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Because The Nature Of Nature Is Fractal: The Liberatory Potential Of A Fractal Epistemology, Katthe P. Wolf Sep 2020

Because The Nature Of Nature Is Fractal: The Liberatory Potential Of A Fractal Epistemology, Katthe P. Wolf

International Journal of Transpersonal Studies

N/A


All The Inbent Fractals Of Connection, William J. Jackson Sep 2020

All The Inbent Fractals Of Connection, William J. Jackson

International Journal of Transpersonal Studies

N/A


Mindfulness Based Intervention For Needle Phobia: A Pilot Study Of Dissociated Ego State Resolution, Genine P. Smith, Glenn Hartelius Sep 2020

Mindfulness Based Intervention For Needle Phobia: A Pilot Study Of Dissociated Ego State Resolution, Genine P. Smith, Glenn Hartelius

International Journal of Transpersonal Studies

This pilot study was designed to investigate the efficacy of a mindfulness based intervention for the treatment of needle phobia. The research question was whether one session of the dissociated ego state [DES] trauma release intervention would result in significant and durable release of needle phobia. It was hypothesized that the process tested in this study may reduce needle phobia by locating, identifying, and engaging with a dissociated aspect of the psyche developed from earlier trauma. Six participants who self reported fear of needles and resulting avoidance of medical assistance completed one 60-minute, individual session of a mindfulness based protocol …


A Task Analytic Model Of Tenderness In Emotion-Focused Therapy For Couples: The Discovery Phase, Corie Mcnally Sep 2020

A Task Analytic Model Of Tenderness In Emotion-Focused Therapy For Couples: The Discovery Phase, Corie Mcnally

Dissertations

The focus in the present study was to develop a refined model of tenderness events in emotion-focused couples therapy. The model was created in the discovery phase of a task analytic research study through a rational-empirical method. The study was designed to combine empirical and rational data on the expression of tenderness and the display of a tenderness expression within the context of therapy. The rational model was derived from a review of the literature on emotions, couples therapy, and tenderness as an emotion. Empirical data were observed and recorded through reviews of videotapes and transcripts obtained during the York …


Mobile Cognitive Training For The Cognitive Symptoms Of Depression In Young Adults: A Double-Blind, Randomized Pilot Study With Active Control, Alice Grinberg Sep 2020

Mobile Cognitive Training For The Cognitive Symptoms Of Depression In Young Adults: A Double-Blind, Randomized Pilot Study With Active Control, Alice Grinberg

Dissertations, Theses, and Capstone Projects

Background: Depression is associated with a broad range of cognitive symptoms, including reduced attention, verbal learning and memory, executive functioning (EF), and processing speed (PS). Computerized cognitive training (CCT) has been shown to ameliorate the cognitive symptoms of depression. Younger adults, in particular, are understood to benefit more from CCT than older adults due to their greater capacity for neuroplasticity. However, several issues remain unclear about the effectiveness of CCT: (1) whether the benefits of CCT are driven by the specific content or by non-specific factors, such as engagement, motivation, novelty, and expectancy, which have been inadequately controlled in prior …


Neurodevelopmental Mechanisms Of Adverse Trauma Outcomes In Emerging Adulthood, Olena Kleshchova Sep 2020

Neurodevelopmental Mechanisms Of Adverse Trauma Outcomes In Emerging Adulthood, Olena Kleshchova

Dissertations, Theses, and Capstone Projects

Background: Exposure to traumatic stress and adversity during the formative years of development can have adverse effects on mental health, neuroendocrine stress system function, and the brain, that persist into adulthood. One candidate mechanism that might confer vulnerability to enduring adverse outcomes of early life trauma is disruption of normal brain maturation. As the brain matures, functional interactions among brain regions change until the functional brain architecture (i.e., the functional connectome) reaches a mature state in adulthood. Given that different neural circuits have distinct developmental trajectories and sensitive periods, traumatic stress at a given point in development might have …


Intra-Familial Microaggressions, Object Relations, And Racial Identity Formation In Multiracial Individuals, Ashley Danies Sep 2020

Intra-Familial Microaggressions, Object Relations, And Racial Identity Formation In Multiracial Individuals, Ashley Danies

