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The Aftermath of the First Children of Brown: Stories of Housing and Education Racial Disparities in St. Louis, Missouri 1950-1970
Get PDFThis study explores residential segregation in two prominently African-American neighborhoods in St. Louis. It is based on past and current scholarship and examines the impact of historical and current housing and educational policies, consequently creating persistent racial disparities. According to Rothstein (2017), past governmental influence played a significant role in creating what he calls government-sponsored urban ghettos in cities across the United States today. St. Louis has been a residentially segregated city for many years. This study looks at St. Louis-specific research about housing, patterns, educational outcomes, and neighborhood experiences of the interview participants. The responses given by the participants provided the raw data for evaluation. Data analysis involved aspects of Critical Race Theory (CRT) and an emerging Theory of Place. CRT seeks to understand racism within a historical context and how it impacts social and economic outcomes (Matsuda et al.,1993). Place identifies a population within an environmental context characterized by social, cultural, and economic influences and organized by economic and socially systemic forces (Johnson, 2012). In other words, where you live can impact a group\u27s social, educational, and economic outcomes. The study uses a qualitative research approach and narrative analysis for interview data. Narratives give form to the experience by providing the participants a physical dimension to make sense of what has or has not happened (Bamberg, 2010)
Has the PCAOB Maintained Political Independence? Evidence from Public Communication
Get PDFThe Public Company Accounting Oversight Board (PCAOB or Board) was created as part of the Sarbanes-Oxley Act of 2022, legislation meant to address lapses in investor confidence in the audit of public companies in the wake of several high-profile accounting scandals. The PCAOB was uniquely structured to avoid direct governmental interference and maintain a level of political independence as it fulfilled its oversight responsibilities. In the 20 years since the PCAOB was established, numerous Board Members have made public statements involving a range of topics. During the life of the PCAOB, the political landscape has become progressively polarized along partisan lines. This research seeks to discern whether the PCAOB has remained true to its nonpartisan mandate in an increasingly polarized political environment by examining partisanship, or lack thereof, based on the public speeches and communiques of PCAOB leaders. Partisan speech is identified based on common individual phrases used in both congressional and PCAOB speeches. Using these definitions, we analyzed all historical speeches and public statements made by individual members of the PCAOB and found that they appeared to publicly communicate topics within their regulatory purview without any significant indication of overt or intentional political interference or bias
Implementing Obesity Management Guidelines in Rural Primary Care
Get PDFAbstract
Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.
Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of at least 25 kg/m2. There were two BMI categories with associated treatments: BMI of 25 to 29.9 kg/m2 or BMI of at least 30 kg/m2. Based on the patient’s BMI, appropriate treatment was provided. Data collection occurred from January 2023 to April 2023.
Results: Of the eligible patients (N =348), 27% (n = 94) patients had a BMI of 25 to 29.9 kg/m2, and 73% (n = 254) had a BMI of at least 30 kg/m2. The algorithm was utilized in 74% (n = 257) of patients. Of the (n = 94) patients with a BMI of 25 to 29.9 kg/m2, 66% (n = 62) of patients were provided treatment. Of the (n = 254) patients with a BMI of at least 30 kg/m2, 76% (n = 195) were provided treatment.
Implications for practice: This QI project demonstrated a feasible and cost-efficient method for the enhancement of clinical practice change within rural primary care. Utilization of the obesity management algorithm by the provider could impact patient treatment plans
Evaluation of Simulation on Medication Errors in the Pediatric Intensive Care Unit
Get PDFProblem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.
Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).
Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded infomation to promote further PDSA cycles and promote further data collection with larger sample sizes.
Implications: An improvement in patient outcomes and care by decreasing medication errors in the pediatric intensive care unit
Social Spaces, Places, and Substance Use in Shaping Queer Identities
Get PDFResearch has suggested that queer people may be more likely than their cisgender heterosexual counterparts to use substances. Largely, these higher rates are commonly explained through frameworks of victimization or (ab)use that render substance use as a form of coping or inherently problematic. While some queer people do use substances to cope, the social spaces, places, and contexts in which use often occurs are often obscured or ignored. More recently, contemporary queer criminologists have explored queer substance use and have considered how it is intimately linked to social space, place, identity formation, and community building. This dissertation draws from queer criminological approaches to theorize and develop the idea of social spaces and places. In particular, it explores how queer people define and create social spaces and places, how social spaces and places shape identity formation, and how social spaces and places are imbued with substances. To investigate, 49 in-depth semi-structured interviews were conducted with self-identified queer people who have used substances or frequented queer social spaces to examine the intersection of social place, contexts, substance use, and queer identity formation. As such, it is argued that social spaces and places can be distinguished, imbued with identities, messy, and crucial sites for substance use and identity formations through use
The Association between Pelvic Floor Dysfunction and Mental Health in Natal Females with a Focus on Native American Populations
Get PDFPurpose
Over half of natal females in the United States suffer from pelvic floor dysfunction (PFD). PFD can increase risk of mental health sequelae; however, no studies have been conducted examining the association between mental health and PFD in the Native American (NA) population. This dissertation aims to evaluate the association between PFD, with a focus on overactive bladder (OAB), and mental health in females with specific attention to NAs.
Methodology
A current state of the science review examined the literature for associations between OAB with depression and anxiety in females. Utilizing this literature review, a theoretical model was constructed examining the relationship between healthcare access and development of PFD, mental health consequences, and impact on overall quality of life. Finally, unsupervised machine learning was employed to identify risk clusters for OAB based on variables identified in the literature using the BRFSS dataset by training the algorithm in White females and testing the algorithms fit for NA females.
