Indiana University-Purdue University Indianapolis (IUPUI) / In the complementary fields of Composition and Writing Center Studies, the common goal is to guide writers toward improvement in literate practices. However, the meaning of the word “improvement” has undergone radical shifts across time within both fields. It has of late shifted away from a concrete, product-oriented definition toward a non-concrete, process and person-centered nebula. In short, the field of Writing Studies has become very sure what improvement is not, while less sure what it is. Despite this uncertainty, one area of recent agreement appears to be the importance of control that writers hold in navigating within and across literate contexts, often referred to by the slippery term, agency. This pilot study seeks to utilize the voices of researchers across a spectrum of fields to more precisely define agency. This definition will be consistent with current scholarship in both Composition and Writing Center Studies and informed by related fields such as linguistics, anthropology, sociology, and philosophy. It will then utilize that definition in constructing a RAD (replicable, aggregable and data-driven) qualitative analysis of post-session interviews between researcher and writer. This method will attempt to determine possibilities and guidelines for future research. Particularly, it will provide a framework for future researchers to measure improvement in writing through a more refined definition of social agency. Through that, it will seek to support previous study which suggests as little as a single session in the Writing Center can demonstrate improvement in students’ perceptions of their own writing.

Exploiting induced genetic diversity through using mutagenesis is particularly important in giant miscanthus (Miscanthus x giganteus; Mxg) due to its restricted genetic variability. Experiments were conducted to develop an efficient in vitro propagation protocol for Mxg, induce mutations in Mxg using a chemical mutagen, and select Mxg in vitro for heat tolerance. To optimize in vitro propagation of Mxg, five explant types [i.e. immature inflorescences, shoot apex (in vitro), shoot apex (greenhouse), leaf explants (in vitro), and leaf explants (greenhouse)] were tested on five media. Shoot forming calli from immature inflorescences, an excellent source of explant in Mxg, grown in media with 13.6 microM 2,4-dichlorophenoxyacetic acid (2,4-D) and 0.44 microM 6-benzylaminopurine (BA) resulted in greatest shoot regeneration rate. Optimization of explant and callus type and media resulted in efficient in vitro proliferation of Mxg and the developed protocol was utilized in consecutive experiments of mutation induction and in vitro selection of Mxg for heat tolerance. Immature inflorescence explants (1-2 mm) were treated with 0.6%, 1.2%, and 1.8% of ethyl methanesulfonate (EMS) whereas the calli (1-2 mm3) were treated with 1.2%, 2.4%, and 3.6% of EMS for 90 min. Results of inter simple sequence repeat PCR analysis revealed polymorphisms indicating presence of genetic differences in Mxg putative mutants. In vitro callus cultures (mutagen treated and non-treated) of Mxg subjected to temperature treatments of 45±2°C for 12 hrs or 40±2°C for 7 days were selected for heat tolerance. Assessment results of electrolyte leakage and photosystem II (PS II) efficiency tests indicated a significant difference in percent membrane damage among Mxg clonal lines whereas PSII was weakly affected by the heat stress. The results suggest that in vitro derived Mxg clonal lines may be utilized for further studies of Mxg heat tolerance in developing potential Mxg ecotypes to adapt to different thermal environments. These studies provided the first investigation of in vitro induced mutagenesis in Mxg using a chemical mutagen. Genetic analysis results presented in this study indicates the potential use of developed Mxg putative mutants in future research programs, although significant morphological alterations were not observed during preliminary screening in the greenhouse.

