Increased intracranial pressure (ICP) is a major cause of secondary neuronal injury after both traumatic and non-traumatic brain injury. Prompt recognition and intervention of increased ICP has been associated with improved neurologic outcomes. Pupillary changes may be an indicator of increased intracranial pressure. However, previous research has shown that the accuracy of assessing pupils with a source of light and the human eye is not a consistently reliable method. Previous studies have reinforced the lack of reliability of this method by showing poor interrater reliability between clinicians. Critical care application of a device referred to as a pupillometer allows objective assessment of pupillary response. There is some consideration that this noninvasive technology does not only quantify pupillary measurement but some pupillometer parameters may be predictive of increased intracranial pressure. Therefore, a hypothesis that automated pupillometry is predictive of increased ICP is warranted. Prospective and retrospective pupillometer data will be collected. Data collection includes: 1) quantitative measurement from the pupillometer and ICP monitoring; 2) qualitative and quantitative data from computed tomography (CT) and magnetic resonance imaging (MRI) reports interpreted by radiologists; and 3) documentation of Therapeutic Intensity Level (TIL) by the critical care nurse as available. We hypothesize that there will be an association between the pupillometer parameters and the other clinical indicators of increased ICP. If confirmed, these findings will provide support for greater clinical application of the pupillometer in the critically ill adult patient with potential or actual increased ICP.

Spirometry is among the most common tests for characterizing pulmonary function and plays a critical role in detecting and improving outcomes related to chronic lung disease. During a spriometry maneuver, a patient rapidly exhales into a machine which records the total volume and flow of air over time. However, patient error in performing the spirometry maneuver, such as by coughing or taking multiple breaths, can lead to clinically misleading results. As a result, spirometry must take place under the supervision of a trained specialist who can detect and correct patient errors. To reduce the need of specialists to coach patients during spirometry, we demonstrate the ability to automatically detect four common patient errors. Applying machine learning techniques on features derived from spirometry data, we were able to automatically classify errors from spirometry data with an F-score between 0.784 and 0.907. Our work provides the first step toward reducing the need for trained individuals to administer spirometry tests by demonstrating the ability to automatically detect specific errors and provide appropriate patient feedback. This will increase the availability of spirometry, especially in low resource and telemedicine contexts.

Patients undergoing ventricular assist device (VAD) therapy are by definition very sick and typically told that they have a high likelihood of dying in the next year without VAD therapy. Though most patients have improved functional status and quality of life, repeated hospitalizations and potentially catastrophic complications post implant can be burdensome. The research aims to assess for decisional regret or ambivalence about VAD implant. During a 3 year program all post VAD implant patients were referred to palliative care. Patients were administered a 5 question decision regret survey that correlates well with decision satisfaction and decisional conflict. On a scale of 0-100, scores >25 were considered to reflect significant ambivalence, and scores between 10-25 were defined as mild ambivalence. Patients were also administered the PHQ-9, a tool for depression inventory. The results found that 102/129 (79%) patients completed decision regret surveys. 64/102 (63%) scored 0, 7/102 (7%) scored >25, and 29/102 (28%) scored between 10-25. The average age of the patients scoring >25 was 44, compared to 55 of the whole cohort. Of those that expressed some degree of ambivalence (n=36), 11/36 (31%) met criteria for at least moderate depression, compared with 18% for the whole cohort. 26% of the total cohort had VADs as bridge to transplant (BTT), while 13/29 (44%) ambivalent patients and 4/7 (57%) very ambivalent patients were living with their VAD as BTT. A majority of patients do not regret their decision; however, a significant minority expressed mild ambivalence, and a small number expressed significant ambivalence. Ambivalence was more common in those who are younger, those with VAD as BTT, and in patients with depression. It is important to recognize pre-implant that patients have different decision-making needs, and that managing their expectations may be a key component of helping them to adjust post VAD.

