Reflections in Passion and Progress: Blending Vision, Resilience, and Evolution as a Writer and Scholar of the English Language

The following is a final master\u27s degree portfolio of revised graduate work in English composition. Consisting of four projects, this portfolio highlights research, theory, and applications in multidisciplinary writing, visual argumentation, linguistics pedagogy, and professional editing. The pieces within reflect significant growth and adaptation in the field of English comprehension and writing, where successful compositions walk hand-in-hand with innovation, audience acknowledgement, and the willingness to change as language ebbs and flows with the passage of time

Why Do Women Reject Bisphosphonates for Osteoporosis? A Videographic Study

Despite access to effective, safe, and affordable treatment for osteoporosis, at-risk women may choose not to start bisphosphonate therapy. Understanding the reasons women give for rejecting a clinician's offer of treatment during consultations and how clinician's react to these reasons may help clinicians develop more effective strategies for fracture prevention and medication adherence.We conducted a videographic evaluation of encounters in the Osteoporosis Choice randomized trial of a decision aid about bisphosphonates vs. usual primary care. Eligible videos involved consultations with women with an estimated 10-year fragility fracture risk >20% who verbalized at least one reason to not take bisphosphonates. Two reviewers independently reviewed eligible videos and verbatim transcripts, classifying patient views about bisphosphonate use, clinicians response to those views, and patient adherence at 6 months post visit.Eighteen video recordings (12 with decision aid) were eligible for analyses. We identified 37 reasons for and against bisphosphonate therapy. Eleven patients rejected treatment, offering 9 (average of 2 per patient) unique reasons against initiating bisphosphonates (most common: side effects 39% and distrust of medications in general 33%). When physicians conceded to patient views the outcome was no bisphosphonate use. Adherence to choices at 6 months was 100%.The expression of patient preferences is sometimes unfavorable to bisphosphonates treatment even among well-informed patients at high risk for osteoporotic fractures. At 6 months, patients who expressed concerns about these medicines behaved consistently with the decision made during the visit

Is the observed high-frequency radio luminosity distribution of QSOs bimodal?

The distribution of QSO radio luminosities has long been debated in the literature. Some argue that it is a bimodal distribution, implying that there are two separate QSO populations (normally referred to as 'radio-loud' and 'radio-quiet'), while others claim it forms a more continuous distribution characteristic of a single population. We use deep observations at 20 GHz to investigate whether the distribution is bimodal at high radio frequencies. Carrying out this study at high radio frequencies has an advantage over previous studies as the radio emission comes predominantly from the core of the AGN, hence probes the most recent activity. Studies carried out at lower frequencies are dominated by the large scale lobes where the emission is built up over longer timescales (10^7-10^8 yrs), thereby confusing the sample. Our sample comprises 874 X-ray selected QSOs that were observed as part of the 6dF Galaxy Survey. Of these, 40% were detected down to a 3 sigma detection limit of 0.2-0.5 mJy. No evidence of bimodality is seen in either the 20 GHz luminosity distribution or in the distribution of the R_20 parameter: the ratio of the radio to optical luminosities traditionally used to classify objects as being either radio-loud or radio-quiet. Previous results have claimed that at low radio luminosities, star formation processes can dominate the radio emission observed in QSOs. We attempt to investigate these claims by stacking the undetected sources at 20 GHz and discuss the limitations in carrying out this analysis. However, if the radio emission was solely due to star formation processes, we calculate that this corresponds to star formation rates ranging from ~10 solar masses/yr to ~2300 solar masses/yr.Comment: 13 pages, 11 figures. Accepted for publication in Ap

Overwhelmed patients: a videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters.