Dissertations, Theses, and Capstone Projects

The concept of the self in relation to others is referred to in psychoanalytic theory as one’s ‘object-relations’ (Kernberg, 1984). One of the earliest object-relationships is between baby and caretaker(s), through which the baby develops a sense of their own identity (Mahler, 1967; Sandler & Sandler, 1978). Multiracial individuals, or those whose families fall in two or more different racial/ethnic groups, report racial microaggressions from within their own families (Nadal, Sriken, Davidoff, Wong, & McLean, 2013). Notably, Multiracial individuals who have one White parent and one non-White parent face a greater possibility of rejection from one or both sides of …


Sex/Gender Differences In Serial Position Profiles In Patients With Mild Cognitive Impairment And Healthy Controls, Emnet Z. Gammada Sep 2020

Sex/Gender Differences In Serial Position Profiles In Patients With Mild Cognitive Impairment And Healthy Controls, Emnet Z. Gammada

Dissertations, Theses, and Capstone Projects

Introduction: Alzheimer’s disease disproportionately affects more women, but paradoxically, men have a higher incidence of Mild Cognitive Impairment (MCI). Researchers have suggested that women’s verbal memory advantage across the lifespan reflects better premorbid skills, which then require more neurodegeneration to manifest early clinical impairment. To date, measurement of sex differences in verbal memory have used total list scores. We proposed that a granular examination of serial position effects (SPE) in list-learning can refine the source of sex/gender differences.

Methods: A cross-sectional analysis of participants with Mild Cognitive Impairment (MCI) and Healthy Controls (HC) was examined from the Alzheimer’s Disease Neuroimaging …


Development Of A Minority Stress Preventive Intervention For Sexual And Gender Minority Youth And Young Adults, Natalie Holt Sep 2020

Development Of A Minority Stress Preventive Intervention For Sexual And Gender Minority Youth And Young Adults, Natalie Holt

Department of Psychology: Dissertations, Theses, and Student Research

Mental health disparities amongst sexual and gender minority (SGM) individuals are spurred by exposure to minority stressors and sustained by mediators of problems with emotion regulation, social support, and cognitive processes. Emerging clinical research suggests empirically supported behavioral health treatments can be culturally adapted to address these mental health disparities, however less work has focused on the prevention of symptoms. The present study developed a brief preventive intervention targeting mediators of the minority stress model for SGM youth and young adults aged 17 to 26. Focus groups with 8 SGM participants informed development to ensure the content and delivery of …


The Relationship Between Subsyndromal Symptomatic Depression And Cognitive Dysfunction, Bryce Jacobson Sep 2020

The Relationship Between Subsyndromal Symptomatic Depression And Cognitive Dysfunction, Bryce Jacobson

Loma Linda University Electronic Theses, Dissertations & Projects

Subsyndromal Symptomatic Depression (SSD), or subthreshold depression, affects roughly 15% of community-dwelling older adults and puts them at increased risk for developing Major Depressive Disorder (MDD), which represents a risk factor for Alzheimer’s Disease (AD) and may expedite disease progression. While the relationship between MDD and AD has been well established, the interaction between SSD and cognitive functioning has not been explored in depth. Further, clinicians have long postulated that depression is not a monolithic disorder but rather a group of disorders which are heterogeneous in onset, symptoms, course, and treatment. One hundred and six participants, 65 and older were …


The Effects Of A Polyphenol-Rich Diet In A Fruit-Fly Model Of Traumatic Brain Injury, Alexandra D. Trofimova Sep 2020

The Effects Of A Polyphenol-Rich Diet In A Fruit-Fly Model Of Traumatic Brain Injury, Alexandra D. Trofimova

Loma Linda University Electronic Theses, Dissertations & Projects

Traumatic brain injury (TBI) is a leading cause of death in the United States. Inflammation and oxidative stress activated by the TBI can lead to systemic inflammation. Gastrointestinal complications are common secondary injuries to TBI and are associated with elevated levels of common pro-inflammatory cytokines and oxidative stress found across the body. Intestinal permeability after TBI has also been established in the fruit fly, Drosophila melanogaster. Pomegranate polyphenols have strong anti-inflammatory properties that may reduce brain and intestinal inflammation and improve functioning after TBI. This study examined the protective effects of pomegranate polyphenol supplementation in a Drosophila model of TBI. …


Career Influences: A Phenomenological Study Of Career Influences Of African American Women In The Counseling Profession., Tamara L. Ford Sep 2020

