How Bats View their Flowers: Exploring the Use of Visual Floral Cues by Nectarivorous Neotropical Bats

Neotropical nectar bats in cloud forest ecosystems must navigate and forage in dark, complex landscapes containing an incredible diversity of flowering plants. Despite these challenges, nectar bats are extremely successful at exploiting nectar resources from plants. Much of the sensory ecology behind these bat-plant interactions has been investigated and we know from previous studies that echolocation and olfaction are critical sensory modalities to nectar bats. Echo-acoustically conspicuous floral and vegetative structures as well as sulfur-containing volatile compounds function as signals, allowing bats to sense plants. However, not all plants exhibit conspicuous echo-acoustic and/or olfactory characteristics. Furthermore, many neotropical bat-pollinated plants exhibit pale/light coloration which could act as a visual signal to nectar bats. Still, the use of vision by foraging nectar bats has seldom been investigated and there is currently no behavioral evidence to suggest whether nectar bats use vision to detect flowers. In Chapter 1, I investigate how Anoura caudifer, a specialist nectarivore, uses vision and echolocation to detect and discriminate between flowers exhibiting different combinations of visual and echo-acoustic cues. I also explore how environmental light (above the range of natural moonlight) influences the sensory modalities that bats employ to aid foraging. The results from this study did not indicate that bats were using achromatic floral cues to discriminate between different flowers. However, we did find evidence that when light was available, bats used vision to detect flowers and visit them indiscriminately. Furthermore, bats only successfully used echo-acoustic cues when no light was present. In Chapter 2, I investigate how Glossophaga soricina, a dietary generalist, uses achromatic visual cues to detect flowers under natural moonlight conditions. The results showed that bats found flowers more quickly when they were presented against a highly contrasting background, indicating that bats were successful at using achromatic contrast to detect flowers. These studies provide evidence that nectar bats can use vision in different contexts to aid foraging. Finally, both studies support the need for further research in this, still largely unexplored, area of nectar bat sensory ecology

An empirical analysis of factors affecting the commercial adoption of autonomous trucks

Autonomous semi-trucks are poised to be a disruptive technology in the motor carrier industry, and many studies extol the virtues of autonomous vehicles. The benefits cited in these studies generally assume high market penetration rates, yet there is a lack of rigorous qualitative studies that investigate the factors that will drive autonomous truck adoption in the commercial transportation sector. This study describes a conceptual model featuring twelve factors that may affect autonomous truck adoption. These factors were identified from a grounded theory analysis of semi-structured interviews with a sample of transportation professionals from different companies, positions, and geographic regions within the United States. The results shed light on what might spur adoption of autonomous technologies in the motor carrier industry and provide information that can guide the development of new technologies, procedures, and regulations

Implementation of Telehealth Optimization to Improve Postpartum Visit Adherence

Problem: Postpartum appointment attendance remains a critical aspect of maternal healthcare, particularly among women in an inner-city, urban outpatient setting. Despite prior efforts to improve scheduling efficiency and telehealth adoption, no-show rates for the first weeks postpartum visit, both in-person and virtual visits, remain consistently high, limiting access to essential postpartum care. This study aimed to increase the postpartum compliance (comp) rate by 5% through the implementation of telehealth scheduling improvements. Methods: A quality improvement (QI) project was conducted at an urban, outpatient Women’s Health Clinic (WHC) serving a diverse inner-city population. The intervention focused on refining scheduling processes by integrating the .PPVISIT communication tool, which facilitated coordination between inpatient discharge providers and outpatient WHC schedulers. Additionally, Nurse Practitioners (NPs) were encouraged to schedule postpartum appointments before an induction of labor (IOL) date to improve attendance rates. Data collection included pre- and post-intervention show rates for virtual and in-person visits, with statistical analysis using a Chi-square test to examine relationships between intervention implementation of the communication tool .PPVISIT and appointment type. Results: Following the intervention period, postpartum appointment compliance rates increased modestly from 54.74% to 59.06%. However, statistical analysis found no significant association between intervention implementation and appointment type, indicating that in-person visits remained the preferred modality. Virtual visit attendance remained unchanged at 50%, with persistent no-show rates among vaginal delivery patients. Also, systemic challenges, including staffing disruptions and communication barriers between inpatient and outpatient teams, limited the overall effectiveness of the intervention. Implications: While the intervention did not achieve a statistically significant increase in compliance rates, the findings highlight potential areas for future improvement. Strengths of the project included its diverse patient population, high patient volume, and the introduction of communication tools that facilitated more efficient scheduling coordination. Future initiatives should focus on addressing telehealth adoption barriers, optimizing scheduling workflows, and refining outreach strategies to enhance postpartum appointment attendance. Incorporating patient-centered engagement efforts and leveraging qualitative feedback could further improve postpartum care accessibility and adherence

