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Childhood adversities and risk of posttraumatic stress disorder and major depression following a motor vehicle collision in adulthood
Get PDFAims Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions. Methods Data came from n = 999 patients ages 18-75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models. Results Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31-1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65-2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43-2.87) and bullying (RR = 1.44; 95% CI = 0.99-2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE. Conclusions Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE
Implementing Trauma-Informed Care Curriculum in a Doctoral Nursing Program
Get PDFPurpose: Trauma is highly prevalent with 70% of individuals encountering at least one traumatic event during their lifetime and approximately 30% experiencing four or more events (Wheeler & Phillips, 2021). Despite the dramatic impact of trauma, there is minimal literature to assist nurses in caring for patients with a trauma history. The purpose of this project was to evaluate the implementation of a virtual, asynchronous trauma-informed care (TIC) educational program for Doctor of Nursing Practice (DNP) students at a midsized, Midwestern public university using knowledge, attitudes, and competency scores as outcome measures.
Methods: This program evaluation (PE) project was an observational pre, immediate-post, and 30-day-post educational design. The 48-item Trauma-Informed Care (TIC) Provider Survey v2.0 was adapted in Qualtrics and utilized to assess DNP students’ knowledge, attitudes, and competency in assessing for trauma and utilizing TIC practices.
Results: Participants (N = 23) included DNP students who completed the pre- and immediate-post TIC surveys. Of the 23 total participants, 10 students also completed the 30-day post retention survey. Repeated-measures t-tests were utilized to test for significant change across time associated with the TIC education. A statistically significant increase in DNP students’ knowledge, competence, and use of TIC interventions was seen following the completion of six educational modules.
Implications for Practice: Statistically significant improvements in knowledge, competency and the use of TIC interventions suggests that DNP students who participate in TIC curriculum during their nursing program can gain the knowledge and competence to effectively use TIC skills in practice
Implementation of a Structured Discharge Checklist for Children Admitted to the Hospital with Acute Asthma
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Problem: The transition process from a hospital setting to home is critical for pediatric patients and their families. However, there is no standardized process to ensure asthma discharge orders and asthma action plans are printed at the time of discharge
Methods: This observational quality improvement project utilized a pre-and-postimplementation of the Kamishibai Card (K-Card) process for pediatric discharge checklist compliance in an inpatient pediatric general medicine unit. This project used a sample of all children aged 2 years to 21 years with an asthma diagnosis admitted to the inpatient general medicine pediatric unit. This project included an education phase and an implementation phase. The QI project was performed using a plan-do-act study method to assess barriers during the implementation phase.
Results: A total of 58 patients were included in the quality improvement project (40) patients pre-implementation phase and 18 patients- post-implementation. During the pre-implementation phase, there was a home management plan of care compliance rate of 95% with November 2022 having the lowest rate of compliance at 83%. After the implementation of the K-card tool, there was an overall home management plan of care compliance rate of 89%. The result of the two-tailed paired samples t-test was not significant based on an alpha value of .05, t (3) = -0.29, p = .790.
Implications for Practice: K-cards may help in enhancing home management plan of care in the pediatric population with asthma by auditing the necessary discharge components set in place by the Joint Commissions Childhood Asthma Care Measure -3 (CAC-3). K-Card audit reports may be used to identify barriers to proper discharge and develop new standardized workflow strategies
From Childhood through Adulthood to Godhood: Trodding the African Ancestral Path to Become a Shining Star of Ourstory
Get PDFThis autoethnographic narrative examines the importance of conceiving and sharing liberating stories, and participating in independent communal training processes that advance young African American males\u27 psychosocial and mental development. To bring my analyses to light, I applied the foundational frameworks of African Worldview and Critical Race Theory to my research to uncover many of the influences that helped me evolve from boyhood (nescient) to manhood (laborer) and later to Godhood (master who is in union with all).
Employing the autoethnographic methodology enabled me to share key points in my educational journey, which propelled my transformation. This contemplative engagement was a moving meditation that revealed both my miseducation in America’s racial caste system and the process that was critical to my liberation from a path of self-destruction to the road of excellence.
My findings highlight the guidance, social connections, mentorship, and actions I needed to not only survive, but more importantly, thrive. This journey involves reconnecting with the cultural and spiritual best practices from my great African past to create healthy communities in the present that positively transforms the future. Learning, in this context, created healthy spaces that helped me to develop a productive life story, and ultimately a personal trajectory of love, peace, and happiness
Evaluating Middle School English Language Learners’ Science and Literacy Proficiency
Get PDFThe academic success and English proficiency of ELL students are receiving more attention as a result of the growing number of ELL students and the demand for accountability and assessment in education. It is widely accepted that ELL students struggle on state standardized tests because they lack the cognitive academic language abilities needed to succeed on extensive subject evaluations (Thakkar, 2013). According to Abedi and Dietel, ELLs\u27 academic performance lags behind that of other segments of population, and the attainment gap reduces only slightly over time (2004).
The NWEA archival data of 6th, 7th, and 8th grade students who attended a Midwest area middle school in 2018-2019 educational year was used to investigate the question of whether or not middle school ELL students’ academic achievement improved in integrated science during one year of instruction while becoming more English language proficient, and improved in integrated science significantly more than the native speakers’ achievement in science after both groups completed a year of science instruction.. The data were used to analyze trends over time and variation in changes over time among groups of individuals in terms of English language and science achievements. Paired t-test and analysis of variances were used to determine if there was a relationship between science achievement and English language proficiency.
The results indicated that there was a significant improvement in academic achievement of ELL students in science during one year of instruction while they were becoming more English language proficient, and ELL students’ academic achievement in science did not improve significantly more than the native speakers’ achievement after both groups completed a year of science instruction.
