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Identifying Predictors of Withdrawal of Life-Sustaining Therapies in Acute Brain Injury at a Level I Trauma Center
No full textBackground: Withdrawal of life-sustaining therapy (WLST) decisions in acute brain injury (ABI) remain complex and variable, with limited data on predictors in Level I trauma centers. This study examines sociodemographic and clinical factors influencing WLST decisions for adults with ABI.Methods: This retrospective cohort study analyzed data from adults with ABI admitted to the Neuroscience ICU at Jackson Health System from June 2020 to January 2025. Mann-Whitney U and Chi-square tests were used to compare continuous and categorical variables, respectively, between WLST and non-WLST patients. Univariate (UVA) and multivariate (MVA) binary logistic regression models were used to explore the relationship between WLST and age, Charlson Comorbidity Index (CCI), Glasgow Coma Scale (GCS), and pupillary reactivity. Bonferroni correction was appplied to address multiple comparisons across all statistical analyses. Crude (OR) and adjusted odds ratios (aOR) were reported with corresponding 95% confidence intervals (95% CI) to quantify associationsResults: Among 127 participants, most were male (81.1%), White (67.7%), or privately insured (38.6%). In total, 22.8% of patients (n=29) underwent WLST; this group was significantly older (pConclusion: The single-center study provides insight into WLST decisions for adults with ABI at a Level I trauma center. Our results align with aggregated data from diverse centers and registries, and the recognition of age as a predictor of WLST, supporting the importance of adjusting for age in clinical decision-making and the need for standardized, patient-centered, and equitable approaches to WLST.</p
Effects of Neighborhood Environment on Child Behavioral Health
No full textExternalizing behaviors in childhood is a major developmental, clinical, and societal concern that have become one of the most prevalent issues in children and youth mental and behavioral health as well as one of the most common reasons for which families seek treatment. Neighborhood environment is an emerging area of research that has implications with children’s physical, emotional, and psychological well-being, including externalizing behaviors. While externalizing behaviors have been extensively studied, there persists gaps in the literature addressing the larger societal influences—including neighborhood environment—that are associated with externalizing behaviors, especially in early childhood (1.5 – 6 years). This dissertation study’s purpose will be to: (1) evaluate the current state of the science linking neighborhood collective efficacy to child externalizing behaviors across developmental trajectories, (2) examine neighborhood-level childhood opportunity and its association with externalizing behaviors in early childhood, and (3) explore whether parenting mediates the relationship between neighborhood-level childhood opportunity and externalizing behaviors in early childhood. Employing quantitative approaches, this dissertation study aims to understand neighborhood environment as a potent social determinant of health to address externalizing behaviors in the context of neighborhoods with shared characteristics of strengths and vulnerabilities.</p
Stressors and Coping Strategies of Venezuelan Migrant Parent-Child Dyads in Colombia: A Qualitative Secondary Analysis
No full textIntroduction: Since 2014, over 7.7 million Venezuelans have emigrated from Venezuela in a mass exodus prompted by economic crisis, political unrest, and severe resource scarcity. Colombia alone has been the recipient of nearly 3 million migrants. Throughout the pre-, during, and post-migration processes, families are impacted by a wide variety of mental health stressors, some of which continue through their lives post-migration. This study utilizes the Family Crisis Migration Stress Framework (FCMSF) to: (1) identify shared and divergent stressors between parents and adolescents, and (2) describe the coping strategies they employed post-migration.Methods: This secondary analysis analyzed a subset of 24 qualitative interviews, 12 adults and 12 adolescents, conducted with parent-child dyads in Bogotá and Medellín, Colombia. The sample included Venezuelan migrant youth aged 12-15, and one of their parents/caregivers who also was willing to participate in the study. The FCMSF was used to create five preliminary code groups: pre-migration stressors, migration journey stressors, post-migration stressors, familial context, and post-migration buffers. Interview transcripts were coded subsequently using a complete coding strategy with inductive codes added to cover necessary gaps.Results: Coding generated five themes related to shared and divergent stressors. These themes were long-term lack of resources, post-migration uncertainty, bullying due to being Venezuelan, separation from their life in Venezuela, and increased exposure to drug and alcohol use. Three additional themes were generated to describe the coping strategies employed by parents and adolescents, including parental sacrifice, seeking social support, and willingness to adapt.Conclusion: This study highlighted the need to further understand the impact of stressors and coping strategies on the short and long-term mental health of migrants post-migration and may allow researchers to expand interventions to target migrants at not just the individual level, but the family and policy levels as well
