gordon Mary , Zuzelo Patti Rager , McTernan Joseph
Published: July 2021

Despite an organizational commitment to patient safety, the medical-surgical registered nursing staff at an urban community hospital had a less positive perception of its hospital's safety culture than Mid-Atlantic colleagues working in medical-surgical units at different hospitals within the geographic region. A quality improvement project was implemented utilizing unit-based safety huddles to address this gap. The huddles were implemented to improve staff perception in five selected composites of the Agency for Healthcare Quality and Research's Hospital Survey on Patient Safety Culture. The composites included: feedback/communication about errors, communication openness, non-punitive response to error, management support for patient safety, and supervisor/manager expectations and actions promoting patient safety. The survey's five composites were used as a baseline measure of the medical-surgical registered nurses' perception of safety. Safety huddles were then implemented at the start of each twelve-hour shift for a three-week period and staff completed a post-survey using the same five composites. Unit-based safety huddles resulted in increased percentages of positive perception in every composite and the corresponding composite items. Statistical analysis demonstrated a statistically significant (p<0.05) improvement in the composites of communication openness, non-punitive response to error and supervisor/manager expectations and actions promoting patient safety, and six composite items. Safety huddles improved the medical-surgical staff nurses' perception of key attributes of hospital safety culture in this project.
Hemoproteins
Authors:   , Stephanos Joseph J. , Addison Anthony William
Published: July 2021

Human hemoglobin, myoglobin, Glycera dibranchiata, elephant, hemoglobins derivatives, and model iron(II) and iron(III) porphyrins such octaethylporphyrin (OEP) have been prepared and characterized by ESR and optical spectroscopy. Kinetics, thermodyamics, binding and optical studies are employed to investigate the influence of the heme environment on the reactivity and electronic properties of the active site. The kinetics of the autoredox process of nitrosyliron(III) hemoproteins were followed in detail, and the activation parameters [delta]H[double dagger] and [delta]S[double dagger] were determined. The thermochromism of myoglobin and Glycera dibranchiata hemoglobin derivatives and of cytochrome-c were monitored. Two different groups of behavior were identified. The first group shows equilibria between two spin states, while the second group is associated with globin conformation changes. Enthalpy-entropy compensation is presented by all these heme derivatives. The isothermal binding affinities of Glycera dibranchiata hemoglobin for heterocyclic amines and other ligands have been evaluated and compared to those of myoglobin. The interactions between the environment and the axial ligand determine the ligand affinity of myoglobin, while the electronic properties of the axial ligand control the binding affinities of Glycera hemoglobin. The heterotropic effectors influence the heme ligation affinities. A comparative analysis of the electronic, circular dichroism and Kuhn anisotropy spectra of heme protein nitrosyls has been carried out in order to identify the relationship between the environment and the electronic structure of the active site. The anisotropy factor of a transition, g, was used here to assign some of the electronic transition.
Design and validation of broad-spectrum guide RNAs for CRISPR/Cas9-mediated HIV-1 elimination and cure
Authors:   , Sullivan Neil Thomas , Wigdahl Brian
Published: July 2021

The CRISPR/Cas9 gene-editing system is effective at disrupting and excising the entire HIV-1 proviral genome from infected cells by targeting the long terminal repeats (LTRs). Of the currently available gRNAs, we have shown that only a few have any capability to target patient-derived HIV-1 quasispecies (vQS). Consequently, there is a pressing need to identify gRNAs to target all vQS in large numbers of patients. This thesis focuses on pioneering advances that we have made in designing/testing broad-spectrum gRNAs targeting the HIV-1 LTR. Studies utilizing 48 patient-derived samples, determined that a hybrid method of one personalized and 3 broad-spectrum gRNAs can target 45 of 48 patient-derived sequences from the Drexel CNS AIDS Research and Eradication Study (CARES) cohort. Given this, it was hypothesized that a novel set of broad-spectrum gRNAs could be designed by increasing the number of patient sequences. Therefore, LTRs from 269 patients were deep-sequenced and a novel package of select gRNAs were analyzed. These gRNAs were predicted to cleave all patient-derived sequences in the CARES cohort and all subtype B sequences in the Los Alamos National Laboratory HIV database without predicted off-target effects. Numerous functional assays demonstrated that these gRNAs were more efficacious than those previously published gRNAs, especially at cleaving patient-derived HIV-1 sequences. In addition, the selected gRNAs were highly effective at targeting other HIV subtypes, thus further demonstrating their broad-spectrum capabilities. Overall, the newly designed gRNAs target the vQS spectrum in large numbers of HIV-1-infected patients and bring us closer to a potential HIV cure.
Examining the Effect of the GAD-7 and PHQ-9 Instruments and Impact on Patient Referrals
Authors:   , Spatar Stacy Berlekamp , Wilson Linda , Okupniak Carol , Moon Won Mitch
Published: July 2021

