From Orwell to Lowry: Why YA Was the Best Thing to Happen to Dystopia

Senior Project submitted to The Division of Languages and Literature of Bard Colleg

Characterization of COPD with biomarkers of inflammation and quantitative CT

BACKGROUND The aim of this thesis was to investigate the role of inflammation in the airways and in the systemic compartment in COPD compared to healthy subjects, and to investigate the relationship between inflammation and the clinical and radiological features of COPD.METHODS 182 COPD patients and 96 healthy control subjects were recruited. Post-bronchodilator spirometry, smoking history, body mass index (BMI), exacerbation frequency, St George's Respiratory Questionnaire (SGRQ) scores, MRC dyspnoea and chronic bronchitis scores, oxygen saturations, 6 minute walking distance and BODE index scores were recorded. Highly sensitive C-reactive protein (CRP), total white cell count and neutrophils were measured in blood. Percentage (%) neutrophils, IL-lp, IL-6 and IL-8 were measured in induced sputum. COPD patients had a quantitative CT scan on inspiration and expiration. Lung volume and density (pixel index -910 HU, pixel index -950 HU, and 15th percentile) were determined using in-house software.RESULTS Systemic inflammation was increased in COPD subjects compared to healthy controls: CRP (p<0.001), blood neutrophils (p<0.001). Pulmonary inflammation was also increased in COPD subjects compared to healthy controls: induced sputum % neutrophils (p=0.001), IL-6 (p=0.02) and IL-8 (p=0.01). Induced sputum IL-1J3 was not increased in COPD compared to controls. Blood neutrophils, CRP, sputum IL-6 and IL-8 were higher in COPD patients compared to healthy controls after adjusting for age, gender and smoking status. Induced sputum was not reliably attainable particularly in healthy control subjects (sample available for 65% of COPD subjects and 26% of healthy controls). In COPD subjects, blood neutrophils (p=0.03) and sputum % neutrophils (p=0.004) were independently related to FEVi after adjusting for age, gender, smoking status and inhaled corticosteroid use. Blood neutrophils and CRP correlated significantly with each other (r=0.408, p<0.001), but were not associated with any of the sputum markers of inflammation. Systemic inflammation was associated with SGRQ total score (neutrophils p=0.02, CRP p<0.001) and MRC dyspnoea score (neutrophils p=0.005, CRP p=0.003) after adjusting for FEVi and smoking status. Blood neutrophils (p=0.02) were associated with oxygen saturations < 93%. BODE index scores correlated with blood neutrophils, (p=0.005), CRP (p=0.03) and sputum IL-8 (p=0.02). After adjusting for potential confounding factors; exacerbation frequency and BMI were not associated with markers of blood or sputum inflammation. Quantitative CT lung volume and density (pixel index -910, pixel index -950 and 15th percentile) on inspiration and expiration were associated with postbronchodilator FEVi % predicted and FEVi/FVC ratio (p<0.001) but not with any of the markers of pulmonary or systemic inflammation. Expiratory CT parameters correlated better with lung function than inspiratory parameters. Lung volumes were inversely associated with BMI on inspiration (r=-0.225, p=0.015) and expiration (r=-0.296, p=0.001). BMI was associated with 15th percentile on inspiration (r=0.518, p<0.001) and expiration (r=0.534, p<0.001) and inversely with pixel index -910 and -950 (p<0.001). BMI was associated with lung density independent of airflow limitation (p=0.03). Lung volume and density were not associated with age, gender, current smoking status, smoking pack years, SGRQ scores, MRC dyspnoea or chronic bronchitis score, exacerbation frequency, oxygen saturations or BODE index.CONCLUSION Markers of inflammation in blood and sputum were increased in COPD compared to healthy controls. Blood and sputum % neutrophils were associated with airflow limitation, but not with lung density. Pulmonary and systemic inflammatory markers had different profiles according to different clinical features of COPD. Inflammatory markers and lung density may be useful in characterizing COPD patients in addition to airflow limitation alone

Coping strategies and adaptation mechanisms utilized by female Holocaust survivors from the Auschwitz Concentration Camp