Career Influences: A Phenomenological Study Of Career Influences Of African American Women In The Counseling Profession., Tamara L. Ford

Dissertations

The current literature concerning African American women in the counseling profession is limited. Research is available regarding women in the profession; however, research on African American women is scarce. This study seeks to add to the body of literature by exploring the reasons African American women become counselors, thereby improving recruitment techniques to increase representation in the field and improve mental health care for the African American community. This qualitative research study used a phenomenological approach to explore, interpret, and describe the lived experiences of eight African American women who are Licensed Clinical Mental Health Counselors currently practicing in the …


Misuse Of Social Behavior In Down Syndrome: Caregiver Conducted Functional Analysis, Sally M. Izquierdo Sep 2020

Misuse Of Social Behavior In Down Syndrome: Caregiver Conducted Functional Analysis, Sally M. Izquierdo

Dissertations, Theses, and Capstone Projects

Young children with Down syndrome often engage in charming non-contextual social behaviors. The developmental literature suggests that non-contextual social behaviors may function to escape from difficult activities to preferred social interactions. Caregivers may reinforce the behavior, perceiving it as evidence of the child’s social strength, when in fact, the pattern of behavior may also contribute to missed learning opportunities and a developmental gap between children with Down syndrome and their typically developing peers. We investigated the pattern by subjecting it for the first time to functional analyses. We identified non-contextual social behavior, confirmed function(s) of escape to attention, and compared …


False Cures Of U.S. Nationalism: The Border Wall – A Raucous Call From The Silent Center, Tatiana N. Browne-Kai Sep 2020

False Cures Of U.S. Nationalism: The Border Wall – A Raucous Call From The Silent Center, Tatiana N. Browne-Kai

Dissertations, Theses, and Capstone Projects

In trying to grasp the authoritarian surge in the U.S. since 2016, political theorists have increasingly turned their focus back to the Studies of the Authoritarian Personality. In response to the risk of these contemporary studies’ use of psychoanalysis in a de-historicized and individualized way, this paper opts for a double historicization of modern mass-formations. In analyzing the Minuteman Civil Defense Corps, the Minuteman Border Fence and We Build the Wall, civil initiatives that aim at fortifying the U.S.-Mexican border wall (D. Trumps central campaign theme), the current surge to the right is shown to be based on and made …


The Cognitive Thalamus: Source Analysis Of Scene Working Memory Delay Activity, Bernard A. Gomes Sep 2020

The Cognitive Thalamus: Source Analysis Of Scene Working Memory Delay Activity, Bernard A. Gomes

Dissertations, Theses, and Capstone Projects

Working Memory represents a limited-capacity store for maintaining information and manipulating the store's contents over a short period for the guidance of goal-directed behavior. Working Memory is an essential component of executive functions that are intricately associated with the prefrontal cortex (PFC). The PFC has been implicated in maintaining task-related information online for brief periods in the absence of relevant information. This active maintenance phase is called the delay period that occurs between encoding and retrieval of the stimulus. Previous studies have attempted to understand the relationship between working memory and the PFC, especially during the delay or maintenance phase …


Rehabilitative Movement Approaches And Dance Interventions In Parkinson’S Disease, Cecilia Fontanesi Sep 2020

Rehabilitative Movement Approaches And Dance Interventions In Parkinson’S Disease, Cecilia Fontanesi

Dissertations, Theses, and Capstone Projects

The scope of this work is to address the functional deficits and symptoms experienced by those living with Parkinson’s Disease through movement interventions.

Chapter 1 offers a brief overview of current pharmacotherapy and rehabilitation approaches in Parkinson’s, focusing on dance in particular as a movement intervention that may be particularly suited to this population.