The purpose of this project was to educate staff on screening tools for anxiety and depression, to consistently use these tools amongst chronic pain patients, and to examine the impact their use has on referrals to mental health. Chronic pain is a wide spread problem and is the leading chronic health care condition in the United States, greater than heart disease, cancer, and diabetes combined (AAPM, 2011). The plan was to implement a practice change to include the consistent use of measurement tools to screen for anxiety and depression and to examine their effect on the number of mental health referrals. Symptom clusters of anxiety and depression are often associated with chronic pain and one pertinent study revealed that out of 250 veterans with chronic pain that 45% screened positive for one or more of the five types of common anxiety disorders and those with anxiety disorders and had significantly higher levels of pain (Pedersen, 2013). One study took place in Michigan through telephone inquiry which determined that 21.9% of participants had chronic pain and 35% of those also had depression, amongst those were younger participants who were more likely to have both depression and chronic pain compared to just having chronic pain alone (Miller & Cano, 2009). The use of reliable tools to screen for anxiety and depression were reviewed and it was determined that when completed correctly the General Anxiety Disorder -7 (GAD-7) is deemed to be highly reliable for screening of anxiety disorders (Spitzer, Kroenke, Williams, & Lowe, 2006). Also deemed reliable for determining the severity of depression is the commonly used patient health questionnaire (PHQ-9) (Kroenke, Spitzer, & Williams, 2001). The concept is that once the standardized use of the screening tools are implemented, referrals to mental health will increase.
Calculus of Higher Order Noncommutative Functions
Authors:   , Stevenson Leonard Charles , Kaliuzhnyi-Verbovetskyi Dmitry S.
Published: July 2021

This thesis extends some standard results familiar from undergraduate calculus to the setting of higher order noncommutative functions. These extensions are accomplished using a difference-differential operator in a completely algebraic, topological free, manner. The results include a version of the mean value theorem, the Taylor formula and an antiderivative. The Taylor formula is applied to obtain results about power series on nilpotent matrices and higher order polynomials.
The Lived Experiences a Selected Group of Female El Salvadoran Child Language Brokers Students in Prince George's County Public Schools
Authors:   , Murray Elaine C. , Grant Allen C.
Published: July 2021

Child language brokering is a phenomenon that occurs frequently among children who speak English and their non-English speaking parents and friends. When children interpret for their family members and friends, it is unnoticed by many organizations such as schools, healthcare organizations and businesses. Therefore, child language brokers have missed the opportunity to be recognized for the unusual work that they perform almost daily. Prior research on this topic has primarily focused on Spanish-speaking children from areas such as Mexico and China. This study sought to share the lived experiences of female students from the country of El Salvador. The following research question guided this study: What are the lived experiences of a select group of female El Salvadoran child language brokers in a large urban school district? This question was explored through a survey and in-depth, semi-structured interviews where participants were able to share their experiences when language brokering. Twenty participants participated in the survey and seventeen completed the instrument. Of those individuals, five female students from El Salvador were selected to participate in a semi-structured interview. The survey results were analyzed using descriptive statistics and the interviews were analyzed to gain a thick, rich, description of the participants lived experiences as child language brokers. Four thematic findings emerged from NVivo coding: (a) trust, (b) happiness, (c) helping, and (d) learning. Given the findings of this study, the following three recommendations are offered to child language broker researchers as they seek to understand children who engage in this work: (a) explore why children broker for their friends and how this may impact that relationship. (b) reduce bias in the research by selecting an outside, non-interpreting researcher to collect both the qualitative and quantitative data, and (c) conduct research that answers the following 1) How do children perceive their abilities when language brokering? 2) Do participants think that their interpretation skills are important and valuable? and 3) How do participants perceive their language brokering skills within their school, school district and society?
Impact of Water, Hygiene and Sanitation on Medication Adherence Intention among HIV Positive Women Enrolled in Option B+ Treatment Regimen in Zambia
Authors:   , Nutor Jerry John Yao , Slaughter-Acey Jaime C.
Published: July 2021

