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MODELING THE EFFECTS OF SURVEY TIMING ON SCORES FOR THE WORKING ALLIANCE INVENTORY IN A SECONDARY DATA ANALYSIS OF CARDIOVASCULAR GENETIC COUNSELING OUTCOMES
No full textGenetic counseling (GC) research has increasingly regarded the therapeutic alliance, often assessed with the Working Alliance Inventory – Short Revised (WAI-SR), as a variable through which GC outcomes may be mediated. In psychological research the WAI-SR is typically measured immediately following an encounter, but the increase in telemedicine has changed how and when patient surveys are administered. This exploratory analysis of GC outcomes aims to identify whether there may be a relationship between the time lag between the visit and administration of the WAI-SR measure.
The data for this analysis were drawn from two groups of research participants being seen for GC at the Johns Hopkins Center for Inherited Heart Disease (Group 1 N = 106, Group 2 N = 242). Multiple linear regression was used to assess possible relationships between WAI-SR scores and time to post-survey completion by quartile, controlling for demographic and session variables, and WAI-SR scores, participant empowerment, and cardiac anxiety. For Group 1, the second time quartile was found to have a statistically significant relationship to WAI-SR scores (p = .003) when controlling for demographic and session confounders. WAI-SR subscale scores were significantly different in the second time quartile, but there were no interaction effects between the subscale scores and time quartile. No significant relationships to time were uncovered for Group 2. The lack of replication in WAI-SR score differences in the second group with a larger sample size offers initial reassurance that therapeutic alliance scores are consistent regardless of whether the measure was administered immediately following a GC visit or at a later time
PHYSICAL THERAPISTS’ PRESCRIPTION OF REHABILITATION IN THE INTENSIVE CARE UNIT
No full textPatients who survive critical illness often have long-lasting physical, cognitive, and/or mental health impairments, collectively known as Post-Intensive Care Syndrome (PICS). Early rehabilitation in the intensive care unit (ICU) setting is recommended to help mitigate these impairments, particularly physical impairments. Physical therapists (PTs) are an important provider of early rehabilitation interventions in the ICU. However, there is limited evidence-based guidelines for PTs to utilize when determining five key parameters of rehabilitation prescription: (1) when to start; (2) frequency of sessions; (3) duration of sessions; (4) intensity (patient effort); and (5) types of intervention.
This background led to the following five parts of this thesis: 1) an overview of recent publications regarding PICS (Chapter 2); 2) a scoping review exploring how intended and delivered early rehabilitation interventions are described in the literature for patients who are mechanically ventilated (Chapter 3); 3) a qualitative study conducting in-depth interviews with ICU PTs across the United States to explore how they determine rehabilitation parameters for critically ill patients (Chapter 4); and 4) a multi-site questionnaire to ICU PTs to determine which factors are most important when determining rehabilitation parameters in the ICU (Chapter 5)
BEYOND CLASSICAL CAUSAL MODELS: PATH DEPENDENCE, ENTANGLED MISSINGNESS AND GENERALIZED COARSENING
No full textClassical causal models generally assume relatively simple settings like static observations, complete observability and independent and identically distributed (i.i.d.) data samples. For many systems of scientific interest, such assumptions are unrealistic. More recent work has explored models with complex properties including (time-invariant) temporal dynamics, data dependence, as well as missingness within the causal inference framework. Inspired by these advances, this dissertation goes beyond these classical causal inference models to explore the following complications that can arise in some causal systems – (i) path dependence, whereby systems exhibit state-specific causal relationships and a temporal evolution that could be counterfactually altered, (ii) entangled missingness, where missingness occurs in data together with causal dependence and finally, (iii) generalized coarsening, where systems entail causal processes operating at multiple timescales, and estimands of interest lie at a timescale different from that in which data is observed. In particular, we use the
language of graphical causal models and discuss an important component of the causal inference pipeline, namely identification, which links the counterfactual of interest to the observed data via a set of assumptions. In some cases, we also discuss estimation,
