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Longitudinal Assessment of Blast-Related Traumatic Brain Injury (TBI): Impact on Structural Neuroimaging Correlates, Working Memory, and Processing Speed
Full text linkThe conflicts in Afghanistan and Iraq led to a significant surge in blast-related traumatic brain injuries (bTBIs). However, our understanding of their lasting neurological impacts remains incomplete. To our knowledge, this is the first longitudinal study of its size to explore whether increasing levels of blast exposure predict neural atrophy or cognitive decline over time. We analyzed 149 baseline and follow-up data sets from service members categorized by blast exposure: blast naïve (n = 57), single blast (n = 70), and multiple blasts (n = 22). Participants underwent structural magnetic resonance imaging (MRI) and neuropsychological assessment.
All data were drawn from the Long-term Impact of Military-relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC). Blast exposure group was determined using self-reported data in combination with a structured clinical interview. Regional brain volume was calculated using FreeSurfer version 7.4.1 on T1-weighted structural scans. Cognitive and psychiatric assessments were collected at the initial visit and repeated at each follow-up timepoint.
We hypothesized that regional and overall brain volume would show the most atrophy in those with the highest blast exposure and greatest time since index injury. We also hypothesized that cognitive outcomes would decline most steeply in the highest blast exposure group over time. Further, we expected that brain volume would predict cognitive decline, even when controlling for blast group. However, no significant effects were found for group, time, or Time × Group interactions in any of our primary analyses.
Several exploratory findings emerged, outside of the scope of our hypotheses. These included caudate volume as a predictor of processing speed; depressive symptom influence on the amygdala; the combined influence of depressive and PTSD symptoms on working memory; and time-since-injury interactions in the thalamus and caudate
Development and Validation of the Informal Safety Leadership Measure
Full text linkThis research develops and validates a measure of the emerging concept of informal safety leadership (ISL), which integrates elements of safety leadership and informal leadership to address a significant gap in organizational safety literature. Despite extensive research on formal safety leadership, there remains limited understanding of how non-managerial employees influence safety practices and culture within organizations. This dissertation develops and validates a comprehensive measure of informal safety leadership through a sequential mixed-methods approach incorporating a pilot study and two additional studies. First, a pilot study employed focus groups with health, safety, and environmental professionals to identify key dimensions of ISL. Study 1 focused on the development and refinement of a multi-dimensional ISL scale with data from 300 employees across high-risk industries. Exploratory factor analysis yielded a robust five-factor structure representing core ISL behaviors: Advocacy (proactive safety communication and initiatives), Support (responsiveness to others\u27 safety concerns), Reluctance (hesitancy to engage in safety leadership), Mindset (safety knowledge and priorities), and Reporting (promoting incident documentation and transparency). Study 2 confirmed this factor structure in a separate sample (N = 283) and established the scale\u27s convergent, discriminant, and criterion-related validity. The ISL measure revealed strong psychometric properties and predicted important safety outcomes including influence on others\u27 safety behaviors, vigilance, and compliance. Supplemental analyses revealed that ISL operates differently across organizational contexts, with medium-sized organizations showing the highest ISL scores, suggesting optimal conditions for informal safety leadership emergence. The findings contribute to both research and practice by providing a psychometrically sound instrument to measure informal safety leadership, enhancing our understanding of how safety culture develops through informal influence processes, and offering organizations practical insights for recognizing and leveraging informal safety leaders to reduce workplace injuries and fatalities
Implementation of Telehealth Optimization to Improve Postpartum Visit Adherence
No full textProblem: Postpartum appointment attendance remains a critical aspect of maternal healthcare, particularly among women in an inner-city, urban outpatient setting. Despite prior efforts to improve scheduling efficiency and telehealth adoption, no-show rates for the first weeks postpartum visit, both in-person and virtual visits, remain consistently high, limiting access to essential postpartum care. This study aimed to increase the postpartum compliance (comp) rate by 5% through the implementation of telehealth scheduling improvements.
Methods: A quality improvement (QI) project was conducted at an urban, outpatient Women’s Health Clinic (WHC) serving a diverse inner-city population. The intervention focused on refining scheduling processes by integrating the .PPVISIT communication tool, which facilitated coordination between inpatient discharge providers and outpatient WHC schedulers. Additionally, Nurse Practitioners (NPs) were encouraged to schedule postpartum appointments before an induction of labor (IOL) date to improve attendance rates. Data collection included pre- and post-intervention show rates for virtual and in-person visits, with statistical analysis using a Chi-square test to examine relationships between intervention implementation of the communication tool .PPVISIT and appointment type.