Background: Mother-to-child transmission (MTCT) of HIV is a major problem in sub-Saharan Africa despite increasing availability of free and subsidized antiretroviral treatment (ART); MTCT can be significantly reduced provided pregnant and breastfeeding mothers adhere to prescribed regimens. Access to potable water and adequate sanitation is a major problem in low-resource countries including Zambia, located in sub-Saharan Africa. This study investigated the influence of water hygiene and sanitation (WASH) on ART adherence intention among HIV positive women enrolled in Option B+ regimen, the current World Health Organization recommendation for low resource countries. Method: Using a cross-sectional descriptive study design, this study recruited pregnant and breastfeeding HIV positive women who were enrolled on Option B+ treatment regimen who resided in Lusaka (urban) or Sinazongwe (rural) Districts of Zambia. Descriptive statistics were used to characterize access to water and toilet in relation to ARV adherence intention in the entire sample and by Zambian District. Four generalized log-gamma regression models were built using a step-wise approach to assess association between access to water and toilet and ART adherence intention. Effect modification by residence in an urban or rural area was examined by stratifying regression models by District of residence. Result: In all, 150 participants were included in the study. Higher proportion (61.6%) of women in Sinazongwe reported adherence intention to the ARV as compared to the women in Lusaka (38.4%). There was a statistical significant association between adherence intention and district of residence (p<0.001). Multivariate analyses showed significant association between adherence intention and access to water after adjusting for socioeconomic variables age and, HIV-EMTCT knowledge. Women who have access to flush toilet are more likely to report adherence intention compared to those who have pit latrine and no toilet facility. Multivariate analysis of toilet access showed significant relationship with adherence intention (PR 1.14, 95%CI, 1.00 - 1.30). Implication: Provision of potable water and toilet facilities could help women living with HIV adhere to ART medication. Community led total sanitation should be introduced in both urban and rural communities. Nurses should conduct WASH assessment and educate women prior to ART initiation. Governments and other stakeholders should get involved in providing clean water to communities especially in rural area.
Using the Edmonton Frail Scale to Trigger Palliative Care Referral for Hospitalized Patients with Heart Failure
Authors:   , Neault Monique , Zuzelo Patti Rager , Roeser Mindi , Rundio Al
Published: July 2021

Objective: To determine whether use of the Edmonton Frail Scale (EFS) by the clinical staff on the medical cardiology unit would increase referrals to palliative care for hospitalized patients with heart failure. Design: Quality improvement project based on the Plan, Do, Check, Act framework. Setting/Local Problem: At a 45-bed cardiology unit at an urban academic medical center, frail hospitalized patients with heart failure were not consistently referred to palliative care. Patients: Patients (N=18) admitted with diagnoses of heart failure from July 16, 2016 through July 30, 2018. Intervention/Measurements: Medical cardiology staff were instructed on the on the new process and how to use the EFS. After training, patients with EFS scores greater than or equal to 10 were referred to palliative care. Results: Eighteen patients were admitted with heart failure: 22% (n=4) were referred to palliative care. Of these four, 75% (n=3) were referred because of EFS screening results. One attending physician declined to participate in this project. Overall, palliative care referrals increased from 9% (n=1) before the process change to 17% (n=3) during the two-week pilot. Conclusion: Frailty screening is an objective method with which to identify patients who may benefit from palliative care. Results from this two-week pilot demonstrate process improvement. However, long term sustainability remains questionable. The quality improvement team has committed to continue the pilot for three months. Keywords: palliative care, palliative care referral, heart failure, frailty, goals of care, patient preferences.
Practicing at the Intersection of Dance/Movement Therapy & Yoga
Authors:   , Goykhman Nathalie Isabelle , Goodill Sherry W.
Published: July 2021

The purpose of this study to clarify and describe dance/movement therapists' use of yoga in a dance/movement therapy (DMT) context. This study aims to address the current problem of limited research in the conceptualization and critique of the use of yoga in DMT, despite available literature on some dance/movement therapists' implementation of yogic elements into DMT practice. The methodology of this modified grounded theory approach includes qualitative semi-structured interviews to better understand the participants' perspectives on the relationship between yoga and DMT. Data from interviews were coded for themes using open, axial and selective coding in order to generate a visual model of findings, which resulted in the preliminary steps of conceptual ordering as the endpoint of the study. Although cultural considerations on the use of yoga in the context of DMT were explored, through the emergent nature of grounded theory methodology, an emphasis on clinical-decision making was developed. The results include an examination of how clinicians navigate the integration of yoga in DMT interventions. Nine aggregated selective codes emerged from the coding process: (1) Yoga is a part of the clinician's identity and clinical skills; (2) Factors of clinical decision-making on the inclusion, exclusion, and modification of yogic elements are foundational to a blended approach; (3) Spontaneity and improvisation are central to the session and the modification of yogic elements; (4) Yoga-related props help structure sessions and provide visual cues for developmentally appropriate and engaging movement tasks; (5) Yoga is used as a mind-body toolbox inside and outside of a session; (6) Yogic elements are modified to function outside of traditional class structure; (7) Yogic elements serve specific symptoms and treatment goals; (8) Differing perspectives on the boundaries between DMT and yoga are represented, and (9) Contraindications and/or conditional considerations are identified when using yogic elements in DMT context. These themes were explored and organized through seven figures to illuminate relationships and processes. A process model figure illustrates the three central concepts of the mind-body toolbox, modification of yogic elements, and the implementation of spontaneity/improvisation as steps in practicing at the intersection of yoga and DMT. Discussion of the results include the differences between the research aim and findings, implications for future research, recommendations for education, and clinical applications.
Iron Complexes As Models for Non-Heme Iron Proteins
Authors:   , Wahlgren Curtis , Addison Anthony William
Published: July 2021

