In Search of a Single Voice: The Politics of Form, Use and Belief in the Kernewek Language

This dissertation is based upon fieldwork performed between 2007 and 2011 in Cornwall, a region of Southwestern Britain notable for its ambiguous ethnic identity - caught between England and the Celtic nations - and its unique, revived Celtic language, Kernewek. During the course of the research, work focused upon the role of the language revival movement as a tool for ethnic identification: hardening boundaries, shoring up faltering communities and nationalist purification. However, the language movement is divided into three primary factions, which take differing approaches to the language, and to their corresponding language ideology based upon their relationship to Cornish identity. These relationships are based upon speakers\u27 sense of ethnic self as formed through class, kinship, linguistic self-perception, religious and political affiliations and place of birth and childhood. However, since the 2006 recognition of the language by the British states, all of these debates have become intensified due to pressure to standardize. This study examines specific examples including: teaching materials and pedagogical approaches in the language, debates over the minutiae of spelling, aesthetic sensibilities, and practices of the naming and renaming of people and places

Retractable Hammock

This Final Design Review will recap the objectives, background, design ideation, and concept development of the Retractable Hammock senior capstone project and continue to report on the final design and manufacturing that resulted in the final iteration of the Retractable Hammock

Virtue, flourishing, and religious and cultural diversity in psychotherapy

[The key thesis across many virtue traditions that growth in character strengths and relational virtues should lead to growth in human flourishing remains mostly untested in the context of mental healthcare. We should empirically test this big idea with appropriate attention to the potentially complex relationships between mental distress, virtue, and flourishing among diverse individuals and contexts over time. ]First author draf

Barriers to Implementation of a Technology-Based Mental Health Intervention in a Rural Setting

This study utilized qualitative focus groups with rural health providers and patients to explore barriers to implementation of a technology-based mental health intervention for the treatment of depression in a primary care setting. A randomized controlled trial (RCT) was implemented in both urban and rural primary care practices to test the feasibility and effectiveness of computerized cognitive behavioral therapy (CCBT) for depression. Early implementation identified lower rates of willingness to participate in the intervention by rural patients. Subsequently, focus groups were conducted with rural providers and patients to explore barriers to participation and strategies to overcome these barriers in future implementation efforts. Two focus groups of five to seven participants each were conducted to understand patient experiences. Groups lasted approximately one hour and were recorded and transcribed for coding purposes. Key themes identified about barriers to use of CCBT by rural patients emerged included: 1) technical barriers, 2) stigma, 3) distrust of outsiders, 4) effort/motivational barriers, and 5) staff resistance/frustration. Conversely, several positive themes related to supports for CCBT also emerged, including: 1) readiness to change/symptom severity, 2) program supports and incentives, 3) clinician support, 4) components of the intervention, and 5) individual patient characteristics

Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial

Importance Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Objectives To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. Design, Setting, and Participants This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire–9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. Interventions CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master’s level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. Main Outcomes and Measures The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder–7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire–8. Results The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, −2.5; 95% CI, −4.5 to −0.8; P = .005) and 3 month (mean difference, −2.3; 95% CI, −4.5 to −0.8; P = .006) and 6 month (mean difference, −3.2; 95% CI, −4.5 to −0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). Conclusions and Relevance In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome

Impact of the COVID-19 Pandemic on Patient Preferences and Decision Making for Symptomatic Urolithiasis