BACKGROUND: Pregnant and parenting women consistently show low rates of engagement and retention in substance use disorder (SUD) treatment. While pregnancy enhances motivation and commitment to treatment, this population faces unique barriers to accessing care. Co-design is an approach that proactively engages service users to create a care system shaped to meet their needs. This study evaluated an adapted experience-based co-design (EBCD) process involving SUD treatment staff and parenting women with SUD (WWLE). METHODS: Semi-structured interviews with WWLE and SUD treatment staff were conducted to develop content for the co-design process and identify barriers and facilitators to treatment. These data were analyzed using the principles of Trauma Informed Care (TIC). Multiple data sources were utilized to evaluate the co-design implementation, including semi-structured interviews, ethnographic observation, and discussion transcripts of EBCD launch events. The Integrated Promoting Action on Research in Health Services (i-PARIHS) framework informed tool development and data analysis of the co-design implementation. RESULTS: The full sample across all stages of the EBCD implementation totaled 34 individuals (WWLE =13 and SUD staff = 21). Findings highlighted the importance of TIC in small pivotal moments that either enhance or diminish treatment engagement and retention. For the evaluation, WWLE reported having a valued voice in the co-design process and attributed their comfort level to small, equally represented workgroups, skilled facilitation and pre-existing, respectful relationships with staff. Professionals expressed commitment to the concept of co-design, but displayed mixed perspectives about the value of EBCD. Complex regulations, limited funding, and uncertainties during start-up presented challenges to the co-design process. Use of a remote platform created accessibility for participants, but presented challenges to communication and relationship building. CONCLUSION: This research demonstrates how the core components of EBCD foster meaningful engagement of WWLE and can effectively create a collaborative co-design process that manages inherent power disparities between WWLW and treatment staff. The TIC analysis provides insight into aspects of care that encourage or deter women from treatment. This research illuminates the importance of integrating a TIC approach throughout a co-design initiative. Co-design presents an opportunity to create women-centered care and health equity in SUD treatment. / 2024-11-08T00:00:00Z

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Medical errors are a continuing issue for healthcare organizations and can lead to patient harm or death. To bring about organizational learning and therefore reduce medical errors, information must successfully flow through an organization. Nurse managers play an essential role as the conduit of information between frontline staff and the organization. The primary purpose of this study is to describe the decision-making process of how nurse managers actively select and transmit information on patient safety concerns. A qualitative constructivist grounded theory approach was used. Nineteen unit-level nurse managers, working full-time in an acute care hospital with a minimum of one-year experience were recruited through professional nursing organizations and snowball recruitment. Semi-structured, conversational, one-on-one interviews were conducted via Zoom or phone call, per the participant's preference. An initial interview guide based on the STOPS framework was used. Participants reported that after they acquired patient safety information, they quickly assessed whether or not the issue was severe and relevant. Then they prioritized the information based on the degree of the severity and relevance, the information source and type, and whether they needed feedback, guidance, or support. The prioritization step determined what mode and how frequently the message was forwarded. Although severity was a consistent consideration on whether to forward information, nurse managers struggled to define the concept. This study suggests that when a patient safety issue is on the extremes of the severity and relevance spectrum the decision-making process is clear. Whether to forward the information that was not on the extremes is less clear and more varied among nurse managers. This part of the decision-making process was inconsistent among nurse managers and has the potential for information to get lost. At the time of the interviews, COVID-19 had created an influx of patients into hospitals, which strained healthcare systems and providers. Nurse managers are in a position where they have insight on how COVID-19 has affected patient safety and can communicate that to their staff and into the organization. Therefore, a secondary thematic analysis of the data was conducted concerning the effects of COVID-19 on patient safety. Nurse managers identified several risks to patient safety that were exacerbated and created by COVID-19. Worsening staffing shortages have negatively affected staff psychological well-being, compelled nurses to work beyond their skill set, and necessitated providing only the mere essentials of nursing care. Burnout and patient isolation have also compounded patient safety concerns. But in the chaos and confusion, nurse managers were able to see some positives that resulted from the pandemic, such as improved teamwork, vigilance, and learning new skills, which can be used to better weather the next pandemic.

The purpose of this project was to evaluate the feasibility of bridging performance gaps in the program stream between BYU Broadcasting's post production and master control environments by implementing a technical infrastructure that supports a file-based workflow. The system that was evaluated was an Apple Xsan running specialized software, called FORK. Performance gaps were identified and a technical evaluation of the system was conducted. Figuring out how the change initiative would affect and be affected by non-technical factors, such as human nature and social and cultural concerns, was integral to the evaluation process. The evaluation concluded that the System was technically capable of supporting the ideal workflow; however a number of organizational interventions would need to be put in place in order for the change initiative to have success. The recommendations were (a) consolidating all operations employees under a Chief Operations Officer, (b)consolidating all engineering functions under a Manager of Engineering, (c) tasking the Chief Operations Officer and Manager of Engineering with encouraging participant support and organizational responsibility, (d)temporarily localizing the system's implementation, and (e) crafting an official media management policy. Included in the stakeholder report was an implementation design for the system. It was beyond the scope of this evaluation to measure for post-implementation improvement. Completing such an evaluation would require a significant amount of time; however, it is recommended that it be conducted subsequently and separately from this project.