Supramolecular Control of Photochemical Reactions and Chemical Equilibria in Confined Media
No full textThis dissertation explores the manipulation of molecular behavior within confined spaces using various supramolecular hosts (octa acid, cucurbiturils, cyclodextrins, palladium nanocage). The research demonstrates how confinement influences chemical equilibria by selectively shifting dynamic covalent reactions towards monomeric forms through size-selective recognition and preserving complex equilibria within larger cavities. Furthermore, it showcases successful co-encapsulation strategies for energy storage applications (MOST) and charge transfer complexes, highlighting the crucial role of host cavity dimensions in controlling guest interactions and access. This work advances supramolecular chemistry by establishing design principles for molecular recognition and offering pathways towards selective separations and functional devices.</p
Integrating Cathodic Protection and Energy Storage in Concrete: A Multifunctional Zn-Cement Anode for Durable and Electrochemically Active Infrastructure
No full textConcrete infrastructures face two major challenges: protecting embedded steel from corrosion and enabling multifunctional capabilities such as energy storage. Achieving durable reinforcement protection is essential for structural longevity, while integrating electrochemical functionality can transform concrete into an active component that supports low-carbon, smart infrastructure. Existing corrosion-mitigation methods and concrete batteries often compromise structural integrity or suffer from limited lifetime and low power output.In this study, a discrete Zn-embedded cement-based anode (DZCA) and a Zn-anode rebar-reinforced cementitious battery (ZARCB) were developed to provide both cathodic protection and energy-storage capability. The DZCA acts as a sacrificial anode and the embedded rebar serves as the cathode, eliminating external electrodes and maintaining structural integrity. Performance was enhanced through increased electrolyte alkalinity, porosity optimization, biochar-induced pore regulation, and a PVA-hydrogel coating that improved ionic connectivity and interfacial stability.Long-term durability was evaluated under simulated field stressors including chloride exposure and cyclic wet–dry conditions. High-alkalinity systems (>5 M KOH) provided superior corrosion protection, while the 5 M condition delivered the most stable microwatt-level energy output. Porosity optimization revealed a trade-off in which moderate porosity (9.1–11.6%) ensured stable long-term performance. Biochar addition buffered electrolyte fluctuations and sustained activity, and the hydrogel coating further enhanced stability and power delivery.These results demonstrate that rational design of composition and microstructure can significantly improve the durability and multifunctionality of cement-based electrochemical systems. DZCAs offer a promising route toward self-sustaining, corrosion-resistant, and energy-integrated concrete infrastructures
Application of Theodor Leschetizky’s Teaching Principles to "Souvenirs d’Italie," Op. 39
No full textTheodor Leschetizky (1830–1915) was one of the most influential pianists and pedagogues during the late 19th and early 20th centuries. Even though his legacy as a teacher is widely acknowledged, how his pedagogical principles and practical methods can be applied to music has not received sufficient attention. Through a focused study of his "Souvenirs d’Italie," Op. 39, a set of character pieces that combine lyrical artistry with technical challenges, this project will demonstrate how Leschetizky’s documented core teaching principles can be applied to specific musical contexts. This project aims to offer modern pianists and educators practical insights into the continued relevance of Leschetizky’s methods and the pedagogical value of his compositional output.</p
The Role of Social Support, Neighborhood Cohesion, and Racism in Black American Mental Health
No full textThe experience of racism among Black people is associated with several negative mental health outcomes such as increased anxiety, depression, psychological distress, stress, and loneliness. Research has demonstrated the mechanistic role that social support plays in the relationship between perceived racism and mental health, a distinct and measurable aspect of social support, neighborhood cohesion, has yet to be explored in this context. The present analysis seeks to address the gap in research by examining how neighborhood cohesion, social support, and racial discrimination impact stress and loneliness in Black Americans. Using data from the All of Us research program, (i.e., a nationwide study based in the United States that studies the relationship of various environmental factors on health outcomes), a series of multiple regression models were conducted to examine how neighborhood cohesion, perceived social support, experiences of discrimination, and their interactions, impact loneliness and stress in Black Americans. Results indicated that there were significant main effects of racial discrimination (b = 0.24, p b = -0.09, p b = -0.12, p b = 0.16, p b = -0.10, p b = -0.28, p b = 0.01, p = .007) on stress. Similarly, there was a significant 2-way interaction effect of racial discrimination and neighborhood cohesion (b = -0.01, p = .017), and a significant 3-way interaction effect of racial discrimination, neighborhood cohesion, social support (b = -0.01, p = .002), on loneliness. These findings show that neighborhood cohesion plays an important role in several indicators of mental health among Black Americans, highlighting the importance of facilitating neighborhood cohesion which, in turn, could help ameliorate racism-driven mental health disparities in Black Americans. </p