Findings may be used to develop strategies to improve English language skills of ELL students of the targeted school settings. Improvement in English language skills may allow ELL students to succeed in all subject areas
UMSL Magazine - Spring 2023
Get PDFThe University of Missouri–St. Louis publishes UMSL Magazine for alumni and friends. The magazine highlights excellence at the university. Circulation is 107,610 and the magazine is released twice a year.https://irl.umsl.edu/magazine/1034/thumbnail.jp
Can You Escape Agency by Falling Asleep? Killing Two Constitutivists’ Problems With One Stone
Get PDFIn this paper, I present a new problem to constitutivism (the idea that agency grounds our practical norms) and argue that the solution to this problem also solves Enoch’s shmagency question. The problem I bring forth involves the fact that agency seems to be metaphysically escapable, such as when we fall asleep, or get hit by a truck. If this is correct, then we allow for perplexing cases in which a wrongdoing is done, but no agent is responsible, nor is any norm broken—for, what grounds responsibility and norms, our agency, has disappeared. I thus argue for a notion of agency immune to such cases (metaphysically inescapable), and argue that as long as this is true, the shmagency question is in fact moot: the content of the question of whether we have reasons to be agents in the first place will make as much sense as asking whether we have reasons to be an elf, a hobbit, or a garuda
The Effects of Mindfulness on Depression in Dialysis Patients
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Problem: Depression is a prevailing global health issue and a typical complication of dialysis patients. This quality improvement project\u27s purpose was to evaluate mindfulness on depression in dialysis patients, aged 18-93, who are on dialysis and participated in a mindfulness program over three months.
Methods: A descriptive, prospective, and retrospective design was used to assess depression pre- and post-implementation of a mindfulness telephone line over three months. A convenience sample of twenty adults aged 18-83 who use this hemodialysis center on Monday, Wednesday, and Friday was utilized. The Iowa Model is the framework selected to guide the implementation of this quality improvement project.
Results: A total of 20 hemodialysis patients (n=20) participated in mindfulness and had pre-and post-PHQ-2 and well-being scores analyzed. The results of pre-and post-PHQ-2 mean score were (M=.90, SD=.788) (M=.35, SD=.48. The mean of the well-being score decreased from (M=2.3) to (M=1.5). All tests were based on an alpha of 0.05. Results revealed statistical significance. Post PHQ-2 resulted in (p
Implications for Practice: Mindfulness meditation has a favorable influence on depression in dialysis patients. Telephone-based mindfulness can reduce depression and well-being scores in the dialysis population. Consistent use of mindfulness can further improve depression scores
Risk and Protective Factors to Well-being in Foster Care Youth Prescribed Psychotropic Medication in a Wraparound Program of Care
Get PDFBackground: Youth in foster care are prescribed psychotropic medications at higher rates and are more likely to experience disruptions to their medical care. Wraparound models of care have been shown to improve outcomes for youths on psychotropic medications, however, these methods have proved difficult to replicate in the foster care population. Government policies have called for better oversight in the foster care population and in response programs have been implemented, however, there remains little research for these programs. Objective: This research will evaluate the characteristics of foster care youth as they enter a Wraparound model of care and the predictive value of these characteristics on psychotropic medication prescribing. The research will also identify the association of Wraparound care on specific outcomes of well-being in foster care youth. Method: This research uses a quantitative analysis of data from a specific Wraparound model of care through a retrospective case control study. The initial data analysis identifies sociodemographic variations, as well as potential protective and risk factors of these youth through linear regression modeling. A second analysis of youth with multiple data points was used to identify the relationship of the measures of well-being of those prescribed psychotropic medications while in this Wraparound model of care. Results: Analysis demonstrates that age, sex, race, BMI, zip code and presence of medical home together can account for the variance in psychotropic medication prescribing, with individual variable significance including age, sex and BMI, and no significant correlation to zip code or medical home. The access to care provided by WAW demonstrate no improved health outcomes with PPP associated with increased number of placements (p\u3c.001), and increased BMI and increased number of placements in those with medical homes (p\u3c.001). Repeated use of psychological care improved with those in WAW with 50% of those with an initial evaluation receiving follow up care, however, there was no associated decrease in the number of psychotropic medications. Discussion and Clinical Implications: These findings contribute to the understanding of the variables that contribute to well-being for foster care youth on psychotropic medications. These findings are essential to ongoing programmatic design, implementation, and evaluation, as well as promoting policy that supports similar programs for foster care youth that promote well-being
Identifying the Drivers of Pollen Limitation in Apples (Malus domestica) Within the Urban Orchards of St. Louis, MO
Get PDFThe human population is projected to continue growing throughout the remainder of the 21st century. Thus, agricultural production will need to increase drastically in order to ensure global food security. Management strategies aimed at enhancing crop pollination by promoting pollinator diversity have shown potential as an environmentally sustainable method of increasing yields. Optimizing the design and implementation of these strategies will require us to expand our understanding of the processes which influence crop pollen limitation. In this study, we examined pollen limitation in self-incompatible apple trees (Malus domestica) within urban orchards located in St. Louis, MO. In our first field season, we conducted a series of pollen limitation experiments to determine if the apple trees were pollen limited, as well as if the spatial arrangement of the trees or the receipt of heterospecific pollen affected pollination success. In our second field season we conducted an experiment which aimed to determine if different bee taxa (A. mellifera, O. cornifrons, and Andrena sp.) differed in their rates of outcross pollen transfer. We found that the apple trees were experiencing pollen limitation, and that this was likely due to high rates of geitonogamous pollen deposition. We also found evidence which indicated that honeybees (A. mellifera) moved between the apple trees less often than the other bee taxa, leading to high levels of within-plant pollen transfer and low rates of outcross pollen deposition. Key words: Malus, pollen limitation, ecological intensification, urban agriculture, pollinator