ALS AND FAMILY FUNCTIONING

Amyotrophic Lateral Sclerosis (ALS) is the most common progressive and fatal neurodegenerative disease and yet a cure remains unknown. Given the growing number of patients with ALS, it is imperative that behavioral health clinicians, medical providers, researchers, and policy makers are aware of their and their support persons' unique biological, psychological, social, and spiritual health concerns, the impact of the disease on family functioning, and the general care management of those living with ALS. This dissertation was written to help identify the impact of ALS on patients and their support persons' family functioning and biopsychosocial-spiritual (BPS-S) health. It includes three manuscripts: (a) a systematic review of the impacts of ALS on immediate family members' health and interactional patterns, (b) a descriptive phenomenological study designed to explore the lived experience of eight patients and nine support persons living with ALS, and (c) a perspective piece that presents an argument for requiring increased competencies in medical education and residency education programs around ALS diagnosis, treatment, and family-centered care. The systematic review resulted in 3,557 articles with 3,509 meeting exclusion criteria and 48 meeting inclusion criteria for full review. The articles in the systematic review demonstrated that previous literature on the BPS-S health outcomes of support persons of patients with ALS is disjointed, with the health components studied independent of one another rather than simultanesouly for a comprehensive understanding. The literature reviewed also revealed a limitation in the amount of research that has focused on the impact of ALS on family functioning. The phenomenological study conducted as a part of this dissertation resulted in five themes relevant to patients and support persons' experiences living with ALS: (a) Dynamic transformations of relational systems, (b) Biological changes and well-being, (c) Emotional processes, (d) Impacts on spirituality, and (e) Healthcare system interactions. The novel findings of this study include: (a) a broader understanding of patients' with ALS (PALS) and SPs' experiences with the impact of ALS on family functioning due to the inclusion of multiple participants in the same interview; (b) participants explanation of progression of physical symptoms and subsequent decrease in verbal communication abilities resulting in a more isolated and frustrated state; (c) participants reporting on their ability to reach acceptance and choose positivity; (d) and the participant's expressing the need for medical providers outside of ALS clinics to have increased knowledge of proper ALS care. It is then recommended that future research should focus on the immediate and longitudinal whole health needs of PALS and SPs and their interactional effects, participant's perspectives on the lack of knowledge by non-ALS specialists, and studies that continue to include multiple family members and SPs conjointly with the PALS to ensure that more robust systemic perspectives are represented. The final manuscript is a perspective piece based on existing literature in combination with findings from this disseration. It is used to highlight the need for increased education among medical professionals on ALS diagnosis, interdisciplinary treatment, BPS-S and family-centered car

Monitoring design for assessing compliance with numeric nutrient standards for rivers and streams using geospatial variables

2013 Summer.Includes bibliographical references.Elevated levels of nutrients in surface waters are among major human and environmental health concerns. Increases in nutrient concentrations in surface waters have been linked to urban and agricultural development of watersheds across the United States. Recent implementation of numeric nutrient standards in Colorado has prompted a need for greater understanding of human impacts on nutrient levels at different locations within a watershed and for how upstream influences affect the monitoring needs of specific locations. The objectives of this research are (i) to explore the variability of annual nutrient concentration medians under varying levels of upstream anthropogenic influences, (ii) to explore the variability of the standard deviation of nutrient concentrations under varying levels of upstream anthropogenic influences, and (iii) to develop a mathematical expression for approximating the number of samples required for estimating nutrient medians in the context of compliance with numeric standards. This analysis was performed in the Cache La Poudre (CLP) River watershed, which provides a gradient of anthropogenic influences ideal for studying water quality impacts. Multiple linear regression (MLR) models were used to explain the relationship of the median and lognormal standard deviation of nutrient concentrations in the CLP River, i.e., Total Kjeldahl Nitrogen (TKN), nitrate (NO3-N), total nitrogen (TN), and total phosphorous (TP) to upstream point and non-point sources of nutrients and general hydrologic descriptors. The number of samples required annually at monitoring locations is predicted based on an equation for determining sample size using relative error of a dataset which accounts for the difference between the median and standard for a lognormal population. MLR models for annual medians performed better for TN (R2 = 0.86) than TP (R2 = 0.90) despite high coefficients of multiple determination. Anthropogenic predictor variables, which characterize upstream urban and agricultural impacts on nutrient concentrations, were sufficient for describing variation of median concentrations between monitoring sites. A general hydrologic predictor was sufficient for characterizing variability of annual medians between years. The preferred MLR for all of the nutrient parameters uses inverse distance weighted WWTP and AFO capacities with annual mean daily discharge as a hydrologic predictor. The percent land use is equivalent to nutrient point source parameters (i.e., number of WWTPs and AFOs) for predicting median nitrogen concentrations in the watershed, though urban and agricultural land use predictors cannot be employed in the same model due to high multicollinearity. Little value is gained in the MLR models by including capacity of point sources in the predictive variables. For TP, a parameter which describes the variability of medians between years was not found, thus limiting the applicability of the model. The MLR models were less successful for predicting lognormal standard deviation of nutrients due to limited datasets. However, for robust datasets, high R2 values were found for TN and TP (0.80 and 0.73, respectively) based on anthropogenic predictors and annual rainfall. Overall, the MLR approach was appropriate for predicting median nutrient concentrations and lognormal standard deviations in the study watershed. Anthropogenic variables and general hydrologic descriptors were sufficient predictive parameters for the MLR models. Results of the application of an expression derived for predicting annual required samples indicate that sampling requirements to meet a 95% confidence level are lower than the current regulatory monthly sampling requirement. The required number of samples for reporting compliance at a 95% confidence level substantially varied among sampling sites depending on the difference between annual median of the nutrient of concern and its numeric standard. When the median is within 20% of the standard, the required number of samples rapidly increases from several samples per year to hundreds of samples per year. A comprehensive monitoring plan that targets sampling to sites near the standard with limited sampling elsewhere will optimize sampling resources and increase confidence level of the results

