Music teacher experiences of trauma sequelae in the elementary general music classroom: a case study

Music educators routinely encounter challenging behaviors in their classrooms. Due to the ubiquity of trauma in our society and the multiple intersections between trauma-related disorders and emotional/behavioral disorder diagnoses, it is possible that challenging behaviors are influenced by trauma and, therefore, require specialized responses. In this study, I investigated the identification of and response to trauma sequelae, the changes to biological and psychological function occurring post-trauma, within an elementary general music classroom for students with severe emotional/behavioral disorders. The questions (a) What were the perceptions of the general music teacher in this study regarding their ability to identify students’ potential trauma triggers?; (b) What were the perceptions of the general music teacher in this study regarding their ability to accurately identify typical trauma reactions including hyperarousal, intrusion, constriction, doublethink, dissociation, and disempowerment?; (c) In what ways did the general music teacher in this study respond to student trauma reactions including hyperarousal, intrusion, constriction, doublethink, dissociation, and disempowerment?; and (d) What barriers, if any, impeded the elementary general music teacher’s appropriate responses to trauma reactions including hyperarousal, intrusion, constriction, doublethink, dissociation, and disempowerment? guided this study. Taking a qualitative approach, the bounded system for this instrumental case study was defined as one music class section, including the students, their music teacher, the classroom assistants, and the paraprofessional staff assigned to that section in a special education setting. The study was conducted in two phases. In Phase One, or the archiving phase, I sought to better qualify the trauma history of the student participants. Through documentation review and interviews with the school’s admissions director, I was able to identify the traumatic experiences that might have influenced behaviors observed in the music classroom. Phase Two of the study included in-person observations in the music room, within the context of the larger school community, and in an online class session, including field notes, sketches of the environment, and videotaping of the class, teacher and researcher free journaling, guided journaling, and adult participant interviews. As the data were analyzed, moments of convergence and divergence surrounding issues of connection, disconnection, and attunement emerged. These moments occurred in multiple ways between all participants within the case. Trauma responses including hyperarousal, intrusion, constriction, doublethink, dissociation, and disempowerment were observed during the class meeting times. The music teacher in the study maintained an accurate perception of her ability to identify trauma responses and acknowledged that externalized behaviors were more likely to identify and respond to than those that were internalized. Although she agreed that the behaviors warranted intervention, she struggled to connect them to the underlying trauma influencing the behaviors. When responding in an attuned manner, leveraging principles of trauma-informed care, she was routinely able to meet the needs of the students and de-escalate trauma-related behaviors. Barriers to the music teacher’s response included lack of attunement to the needs of the students, inadequate pre- in-service instruction specific to music pedagogy for students with advanced behavioral health needs, scheduling and collaboration conflicts, lack of access to educational and biopsychosocial documentation, and the experiencing of secondary traumatic stress symptoms. In refining trauma theory in the context of elementary general music teacher experiences of trauma sequelae, I documented an additional facet of the crucial adult response to children with trauma. The case was consistent with patterns outlined in existing trauma research. Music was a mediator and catalyst for emotional response. By utilizing a trauma-informed approach, music teachers might be able to meet extensive behavioral needs with compassion, strengthen relationships, create more avenues for access in general music, and avoid re-traumatization in the classroom

Clinical Practice Guideline: Maintaining Skin Integrity in the Surgical Patient

The purpose of this project was to develop clinical practice guidelines for intraoperative positioning that will help prevent deep tissue injury and skin breakdown. Maintaining skin integrity in the surgical patient by preventing deep tissue injuries and skin breakdown is an identified gap in practice for surgical patients in the Operating Room environment that a clinical practice guideline could positively impact. To assist in achieving the development of a clinical practice guideline to maintain skin integrity, Bennerâs novice to expert theory addressing the educational needs for novice operating room nurses was applied. The clinical practice guideline, based on evidence, should be made available to the peri-operative nurses that would include evidence-based guidance on positioning devices. A comprehensive literature search was performed, and the evidence obtained was synthesized based on the hierarchy of evidence table. The guideline was evaluated by a multidisciplinary expert panel using the Agree II tool. The multidisciplinary team consisted of an Operating Room Registered Nurse, a Certified Registered Nurse Anesthetist, and an Anesthesiologist. Each of the panel members is currently working in the operating room and has had at least 12 years of recent experience in that service line. The expert panel had additional recommendations that were included with the final guideline. A final clinical practice guideline was established for the project. Establishing a clinical practice guideline to prevent skin breakdown and deep tissue injuries will demonstrate a social change by assisting the nurses to adequately manage the surgical patientâs needs, improve quality outcomes for the patients, and increase reimbursements for the facilities

Clinical Practice Guideline: Maintaining Skin Integrity in the Surgical Patient

The purpose of this project was to develop clinical practice guidelines for intraoperative positioning that will help prevent deep tissue injury and skin breakdown. Maintaining skin integrity in the surgical patient by preventing deep tissue injuries and skin breakdown is an identified gap in practice for surgical patients in the Operating Room environment that a clinical practice guideline could positively impact. To assist in achieving the development of a clinical practice guideline to maintain skin integrity, Benner\u27s novice to expert theory addressing the educational needs for novice operating room nurses was applied. The clinical practice guideline, based on evidence, should be made available to the peri-operative nurses that would include evidence-based guidance on positioning devices. A comprehensive literature search was performed, and the evidence obtained was synthesized based on the hierarchy of evidence table. The guideline was evaluated by a multidisciplinary expert panel using the Agree II tool. The multidisciplinary team consisted of an Operating Room Registered Nurse, a Certified Registered Nurse Anesthetist, and an Anesthesiologist. Each of the panel members is currently working in the operating room and has had at least 12 years of recent experience in that service line. The expert panel had additional recommendations that were included with the final guideline. A final clinical practice guideline was established for the project. Establishing a clinical practice guideline to prevent skin breakdown and deep tissue injuries will demonstrate a social change by assisting the nurses to adequately manage the surgical patient\u27s needs, improve quality outcomes for the patients, and increase reimbursements for the facilities