which allows us to obtain identified parameters from finite samples of data. We illustrate the use of these novel models on observational data obtained from biomedical and clinical settings
DEVELOPMENT AND PERFORMANCE EVALUATION OF BONE ADHESIVE FOR METAPHYSEAL FRACTURE FIXATION
No full textMetaphyseal fractures or injury to the metaphysis (Trabecular bone at each end of the long bone such as tibia or femur) resulting from standing height and low energy trauma account for 67.6 upper extremities and 13.9 lower extremities fractures per 10,000 people(1,2) in the elderly population. These injuries can result in difficulty in performing daily tasks and can lead to loss of independence. The current treatment methods include external or internal fixation procedures that involve use of metallic plates for providing mechanical support to the fracture site. However, these methods involve complex surgical procedures and have a high complication rate of 36% and 24% for upper and lower extremities respectively(3,4). Furthermore, these techniques are harder to implement when joining a complex fracture involving multiple bone fragments. Hence, surgeons always wanted to have a glue to join these fragments and treat the fracture. However, the current bone cement does not possess any adhesive properties and hence cannot be used in these surgeries. The Tetranite (RevBio, Inc) bone adhesive product was created to address this unmet need. This product acts as an adhesive and allows the surgeons to glue the bone fragments together. Additionally, the adhesive can stick to implant surfaces and can be used in combination with current plates. Animal studies are conducted test the safety and efficacy of the product. However, the product should be easy to use and should perform as intended during the surgical procedure. To test the usability of the product in a surgical environment, validation studies were conducted. The surgical environment was simulated, and the product was used on the specimen. Then, the users provided feedback on the delivery system, packaging, and overall experience. This feedback was incorporated, and modifications were made to the product. Lastly, a follow up validation study was carried out. In this study, the new modifications were tested by the user and feedback was recorded to ensure that the modifications fulfilled the user needs
THE REGULATION OF EPITHELIAL TO MESENCHYMAL TRANSITION BY MUTANT HISTONES IN UTERINE CARCINOSARCOMA
No full textCarcinosarcomas, also known as mixed malignant mullerian tumors (MMMTs) are biological cancers with poor prognosis and account for 15% of all gynecological cancer deaths. Previous studies have shown that whole exome sequencing of uterine carcinosarcomas identified an excess of mutations in H2A and H2B histones. Stable transfection into uterine carcinoma revealed the regulation of epithelial-to-mesenchymal transition (EMT), migration, and invasion by these mutants. While these observations suggest a direct involvement in carcinogenesis, the functional and structural characterization of these mutants in carcinosarcomas is unknown. Therefore, we conducted a study where we demonstrated that these mutations have the potential to destabilize the octamer and dysregulate nucleosome stability. Additionally, RNA-Sequencing (RNA-Seq) results have identified that these mutations promote global differential gene expression compared to the wild type and upregulate EMT along with an enrichment of genes that are important for migration and invasion. To validate our RNA-Seq findings, we performed quantitative PCR, which corroborated our findings. This study should enhance our understanding of the mechanistic role of these mutations that cause carcinosarcoma, and ongoing research will reveal the function that these mutations play in controlling chromatin accessibility, nucleosome instability, and their function in promoting oncogenesis
Antifungal Drug Formulation for Vaginal Yeast Infection
