Digital Commons Network^™

The Influence Of Personality Type On Patient Outcome Measures And Therapeutic Alliance In Patients With Low Back Pain, William J. Hanney, Fahim Dhalla, Chase Kelly, Alicia Tomberlin, Morey J. Kolber, Abigail T. Wilson, Paul A. Salamh

HPD Articles

Background: Low back pain (LBP) has been shown to have various biological, psychological, and social factors that affect prognosis. However, it is unclear how personality may influence self-reported outcome measures and therapeutic alliance (TA). Methods: Eysenck’s personality inventory was used to assess personality, while the numeric pain rating scale (NPRS), Oswestry Disability Index (ODI), Tampa Scale of Kinesiophobia (TSK), Global Rating of Change (GROC), and the Working Alliance Inventory (WAI) measured patient progress and relationship strength. All outcome measures were formulated in a single survey that both the therapist and patient completed electronically. Results: Sixty-seven patients with LBP and twenty-two …

Heavy Metals Within The Hawaiian Islands Archipelago As Evidenced In The Hawaiian Monk Seal And Their Prey, Yvanna M. Strait

All HCAS Student Capstones, Theses, and Dissertations

The Hawaiian monk seal (HMS) is an endangered, endemic seal native to the Northwestern Hawaiian Islands (NWHI). During the 21^st century, members of the HMS population have established residency within the Main Hawaiian Islands (MHI). This habitat shift may increase exposure of the animals to greater anthropogenic (urban industrialization, agricultural practices, and military activity) and natural (volcanic activity) heavy metal contaminants. Induced coupled plasma mass spectroscopy (ICPMS) analysis compared 16 heavy metal concentrations in HMS bone segregated by region, age, and sex. In additions, metal concentrations from potential prey items from the southern extent of the Northwestern Hawaiian Islands …

Paradoxical Tumor Necrosis Factor-Alpha (Tnf-Α) Inhibitor-Induced Psoriasis: A Systematic Review Of Pathogenesis, Clinical Presentation, And Treatment., Aditi Chokshi, Michelle Demory Beckler, Anita Laloo, Marc M. Kesselman

HPD Articles

Tumor necrosis factor-alpha (TNF-α) inhibitors have been shown to be well tolerated among patients with rheumatoid arthritis, inflammatory bowel disease, and psoriasis. Meanwhile, more recently, clinical practice and research efforts have uncovered increasing cases of psoriatic lesion development tied to initiating treatment with a TNF-α inhibitor. The underlying mechanisms associated with this occurrence have yet to be fully elucidated. A review and analysis of cases of paradoxical psoriasis currently published in the literature is warranted. In addition, exploring possible mechanisms of action and potential treatment options associated with favorable outcomes is much needed. A systematic literature review was performed utilizing …

Bioinspired Polymers: Transformative Applications In Biomedicine And Regenerative Medicine., Hossein Omidian, Renae L. Wilson, Niloofar Babanejad

HPD Articles

Bioinspired polymers have emerged as a promising field in biomaterials research, offering innovative solutions for various applications in biomedical engineering. This manuscript provides an overview of the advancements and potential of bioinspired polymers in tissue engineering, regenerative medicine, and biomedicine. The manuscript discusses their role in enhancing mechanical properties, mimicking the extracellular matrix, incorporating hydrophobic particles for self-healing abilities, and improving stability. Additionally, it explores their applications in antibacterial properties, optical and sensing applications, cancer therapy, and wound healing. The manuscript emphasizes the significance of bioinspired polymers in expanding biomedical applications, addressing healthcare challenges, and improving outcomes. By highlighting these …

Improving The Design And Conduct Of Aquatic Toxicity Studies With Oils Based On 20 Years Of Croserf Experience, Wa Stubblefield, M Barron, G Bragin, Me Delorenzo, B De Jourdan, B Echols, Dp French-Mccay, P Jackman, Jr Loughery, Tf Parkerton, D. Abigail Renegar, Jl Rodriguez-Gil