Background: Pandemic restrictions have changed how patients approach symptomatic kidney stones. We used a mixed-methods digital ethnographic approach to evaluate social media discussions about patient concerns and preferences for urolithiasis care during the COVID-19 pandemic. Materials and Methods: We retrospectively analyzed kidney stone-related discussions on a large social media platform using qualitative analysis and natural language processing-based sentiment analysis. Posts were mined for demographic details, treatments pursued, and health care encounters. Pre-COVID-19 (January 1, 2020-February 29, 2020) and COVID-19 (March 1, 2020-June 1, 2020) posts were extracted from the popular online Reddit discussion board, r/KidneyStones, which is dedicated to discussions related to urolithiasis. Results: We extracted n = 649 posts (250 pre-COVID-19, 399 COVID-19); 150 from each cohort underwent thematic analysis and data extraction. Quantitative sentiment analysis was performed on 418 posts (179 pre-COVID-19, 239 COVID-19) that described stone-related decision making before intervention. Notable discussion themes during COVID-19 focused on barriers to care and concerns about stone management. Discussants exhibited more negative and anxious tones during COVID-19, based on sentiment analysis (p \u3c 0.01). Patient preferences shifted away from in-person visits and procedures (p \u3c 0.001). Mean reported stone size among those visiting emergency room (ER) increased from 5.1 to 10.5 mm (p \u3c 0.001). The proportion of discussants preferring conservative management with stones ≥10 mm increased (12.5% pre-COVID-19 vs 26% during COVID-19, p = 0.002). Opioid mentions increased from 9% to 27% of posts (p \u3c 0.001) and were most associated with conservative management discussions. Conclusions: Online discussion forums provide contemporaneous insight into patients\u27 experiences during a time when traditional patient-centered research methodologies are limited due to social distancing. During the pandemic, patients with symptomatic kidney stones expressed anxiety regarding outpatient encounters and reluctance toward procedural intervention. Patients opted instead for at-home conservative treatment beyond clinical guidelines and reserved ER visits for larger stones, potentially causing self-harm. Opioid discussions proliferated, an alarming consequence of the pandemic

Session Reactions Scale-3 : initial psychometric evidence

Objective This study aimed to develop an updated brief self-report post-session measure, suitable for collecting systematic feedback on clients’ session reactions in the context of measurement-based care (MBC). Method: The Session Reactions Scale-3 (SRS-3; 33 items) was developed by extending and adjusting the Revised Session Reactions Scale. In Study 1, the psychometric properties of the SRS-3 were tested on N = 242 clients. In Study 2, a brief version of the SRS-3 (SRS-3-B; 15 items) was developed using a combination of conceptual, empirical, and pragmatic criteria. In Study 3, the psychometric properties of the SRS-3-B were tested on a new sample of N = 265 clients. Results: Exploratory factor analysis supported the use of the SRS-3-B as a two-factor (helpful reactions, hindering reactions) or unidimensional (overall session evaluation) instrument. The SRS-3-B was meaningfully related to another process measure (Individual Therapy Process Questionnaire) both on the item and factor levels. Conclusions: The SRS-3-B is a reliable process measure to elicit rich and clinically meaningful feedback from clients within the MBC context and as a research instrument to assess the helpful and hindering aspects of therapy sessions

Phylogenetic evidence from freshwater crayfishes that cave adaptation is not an evolutionary dead-end.

Caves are perceived as isolated, extreme habitats with a uniquely specialized biota, which long ago led to the idea that caves are evolutionary dead-ends. This implies that cave-adapted taxa may be doomed for extinction before they can diversify or transition to a more stable state. However, this hypothesis has not been explicitly tested in a phylogenetic framework with multiple independently evolved cave-dwelling groups. Here, we use the freshwater crayfish, a group with dozens of cave-dwelling species in multiple lineages, as a system to test this hypothesis. We consider historical patterns of lineage diversification and habitat transition as well as current patterns of geographic range size. We find that while cave-dwelling lineages have small relative range sizes and rarely transition back to the surface, they exhibit remarkably similar diversification patterns to those of other habitat types and appear to be able to maintain a diversity of lineages through time. This suggests that cave adaptation is not a dead-end for freshwater crayfish, which has positive implications for our understanding of biodiversity and conservation in cave habitats

Turbulence-driven ion beams in the magnetospheric Kelvin-Helmholtz instability

The description of the local turbulent energy transfer via a heuristic proxy derived from the third-order moment scaling law, and the high-resolution ion distributions measured by the Magnetospheric Multiscale mission, together provide a formidable tool to explore the cross-scale connection between the fluid-scale energy cascade and plasma processes at sub-ion scales. Using magnetospheric boundary layers measurements, we show that when the small-scale energy transfer is dominated by Alfvénic, correlated velocity and magnetic field fluctuations, beams of accelerated particles are more likely observed. Here, for the first time we report observations suggesting the nonlinear wave-particle interaction as one possible mechanism for the energy dissipation in space plasmas