This study examined the effect of speaking contexts on articulatory kinematics in habitual and clear speech conditions. Ten male and 10 female participants (ages 18"“29) completed speaking tasks in three contexts and two conditions. The contexts were word, phrase, and passage, with both mid-sentence and end of-sentence stimuli in the phrase and passage contexts. The two conditions were habitual and clear speech. Participants had sensors attached to the mid-tongue, jaw, lower lip, and upper lip, and an electromagnetic articulograph tracked their movements. Three tokens for each stimulus were analyzed for duration, displacement, and velocity. Articulatory coordination was measured through absolute and percent jaw contribution, and displacement correlations. Statistical analysis revealed significant changes across both conditions and contexts. Generally, the articulator movements were larger for clear versus habitual speech and decreased progressively in size from word to phrase to passage. Duration significantly increased in the clear speech condition and decreased from word to phrase to passage, which likely underlies the changes seen in the other measures. Percent jaw contribution to lower lip movement was significantly higher in the clear speech condition, percent jaw contribution to tongue movement was significantly higher for the passage compared to the other contexts, and jaw and lower lip correlations with the tongue were higher in the clear condition and lower in the passage context. Incidental rate variation and motor equivalence across speakers limit the degree to which we can interpret these results in terms of articulatory coordination. Overall, this study demonstrates significant changes in speech kinematics across contexts in both clear and habitual conditions, indicating that researchers should exercise caution when generalizing findings from studies using short, contrived stimuli.

This dissertation looks at how new sources of information should be incorporated into medical decision-making processes to improve patient outcomes and reduce costs. There are three fundamental challenges that must be overcome to effectively use personalized medicine, we need to understand: 1) how best to appropriately designate which patients will receive the greatest value from these processes; 2) how physicians and caregivers interpret additional patient-specific information and how that affects their decision-making processes; and finally, (3) how to account for a patient’s ability to engage in their own healthcare decisions. The first study looks at how we can infer which patients will receive the most value from genomic testing. The difficult statistical problem is how to separate the distribution of patients, based on ex-ante factors, to identify the best candidates for personalized testing. A model was constructed to infer a healthcare provider’s decision on whether this test would provide beneficial information in selecting a patient’s medication. Model analysis shows that healthcare providers’ primary focus is to maximize patient health outcomes while considering the impact the patient’s economic welfare. The second study focuses on understanding how technology-enabled continuity of care (TECC) for Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) patients can be utilized to improve patient engagement, measured in terms of patient activation. We shed light on the fact that different types of patients garnered different levels of value from the use of TECC. The third study looks at how data-driven decision support systems can allow physicians to more accurately understand which patients are at high-risk of readmission. We look at how we can use available patient-specific information for patients admitted with CHF to more accurately identify which patients are most likely to be readmitted, and also why – whether for condition-related reasons versus for non- related reasons, allowing physicians to suggest different patient-specific readmission prevention strategies. Taken together, these three studies allow us to build a robust theory to tackle these challenges, both operational and policy-related, that need to be addressed for physicians to take advantage of the growing availability of patient-specific information to improve personalized medication processes.

There is a growing need for employing sustainable soil improvement techniques. Concurrently, soil carbon sequestration methods continue to receive more attention in an attempt to reduce greenhouse gas levels contributing to climate change. Exploring the use of gasifier biochar for soil improvement can possibility address these two needs simultaneously. This study investigates the effect of gasifier biochar amendment on mechanical, chemical and hydraulic properties of a local clay with poor engineering properties. Specifically, strength, swelling, compressibility, collapsibility, permeability, water retention, cation exchange capacity, pH, and microstructural characteristics were determined for the clay amended with 5, 10, and 20% biochar. Two sizes of biochar were used. The results showed that biochar amendment improves the strength, swelling potential, permeability, and water retention properties of the clay. Findings suggest that biochar amendment offers a sustainable solution for improving geotechnical properties of marginal soils while providing an efficient method for biospheric carbon sequestration.