Addressing Psychological Distress in Orthopaedic Trauma Patients

Background: Psychological outcomes of trauma play an integral role in the long-term recovery of patients. Previous studies show that almost half of patients with severe lower-extremity trauma screened positive for psychological distress, including moderate to severe depression and phobic anxiety. In trauma patients, post-traumatic stress disorder (PTSD) has been shown to be the strongest determinant of health outcomes and is more influential than injury severity, chronic medical conditions, age, sex, pre-injury function, and alcohol use. Higher levels of psychological distress have been linked with lower levels of physical function during early and late recovery following injury. Many psychological interventions are based on Bandura’s concept of self-efficacy. Self-efficacy is defined as one’s belief in one’s capacity to perform any activity and has been shown to mediate the relationship between pain intensity, depression, and disability. To ensure trauma care is patient-centered, all providers involved in the care of trauma patients must begin to attend to the psychological as well as the physical manifestations of injury at admission as well as during recovery. Methods: I conducted key stakeholder interviews with 15 providers and staff at UNC Health Care to identify the obstacles to developing a clinic-based mental health program for trauma patients. These interviews yielded 236 minutes of responses, which I systematically coded for kind, type, and direction of substantive comments. Results: Thirteen (87%) respondents stated there was a large burden of psychological distress in trauma patients, and a different 13 (87%) respondents noted that trauma patients’ psychological distress is poorly assessed, or not assessed at all, currently at UNC. Twelve (80%) respondents mentioned using a screening tool to improve assessment. Money (or cost) was most commonly mentioned (11 or 73%) as a barrier to creating new services. Respondents also recognized time, space, and personnel support as other major challenges. Systematic barriers included a fragmented health system, lack of primary care physician, lack of access to mental health care resources, and poor reimbursement for mental health care. Seven (47%) respondents emphasized the need for effective interventions, stressing a direct relationship between effectiveness and sustainability. Conclusions: There is a large unmet need for mental health services in trauma patients. These interviews reveal the strong agreement across all domains of clinical service on the size of the problem and the need to solve it: establishing mental and behavioral health services as a routine part of trauma patients’ care and recovery is essential, but at present it will take creative collaboration to initiate such services in the face of real obstacles of time, money, and space. Clinical Relevance: The global goal of this proposed intervention will be to improve health-related quality of life and lower the likelihood of injury-related disability in orthopaedic trauma patients by helping them to develop their self-efficacy and mitigate mental health sequelae. Cost is an obvious concern, as is determining efficacy and utility.Master of Public Healt

Time dependent CP asymmetry in B0→ρ0γB^0 \to \rho^0 \gamma decay to probe the origin of CP violation

Since the CP violation in the $B$ system has been investigated up to now only through processes related to the $B$--$\bar{B}$ mixing, urgently required is new way of study for the CP violation and establishing its origin in the $B$ system independent of the mixing process. In this work, we explore the exclusive $B^0 \to \rho^0 \gamma$ decay to obtain the time-dependent CP asymmetry in $b \to d$ decay process in the standard model and the supersymmetric model. We find that the complex RL and RR mass insertion to the squark sector in the MSSM can lead to a large CP asymmetry in $b \to d \gamma$ decay through the gluino-squark diagrams, which is not predicted in the Standard Model induced by the $B$--$\bar{B}$ mixing.Comment: 10 pages, 4 eps figure

Early Predictors of Successful Military Careers Among West Point Cadets

The importance of leadership to organizational performance puts a premium on identifying future leaders. Early prediction of high-potential talent enables organizations to marshal scarce develop- mental resources and opportunities to those who are best positioned to show distinction in elevated roles. Much of the existing literature indicates that general mental ability remains the strongest predictor of future professional performance. Using data from 13 classes of West Point graduates who stayed in the Army to be considered for at least early promotion to the rank of major (N = 5,505), regression analyses indicate that cadet military grade point average surpasses both cognitive ability and academic performance by a considerable margin in the ability to predict future professional outcomes such as selection for early promotion or battalion command. Moreover, these differences in predicting managerial career outcomes endure over 16 years. Both practical and theoretical implications are discussed.https://digitalcommons.usmalibrary.org/books/1054/thumbnail.jp

Using a Case Study to Teach Leaders How to Enact Positive Organizational Change

https://digitalcommons.usmalibrary.org/books/1062/thumbnail.jp

Comparison of the scintillation noise above different observatories measured with MASS instruments