Does engagement with exposure yield better outcomes?: Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia

Virtual reality exposure (VRE) has been shown to be effective for treating a variety of anxiety disorders, including social phobia. Presence, or the level of connection an individual feels with the virtual environment, is widely discussed as a critical construct both for the experience of anxiety within a virtual environment and for a successful response to VRE. Two published studies show that whereas generalized presence relates to fear ratings during VRE, it does not relate to treatment response. However, presence has been conceptualized as multidimensional, with three primary factors (spatial presence, involvement, and realness). These factors can be linked to other research on the facilitation of fear during exposure, inhibitors of treatment response (e.g., distraction), and more recent theoretical discussions of the mechanisms of exposure therapy, such as Bouton’s (2004) description of expectancy violation. As such, one or more of these components of presence may be more strongly associated with the experience of fear during VRE and treatment response than the overarching construct. The current study (N=41) evaluated relations between three theorized components of presence, fear ratings during VRE, and treatment response for VRE for social phobia. Results suggest that total presence and realness subscale scores were related to in-session peak fear ratings. However, only scores on the involvement subscale significantly predicted treatment response. Implications of these findings are discussed

Estimation of GFR in Patients With Cystic Fibrosis: A Cross-Sectional Study

Background: Patients with cystic fibrosis (CF) have frequent infectious complications requiring nephrotoxic medications, necessitating monitoring of renal function. Although adult studies have suggested that cystatin C (CysC)-based estimated glomerular filtration rate (eGFR) may be preferable due to reduced muscle mass of patients with CF, pediatric patients remain understudied. Objective: Our objective was to determine which eGFR formula is best for estimating glomerular filtration rate (GFR) in pediatric patients with CF. Methods: A total of 17 patients with CF treated with nephrotoxic antibiotics were recruited from the Children’s Hospital at London Health Sciences Centre, London, Ontario, Canada. 99Tc DTPA GFR (measured GFR [mGFR]) was measured with 4-point measurements starting at 120 minutes using a 2-compartmental model with Brøchner-Mortensen correction, with simultaneous measurement of creatinine, urea, and CysC. The eGFR was calculated using 16 known equations based on creatinine, urea, CysC, or combinations of these. Primary outcome measures were correlation with mGFR, and agreement within 10% for various eGFR equations. Results: Mean mGFR was 136 ± 21 mL/min/1.73 m2. Mean creatinine, CysC, and urea were 38 ± 10 μmol/L, 0.72 ± 0.08 mg/L, and 3.9 ± 1.4 mmol/L, respectively. The 2014 Grubb CysC eGFR had the best correlation coefficient (r = 0.75, P =.0004); however, only 35% were within 10%. The new Schwartz formula with creatinine and urea had the best agreement within 10%, but a relatively low correlation coefficient (r = 0.63, P =.0065, 64% within 10%). Conclusions: Our study suggests that none of the eGFR formulae work well in this small cohort of pediatric patients with CF with preserved body composition, possibly due to inflammation causing false elevations of CysC. Based on the small numbers, we cannot conclude which eGFR formula is best

Differentiation of Human, Dog, and Cat hair Fibers using DART TOFMS and Machine Learning

Hair is found in over 90% of crime scenes and has long been analyzed as trace evidence. However, recent reviews of traditional hair fiber analysis techniques, primarily morphological examination, have cast doubt on its reliability. To address these concerns, this study employed machine learning algorithms, specifically Linear Discriminant Analysis (LDA) and Random Forest, on Direct Analysis in Real Time time-of-flight mass spectra collected from human, cat, and dog hair samples. The objective was to develop a chemistry- and statistics-based classification method for unbiased taxonomic identification of hair. The results of the study showed that LDA and Random Forest were highly effective in separating mass spectra collected from hair samples with accuracies ranging from 94-98%. This approach holds significant promise for forensic investigations, archaeology, and artifact analysis

Spiderly sympoiesis : tensegral tentacularity and speculative clews

With Spider(s) as our guide, we tentatively prod and turn felt concepts of situatedness and entanglement; stickiness and attachment; plasticity and pliability; precarity, uncertainty, and leaps of vulnerability. Inspired by multitudinal spiderly threads, we turn to spinning—not as a rote practice, self-serving tidy manipulation or fabrication, but rather as a working-with-world in care-full tending and continual creation of a supportive mesh. The figure of the web allows a transdisciplinary, heterogeneous, and generative weaving-together through which to gather seemingly disparate theoretical threads, not only to consider Spider(s) anew but also to spin-with as a performative thinking-with in scholarly becomings. We follow and carry with us many Æffective encounters with tentacular companions and sticky traces. In Æsthetic (re)turning, we find value in the space for attentive, collaborative tending and response with/in the tensions of inquiry in a more-than-academic world.The National Research Foundation (NRF).https://journals.sagepub.com/home/QIXhj2023Visual Art