No full textOver 138 million women worldwide are affected by recurrent yeast vaginitis or Candidiasis [1]. Candidiasis is a type of infection caused by yeast Candida albicans overgrowth, and it is one of the most common diseases affecting women. Three out of four women will have a yeast infection during their lifetime, and most women experience infection at least two times [2]. Yeast infection is often mild with symptoms including vaginal itching, pain or discomfort during urinating, redness, and swelling in the vagina. To alleviate this infection, oral doses of fluconazole and vaginal doses of miconazole in the form of a suppository are prescribed. Sulconazole is currently used as a topical antifungal treatment for skin infections. Miconazole is reported with adverse effects such as diarrhea, headache, nausea [31]. Even though there are no adverse effects of low-dose fluconazole, patients experience adverse effects when prescribing with high-dose fluconazole daily [32]. Adverse effects of sulconazole include redness, irritation, and contact dermatitis [33]. Considering that oral administrated drugs need to circulate systemically, vaginal delivery is more optimal due to dosing directly to the site of infection. On the other hand, vaginal administration would have higher efficiency in drug delivery due to its local effect on the vaginal microbiota. To formulate drugs for vaginal delivery, nanosuspension of drugs under 300 nm can help to get through mucus layer for better absorption. Antifungal drugs fluconazole, miconazole, and sulconazole were formulated in nanosuspension using various Pluronic block copolymers as stabilizers. All antifungal drugs were tested in vitro to assess potency. The effectiveness of antifungal drugs in treating vaginal C. albicans infection in mice was then tested in vivo. Antifungal drugs formulated fluconazole and sulconazole showed effectiveness in killing C. albicans both in vitro and in vivo, however, formulated miconazole only showed effectiveness in killing C. albicans in vitro. More studies are needed
Pragmatic Inference in Spatial Language
No full textSpatial prepositions left, right, above, below, in, on, and others belong to a closed lexical class, meaning that the same spatial term frequently describes a wide range of spatial relations. As a result, speakers have to make generalizations about what kind of spatial relations can be described with the same term. Given the wide range of uses for any given spatial preposition, the nature of the representations that underlie their meanings is elusive and has given rise to much debate in literature. Two prominent approaches to the meaning of spatial prepositions arose: the geometric approach, according to which all spatial prepositions encode the geometric structure of spatial scenes (Zwarts, 1997, Zwarts and Winter, 2000), and the functional approach, which instead highlights the importance of functional and force-dynamic relationships between objects for prepositions like in and on (Coventry and Garrod, 2004, Coventry et al., 2010, Landau, 2017). Recently, pragmatics has been proposed as a point of view that could help bridge the gap between these two approaches (Zwarts, 2017); however, existing accounts of pragmatic inference in spatial language (Carstensen et al., 2014, Herskovits, 1987, Levinson, 1999, Ullman et al., 2016) do not provide a systematic explanation of how the geometric and functional information is resolved. In this dissertation, I evaluate the geometric and functional approaches by testing their predictions about the effect of pragmatics on spatial language production and comprehension. To this end, I conduct a series of controlled experiments that manipulate both the geometry of the scene and the amount of functional information about objects and their functional and force-dynamic relationships. Next, I quantitatively test a model of spatial language pragmatics using the Rational Speech Act Framework (Frank and Goodman, 2012). I specify two distinct models for functional prepositions in and on and geometric prepositions above/below/left/right. I find that the pattern of speakers’ production and comprehension of spatial terms, as well as the model’s fit to the experimental data, provide strong support for the functional approach. This pattern indicates that prepositions in and on encode functional relationships between objects, while
above/below/left/right encode the geometric structure of spatial scenes
Analytical Equations for Critical Local Buckling Stress of Lipped Channels
No full textThe objective of this study is to develop accurate analytical equations for calculating the critical local buckling stress of lipped channels with or without punchouts under compression and bending. Finite strip analysis is conducted on over 1000 lipped channel sections under four different loading conditions. Simple polynomial ratio equations are fit to the finite strip analysis results. The performance of the developed expressions are compared against the finite strip analyses and the element method currently provided in the AISI S100 Specification. The developed expressions are intended for use by engineers in future versions of the AISI S100 Specification.American Iron and Steel Institute (AISI), Steel Framing Industry Association (SFIA
Oral History of William "Bill" J. Winslade
No full textThis interview with William “Bill” J. Winslade, PhD, JD, PhD, was conducted by
