Contributors to Faculty Wellness in an Academic Emergency Department Before and During the Pandemic: A Qualitative Study

Introduction: Burnout is well known as a prevalent hazard in emergency medicine (EM) careers, but the literature is less clear about what specific work-related factors actually contribute to wellness and burnout among academic EM faculty. Objectives: 1) To explore themes and specific concerns that contribute to faculty wellness in an academic emergency department, in a qualitative fashion. 2) To determine whether these themes and concerns changed appreciably in the time of the COVID-19 pandemic. Methods: EM faculty members at an academic institution were invited to participate in the study, including an on-line survey and a structured interview. Survey results were analyzed using descriptive statistics, interviews were coded and analyzed in qualitative fashion with frequency of themes as the primary outcome. Results: 33 of 40 EM faculty members at one institution participated in interviews with the study team. Twenty-four returned Maslach Burnout Inventory (MBI) and Areas of Worklife surveys, with 5 of the 24 registering as burned out by standard definitions. In qualitative analysis of the interviews, the most common negative themes were psychological stress, balancing work and family life, negative perceptions of non-departmental administration and certain aspects of clinical work. The most common positive themes included positive views of departmental leadership, teamwork among colleagues, trainees and others, and self-worth derived from doing the work of EM. Themes before and during the COVID-19 pandemic were similar, with an increase in positive comments related to patient care during the COVID-era (p = 0.02). Conclusion: Among one group of EM faculty, positive drivers of wellness were primarily relational in nature, including working in teams to care for patients and carry out the various missions of academic EM. Negative drivers were consistent with previous work in burnout among medical professionals, to include stress, tensions between work and family obligations, and conflicts in the care and work environments

Development and evaluation of a modeling platform for evaluating immunotherapeutic efficacy in the tumor microenvironment.

The tumor microenvironment (TME) represents the complex outcome of numerous tumor, stromal, and immune interactions, and whose composition can significantly affect treatment response. Particularly, immunotherapeutic efficacy is subject to multiple tumor-specific TME interactions that may be difficult to evaluate/predict clinically. Mathematical modelling has been formulated to evaluate specific aspects of the TME, including vasculature, ECM deposition, and immune-tumor interactions. However, the computational challenge of simulating multiple TME interactions has led to sacrificing varying degrees of model generalizability and clinical relevance. This work describes increased computational performance of a 3D continuum model that simulates tumor tissue, ECM, and vasculature using a Message Passing Interface (MPI) CUDA-accelerated framework (Chapter 2) and expanding biological scope to include TME immune interactions (Chapter 3). Model performance is scaled to 2.56x2.56x2.56 cm3 domain sizes while preserving mm-resolution interactions. The model’s host tissue phase is expanded to include an immune component. This component includes multiple innate and adaptive immune species whose local activation influences the TME into varying degrees of pro- or anti-tumor states. This model is applied to simulate the effect of a macrophage-mediated immunotherapeutic regimen against multiple breast cancer liver metastases (BCLM) simultaneously in a simulated mouse liver lobe (Chapter 4). The model results indicate that tumor burden could be potentially curbed with treatment intervals lasting less than 7 days. The effects of anti-Programmed Death Ligand 1 and antigen-loaded chitosan nanoparticle immunotherapies were quantified against primary and liver-metastatic pancreatic ductal adenocarcinoma (PDAC), finding that applying both therapies simultaneously may synergistically decrease tumor burden (Chapter 5). Lastly, as a first step towards evaluating the patient-specific TME immune landscape for BCLM, a machine learning workflow is presented that classifies expression of BCLM imaging mass cytometry (IMC) data from paired primary IMC data, with validation subset AUROC ≥0.75. Longer-term, this overall work could be applied across a broad spectrum of tumor types and therapeutic approaches to identify optimal strategies tailored to specific tumors. Chapter 2 is published in Computers in Biology and Medicine. Chapter 3 is published in the Journal of Theoretical Biology. Chapter 4 is published in Immunology. Chapters 5 and 6 are in preparation for submission

Authentic fake: Authenticity and authentication.