Celebrating Eric Williams

A scholar and statesman, the Honorable Dr. Eric Eustace Williams (1911-1981) led Trinidad and Tobago for over a quarter of a century. He oversaw the country’s independence from Britain in 1962 and 1976 transition to a Republic. Williams served as Prime Minister until his death in 1981.UT Librarie

Counseling Groups for High School Students

Groups were first established in the public schools in the early 1900s. At this time, the group provided an environment in which to learn life skills and values rather than focusing on the group process (Gladding, 1995). There was a growth of groups in select schools during the 1910s, although the focus continued to be on individual counseling. In the 1930s, the focus of groups was on vocational and personal themes. They were often the responsibility of homeroom teachers. In these groups, the teacher was responsible for establishing friendly relationships and developing the right attitudes toward school, home, and the community in the students (Strange, 1935, as cited in Gladding, 1995). This group guidance approach to counseling was replaced with group counseling as a way to bring about behavioral changes in the late 1950s. More recently, group work has become more increasingly utilized in the school settings as a primary was to influence educational endeavors and social skills (Hudson, Doyle, & Venezia, 1991, as cited in Gladding, 1995). In addition, as professional associations continue to grow, more training and educational opportunities are being offered in group work

Effects of pretreatment tree dominance and conifer removal treatments on plant succession in sagebrush communities

In sagebrush (Artemisia tridentata Nutt.) communities, the expansion and infilling of conifers decreases perennial vegetation cover and density, and lowers ecosystem resilience and resistance of the shrub-grass dominated state. Successional trajectories following disturbance are highly dependent upon residual species abundance, composition, and resulting structure. Understanding how tree dominance and tree-reduction treatments interact over time will help inform state-and-transition-models to guide management. Juniper (Juniperus spp. L.) and pinyon (Pinus spp. L.) trees were reduced by prescribed fire and cutting at 10 sites across the western United State. Vegetation cover and density were measured on untreated and treated plots across a gradient of tree dominance index (TDI, defined as tree cover / (tree + shrub + tall grass cover)) 3 and 6 years after treatment. I analyzed responses by functional group using mixed model analysis of covariance, with TDI treated as a covariate. As tree cover increased and TDI approached 0.5 (22% tree cover), shrub cover declined to 25% of the maximum. Three years after treatments, prescribed fire reduced both shrub and perennial herbaceous cover. Although total shrub cover returned to pre-burn percentages 6 years after treatment, it was still much lower than on the unencroached reference state and sagebrush cover was still < 1%. Six years after cut treatments, total shrub cover increased by 7% and sagebrush cover increased by 2.2% compared to no treatment. Tall perennial grasses are especially important in resisting dominance by invasive species such as cheatgrass (Bromus tectorum L). By 6 years after treatment, tall grass and cheatgrass cover both increased on prescribed fire and cut treatments, especially at higher pretreatment TDI. However, ratios of cheatgrass to tall grass cover were much lower on cut than on burn plots. This outcome suggests that system resistance to cheatgrass dominance is best supported by tree cutting. To retain the shrub, and especially sagebrush, components on a site and increase ecosystem resilience and resistance through increases in tall grasses, I recommend treating at low to mid TDI and using mechanical methods, such as cutting or mastication. Differential effects of prescribed fire compared to mechanical tree reduction, when implemented at different phases of tree dominance, should be incorporated into state-and-transition-models to clarify transitional effects and state outcomes

Exploring College Student Experiences in a Kinesiology Course Using a Gamified Grading System