We hypothesize that neurons in the visual cortical area V4 have a distinct temporal integration time on the order 40 to 100 milliseconds that is required to perceive rapidly moving or changing shapes. If this is true, then we should be able to characterize these neurons using fast streams of dynamic stimuli. To test this, we created stimuli that change their boundary features rapidly by presenting different shapes in immediate temporal progression at various durations for visual fixations lasting just over one second. The duration for which each of the shapes was presented within the sequence was held constant for each fixation trial and varied randomly across trials for durations of 40, 80, 160 and 320 milliseconds. To access which shape durations were sufficient to cause differential, shape-tuned responses, we constructed tuning curves of the mean firing rate as a function of the duration of shape presentation. Our results suggest that shape tuning is consistent across durations from 80 to 320 milliseconds and exists at a lesser amount at 40 milliseconds. This raises the possibility that our future experimental design can involve showing stimuli for shorter durations, allowing us to characterize shape tuning for 3D stimuli, which requires the presentation of a greater number of stimulus images. It also suggests that V4 neurons may play an important role in encoding dynamic scenes as objects change shape or move or rotate with respect to the observer.

Dacarbazine (DTIC) is a chemotherapeutic drug, which targets cells at the time of cell division by damaging the DNA or RNA, thus interrupting cell duplication and division. DTIC is a DNA-methylating agent and is commonly used with adriamycin, bleomycin, and vincristine to fight certain types of cancer such as malignant melanoma and Hodgkin’s Lymphoma. Hormones and enzymes change during pregnancy, which affects the efficacy and toxicity of drugs in the body. With this study, we better understand how Dacarbazine is metabolized during pregnancy as compared to the non-pregnant state. Two pregnant patients with Hodgkin’s Lymphoma were recruited for our study. The first was a 31-year-old who presented with enlarged supraclavicular nodes at 10 weeks gestation and the second subject was a 34-year-old who sought medical attention for enlarged cervical nodes at 15 weeks gestation. Dacarbazine relies on the P450 enzyme CYP1A2 as the primary pathway for DTIC metabolism. It has been reported in the literature that CYP1A2 activity during pregnancy is significantly reduced. As a result, the concentrations of DTIC, an inactive pro-drug, are higher and its active metabolites, MTIC, HMMTIC, and AIC, are lower during pregnancy compared to postpartum. Since DTIC is inactive and the lower enzyme activity leads to lower concentrations of the active metabolites, the lower CYP1A2 activity potentially decreases the efficacy of DTIC during pregnancy. Although the women in this study had lower concentrations of the active metabolites of dacarbazine during pregnancy, both patients still successfully achieved remission of their lymphomas. This research will help us better prescribe chemotherapeutic drugs that interact with P450 enzyme CYP1A2 to pregnant women who have certain types of cancer. Personally, I analyzed the specimen results to determine drug concentrations in the blood and excretion along with other PK parameters and wrote a manuscript describing the results.

Over the past few years, marijuana use has been on the rise in colleges, with 5.7% of college students saying that they smoke marijuana daily or almost daily according to a study done by the University of Michigan. Although this shows that daily marijuana use has increased, it does not explore the relationship between living situations and how much marijuana college students smoke. The purpose of this exploratory study is to examine living situations, specifically college students who live in fraternity/sorority housing, in residence halls, or in off-campus apartments/townhouses, and marijuana use among college students during a year. It is hypothesized that students who live in fraternity/sorority houses will have smoked more marijuana than students who live in apartments/townhouses and residence halls, respectively. The sample is comprised of three groups who attend four-year universities: 25 participants were Greek members, 634 participants lived in off-campus housing, and 121 participants lived in residence halls. Study participants were Washington State emerging adults (18-25) who completed the current measures as part of a larger assessment in 2016. A chi-squared test was conducted and it was seen that 44% of the Greek members, 15.77% of off-campus housing members, and 4.96% of residence hall members smoked marijuana at least 2-3 times per month. Preliminary findings support the hypothesis, showing that Greek members smoked the most out of all three groups and further analysis will be done to show whether these findings are significant.