A series of ligands containing aromatic nitrogen donors was used to prepare iron(II) and iron(III) complexes with the aim of studying the effect of ligand composition on spin state. By substituting benzimidazole, methylbenzimidazole, or benzothiazole for one or more pyridine groups in the above ligands and by introducing methylene groups to break up the [alpha]-diimine linkage, spin-equilibrium behavior was introduced into some of these compounds in the solid state. The iron complexes are examined with Mossbauer, ESR, and electronic absorption spectroscopy and by electrochemical methods. The temperature dependence of magnetic susceptibility is measured and the causes of spin equilibrium behavior are discussed. A thermochromism study of (Fe(Bzimpy)2) (ClO4)2 is presented and the molecular structure of (Fe(Dipica)2) (BF4)2 is outlined. Several iron(III) complexes were synthesized using aromatic nitrogen and oxygen donor ligands which are mimetic of the histidine imidazole and tyrosine phenolate donors coordinated to iron in most of the non-heme, non-sulfur, iron proteins. The spectroscopic and electrochemical behavior of these compounds was examined and is compared to some of the non-heme iron-containing proteins whose active-site composition is known to some degree. A putative correlation between spin state and ligand composition is observed. Finally, a series of ligand was prepared using several substituted benzothiazolephenols and two hydroxybenzyl-benzimidazoles. Complexation of these ligands with iron(III) was found to favor formation of binuclear iron complexes with oxo or hydroxo bridges. The effect of ligand composition on the strength of antiferromagnetic coupling was examined using non-linear curve fitting of magnetic susceptibility versus temperature data to Van Vleck's equation for spin only magnetism. One electron reduction of the binuclear center is observed which parallels the behavior of some of the binuclear iron-containing proteins.
The Effect of Resilience-Based Psychoeducation on College Resident Advisors
Authors:   , Bondarenko Ruta , Wilson Linda
Published: July 2021

Deteriorating mental health and wellness in adolescents and young adults is a significant concern, especially among those in college and university settings. Research evidence suggests that cognitive behavioral therapy approaches within resilience-based psychoeducation programs may be effective in promoting mental wellness in this demographic. A pilot pre-test/post-test study was conducted at a public university's health and wellness center in northern New Jersey. A total of seven resident advisors participated in resilience-based psychoeducation training specifically designed for college students. Participants' resilience and depression levels were measured before and after the resilience-based training using the Connor-Davidson Resilience Scale (CD-RISC-25) and the Center for Epidemiologic Studies Depression Scale (CES-D). Statistical analysis conducted using a Wilcoxon signed-rank test revealed no statistically significant change in depression (Z = -0.85, p = 0.93) or resilience (Z = -0.76, p = 0.45), which may be attributable to the study's small sample size (n = 7). Nonetheless, there was no attrition from the study, and all participants stated they found benefit in the program and would utilize the learned material in their peer-to-peer interactions. Clinical significance includes an important precedent for health and wellness centers at colleges and universities across the United States. Implementation of useful resilience-based psychoeducational interventions needs further study and consideration.
Improving Attendance in Mental Health Using Text Message Appointment Reminders
Authors:   , Beaupre Michelle D. , Lorman William J. , Rundio Al
Published: July 2021

Background: Missed appointments interfere with treatment progress and affect patient outcomes. Additionally, there is an inefficiency in staff productivity and clinic costs. Purpose: To determine if implementing a text message appointment reminder system will improve patient attendance and clinic cost when compared to phone call reminders at an outpatient mental health clinic. Methods: A prospective cohort trial was implemented to compare attendance rates and cost among patients who receive text message appointment reminders to those who receive phone call reminders at a mental health clinic in Harris County, Texas. Evaluation: The data was cleaned, coded and checked for outliers and shape of distribution. Comparison analysis between the two intervention groups were performed using a student t-test. A total of 350 participants were included in the study. 183 (52.3%) participants chose to receive a text message appointment reminder and 167 (47.7%) chose to receive a phone call reminder. There was a total of 112, 32% (m 0.50, SD 0.50) males and 238, 68% (m 0.5, SD 0.497) females. Bivariate correlations were run on all variables. On average, people who received text message appointment reminders were more likely to attend their appointments (m = .96, SE .015) than those who received phone call appointment reminders (m = .72, SE .035). Demographic data analysis was also performed. Clinical Implications: Improving appointment attendance is critical in a multitude of medical settings; reducing failure to attend rates improves quality of patient care which improves patient outcomes. From a business perspective, text message appointment reminders may result in reducing costs.