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults Abstract: Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population. Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive statistics were used for the demographic data and the pre- and post-intervention Visit-A-Bit screening assessment instrument data. The Wilcoxon signed-rank test was used to analyze changes in the Visit-A-Bit screening assessment instrument pre- and post-intervention. Results: A total of seven participants completed the intervention. Findings demonstrated a statistically significant decrease in loneliness frequency and a statistically significant increase in quality of life. No statistically significant differences were observed in the PHQ-2, LSNS-6, or DJGLS. Implications for Practice: Implementing weekly befriending visits and mindfulness interventions can help increase social interaction and decrease the frequency of loneliness. The results of this project can encourage other facilities with a similar population of residents to implement or develop a similar program

A Four-Truth Exploration of Memory, Social Connection, and Belonging in Fairground and Tower Grove Parks in St. Louis, Missouri

Historic racism supported practices such as redlining, discriminatory zoning, and racial steering that separated people and determined the flow of resources and investment into neighborhoods. Communities continue to experience the long tail effects of historic patterns of racism. That is, historic inequities influence the opportunities that residents have to connect with each other and thrive in urban areas. Urban neighborhood parks have the potential to bridge social divides and bring a community together. This basic qualitative research study examines two contested heritage sites in St. Louis, Missouri: Fairground Park, a park in a Black neighborhood that has been historically disinvested in, and Tower Grove Park, a park in a predominantly white area that has received substantial investment. Researchers conducted 22 interviews with park goers, residents, community stakeholders, and organizational leaders, immersed themselves in onsite observations, and examined relevant documents and artifacts to explore people-place connections. Data were analyzed using reflexive thematic analysis, including a priori and in vivo coding of interview transcripts, to understand how participants experience and engage with their neighborhood parks. Our examination of park-community interactions and place attachment in urban parks highlights the importance of memory, social connection, and belonging as factors that support efforts to build and sustain community wellbeing. Researchers produced two research products: (1) a journal article that uses place attachment theory and the PPP Framework to examine how the process and place dimensions of parks create a sustainable community, and (2) a creative nonfiction chapter that harnessed the power of four truth framework to explore the connections that park goers have to their neighborhood park. Respondents from both parks emphasized that memory shapes one’s identity; social connection reinforces memory and belonging; and belonging helps people move from visiting a park to contributing to a community. Our research explored processes that, when combined with policies and investments to address historic imbalances, help dismantle the lingering effects of systemic inequities due to historic racism and ensure that parks are equitable spaces that serve all community members

Variable Importance, Knockoff Filters, and Improving False Discovery and False Negative Rates

Tree ensemble methods such as Random Forests and Boosted Trees have introduced a range of variable importance statistics, offering powerful tools for feature selection. The advent of knockoff filters marked a significant advancement by combining the use of these variable importance statistics with the ability to control the False Discovery Rate (FDR). However, achieving a low FDR frequently comes at the cost of a high False Negative Rate (FNR), limiting the power of such approaches. In this work, we propose a novel method for leveraging knockoff variables to keep both FDR and FNR low. While this method does not have a specific mechanism to control the FDR, for many data sets the method produces results with lower FDR and FNR. Our approach builds upon established techniques for knockoff variable construction and incorporates a comparative analysis of variable importance measures derived from tree ensemble models. We introduce a new variable selection strategy and demonstrate its performance relative to existing methods. We call this strategy the Positive Difference Algorithm

Palliative Care Beyond Cancer: The Use of the P-CaRES Tool

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers? This project was conducted over 9 weeks, utilizing convenience sampling to select 20 patients who screened positive for potential benefits from palliative care. The project was conducted in a 28-bed rural emergency department in southeast Missouri. Providers who assisted in the screening and placement of orders were surveyed after the collection period to evaluate their experience. The most frequently identified interventions for patients included Social Work consultation, medical device use, and therapeutic and supportive medications. The results did not show a high frequency of referrals to palliative care services, despite the high frequency of positive screenings. No significance was found within the Admit, Transfer, or Discharge Categories for disposition. However, findings suggest a relationship between the P-CaRES screening form and the number of patients placed on hospice care during the study period. Analysis of providers’ opinions suggest that the P-CaRES screening is a valuable tool in identifying patients who may benefit from palliative care or hospice services. Further investigation should be undertaken to expand the role of palliative care screening and hospice screening within the emergency department. Future research should focus on overcoming barriers such as staff involvement, patient assessment, and earlier screening efforts. Expanding the role of screening to both palliative and hospice care may offer more opportunities for individuals with advanced chronic diseases to receive support and quality healthcare for their disease management