Amongst the graffiti blanketing the cities of Athens and Berlin, depictions of children stand out as a solemn reminder of the dire nature of the current refugee crisis in Europe. Due to the large number of refugees passing through, or settling, in various European states, governments have reduced individuals to statics. This data-driven approach, focused on the number of people and the cost of providing basic resources, dominates the news and international discourse. Combating this statistical discussion, artists have created works that demonstrate the humanity of the crisis. Because paint and printers are easily accessible, street art portrays a broader public sentiment towards the crisis, countering the governmental narrative. This project examines graffiti in Athens and Berlin, and the insights it provides on the refugee crisis that cannot be derived from the official discourse. Using images of children, artists in both cities have manufactured an alternative narrative articulating the challenges facing the individuals involved in the crisis and highlighting their struggle in Europe. Because Athens and Berlin function as endpoints of the refugees’ journey, as many enter through Greece before traveling northwest to Germany, a study of the graffiti responding to the migration in these cities is of particular importance. After collecting hundreds of images in-situ during July of 2016, using geo-tagged web-based content and information from locals on hubs of graffiti, several themes emerged, the most prevalent being representations of children. The lack of scholarship on graffiti pertaining to this refugee crisis necessitated the use of art historical images of children in conjunction with current graffiti scholarship to create a methodological framework. Employing the iconographic, semiotic and socio-economic methodologies, I conclude that the works promote the humanization of the crisis and force recognition of the refugees as individuals, thereby opposing the governmental narrative.

For our Jackson School of International Studies capstone class, Task Force, we created a strategic communications plan tied with a digital story to create a social media campaign. The goal of this campaign is to communicate Tribal Treaty Rights between tribal and non-tribal millennials in the Puget Sound area. The Treaty Rights target issues in the Puget Sound caused by climate change, including decreasing salmon populations and managing non-tribal fishing rights around the region. Most millennials are unaware of these rights, or these issues in general, despite living in the Puget Sound. Our research, primarily self-hosted surveys and focus groups, show a trend in millennials to be sensitive to cultural diversity and climate change acceptance, making them a prime demographic for a marketing campaign. After data collection, we created social media groups, including Facebook, Instagram, and a digital story for potential use in the Tulalip Tribes website. We worked closely with the Tulalip Tribes in Marysville, and visited their location, supervised by Tulalip Tribes' Public Affairs Coordinator Francesca Hillery. UW campus resources will be invaluable in our pursuits; we will contact the school newspaper "The Daily", as well as collaborate with various departments, such as the Intellectual House, to spread awareness and to set up relevant lectures. Millennials are apt to be interested in this topic, therefore, one of our main campaign goals is to create the knowledge in the first place. If successful, our social media campaign will grow towards increasing implementaion on campus and for the tribes themselves. Overall, this can lead to future, independent student involvement and efforts to make a change for themselves, for the tribes, and for all in the Salish Sea region. 

Discussing end-of-life care, especially for patients with serious illness, is an important way to ensure that clinicians understand their patients’ wishes and that patients therefore receive the types of care and treatments they want. Conversations about end-of-life care are often not a part of outpatient clinic visits even though the outpatient setting is the best place to have these conversations before a crisis occurs. In this randomized trial, we are investigating whether the use of a short feedback form, the “Jumpstart” form, can help facilitate improved communication about end-of-life care and treatment preferences. The “Jumpstart” form is based on survey questions that the patient completes at the time of enrollment into the study, and the form is shared with the patient, his/her family and clinician. The form provided to the clinician includes prompts to assist the clinician in discussing the patient’s end-of-life care and communication preferences. The effectiveness of this communication feedback intervention will be measured by comparing patients who received the “Jumpstart” form with patients who received usual care. If the “Jumpstart” intervention is effective, patients in the intervention group, as compared with those in the control group, should report improved frequency and quality of communication with their clinician and better agreement between the care they desire and the care they receive. These outcomes were measured by data in the electronic health record (EHR) and abstracted from clinic visit notes and from a series of surveys collected at three time points after the target visit, during which the intervention was implemented (2 weeks, 3 months and 6 months). If this intervention is successful, healthcare systems could implement the "Jumpstart" forms as a tool to improve patient care.