Chapter 2 focuses on brain plasticity and motor learning in PD, reporting the effects of rTMS applied after the acquisition of a motor skill. In this study, adaptation tested in patients with PD was comparable in the sham and TMS sessions, while retention indices tested on …


Affect, Behavior And (Dys)Regulation: Integrating Youth's Projective Tests And Self-Reports, Laurel Wright Sep 2020

Affect, Behavior And (Dys)Regulation: Integrating Youth's Projective Tests And Self-Reports, Laurel Wright

Dissertations, Theses, and Capstone Projects

Past and current research indicates that unconscious processes (e.g., outside the realm of conscious awareness) contribute to aspects of adaptation and development, such as emotion regulation, adaptability, interpersonal flexibility and overall identity formation. Further, unconscious processes including: Defense Mechanisms (DMs), Affect Maturity (AM) and Object Relations (OR), can be operationalized and scored using valid and reliable psychodynamic instruments (e.g., Rorschach Inkblot Method), with theoretical and empirical links to underlying emotion regulation processes. Currently however, emotional dysregulation and its sequelae (e.g.,depression and ADHD symptoms) are most often assessed based on one’s conscious awareness, using standardized self-report measures or structured clinical interviews. …


The Political Personality Of 2020 Democratic Vice-Presidential Nominee Kamala Harris, Anne Marie Griebie, Aubrey Immelman, Yitao Zhang Sep 2020

The Political Personality Of 2020 Democratic Vice-Presidential Nominee Kamala Harris, Anne Marie Griebie, Aubrey Immelman, Yitao Zhang

Psychology Faculty Publications

This preliminary report presents the results of an indirect assessment of the personality of U.S. senator Kamala Harris, Democratic vice-presidential nominee in the 2020 U.S. presidential election, from the conceptual perspective of personologist Theodore Millon.

Psychodiagnostically relevant data about Harris were collected from biographical sources and media reports and synthesized into a personality profile using the Millon Inventory of Diagnostic Criteria (MIDC), which yields 34 normal and maladaptive personality classifications congruent with DSM-III-R, DSM-IV, and DSM-5.

The personality profile yielded by the MIDC was analyzed in accordance with interpretive guidelines provided in the MIDC and Millon Index …


How To Enhance Tourist Perceptions Of Environmental Issues Through Nature Images: An Importance-Performance Analysis, Hye Jeong Park, Eunkyoung Park Sep 2020

How To Enhance Tourist Perceptions Of Environmental Issues Through Nature Images: An Importance-Performance Analysis, Hye Jeong Park, Eunkyoung Park

Journal of Global Business Insights

Environmental problems have been discussed as a serious issue across the world. To conserve nature, many environmental organizations have tried to facilitate tourists’ environmental perceptions by using nature images on their websites. However, few guidelines have been introduced regarding how to select appropriate nature images. Given this gap, this study conducted an importance-performance analysis (IPA) which provides the specific guideline for the use of appropriate nature images through nature-related websites. A total of 526 participants were recruited through an online survey. The results revealed that 14 nature images were categorized as Useful, Healthy, and Spontaneous nature images and identified different …


Psychotherapy For Borderline Personality Disorder: Does The Type Of Treatment Make A Difference?, William D. Ellison Sep 2020

Psychotherapy For Borderline Personality Disorder: Does The Type Of Treatment Make A Difference?, William D. Ellison

Psychology Faculty Research

Purpose of Review: The first aim of this review is to summarize the major evidence-based psychotherapies for borderline personality disorder (BPD) and the research supporting their use. The second aim is to explore the evidence for the differential effectiveness of these treatments. Recent Findings: Four types of specific psychotherapies are identified that show promising results in at least two randomized controlled trials. In addition, several adjunctive and minimal/pragmatic interventions are available that are supported by research evidence. Recent findings highlight the applicability of these treatments across settings and populations and have begun to show that modified versions of them are …


Masculinized Second-To-Fourth Digit Ratio (2d:4d Ratio) Is Associated With Lower Cortisol Response In Infant Female Rhesus Monkeys (Macaca Mulatta), Elizabeth K. Wood, Parker Jarman, Elysha Cash, Alexander Baxter, John P. Capitanio, James Dee Higley Sep 2020

Masculinized Second-To-Fourth Digit Ratio (2d:4d Ratio) Is Associated With Lower Cortisol Response In Infant Female Rhesus Monkeys (Macaca Mulatta), Elizabeth K. Wood, Parker Jarman, Elysha Cash, Alexander Baxter, John P. Capitanio, James Dee Higley

Faculty Publications

The second-to-fourth digit ratio (2D:4D ratio) is considered a postnatal proxy measure for the degree of prenatal androgen exposure (PAE), which is the primary factor responsible for masculinizing the brain of a developing fetus. Some studies suggest that the organizational effects of PAE may extend to the hypothalamic-pituitary-adrenal (HPA) axis response to stress. This study investigates the relationship between 2D:4D ratio and HPA axis functioning using a rhesus monkey (Macaca mulatta) model. Subjects were N = 268 (180 females, 88 males) rhesus monkey infants (3–4 months of age). Plasma cortisol concentrations were assayed from two blood samples obtained …