Increasing Access to Asthma Education through Digital Technology and Surveying Preferences of Children and Families

Abstract Asthma is a chronic respiratory condition impacting approximately 4.6 million children, with high rates of uncontrolled cases in Missouri. This quality improvement project aimed to explore the use of a digital media system to provide asthma education to children and families receiving care in a rural pediatric pulmonology clinic aged 6 months- 21 years of age; and to assess preferred media format, priority topics, and knowledge gained from exposure to digital educational materials. Utilizing a prospective cohort design, families completed a pre-survey to identify educational preferences and tailored digital asthma education through the use of Patient Education Genius (PEG). A post-survey measured knowledge retention and satisfaction. Over the 20-week period, 37 families expressed interest in digital asthma education, 13 completed the pre-survey, and one completed the post-survey. Although statistical analysis was not feasible due to insufficient data, initial data showed strong interest in digital education. Families prioritized areas of learning such as emergency care, trigger identification, and medication administration. Non-cartoon and cartoon media were rated as equally beneficial for learning purposes. Multiple limitations were observed over the course of this quality improvement study. However, this project indicates digital tools may enhance asthma education. Future research is encouraged with utilization of a large sample size and robust study design to combat observed limitations and evaluate digital media’s true impact on asthma education and disease management within the pediatric population

The Clinical Utility of Measuring Emotion Dysregulation in Autistic Youth

Autistic youth experience disproportionately high rates and severity of emotion dysregulation, which is linked to behavioral challenges, psychiatric comorbidities, familial stress, and increased emergency service and hospitalization use. Despite its clinical significance, emotion dysregulation in autistic youth remains relatively understudied and misunderstood, partly due to the lack of standardized assessment tools and limited research on its heterogeneity within autistic populations. In the present study, structural equation modeling was used to 1) validate the Emotion Dysregulation Inventory (EDI) and assess measurement invariance in a diverse sample and 2) explore associations among emotion dysregulation, autism symptoms, and related child and family characteristics, and 3)identify unique profiles of emotion dysregulation and core autism symptoms, exploring their associations with treatment-relevant factors including behavior problems, parental and environmental stress, sleep, and feeding behaviors. Results supported the two-factor structure of the EDI and demonstrated measurement invariance across racial, ethnic, and linguistically diverse groups, confirming its utility as a robust and flexible tool. Additionally, latent profile analysis identified three distinct phenotypic subgroups with varying levels of emotion dysregulation and autism symptoms, which were meaningfully associated with key child and family characteristics, highlighting their relevance for intervention and support planning. This study advances the understanding of emotion dysregulation in autism and underscores the importance of individualized assessment and intervention approaches. Findings also emphasize the need for continued refinement of measurement tools and exploration of the mechanisms underlying emotion dysregulation in autistic youth. Ultimately, improving our ability to assess and characterize emotion dysregulation will support more personalized, equitable, and effective interventions for autistic individuals and their families

Race-Neutral PFT: Implementing Patient Activation Measure Following Race- Neutral Pulmonary Function Testing

Abstract Background The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool. Purpose The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient activation. Methods A prospective study was conducted at an adult pulmonary medicine clinic. An initial PAM survey was conducted for adult patients who identified as a minority in the electronic health record with a previous pulmonary function test who are scheduled for a race-neutral PFT. A second PAM survey was conducted for those patients who received a new or modified diagnosis after the race-neutral PFT. Demographic data including race, age, and biological sex was collected from the electronic health record. The pre- and post-PAM survey data was analyzed using a paired t-test and Wilcoxon signed-rank test. Results There were 630 patients scheduled for a PFT during the study period. Out of the 630 patients, 21 patients met initial criteria to receive the PAM survey, and eight patients received both the initial and secondary (pre and post) PAM survey. The sample included six patients who identified as black/African American, one who identified as Hispanic, and one who identified as Asian. The mean pre-PAM score was found to be 1.38 and the post PAM score was 2, showing a slight average improvement. Both the two-sided paired t-test and Wilcoxon signed rank test were not statistically significant. Conclusion Although limited by the small sample size, the study identified a low baseline PAM level of the participants which is consistent with existing literature. Identifying a low PAM level is clinically significant because it highlights a critical area for possible interventions to improve patient outcomes and self-management. Future studies are needed to improve statistical insights and generalizability of the findings. Keywords: race-neutral pulmonary function testing, Patient Activation Measure (PAM), health equity, chronic lung diseas