Scintillation noise is a major limitation of ground base photometric precision. An extensive dataset of stellar scintillation collected at 11 astronomical sites world-wide with MASS instruments was used to estimate the scintillation noise of large telescopes in the case of fast photometry and traditional long-exposure regime. Statistical distributions of the corresponding parameters are given. The scintillation noise is mostly determined by turbulence and wind in the upper atmosphere and comparable at all sites, with slightly smaller values at Mauna Kea and largest noise at Tolonchar in Chile. We show that the classical Young's formula under-estimates the scintillation noise.The temporal variations of the scintillation noise are also similar at all sites, showing short-term variability at time scales of 1 -- 2 hours and slower variations, including marked seasonal trends (stronger scintillation and less clear sky during local winter). Some correlation was found between nearby observatories.Comment: Accepted for publication in Astronomy and Astrophysics, 14 pages, 11 figure

The design and operation of locomotive laboratories

Thesis (BS)--University of Illinois, 1913TypescriptIncludes bibliographical reference

De-Trending Time Series for Astronomical Variability Surveys

We present a de-trending algorithm for the removal of trends in time series. Trends in time series could be caused by various systematic and random noise sources such as cloud passages, changes of airmass, telescope vibration or CCD noise. Those trends undermine the intrinsic signals of stars and should be removed. We determine the trends from subsets of stars that are highly correlated among themselves. These subsets are selected based on a hierarchical tree clustering algorithm. A bottom-up merging algorithm based on the departure from normal distribution in the correlation is developed to identify subsets, which we call clusters. After identification of clusters, we determine a trend per cluster by weighted sum of normalized light-curves. We then use quadratic programming to de-trend all individual light-curves based on these determined trends. Experimental results with synthetic light-curves containing artificial trends and events are presented. Results from other de-trending methods are also compared. The developed algorithm can be applied to time series for trend removal in both narrow and wide field astronomy.Comment: Revised version according to the referee's second revie

Oxytocin, Cortisol, and Cognitive Control During Acute and Naturalistic Stress

Although stress is a strong risk factor for poor health, especially for women, it remains unclear how stress affects the key neurohormones cortisol and oxytocin, which influence stress-related risk and resilience. Whereas cortisol mediates energy mobilization during stress, oxytocin has anti-inflammatory, anxiolytic, and analgesic effects that support social connection and survival across the lifespan. However, how these neurohormones interrelate and are associated with cognitive control of emotional information during stress remains unclear. To address these issues, we recruited 37 college-aged women (Mage = 19.19, SD = 1.58) and randomly assigned each to a one-hour experimental session consisting of either an acute stress (emotionally stressful video) or control (non-stressful video) condition in a cross-sectional manner across the semester. Salivary cortisol and oxytocin samples were collected at baseline and after the video, at which point participants also completed measures assessing affect and an emotional Stroop task. As hypothesized, the emotional stressor induced negative emotions that were associated with significant elevations in cortisol and faster Stroop reaction times. Moreover, higher baseline oxytocin predicted greater positive affect after the stressor and also better cognitive accuracy on the Stroop. Analyses examining the naturalistic stress effects revealed that basal oxytocin levels rose steeply three weeks before the semester’s end, followed by rising cortisol levels one week later, with both neurohormones remaining elevated through the very stressful final exam period. Considered together, these data suggest that women’s collective experiences of stress may be potentially buffered by a synchronous oxytocin surge that enhances cognitive accuracy and reduces stress “when the going gets tough”

MHD Accretion-Disk Winds as X-ray Absorbers in AGNs

We present the 2D ionization structure of self-similar MHD winds off accretion disks around irradiated by a central X-ray source. Based on earlier observational clues and theoretical arguments, we focus our attention on a subset of these winds, namely those with radial density dependence n(r)~1/r. We employ the photoionization code XSTAR to compute the ionic abundances of a large number of ions of different elements and then compile their line-of-sight (LOS) absorption columns. Particular attention is paid to the absorption measure distribution (AMD), namely their Hydrogen-equivalent column per logarithmic ionization parameter \xi interval, d N_H/(d \log \xi), which provides a measure of the winds' radial density profiles. For n(r)~1/r the AMD is found to be independent of \xi, in good agreement with its behavior inferred from the X-ray spectra of several AGNs. For the specific wind structure and X-ray spectrum we also compute detailed absorption line profiles for a number of ions to obtain their LOS velocities, v~100-300 km/sec (at \log \xi~2-3) for Fe XVII and v~1,000-4,000 km/sec (at \log \xi~4-5) for Fe XXV, in good agreement with the observation. Our models describe the X-ray absorption properties of these winds with only two parameters, namely the mass-accretion rate \dot{m} and LOS angle \theta. The probability of obscuration of the X-ray ionizing source in these winds decreases with increasing \dot{m} and increases steeply with \theta. As such, we concur with previous authors that these wind configurations, viewed globally, incorporate all the requisite properties of the parsec scale "torii" invoked in AGN unification schemes. We indicate that a combination of the AMD and absorption line profile observations can uniquely determine these model parameters and their bearing on AGN population demographics.Comment: Accepted to ApJ, 34 pages, 8 figures, 1 tabl