An Ecological Momentary Assessment Study of Intolerance of Uncertainty: Linking Computational Measures with Clinical Factors
No full textIntolerance of uncertainty (IU) is the tendency to react negatively to uncertainty across emotional, cognitive, and behavioral domains. Research on IU is limited from a conceptual and measurement perspective. The current study compares a self-report measure of IU to task-based computational indices. We relied on ecological momentary assessment (EMA) to assess whether clinical and computational measures of IU predicted daily negative affect and avoidance, and examined whether IU contributed to anxiety one month later. A diverse sample of community adults (N = 236) completed a self-report measure of IU and the Risk and Ambiguity Task, a computerized monetary decision-making task that captures gain and loss decisions under uncertainty. Computational modeling was used to estimate risk and ambiguity aversion for both gains and losses. Participants then reported momentary affect and avoidance via EMA over 21 days, followed by a semi-structured diagnostic interview one month later. Greater self-reported IU was significantly associated with greater risk aversion for both gains and losses, as well as lower ambiguity aversion for gains. Greater self-reported IU predicted higher levels of daily negative affect and avoidance, whereas greater ambiguity aversion for gains predicted lower daily avoidance. Self-reported IU predicted both self-reported and interview-based anxiety, but only greater risk aversion for losses was associated with greater interview-based anxiety. Negative affect, but not avoidance, mediated the link between self-reported IU and later anxiety. Findings suggest people with higher self-reported IU were more likely to make fewer risky decisions in a monetary gambling task. This relationship was reversed for ambiguity aversion. Our findings also suggest that a person’s perception of their uncertainty tolerance rather than their behavioral task performance is more predictive of anxiety. Daily negative affect may be a key mechanism linking IU to anxiety. This study advances our understanding of IU by integrating clinical and computational assessments.</p
Water - An Underappreciated Medium for Photoreactions
No full textWater, despite being Earth's most abundant and sustainable solvent, has been historically underutilized in photochemistry due to conventional assumptions that hydrophobic organic molecules require organic solvents for efficient reactions. This dissertation establishes water as a superior medium for intermolecular photoreactions by demonstrating that its unique properties drive molecular pre-organization that dramatically enhances photodimerization rates and enables control over product selectivity.Through systematic investigation of model olefins and cyclic enones, this research reveals that photodimerization quantum yields in water exceed those in organic solvents by up to two orders of magnitude, achieving efficient reactions at concentrations as low as 0.02 M, an order of magnitude below the theoretical diffusion-controlled threshold. Computational studies employing quantum chemical calculations and molecular dynamics simulations establish a predictive framework integrating experimental characterization with computational modeling, enabling rational design of aqueous photochemical processes. By eliminating organic solvents while enhancing reaction efficiency and selectivity, this research advances green chemistry principles and provides methodologies for sustainable photochemical technologies
Modeling Opioid Overdose Related Indicators for Data Driven Decision Making
No full textOpioid use disorder (OUD) is a chronic condition affecting more than 2.1 million individuals in the United States and over 16 million worldwide. The HEALing Communities Study® aimed to reduce opioid overdose deaths through data-driven interventions. In this study, we evaluate alternative statistical frameworks for interpreting community-level data on three interrelated outcomes—opioid overdose deaths, substance use treatment, and naloxone (Narcan) administration. Given their dynamic interdependence over time, these outcomes were modeled using panel vector autoregression model estimated using both the Maximum Likelihood Estimator (MLE) and the Generalized Method of Moments (GMM). The models incorporate geospatial effects and social determinants of health to capture spatial dependencies and societal factors influencing opioid-related outcomes. Simulation studies were conducted to assess model selection and compare estimator performance under varying conditions. Additionally, out-of-sample forecasting analyses were performed to evaluate predictive accuracy across modeling approaches. Findings indicate that the MLE provides more stable parameter estimates and superior forecasting performance relative to GMM methods in this application.</p