Exploring The Relationship Between Children’S Vocabulary And Their Understanding Of Cardinality: A Methodological Approach, Justin Slifer, Emily Carrigan, Kristin Walker, Marie Coppola Aug 2020

Exploring The Relationship Between Children’S Vocabulary And Their Understanding Of Cardinality: A Methodological Approach, Justin Slifer, Emily Carrigan, Kristin Walker, Marie Coppola

Honors Scholar Theses

Is there a relationship between vocabulary and children’s understanding of cardinality? Does the way in which we classify cardinality data as tested by the Give-a-Number task affect finding such a relationship? This thesis explored these questions using a methodological approach, by testing the relationship between children’s receptive vocabulary scores and Give-a-Number scores classified in two different ways, the traditional knower-level assessment, as well as by calculating the proportion of trials answered correctly. A significant correlation was found between participants’ receptive vocabulary scores and Give-a-Number scores using both manners of classification, independent of the children’s ages. The results were compared with …


Book Review: Reconnecting To The Source By Ervin Laszlo, Elizabeth W. Szatmari Krasnoff Aug 2020

Book Review: Reconnecting To The Source By Ervin Laszlo, Elizabeth W. Szatmari Krasnoff

Journal of Conscious Evolution

Quantum philosopher Ervin Laszlo has taken one step further outside of the contemporary mainstream scientific view, which believes in a reductive “scientific” method primarily of highly controlled experiments to determine truth. In this visionary work, Laszlo proposes that the true laws of nature can also be accessed and felt experientially. Here he argues that the new quantum science can support this view, and even assist us as we heal the rift between mind and spirit and reconnect to our source. Laszlo proposes a new paradigm, a holotropic worldview with love as the core attracting force of wholeness. Indeed, as the …


Book Review: The Intelligence Of The Cosmos: Why Are We Here? By Ervin Laszlo, Elizabeth W. Szatmari Krasnoff Aug 2020

Book Review: The Intelligence Of The Cosmos: Why Are We Here? By Ervin Laszlo, Elizabeth W. Szatmari Krasnoff

Journal of Conscious Evolution

Ervin Laszlo breaks down his theory of everything into a credo of 8 statements. This review looks in some detail at Laszlo’s theories and also touches on the other writers who have been invited to participate. It is noteworthy that Laszlo breaks with the current scientific belief that we are without purpose, and that evolution has no purpose. He believes that compassion, love, and expansion are our purposes for being here.


Defining The Relationship Between Maternal Care Behavior And Sensory Development In Wistar Rats: Auditory Periphery Development, Eye Opening And Brain Gene Expression, Jingyun Qiu, Preethi Singh, Geng Pan, Annalisa De Paolis, Frances A. Champagne, Jia Liu, Luis Cardoso, Adrián Rodríguez-Contreras Aug 2020

Defining The Relationship Between Maternal Care Behavior And Sensory Development In Wistar Rats: Auditory Periphery Development, Eye Opening And Brain Gene Expression, Jingyun Qiu, Preethi Singh, Geng Pan, Annalisa De Paolis, Frances A. Champagne, Jia Liu, Luis Cardoso, Adrián Rodríguez-Contreras

Advanced Science Research Center

Defining the relationship between maternal care, sensory development and brain gene expression in neonates is important to understand the impact of environmental challenges during sensitive periods in early life. In this study, we used a selection approach to test the hypothesis that variation in maternal licking and grooming (LG) during the first week of life influences sensory development in Wistar rat pups. We tracked the onset of the auditory brainstem response (ABR), the timing of eye opening (EO), middle ear development with micro-CT X-ray tomography, and used qRT-PCR to monitor changes in gene expression of the hypoxia-sensitive pathway and neurotrophin …


Vocational Expectations From Adolescence To Early Adulthood: An Integrative Exploration Of Their Formation, Consistency, Change, And Predictive Value, Leah Hope Schultz Aug 2020

Vocational Expectations From Adolescence To Early Adulthood: An Integrative Exploration Of Their Formation, Consistency, Change, And Predictive Value, Leah Hope Schultz