My thesis exhibition questions the modern sanctification of authenticity. No longer believing in objective truths, the postmodern society seeks epistemic grounding on being true to oneself. The categories of authentic-or-fake replaced the binary of true-or-false. But authenticity is a trojan horse for authentication. As a Korean American artist, I\u27m encouraged to express my “authentic” Korean identity. This encouragement can also imply my works will receive recognition as authentic and meaningful only when they embody Korean cultural expression. Authenticity becomes a performance for the sake of authentication. Ironically, authenticity turns into an act of conformity/confirmation. Authenticity demands you stay true to that one unchanging identity, an essentialist understanding. My four bodies of work raise distinct challenges to the essentialist notion of identity. A fabric art installation presents fabric, a fluid medium, to present the fluid nature of identities in contrast to the canvas which suggests a fixed notion of identity. A large piece reflects on the nature of Ocean as water that separates and connects lands, a space of in-between, and liminality. Two series of paintings mixing visual art with music and poetry explore the nature of hybridity. And the presentation of four distinct bodies of works in the same show and same space is itself a contestation of a singular identity. Which of these works is more authentic? That question is not useful, even harmful. Through diverse forms of art, I show I am multiple, expansive, hybrid and fluid

Historical Horse Racing Dominates Gambling Expenditures in Kentucky—Even Outperforms the Lottery. But Why?

With sports gambling coming to the Commonwealth of Kentucky in September 2023, another competitor to various gaming activities in the state raises the question of how it is doing relative to the others, especially its major competition. As can be seen in the table below, for its first four months of operation, sports gambling in the state brings in almost $900 million and averages around$223 million per month. This average is better than typical monthly lottery sales which come in at around $161 million per month and is far above on and off-track (including simulcasting) racing betting which averages only between$8 and $9 million monthly. But what is most interesting is the size of historical horse racing (HHR) gaming revenues. It is far and above the leader when it comes to gambling revenues in the state and averages from August 2022 to December 2023 around$716 million per month

Mental health counseling for individuals with intellectual disabilities: A phenomenological study of client perspectives.

Mental illness is three to four times as prevalent among individuals with intellectual disabilities compared to those without intellectual disabilities (Munir, 2016). There is a body of research supporting the efficacy of mental health counseling to decrease symptoms and behaviors in individuals with intellectual disabilities, but scarce research exists which describes the experiences of these individuals. This interpretive phenomenological analysis was designed to gather information about how individuals with mild intellectual disabilities experience the four common components of psychotherapy that contribute to change (from Lambert, 1992; Thomas, 2006) – client and extra therapeutic factors, relationships factors, expectancy, and model / techniques – and counseling outcomes. Individuals with mild intellectual disabilities between the ages of 18 and 40, who have had experience with mental health counseling, were interviewed. Interview data from 11 participants were used in this interpretive phenomenological analysis. It was found that the study participants highlighted the power of hope and expectation, as well as the importance of therapeutic alliance. Participants spoke about their family and other caregivers being helpful while they worked to make changes. Many participants also identified strengths within themselves that they drew on. The findings from this study led to several recommendations for mental health counselors and counselor educators. For example, the study highlighted the need for counselors to be aware of the problems for which their clients are at-risk, assess whether their client’s basic needs are being assessed, and be prepared to refer clients for additional support as needed. Counselor educators can provide education, training, and supervision on the needs of individuals with intellectual disabilities to counselors-in-training. Counselor educators can also continue researching best practices for serving individuals with intellectual disabilities. Future research will allow for a fuller understanding of how the field of counseling can best serve this population

Fingerprinting cinematic soundtracks: Examining identity in film music through gender and temporality.

This study examines the soundtracks of six Hollywood films and their treatments of two factors of cinematic identity – gender and temporality. Six case studies are used throughout the thesis using an original analytic system I designate as Fingerprinting, which examines film using a five-tier, intersecting system on both the macro and micro level. The gender chapter analyzes Weird Science (1985) and Pretty Woman (1990) in order to demonstrate the utility of the cinematic soundtrack in constructing new frameworks of gender expression within fictional media. The temporality chapter uses four case studies - Easy Rider (1969), Eddie and the Cruisers (1983), Forrest Gump (1994) and Bill and Ted’s Excellent Adventure (1988) – to expand upon the role that the soundtrack plays in organizing time both within the narrative and as experienced by the audience. Both categories illustrate the utility of Fingerprinting in analyzing music and its relationship to identity in modern cinema

Origin stories.