Past findings indicate mixed results on the effectiveness of gamification in college courses. The use of a gamified version of specifications-based grading (e.g., gamified grading) is not yet well understood. The purpose of this two-part study was to understand students’ perceptions of intrinsic motivation and engagement in a kinesiology course using gamified grading, facilitated by a gamified grading platform called GradeCraft©. We used qualitative inquiry to capture a robust description of the student experience across a semester, identifying themes describing the course management (e.g., comparison with traditional course, individual approach), and the psychological experience (e.g., autonomy, stress). The following semester, we surveyed students, finding an increase in competence and choice and decrease in pressure from the beginning of the term to the end. Findings suggest that students perceived GradeCraft to promote intrinsic motivation, but only to a small degree and not without some initial stress due to the novelty associated with the gamified grading system

OncoLog Volume 50, Number 01, January 2005

New Perspectives on Brain Metastasis Out of the Darkroom Equity and Health House Call: Blood and Platelet Donors Give Life DiaLog: Cancer Pain Control in the New Millennium, by Allen W. Burton, MD, Section Chief, Cancer Pain Management Department of Anesthesiology and Pain Medicinehttps://openworks.mdanderson.org/oncolog/1146/thumbnail.jp

Challenges of conflict of interest, co-ordination and collaboration in small island contexts:Towards effective tobacco control governance in the UK Overseas Territories

INTRODUCTION: The UK Overseas Territories (UKOTs) are semi-autonomous jurisdictions that face distinctive challenges in implementing tobacco control and protecting policy from industry influence. They are not eligible to become independent parties of the WHO Framework Convention on Tobacco Control (FCTC), although they can apply for treaty extension under the UK’s ratification. This study explores the relevance of the FCTC—particularly Article 5.3—for tobacco control governance across a sample of UKOTs. METHODS: From March to May 2019, we interviewed 32 stakeholders across four territories (Anguilla, Bermuda, Cayman Islands, St Helena) at diverse stages in implementing key FCTC measures. Thematic qualitative analysis explored awareness and perceptions in relation to tobacco control. RESULTS: Interviewees’ accounts highlight the complexity of protecting health policy from industry influence in a context where the ‘tobacco industry’ covers a diverse range of actors. Despite not being formally covered by the FCTC, several health officials spoke about the strategic value of invoking Article 5.3 in the context of tensions with economic priorities. Nevertheless, effective tobacco control governance is complicated by territories’ reliance on local businesses—including tourism—and close social connections that occasionally blur the lines between private and public spheres. CONCLUSIONS: The UKOTs share many characteristics with other small island jurisdictions, creating distinctive challenges for advancing tobacco control and protecting policy from industry interference. Despite their complex status in relation to WHO and its architecture, these territories benefit from the norms embedded in the FCTC and the systems that support its implementation

Rapid Orthotics for CURE Kenya - Mechanical Design and Official Testing of 3D Printed Sockets

Rapid Orthotics for Cure Kenya (ROCK) collaborates with CURE, a non-profit orthopedic workshop in Kjabe, Kenya, to implement a 3D printing system for manufacturing custom prosthetics and orthotics. The goal is to reduce the production time and cost for the current transtibial sockets being manufactured in the orthotic workshop to give the patients a way to integrate into society and reduce stigma from their communities. The team designed a system for manufacturing transtibial sockets by converting a scan of the residual limb to a digital file customized by the orthopedic technicians and converted to a file to be 3D printed. The team designed a procedure to ensure the safety of the sockets within the constraints and offsets of the ISO 10328 Standard. The standard requires twelve official tests specifying the type and conditions to be conducted for the Ultimate Strength and Static Proof tests. The team has designed a testing rig that interfaces with the Materials Testing System machine at Messiah University to apply the necessary forces according to the complex geometry outlined in the standard. Additionally, research has determined the optimized 3D printing settings to increase the quality and consistency of the sockets. To smoothly institute the system developed in the orthopedic workshop, the team has developed a Training Manual outlining the step-by-step procedure for the system. Using this system, the team completed all twelve tests with a passing socket result which will contribute to determining the steps for next semester and for the summer site team trip. Funding for this work provided by The Collaboratory for Strategic Partnerships and Applied Research and by The Collaboratory for Strategic Partnerships and Applied Research.https://mosaic.messiah.edu/engr2022/1014/thumbnail.jp

OncoLog Volume 50, Number 01, January 2005

New Perspectives on Brain Metastasis Out of the Darkroom Equity and Health House Call: Blood and Platelet Donors Give Life DiaLog: Cancer Pain Control in the New Millennium, by Allen W. Burton, MD, Section Chief, Cancer Pain Management Department of Anesthesiology and Pain Medicinehttps://openworks.mdanderson.org/oncolog/1142/thumbnail.jp