The female experience during the Holocaust has largely been ignored as significantly different than that of male counterparts. This gender-specific research study investigates the unique, poignant voices of women\u27s coping strategies utilized during internment in the Auschwitz Concentration Camp. Focusing specifically on the video oral history testimonies of the complete collection of female survivors of Auschwitz, which were produced by the United States Holocaust Memorial Museum, the study suggests that the predominate coping strategies used by females was affiliation with others as the means of survival. Through the utilization of clustering sheets, the data suggested that affiliation and assistance from others was essential in female survival and coping, coupled primarily with the utilization of emotion-focused coping strategies. Additionally, the study utilizes telephone interviews with the Holocaust survivors in the sample, three to five years after their testimonies were elicited as part of the permanent exhibits and research archives at the United States Holocaust Memorial Museum. The findings from the interviews concur with the predominant utilization of affiliation as a coping mechanism for survival of massive traumatization during internment in the Auschwitz Concentration Camp

Measuring the Impact of Cognitive Behavioral Coaching with Nonverbal Immediacy on the Self-Efficacy of Undergraduate Students in STEM Courses

A quasi-experimental study explored whether the practice of cognitive behavioral coaching with an intentional focus on nonverbal immediacy has an impact on the self-efficacy of undergraduate students taking college-level STEM (Science, Technology, Engineering, and Mathematics) courses. A positive impact to self-efficacy for students who receive the coaching intervention was anticipated. The research took place at a public research university located in the Midwest. Subjects included students who were required to work with a success coach as a condition of their enrollment and/or financial aid eligibility. Information obtained included perception of nonverbal immediacy of the coaches and self-efficacy of the student, as determined by existing assessments called, Nonverbal Immediacy Scale – Observers and Self-Efficacy for Learning Form – Abridged version. Success coaches provided the coaching intervention to students through a prescribed protocol of at least four face-to-face meetings throughout the semester with regular contact via email and phone. Students participated in the coaching interventions as mentees. Students received support by coaches to supplement their academic pursuits. Paired t-Tests (see Table 7) did not confirm that there was a significant difference between the pre-assessment scores, and the post-assessment scores; therefore, the null hypotheses were not rejected

Chronic pain self-management support with pain science education and exercise (COMMENCE): Study protocol for a randomized controlled trial

© 2015 Miller et al. Background: Previous research suggests that self-management programs for people with chronic pain improve knowledge and self-efficacy but result in negligible effects on function. This study will investigate the effectiveness self-management support with pain science education and exercise on improving function for people with chronic pain in comparison to a wait-list control. A secondary objective is to determine which variables help to predict response to the intervention. Methods/Design: This study will be an unblinded, randomized controlled trial with 110 participants comparing a 6-week program that includes self-management support, pain science education and exercise to a wait-list control. The primary outcome will be function measured by the Short Musculoskeletal Function Assessment - Dysfunction Index. Secondary outcomes will include pain intensity measured by a numeric pain rating scale, pain interference measured by the eight-item PROMIS pain interference item-bank, how much patients are bothered by functional problems measured by the Short Musculoskeletal Function Assessment - Bother Index, catastrophic thinking measured by the Pain Catastrophizing Scale, fear of movement/re-injury measured by the 11-item Tampa Scale of Kinesiophobia, sense of perceived injustice measured by the Injustice Experience Questionnaire, self-efficacy measured by the Pain Self-Efficacy Questionnaire, pain sensitivity measured by pressure pain threshold and cold sensitivity testing, fatigue measured by a numeric fatigue rating scale, pain neurophysiology knowledge measured by the Neurophysiology of Pain Questionnaire, healthcare utilization measured by number of visits to a healthcare provider, and work status. Assessments will be completed at baseline, 7 and 18 weeks. After the 18-week assessment, the groups will crossover; however, we anticipate carry-over effects with the treatment. Therefore, data from after the crossover will be used to estimate within-group changes and to determine predictors of response that are not for direct between-group comparisons. Mixed effects modelling will be used to determine between-group differences for all primary and secondary outcomes. A series of multiple regression models will be used to determine predictors of treatment response. Discussion: This study has the potential to inform future self-management programming through evaluation of a self-management program that aims to improve function as the primary outcome. Trial registration: ClinicalTrials.gov NCT02422459 , registered on 13 April 2015