The modern human foot, with its pronounced longitudinal arch (the ratio of difference between mid-foot and total foot area) and suite of derived morphologies, evolved in an unshod context on natural substrates. Today, unshod (barefoot) populations are uncommon, and the majority of modern humans walk shod (wearing shoes) on artificial substrates. The unshod populations that do exist today typically have wider feet than do western populations, but western populations have a more variable longitudinal arch index and therefore exhibit more variation, from “flat” to “arched” feet. The reason for this difference remains obscure. The purpose of this study was to investigate the effect of childhood footwear choices on arch index variation in adults. Participants (56 women, 19 men, mean age: 24±7.2 years) were asked about their footwear, both in childhood (<18 years) and adulthood (>18 years), to classify those who wore rigid/supportive shoes throughout development and those who were frequently unshod or wore unsupportive shoes. Participant footprints were captured using a RSscan pressure plate in three stances: (i) static double stance; (ii) static single stance; and (iii) dynamic. Arch indices were then calculated for each participant and multiple regression with Bonferroni correction used to determine if childhood footwear predicted adult arch index. The results indicate that childhood footwear does not predict adult arch index (all p-values > 0.05). The implications of these results are that longitudinal arch index variability in western populations is not determined by childhood footwear choice. Further research is required to shed light on this phenomenon.

Frailty is an age-related, clinically recognizable state of heightened vulnerability that is defined by having 3 of the following criteria: muscle weakness, slow walking speed, exhaustion, unintentional weight loss, and low physical activity. Frailty is associated with increased risk of disability, hospitalization, and mortality among older adults and therefore there is a critical need to identify potentially modifiable risk factors. It is conceivable that chronic pain increases the risk of frailty through multiple biopsychosocial mechanisms, including physical deconditioning. Accordingly, we sought to determine whether pain and the number of pain sites increases risk of frailty in a nationally representative, prospective cohort study of community-dwelling older adults. We analyzed data on 7,601 Medicare beneficiaries aged ≥65 years who participated in the National Health and Aging Trends Study. Participants were interviewed annually in their homes from 2011 through 2015. Over the 4-year follow-up period, the cumulative incidence of frailty was 17.6% (1,327 new cases). Incidence increased with advancing age and was higher in women than in men. Importantly, frailty was significantly more likely to develop among older adults with pain (23.0%) than in those without pain (12.5%). When adjusted for demographic and health characteristics, the risk of frailty was 54% higher in those with pain than without pain (Incidence Ratio [IR]=1.54; 95% confidence interval [CI]: 1.32-1.80). Frailty incidence also increased significantly with the total number of pain sites. Compared to those without pain, the adjusted IRs for frailty were 1.14 (95% CI: 0.89-1.47), 1.34 (95% CI: 1.10-1.64), 1.52 (95% CI: 1.23-1.88), and 2.08 (95% CI: 1.66-2.61) for older adults with 1, 2, 3, and ≥4 pain sites, respectively. In summary, pain was independently associated with increased risk of frailty among community-dwelling older adults. This finding suggests that multicomponent intervention programs should integrate pain management to more effectively prevent frailty among older adults.

Both content knowledge and problem-solving strategies are important components for academic success in biology. All problem-solving strategies begin with the ability to understand the problem being presented. In the context of biology, this means identifying the core concept being asked in complex questions. Identifying keywords, words that are important or significant, can help students identify these core concepts. The purpose of this study was to explore how well students can identify keywords and if this ability is correlated to exam performance. Students in an Introductory Biology course took weekly practice exams (PE), after each PE they either graded their own or a peer’s PE. In addition, students were asked to “identify the keywords in the question that should have caused you to provide the complete and correct answer given in the key”. This experimental design also allowed us to explore how grading an anonymous PE affects quality of students’ keyword selections. Students’ keyword selections were compared to a keyword rubric created by the research team. Data was coded by two researchers to 90% inter-rater reliability. On average, students only correctly identified 39% of keywords each week. Multiple regression models were used to explore correlations between correct identification of keywords and performance on both PEs and course exams. Interestingly, students who self-graded were more consistently engaged with the keyword activity as compared to peer-graders. In both cases, percent keywords correct could predict overall exam performance. These results indicate that if instructors want to help students improve their problem-solving skills of complex biological problems, helping students recognize keywords may be one solution. Furthermore, identifying which students have trouble simplifying complex exam problems and helping these students improve their ability to identify keywords may be beneficial in addressing learning disparities within large introductory classes.