Results
The literature largely supports a relationship between OAB and mental health sequelae; with no research reports in NA females. Increased parity, diabetes, overweight, smoking, and poor healthcare access can increase risk of developing PFD and its consequences, including OAB. Research supported OAB increases the risk of developing depression and anxiety which are known to decrease the overall quality of life. Unsupervised machine learning identified the strongest predictive factors for the development of OAB in females appear to be BMI and time lived with diabetes; however, the fit of the model examining White females (56.8%) was stronger than in NA females (53.7%).
Discussion
Factors that increase risk of developing PFD include overweight, diabetes, smoking, and increased parity, all of which are experienced at higher rates by NA natal females than females of other races. Current risk factors for PFD and OAB do seem to fit similarly in White and NA females. As research indicates a strong relationship between OAB and depression and anxiety, clinicians should focus on screening for both in females with PFD and OAB including NA females in order to mitigate the risk of developing or early detection of these mental health consequences
Near-IR Spectroscopic Analysis of the Primary Volatile Composition of Long and Short-period Comets
Get PDFComets are among the most well-preserved objects that formed in the protosolar nebula ∼4.5 Gyr ago. Hence, they are important for understanding various aspects of the formation, evolution, and habitability of the solar system. Multiple primary volatiles (molecules directly sublimating into the coma from the nucleus) emit via rovibrational transitions in the near-IR, providing opportunities to calculate their abundances. To date, only ∼50 comets have been characterized for their primary volatiles, with the short-period Jupiter-family comets (JFCs) being significantly underrepresented. In contrast, hundreds of comets have been sampled at optical/UV wavelengths, primarily for the composition of daughter species, leading to the emergence of taxonomic schemes. To develop a near-IR comet taxonomy, more comets need to be characterized. This dissertation focuses on understanding the chemical composition of JFC 46P/Wirtanen. The comet was observed during its historic 2018 apparition using the high-resolution, near-IR spectrograph iSHELL. This work presents the first comprehensive analysis of molecular production rates (molecules s−1) and abundances (production rates relative to H2O and C2H6) of a large set of primary volatiles, H2O, HCN, C2H2, NH3, CH3OH, CH4, C2H6, H2CO, CO, and HC3N in 46P/Wirtaten. The multiple pre, near, and postperihelion measurements spanning ∼2 months allowed for testing temporal variability in productions and abundances. This work places the results in context by comparing them with those from the comet population observed using ground-based near-IR observations. Using iSHELL’s long-slit, spatial profiles of multiple primary volatiles were obtained to understand their outgassing sources, and the results are discussed in detail in this work. In particular, H2O exhibited spatial profiles that are indicative of the presence of extended outgassing sources in the coma, similar to the EPOXI mission target and 46P/Wirtanen’s “twin” comet 103P/Hartley 2. This work will add important measurements to the pool of already sampled comets, in particular to underrepresented JFCs, which will in turn improve our understanding of the solar system
Acute Agitation Intervention Tool for Reduction of Polypharmacy
Get PDFIntroduction: Patients with behavioral health diagnoses are among the highest risk foraggression. For pediatric patients with behavioral health needs, urgent treatment isneeded for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guidepharmacological intervention for mild and moderate to severe agitation in pediatricpatients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.
Methods: This QI included a retrospective analysis of PRN medications pre (Oct. 2022-Dec. 2022) and post (Jan 2023-Mar 2023) implementation of the Acute AgitationIntervention Tool using the BVC to inform pharmacological intervention. The IowaModel Revised: Evidence-Based Practice to Promote Excellence in Health Care was the framework.
Results: A (N=337) agitation occurred when combining the pre and post-implementation periods. Pre-Implementation (n=237) Post Implementation (n=100). Adecrease in the number of medications utilized per agitation event by 6.6% was found. A two-tailed independent sample t-test was performed.
Implication for practice: Continued utilization of the Acute Agitation Intervention Tool,modifying the tool to self-injurious behaviors, continual support, and audits of thoseadministering the medication of the order set will be completed. There will continue to be areas of opportunity for improvement in aggression assessment and PRN medication practice
Pediatric Streptococcal Pharyngitis Testing and Treatment Practices
Get PDFObjective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.
Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from October 2022 and April 2023. The IOWA Model of Evidence-Based Practice was applied to evaluate the use of SmartPhrases. Sampling was done by convenience method.
Results: There were (N=116) met criteria for the pre and post-timeframe.Timeframe data was compared using the Chi-Square Goodness of Fit test, revealing a significant difference (p
Conclusion: The impact of SmartPhrases on IDSA guideline usage was inconclusive. Recommendations for future studies is to investigate interventions to help improve guideline adherence, such as SmartPhrases, education, and protocols. Implications for practice are education and SmartPhrases may be able to improve guideline utilization
Effects of the True Crime Genre on Anxiety
Get PDFWithin the literature, violent media is well-established to induce acute and chronic anxiety; violent media is often utilized in experimental research to induce anxiety. Because a relationship between violent media and anxiety has been established, it is plausible exposure to true crime media may also induce anxiety. The true crime genre features criminal cases of a violent nature, often communicated through visual or auditory media (e.g., television or podcasts, respectively). Within the literature, true crime is an exploratory area of research, thus, additional research is required to determine whether exposure to true crime increases anxiety. The present study will add to the literature by reviewing research which pertains to exposure to true crime media and anxiety. Further, gender differences will be assessed to analyze the relationship between true crime consumption and gender. Additional implications and future directions are discussed