Marine & Environmental Sciences Faculty Articles

Laboratory toxicity testing is a key tool used in oil spill science, spill effects assessment, and mitigation strategy decisions to minimize environmental impacts. A major consideration in oil toxicity testing is how to replicate real-world spill conditions, oil types, weathering states, receptor organisms, and modifying environmental factors under laboratory conditions. Oils and petroleum-derived products are comprised of thousands of compounds with different physicochemical and toxicological properties, and this leads to challenges in conducting and interpreting oil toxicity studies. Experimental methods used to mix oils with aqueous test media have been shown to influence the aqueous-phase hydrocarbon composition and concentrations, hydrocarbon …

The Dilemma Of Socrates’ Position: Interview Methods And Feminist Empirical Bioethics, Michiel De Proost

The Qualitative Report

There is a growing body of bioethics research that addresses the importance of adapting empirical, predominantly qualitative, methods to generate debate on ethical arguments. However, there is an absence of illustrative work examining how this could be realised from a feminist perspective. This article, seeking to address the research gap, examines interview methods through a reflexive lens. Drawing on the doctoral research I conducted through interviews with women who were interested in social egg freezing (i.e., healthy women freezing their eggs in anticipation of future infertility), I describe how I encountered a dilemma because of my gendered positionality and the …

International Society Of Sports Nutrition Position Stand: Coffee And Sports Performance, Lonnie M. Lowery, Dawn E. Anderson, Kelsey F. Scanlon, Abigail Stack, Guillermo Escalante, Sara C. Campbell, Chad M. Kerksick, Michael T. Nelson, Tim N. Ziegenfuss, Trisha A. Vandusseldorp, Douglas S. Kalman, Bill I. Campbell, Richard B. Kreider, Jose Antonio

HPD Articles

Based on review and critical analysis of the literature regarding the contents and physiological effects of coffee related to physical and cognitive performance conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society:

(1) Coffee is a complex matrix of hundreds of compounds. These are consumed with broad variability based upon serving size, bean type (e.g. common Arabica vs. Robusta), and brew method (water temperature, roasting method, grind size, time, and equipment).

(2) Coffee’s constituents, including but not limited to caffeine, have neuromuscular, …

Fun Azores: A Functional Trait Database For The Meio-, Macro-, And Megafauna From The Azores Marine Park (Mid-Atlantic Ridge), Neus Campanyà-Llovet, Amanda E. Bates, Daphne Cuvelier, Eva Giacomello, Diana Catarino, Andrew J. Gooday, Björn Berning, Blanca Figuerola, Manuel A. E. Malaquias, Carlos J. Moura, Joana R. Xavier, Tracey Sutton, Laurence Fauconnet, Sofia P. Ramalho, Bárbara De Moura Neves, Gui M. Machado, Tammy Horton, Andrey V. Gebruk, Kirill Minin, Joël Bried, Tina Molodtsova, Mónica A. Silva, Anna Dilman, Antonina Kremenetskaia, Eudriano F. S. Costa, Jameson Clarke, Helen R. Martins, Christopher K. Pham, Marina Carreiro-Silva, Ana Colaço

Marine & Environmental Sciences Faculty Articles

Trait-based approaches that complement taxonomy-based studies have increased in popularity among the scientific community over the last decades. The collection of biological and ecological characteristics of species (i.e., traits) provides insight into species and ecosystem vulnerability to environmental and anthropogenic changes, as well as ecosystem functioning. Here, we present the FUN Azores trait database, describe our approach, evaluate its scope, compare it to other marine trait databases, and explore the spatial distribution of its traits with “functional maps.” While most of the available trait databases to date contain essential information to understand the functional diversity of a taxonomic or functional …

The Cultural Meaning In Ritual Traditions For The Character Of Osing People Banyuwangi, Indonesia, Imam Suyitno, Yuni Pratiwi, Kusubakti Andajani, Heni Dwi Arista Mrs.