Arts & Sciences Graduate Student Theses and Dissertations

Career expectations show predictive validity for future job selection and work outcomes above traditional vocational interest inventories, yet are rarely tracked longitudinally. The current study explored characteristics of adolescents’ freely reported career expectations by examining their formation, typical trajectories of their development, individual differences in their development, and their utility as predictors of life outcomes. Though some past research has examined longitudinal trends in adolescents’ career expectations, this was the first study to assign dimensional RIASEC scores to participants’ expected occupations rather than a single categorical code. Using data from 21,444 students in the High School Longitudinal Study (HSLS 09:16; …


Generalized Anxiety Symptoms And Interpersonal Self-Perceptions During Stressors: A Prospective Examination Of Psychological And Biological Stress, Jamie A. Lewis Aug 2020

Generalized Anxiety Symptoms And Interpersonal Self-Perceptions During Stressors: A Prospective Examination Of Psychological And Biological Stress, Jamie A. Lewis

Clinical Psychology Dissertations

Individuals with generalized anxiety disorder (GAD) symptoms endorse negative emotionality, psychosocial dysfunction, and biological dysregulation. Interpersonal dominance and affiliation have also been linked to GAD symptoms. Little research has examined individuals with GAD symptoms in terms of naturalistic stressors and chronic use of interpersonal behaviors. GAD symptoms, as well as lower dominance and affiliation, have been linked to hypothalamic-pituitary-adrenal (HPA) dysregulation. However, no studies have examined the unique and interacting contributions of GAD symptoms and interpersonal processes to chronic cortisol levels and distress. College students completed baseline measures of GAD symptoms, measures of interpersonal self-perceptions and distress for five weeks, …


The Effect Of Teacher-Child Interaction Training On Children Who Are Exhibiting Disruptive Behaviors Within The Classroom Setting, Jaclynn Susan Stankus Aug 2020

The Effect Of Teacher-Child Interaction Training On Children Who Are Exhibiting Disruptive Behaviors Within The Classroom Setting, Jaclynn Susan Stankus

Electronic Theses and Dissertations

Teacher-Child Interaction Training (TCIT) is an adaption of the evidenced-based treatment of Parent-Child Interaction Therapy (PCIT). The TCIT intervention is used with students, typically in a preschool setting, who are exhibiting disruptive behaviors within the classroom. Teacher-Child Interaction Training improves the teacher-child relationship, while also training teachers to use effective and consistent consequence strategies. The large research base behind PCIT and the growing empirical base for TCIT provides evidence that this model would be an effective early intervention treatment for young children exhibiting disruptive behaviors in their school settings.

The success of Teacher-Child Interaction Training (TCIT) with the general preschool …


Therapeutic Potential Of A Ketogenic Diet In The Treatment Of Major Depressive Disorder, Jordan A. Murrin Aug 2020

Therapeutic Potential Of A Ketogenic Diet In The Treatment Of Major Depressive Disorder, Jordan A. Murrin

Masters Theses, 2020-current

Major depressive disorder (MDD) is the second most common mental health condition and a leading cause of disability in the world. It is theorized that MDD develops from a combination of biological, psychological, and social stressors. The condition is typically treated using pharmaceuticals and psychotherapy. However, not all individuals with MDD have access to or choose to use these treatments, or may prefer to incorporate therapeutic lifestyle changes such as exercise, sleep, and healthy eating. Even with treatment, MDD can alter brain structure and function, leading to the development of comorbid mental health and chronic metabolic conditions like obesity, cardiovascular …


Survivors Of Human Trafficking: A Review Of Current Mental Health Practices And Recommendations For Improvement, Caleb Andreason Aug 2020

Survivors Of Human Trafficking: A Review Of Current Mental Health Practices And Recommendations For Improvement, Caleb Andreason

Undergraduate Honors Theses

Human trafficking is a global issue that is increasing in prevalence. For survivors and those exploited by human trafficking, the psychological, developmental, and physical health consequences of human trafficking are complex and often debilitating. Unfortunately, there continues to be a lack of attention regarding these issues in the professional psychology literature. A qualitative study was conducted that included nine semi-structured interviews of professionals working with survivors of human trafficking. The data were analyzed and themes were derived using content analysis. The results showed the need for long-term comprehensive care, but many principles found in the research literature have not yet …