Suzanne Snider on March 28 and March 29, 2023 in Friendswood, Texas as part of Moral Histories: Voices and Stories from the Founding Figures of Bioethics, an oral history project of the Johns Hopkins Berman Institute of Bioethics. Prof. Winslade was born in 1941. He is the James Wade Rockwell Professor of Philosophy of Medicine at the Institute for Bioethics and Health Humanities, University of Texas Medical Branch at Galveston; Distinguished Visiting Professor of Law and Associate Director for Graduate Programs, Health, Law, and Policy Institute at the University of Houston Law Center; and an elected Fellow of The Hastings Center. His areas of expertise include psychodynamics of medical practice, traumatic brain injuries, bioethics and the law, and clinical ethics.On Day 1, Prof. Winslade speaks about his childhood in Illinois and his undergraduate career at Monmouth College, where he completed a double major in philosophy and economics. He describes his transition to the philosophy department at Northwestern University, where he received his PhD in 1967. Prof. Winslade discusses how the interdisciplinary approach and connections to international visitors he experienced enriched his education. Prof. Winslade mentions his experience teaching philosophy at University of Maryland in the late 1960s before enrolling at UCLA School of Law. He narrates an early childhood brain injury and explores this as inspiration for his eventual research focus on traumatic brain injuries later in his career. Prof. Winslade states his position in favor of patient autonomy as an ethics consultant and in the context of end-of-life decisions particularly. During his time at UCLA, Prof. Winslade discovered his commitment to psychodynamics and pursued his PhD in psychoanalysis, which he completed in 1984.Prof. Winslade recounts his collaboration with Albert Jonsen and Mark Siegler on the book Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (1982). He understands this book as a practical complementary guide to Tom L. Beauchamp and James F. Childress’ Principles of Biomedical Ethics, which Prof. Winslade describes as more theoretical. Prof. Winslade explains the four box method for assessing clinical ethics issues. Prof. Winslade discusses his move from UCLA to the University of Texas Medical Branch (UTMB) in Galveston, Texas, which allowed him to work within one department dedicated to bioethics rather than across many as had been the case at UCLA. Prof. Winslade offers a definition of bioethics. He narrates his professional and personal relationship to Dax Cowart, a burn survivor whose case raised questions about individual decision making and the right to die. Prof. Winslade briefly describes his experience with teaching.On Day 2, Prof. Winslade returns to traumatic brain injuries, mentioning a case which inspired him to write his book The Insanity Plea: The Uses and Abuses of the Insanity Defense (1983). He discusses the case of Dennis Thorpe, a 70-year old man who refused physician’s recommendations to amputate his gangrenous foot. Thorpe only accepted this treatment once the judge ruled the amputation as necessary; Prof. Winslade shares his reflections on this outcome as a lesson in the influence of authority and trust.Prof. Winslade shares his personal views against boxing and his professional ambivalence towards boxing as a sanctioned sport; he subsequently addresses ambivalence as a valid stance on ethical issues. He talks about three patients he treated as a practicing psychoanalyst at UCLA whose recovery from grief inspired his current project that centers on Freud’s Mourning and Melancholia.Prof. Winslade emphasizes the importance of psychoanalytic education in medical school. He mentions his consultation work for legislators in relation to a law that would allow voluntary castration for sex offenders in Texas, and describes his relationships with three people who were castrated under this law as well as their outcomes. Prof. Winslade distinguishes his role as a consultant during his time on the ethics consultation services at UTMB and UCLA as a facilitator to support patients’ own decisions, rather than a decision-maker. Prof. Winslade briefly discusses the ethics of working as a consultant for private companies, his work with the Children’s Organ Transplant Association, and privacy and confidentiality in psychoanalysis. Prof. Winslade concludes the interview by acknowledging the involvement of clinical ethics consultants in bioethics conversations.This interview may be of interest to those wishing to learn more about the field of bioethics; clinical ethics; regional histories of bioethics (Texas); bioethics, law, and psychoanalysis; work in prisons; and traumatic brain injury