The Qualitative Report

This study examined the cultural meaning of the ritual tradition for the character of the Osing people, Banyuwangi. The study focused on describing (a) the personal character in ritual tradition, (b) the social character in ritual traditions, and (c) the character values in ritual traditions. This study was qualitative research with the hermeneutic approach to interpret and explain the meaning of ritual tradition by involving three culturalists and community leaders as data resources. The study found that ritual tradition has cultural meaning for Osing people to build (a) personal character, which includes responsible, consistent, caring, sincere in their work, willing …

Podcast Listening And Informal Learning, Christopher Shamburg, Veronica O'Neill, Remberto Jimenez, Juan Rodriguez, Kristina Harb

The Qualitative Report

Listening to podcasts is a popular way adults learn outside of formal school settings. Examining podcast listening through the lens of informal learning is an important and underexplored area of inquiry. This is especially important considering the growth of the adult population in the United States and the new opportunities for learning and recreation. In this research, we interviewed 31 adult podcast listeners from across the United States about their experiences listening to and learning from podcasts. We open coded and refined the analysis to three themes. There was a strong connection between listening, learning, and personal growth among the …

Evaluating The Effect Of Symbiodiniacea On Survival, Growth, And Acquisition Of Newly Settled Corals Of Three Caribbean Species, Michael B. Hood

All HCAS Student Capstones, Theses, and Dissertations

Symbiosis between corals and Symbiodiniaceae is critical to coral reef health. However, this mutually beneficial relationship is threatened by a variety of stressors. This study aims to assess if seeding newly settled corals with different species of Symbiodiniaceae promotes differences in survival, growth, and symbiont acquisition in corals. Three reef-building species (Colpophyllia natans, Orbicella faveolata, and Pseudodiploria strigosa) reared in sterile saltwater baths were seeded with one of four Symbiodiniaceae species (Breviolum minutum, Durusdinium trenchii, Fugacium kawagutii, and Symbiodinium microadriaticum). Coral survival, growth, and symbiont acquisition were assessed biweekly during the first two months and monthly …

A Qualitative Study On Malaysian Academics' Perceptions And Suggestions On Gamified Learning, Mohd. Elmagzoub Eltahir, Nagaletchimee Annamalai, Arulselvi Uthayakumaran, Samer H Zyoud, Bilal Zakarneh Dr, Najeh Rajeh Alsalhi

The Qualitative Report

This study explores lecturers' perceptions and suggestions on integrating gamified lessons in Malaysian higher institutions. The COVID-19 pandemic has drastically changed the norm of traditional classroom teaching by accelerating digital integration amongst educators and necessitating the need to address classroom gamification. To further understand educators' perceptions, we conducted in-depth interviews with 25 lecturers. We thematically analyzed the interviews by following the steps undertaken by Braun and Clarke (2006) to identify the emerging themes. The findings determine that educators found gamification suitable in teaching and learning activities during the set induction, reinforcement and assessment of specific skills. Several misconceptions also evident …

Cpg Odn/Mangiferin Dual Delivery Through Calcium Alginate Hydrogels Inhibits Immune-Mediated Osteoclastogenesis And Promotes Alveolar Bone Regeneration In Mice., Yingzhi Gu, Yang Hu, Shengyuan Huang, Sunniva Ruiz, Toshihisa Kawai, Yuxing Bai, Xiaozhe Han

HPD Articles

The immune system plays an important role in the skeletal system during bone repair and regeneration. The controlled release of biological factors from the immune system could facilitate and optimize the bone remodeling process through the regulation of the activities of bone cells. This study aimed to determine the effect of the controlled delivery of immunomodulatory biologicals on bone regeneration. Immunostimulatory cytosine-phosphate-guanosine oligodeoxynucleotides (CpG ODN) and glucosylxanthone Mangiferin (MAG)-embedded microbeads were incubated with P. gingivalis-challenged splenocytes, or co-cultured with RAW264.7 cells. The effect of CpG ODN/MAG-containing microbeads on bone regeneration was then tested in vivo in a mouse alveolar bone …

A Critical Perspective Over Whether And How To Acknowledge The Use Of Artificial Intelligence (Ai) In Qualitative Studies, Prokopis Christou