Student-graded practice exams (PEs) have been used to facilitate learning in large classrooms. In a large introductory biology class, we investigated the impact of self vs peer-grading of PEs. We hypothesized that students who graded their own PEs would grade more accurately than peer graders because they are more motivated and reflective in their grading. Over time this more accurate grading would lead to increased performance on course exams. One question from each week’s PE was graded by a team of experts. We calculated PE grading accuracy by comparing the expert grade to the grade assigned by the student. We analyzed the correlation of PE grading accuracy with exam performance. For each metric we investigated the impact of treatment, incoming GPA, and student demographics (e.g., gender, socioeconomic status, first generation, race/ethnicity) using general linear models. There was no difference in average expert PE grade between the two treatments. Incoming GPA was the only significant predictor of expert PE grade with GPA positively correlated with expert PE grade. There was a significant interaction between incoming GPA and treatment on grading accuracy. Students with high GPAs who graded peers consistently underestimated their peers’ PE performance. Students with lower GPAs who graded peers either graded similarly to experts or slightly overestimated their peers’ PE performance. Students who graded their own PEs more accurately predicted their PE performance regardless of incoming GPA. There was an interaction between GPA and treatment on course exam performance, as high GPA self-graders earned more course exam points than high GPA peer-graders. Average GPA students earned the same amount of course exam points regardless of treatment. Given these findings and the logistical complications of peer-grading in large classes, instructors can use the more easily administered self-grading method of providing feedback on low-stakes practice exams.

We investigated how grading treatment, self-evaluation versus peer-evaluation, on weekly practice exams (PE) in an Introductory Biology course affects the advice students give to improve academic performance. We hypothesize that students who suggest more resources and study strategies perform better on course exams because they are aware of how improvements need to be made and what resources to use. Students in the class (approximately 550) take a PE on Thursday and then grade the PE responses on Friday. The grading groups were split up into two treatments: half of the class self-evaluated whereas the other half evaluated their peers’ responses. In addition, they were prompted to answer two questions: 1) Pick a single thing that you/this student should work on. 2) What resource should they consult before the next exam? We used this information to explore how study strategies and resources that students suggest relate to their test scores. To analyze the responses, we created specific codes corresponding to student answers. Results of the codes indicate that the students’ responses fall into four categories for question 1 and two sets of categories for question 2 (with three and two codes in each set). When asked to provide ways to improve PE performance, the four specific codes were being descriptive, increasing knowledge of content, interpreting the question, and time management. When providing resources, the two sets of categories were active versus passive resources and expert, peer, and self resources. Over the course of ten weeks, students who suggested more strategies and resources tended to perform better on exams. As well, both self-evaluators and women in the course suggested more strategies and resources than peer-evaluators and men respectively. Given this study, instructors can better understand what resources students are utilizing but also which study strategies tend to be more successful for students.

The loss of mechanosensory hair cells in the inner ear gives rise to many hearing and balance-related disorders. The most common causes of acquired hair cell loss are normal aging, ototoxic medications and frequent exposure to unusually loud environments, noise exposure. Two main drug classes, aminoglycoside antibiotics and cisplatin-based chemotherapeutic drugs, are known to be ototoxic, with usage resulting in varying levels of temporary or permanent hearing loss through hair cell death. Our goals are to understand and eventually prevent hearing loss due to treatments with these drugs. Because of the inaccessibility and complexity of the mammalian inner ear, hair cells in the zebrafish lateral line have emerged as an outstanding system for studying hair cell death. The external location of the hair cells allows for direct access and visualization of the hair cells, in order to study the cellular pathways underlying hair cell death, and for large drug library screens to identify compounds that protect against ototoxic effects. As a result of a drug screen and subsequent compound analog analysis, a compound named ORC-13661 has been found to be robustly protective against several aminoglycosides in a dose-dependent manner. We have found that there are distinct mechanisms that underlie antibiotic-induced toxicity, distinguished by different temporal events. Some aminoglycosides, including neomycin, kill hair cells rapidly, within one hour of exposure. Other aminoglycosides, including gentamicin, have a much slower time course, taking up to 24 hours to kill hair cells after an initial one-hour exposure. We find that ORC-13661 provides maximal protection to both classes of aminoglycosides if it is present at the same time as the toxic compound. Additionally, the delayed aminoglycoside exposure paradigm gives us an opportunity to use compounds with known effects on cell death pathways to shed light on new mechanisms underlying hair cell death.