OBJECTIVE: Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits. RESEARCH DESIGN AND METHODS: Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT). RESULTS: Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time. CONCLUSIONS: BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Background & Aims Patients with inflammatory bowel diseases (IBDs) have increased risk for venous thromboembolism (VTE); those who require hospitalization have particularly high risk. Few hospitalized patients with IBD receive thromboprophylaxis. We analyzed the frequency of VTE after IBD-related hospitalization, risk factors for post-hospitalization VTE, and the efficacy of prophylaxis in preventing post-hospitalization VTE. Methods In a retrospective study, we analyzed data from a multi-institutional cohort of patients with Crohn's disease or ulcerative colitis and at least 1 IBD-related hospitalization. Our primary outcome was a VTE event. All patients contributed person-time from the date of the index hospitalization to development of VTE, subsequent hospitalization, or end of follow-up. Our main predictor variable was pharmacologic thromboprophylaxis. Cox proportional hazard models adjusting for potential confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results From a cohort of 2788 patients with at least 1 IBD-related hospitalization, 62 patients developed VTE after discharge (2%). Incidences of VTE at 30, 60, 90, and 180 days after the index hospitalization were 3.7/1000, 4.1/1000, 5.4/1000, and 9.4/1000 person-days, respectively. Pharmacologic thromboprophylaxis during the index hospital stay was associated with a significantly lower risk of post-hospitalization VTE (HR, 0.46; 95% CI, 0.22–0.97). Increased numbers of comorbidities (HR, 1.30; 95% CI, 1.16–1.47) and need for corticosteroids before hospitalization (HR, 1.71; 95% CI, 1.02–2.87) were also independently associated with risk of VTE. Length of hospitalization or surgery during index hospitalization was not associated with post-hospitalization VTE. Conclusions Pharmacologic thromboprophylaxis during IBD-related hospitalization is associated with reduced risk of post-hospitalization VTE.National Institutes of Health (U.S.) (U54-LM008748

What turns galaxies off? The different morphologies of star-forming and quiescent galaxies since z~2 from CANDELS

We use HST/WFC3 imaging from the CANDELS Multicycle Treasury Survey, in conjunction with the Sloan Digital Sky Survey, to explore the evolution of galactic structure for galaxies with stellar masses >3e10M_sun from z=2.2 to the present epoch, a time span of 10Gyr. We explore the relationship between rest-frame optical color, stellar mass, star formation activity and galaxy structure. We confirm the dramatic increase from z=2.2 to the present day in the number density of non-star-forming galaxies above 3e10M_sun reported by others. We further find that the vast majority of these quiescent systems have concentrated light profiles, as parametrized by the Sersic index, and the population of concentrated galaxies grows similarly rapidly. We examine the joint distribution of star formation activity, Sersic index, stellar mass, inferred velocity dispersion, and stellar surface density. Quiescence correlates poorly with stellar mass at all z<2.2. Quiescence correlates well with Sersic index at all redshifts. Quiescence correlates well with `velocity dispersion' and stellar surface density at z>1.3, and somewhat less well at lower redshifts. Yet, there is significant scatter between quiescence and galaxy structure: while the vast majority of quiescent galaxies have prominent bulges, many of them have significant disks, and a number of bulge-dominated galaxies have significant star formation. Noting the rarity of quiescent galaxies without prominent bulges, we argue that a prominent bulge (and perhaps, by association, a supermassive black hole) is an important condition for quenching star formation on galactic scales over the last 10Gyr, in qualitative agreement with the AGN feedback paradigm.Comment: The Astrophysical Journal, in press; 20 pages with 13 figure

Properties of submillimeter galaxies in the CANDELS GOODS-south field

We derive physical properties of 10 submillimeter galaxies located in the CANDELS coverage of the GOODS-S field. The galaxies were first identified as submillimeter sources with the LABOCA bolometer and subsequently targeted for 870 m continuum observation with ALMA. The high angular resolution of the ALMA imaging allows secure counterparts to be identified in the CANDELS multiband data set. The CANDELS data provide deep photometric data from UV through near-infrared wavelengths. Using synthetic spectral energy distributions, we derive photometric redshifts, stellar masses, extinction, ages, and the star formation history. The redshift range is z = 1.65-4.76, with two of the galaxies located at z > 4. Two submillimeter galaxy (SMG) counterparts have stellar masses 2-3 orders of magnitude lower than the rest. The remaining SMG counterparts have stellar masses around 1 x 1011 M. The stellar population in the SMGs is typically older than the expected duration of the submillimeter phase, suggesting that the star formation history of SMGs is more complex than a single burst. Non-parametric morphology indices suggest that the SMG counterparts are among the most asymmetric systems compared with galaxies of the same stellar mass and redshift. The Hubble Space Telescope images show that three of the SMGs are associated with ongoing mergers. The remaining counterparts are isolated. Estimating the dust and molecular gas mass from the submillimeter fluxes, and comparing with our stellar masses shows that the gas mass fraction of SMGs is ~28% and that the final stellar mass is likely to be ~(1 - 2) x 1011 M.IS