This thesis is an investigation into the Peruvian pre-Columbian collection at the Speed Art Museum in Louisville, Kentucky. The Speed Art Museum acquired this collection in 1934 and it has largely remained unresearched for nearly a century after acquisition into the museum’s collection. This investigation is not an attempt to make broad characterizations of pre-Columbian ceramics. Nor is its goal to fill in all the gaps of the collection’s history. Instead, this thesis follows the evidence the collection presents: the physical attributes of the ceramics, the donor’s history, U.S. history, and information from the collection file provided by the Speed Art Museum. A small subset of this collection is investigated in this thesis due to time constraints. Of this subset, two ceramics can be attributed to the Moche civilization and two ceramics can be attributed to the Chimú civilization. With these attributions, the next step is to authenticate the ceramics. The profuse reproduction of pre-Columbian ceramics has been frequently ignored by opportunistic dealers and overlooked by collectors in private collections and directors and curators in museum collections. It is much simpler to brush aside these concerns of authenticity than actually delving into the origins of the object, as detailed in this thesis. Still, the story of this collection should have been written long ago, as many of the resources relied on for this investigation have been available for the past 30 years or more

Focused interventions to decrease inpatient falls

Background: Falls are the most commonly reported safety incidence in the hospital setting (Morris R. et al., 2017). Because falls may be a result of many factors, evidence shows that multicomponent fall interventions best reduce fall rates (Bargmann et al., 2020; Dykes et al., 2010; Dykes et al., 2020; Strini et al., 2021). In this project, a needs assessment identified a need for fall prevention strategies to reduce fall rates on inpatient units. Setting: A step-down/telemetry Cardiovascular Intervention Unit (CVI) (15 beds) and Cardiovascular Unit (CVU) (12 beds) in a suburban private hospital. Purpose: The purpose of this evidence-based project was to evaluate the effectiveness of education on nurses’ implementation and documentation of falls prevention interventions on the CVI and CVU Methods: This project consisted of an interrupted time series design. Fall rates, fall prevention and documentation rates were audited and compared before and after an educational read-and-sign discussing multicomponent changes (new falls risk assessment, new interventions, and focus on documentation). Intervention: The intervention was an educational read-and-sign conducted with unit staff to review the current falls prevention interventions and documentation requirements. Data regarding the use of interventions and documentation were collected and analyzed. Results: Post-intervention, four of eight variables demonstrated significant improvement including use of fall bracelet (

A parenting-skills intervention to mitigate adverse childhood experiences for children of parents in substance use disorder recovery.

Abstract Background: Parents recovering from substance use disorder (SUD) are prone to neurobiological alterations that affect parental emotional regulation, increasing occurrence of harsh parenting, heightened stress, and relapse. Children with parents who suffer from SUD experience adverse childhood experiences (ACE), predisposing them to negative health and lifestyle risks. Implementing a parenting-skills intervention for parents in recovery can promote positive-parenting, reduce parenting stress, improve the parent-child relationship, and mitigate the effects of ACEs. Setting: ChooseWell Communities (CWC), a sober-living community, in Louisville, KY served as the project site. Participants at CWC are sober parents with primarily young children under 5 years old, who meet weekly on Wednesday night for accountability and to learn techniques to maintain sobriety. Purpose: This quality improvement project was intended to implement Hope at Home, a parenting-skills curriculum designed for parents with SUD, to decrease parenting stress and improve parent-child relationship to mitigate adverse childhood experiences in their children. This project intended to show that the Hope at Home curriculum could be well received by participants and feasibly and sustainably implemented at CWC. Procedures: Hope at Home was delivered to participants once a week, for 8-weeks, at CWC during regular weekly meeting sessions. Each session lasted approximately 45-60 minutes. Measures: Parental stress was measured utilizing the parenting stress index-short form (PSI-SF). Pre- and post-implementation data were compared to analyze the effectiveness of Hope at Home on decreasing parental stress, thus improving parental engagement, bond, and skills (American Psychological Academy [APA], 2011). Results: There was a statistically significant difference between the pre-PSI-SF and post-PSI-SF at 12-weeks (p=.030). Although not statistically significant, there was a moderately negative correlation between sessions attended and post-8-week PSI-SF total stress scores and post-12-week total stress scores. Paired t-tests comparing male and female participant PSI-SF scores at each phase of data collection did not suggest statistical significance. Discussion: The parenting skills intervention was well received by participants in which they reported high acceptance and agreeance to feedback regarding programming. Generalizability to practice and implementation in other recovery programs is limited as each program is unique. With improved adherence and consistency in participant engagement, more data would have been available to analyze of the participants. CWC intends to incorporate Hope at Home curriculum into their orientation process consisting of 4 to 6 sessions. Lessons will be taught by a board certified Psychiatric Mental Health Nurse Practitioner (PMHNP