Results: Following the intervention period, postpartum appointment compliance rates increased modestly from 54.74% to 59.06%. However, statistical analysis found no significant association between intervention implementation and appointment type, indicating that in-person visits remained the preferred modality. Virtual visit attendance remained unchanged at 50%, with persistent no-show rates among vaginal delivery patients. Also, systemic challenges, including staffing disruptions and communication barriers between inpatient and outpatient teams, limited the overall effectiveness of the intervention.
Implications: While the intervention did not achieve a statistically significant increase in compliance rates, the findings highlight potential areas for future improvement. Strengths of the project included its diverse patient population, high patient volume, and the introduction of communication tools that facilitated more efficient scheduling coordination. Future initiatives should focus on addressing telehealth adoption barriers, optimizing scheduling workflows, and refining outreach strategies to enhance postpartum appointment attendance. Incorporating patient-centered engagement efforts and leveraging qualitative feedback could further improve postpartum care accessibility and adherence
The Roots of Our Food: Relationships Are the Seeds of Care-based Food Heritage
Full text linkThe purpose of this co-authored, general qualitative research
study was to examine food relationships between individuals,
communities, and Earth. We explored the concept of relational food
systems pertaining to engagement ideas at EarthDance Organic Farm
School and Hawai’i Institute of Pacific Agriculture. Our research
furthers understanding about how to engage people, individually and
collectively, with the land to inspire action. We argue that care-based
relationships can inspire action, helping individuals reconnect with
their food heritage by engaging with land, community, and self.
Heritage site leaders in food systems who center interconnectedness
create places where relationships between people, land, and food are
more care-based, inviting all life, human and non-human, to flourish.
This dissertation first offers a journal article which elaborates on the
ways people might be inspired toward action within food heritage. We
crafted the Model of Inspired Action to Escape Disconnection, which
provides a foundation for engaging with hands, head, and heart within
the self, community, and land when trapped within a system of
disconnection. Secondly, the dissertation presents a creative nonfiction
chapter that utilizes a more poetic approach in describing the
intersection of self, community, and land. The dataset for this study
consists of interviews with 29 food system experts, including
Indigenous knowledge holders. Thematic analysis was used to
interpret interview transcripts and the qualitative results produced
three major themes: Barriers to reciprocal relationships exist when
trapped in a system, First-hand experiences of awe steward
relationships with self, community, and the Earth, and Inspiring action
for shared future generations begins with awareness, understanding,
and hope. Results showed that the U.S. food system is based on
exploitation and consumption, preventing reciprocal and respectful
relationships. Relationships are the bridge between being trapped in a
system and engaging in meaningful action. Diverse first-hand
experiences encourage perspective-taking of others, human and non-
human, and increases opportunities for awe, connection, and care.
These results corroborate previous research around relational food
systems and Ecologies of Care, while providing material for future
research such as an examination of how to bring awareness to the
Earth as an honorable harvest rather than an exploitable resource
Implementation of an Evidence-Based Postpartum Depression Screening Tool in a Level IV Neonatal Intensive Care Unit
Full text linkProblem: Postpartum depression (PPD) affects up to 40% of mothers with infants admitted to the Neonatal Intensive Care Unit (NICU), yet many remain undiagnosed due to the absence of standardized screening protocols. Early identification and referral to Perinatal Behavioral Health Services (PBHS) is critical to support maternal well-being and improve neonatal outcomes.
Methods: This evidence-based quality improvement project utilized a descriptive and correlational design to evaluate the impact of implementing the Patient Health Questionnaire-8 (PHQ-8) for PPD screening among mothers of infants born ≤ 32 weeks’ gestation in a Level IV NICU. A convenience sample of 29 mothers received the PHQ-8 via phone at 48-hours and four-weeks postpartum. Referrals to PBHS were initiated for mothers who screened positive (PHQ-8 ≥ 5) and consented to a referral. Screening and referral rates were compared to retrospective pre-intervention data.
Results: Among participants, 65.52% (n = 19) screened positive at either time point. Referral rates to PBHS significantly increased following PHQ-8 implementation (p = .001), with 14 mothers consenting to services. Six of ten mothers referred at 48-hours showed symptoms improvement by week four. While no significant change in overall screening positivity or severity was observed between time points, symptom fluctuation emphasized the importance of repeated screening.
Implications for Practice: Routine use of the PHQ-8 in the NICU setting can increase identification of PPD and facilitate timely referral to PBHS. Integrating simple, validated screening tools into standard NICU workflows may address unmet mental health needs in high-risk mothers. Repeated assessments at multiple time points can enhance early intervention and promote long-term maternal-infant health
Bowel Regimen Protocol Implementation for Pediatric Patients Following Cardiac Surgery
Full text linkProblem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).
Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients aged zero to 21 years undergoing cardiac surgery. Patients requiring extracorporeal membrane oxygenation (ECMO) within 24 hours of surgical intervention were excluded. Pre- and post-implementation data was collected via chart review and included age, sex, day bowel regimen was ordered, type of medications ordered, time of administration, and time in days to first postoperative stool.
Results: A chi-square test of independence, Mann-Whitney U test, and two Fisher’s exact tests were conducted to analyze results. Following implementation of the bowel regimen protocol, this study demonstrated a 6.96% decrease in the incidence of postoperative constipation, and provider compliance with ordering bowel regimen medications on postoperative day (POD) zero increased by 21.62%.
Implications for practice: Implementation of standardized protocols could decrease the incidence of postoperative constipation in the pediatric CICU by promoting provider adherence to ordering prophylactic bowel regimens in the early postoperative period
A Program Evaluation: Insomnia in Adults with Major Depression Disorder with Cognitive Behavioral Therapy for Insomnia (CBT-I)
Full text linkAbstract
Problem: In 2023, Compass Health Network (CHN) data analysts found that 91% of CHN patients in the United States who have died by suicide reported problems with sleep, which was the highest risk factor for suicide. The objective of this program evaluation project is to evaluate CHN CBT-I effectiveness on patients ‘suicidality by improving their insomnia.
Methods: CHN quality improvement (QI) project used a quantitative method pre/post score design. Quantitative aggregate data was collected on the participants who met the inclusion criteria via retrospective and prospective chart review prior to CHN implementing the intervention. CBT-I clinicians collected PHQ-9, Columbia-Suicide Severity Rating Scale (C-SSRS), and Insomnia Severity Index (ISI) scores before and after implementing the intervention.
Results: A Wilcoxon-signed rank test revealed that there was no statistically significant difference between the pre-test and post-score for the following: suicidality intensity z = -1.342, p = .180, suicidality frequency z = -1.342, p = .180, insomnia severity z = -1.342, p = .180, or in PHQ-9 z = -.447, p = .655. Clinical significance has been identified when looking at the differences between pre-and post- scores. Participant 1 had a 4-point decrease in suicidality intensity and frequency, a 6-point decrease in insomnia severity, and a 1-point increase in depression severity. Participant 2 had a 1-point decrease in suicidality, intensity and frequency, a 13-point decrease in insomnia severity, and an 11-point decrease in depression severity.
Implications for Practice: There is insufficient evidence to conclude that the CHN CBT-I intervention is effective in reducing patient’s suicidality. Future PDSA cycles and data collection should take place for ongoing QI analysis
Ask us for naloxone
Full text linkA post for the UMSL libraries
Is someone you know at risk of an overdose?
Ask us for naloxone.
Kits are available at the service desk.
Naloxone saves lives.
UMSL Librarie
Photoflow Synthesis and Characterization of cis- and trans-n-isohumulone
No full textPreviously published efforts by the Hamper group demonstrated the viability of photochemistry in the isomerization of n-humulone to n-isohumulone. Photochemical isomerization reactions of n-humulone performed under 400nm light over 8 hours resulted in high yields (84% reported) of largely trans-n-isohumulone (\u3e95%). These promising results invited further examination of the photochemical process and the application of photoflow procedure. Herein we report the beginnings of a comprehensive slate of n-humulone isomerization reactions performed under iterative photoflow conditions
Visualizing and Evaluating Binary Classifier Performance with Contingency Space
No full textTraditional metrics for evaluating binary classifiers, such as Accuracy, F1 Score, and True Skill Statistic (TSS), often obscure the underlying tradeoffs between true positive and true negative performance—particularly in imbalanced or high-stakes domains. This poster introduces the Contingency Space, a two-dimensional representation of classifier behavior defined by true positive rate (TPR) and true negative rate (TNR). Within this space, scalar performance metrics become geometric surfaces, revealing how scores vary across the entire landscape of possible classifier outputs.
We present a Python package that implements this framework, enabling users to map model predictions into the Contingency Space, visualize metric surfaces (including the effects of class imbalance), and trace classifier trajectories across it. Critically, the tool allows users to define custom performance metrics as analytic functions of TPR and TNR, empowering researchers to design evaluations that reflect domain-specific priorities. This work reframes classifier evaluation as a geometric and exploratory task—offering a visual, flexible, and intuitive alternative to one-size-fits-all metrics