The Qualitative Report

There has been a rise in scepticism regarding the use of Artificial Intelligence (AI) in qualitative research tasks such as critical reviews, conceptualization, thematic and content analysis, and potentially theory development. Concerns have been raised over the possibility that researchers intentionally avoid discussing or even mentioning the use of AI in their studies for a variety of reasons, including the "fear" of criticism and rejection of their papers. The purpose of this paper, which is guided by critical perspective principles, is to examine the controversy surrounding the appropriate recognition of AI in theoretical discussions and qualitative research, including conceptual, critical …

High-Performing Conductive Hydrogels For Wearable Applications., Hossein Omidian, Sumana Dey Chowdhury

HPD Articles

Conductive hydrogels have gained significant attention for their extensive applications in healthcare monitoring, wearable sensors, electronic devices, soft robotics, energy storage, and human-machine interfaces. To address the limitations of conductive hydrogels, researchers are focused on enhancing properties such as sensitivity, mechanical strength, electrical performance at low temperatures, stability, antibacterial properties, and conductivity. Composite materials, including nanoparticles, nanowires, polymers, and ionic liquids, are incorporated to improve the conductivity and mechanical strength. Biocompatibility and biosafety are emphasized for safe integration with biological tissues. Conductive hydrogels exhibit unique properties such as stretchability, self-healing, wet adhesion, anti-freezing, transparency, UV-shielding, and adjustable mechanical properties, making …

Patient's Perspective Of Shared Decision-Making In Rheumatoid Arthritis Treatment: A Grounded Theory Exploration, Isabela Viana Oliveira, Mariana Martins Gonzaga Nascimento, Cristiane P. Rezende Mrs, Carina M. Neves, Hagabo Mathyell Silva, Ana Luiza Mourawad Cesar, Djenane Ramalho De Oliveira

The Qualitative Report

Current guidelines for rheumatoid arthritis (RA) treatment state that all decisions should be shared with the patient. Therefore, it becomes necessary to understand in-depth how patients with RA with different levels of health literacy and activation feel about sharing the decision with the health professional and how they experience this process. Grounded theory was used. Data collection included semi-structured interviews with 14 patients with RA. From the analysis of the patients’ narratives, four categories were built: “Accepting the changes: non-shared decisions”; “The patient's rationale: why not share?”; “Reaching the requirements for sharing the decision: expanding the patient’s autonomy"; and "Experiencing …

Endemic Galapagos Tree Daisy Scalesia Pedunculata Threatened By Competition With Nonnative Blackberry Rubus Niveus, Heinke Jäger, Christian Sevilla, Bernhard Riegl

Marine & Environmental Sciences Faculty Articles

There is a debate whether invasive plants can induce extinction debt in native flora that is not immediately obvious. Competitive effects of invasions and how competition causes native biodiversity loss are complicated to evaluate. Experi-mental removal or introduction bears the most promise of demonstrating native species displacement mechanics. Over an eight- year period, we followed plots in the only remaining Scalesia pedunculata forest on Santa Cruz Island, Galapagos, where invading Rubus niveus was either removed or retained. Demographic param-eters and total recruitment failure in the presence of R. niveus suggest that S. pedun-culata may face local extinction in two decades …

Advancements And Applications Of Injectable Hydrogel Composites In Biomedical Research And Therapy., Hossein Omidian, Sumana Dey Chowdhury

HPD Articles

Injectable hydrogels have gained popularity for their controlled release, targeted delivery, and enhanced mechanical properties. They hold promise in cardiac regeneration, joint diseases, postoperative analgesia, and ocular disorder treatment. Hydrogels enriched with nano-hydroxyapatite show potential in bone regeneration, addressing challenges of bone defects, osteoporosis, and tumor-associated regeneration. In wound management and cancer therapy, they enable controlled release, accelerated wound closure, and targeted drug delivery. Injectable hydrogels also find applications in ischemic brain injury, tissue regeneration, cardiovascular diseases, and personalized cancer immunotherapy. This manuscript highlights the versatility and potential of injectable hydrogel nanocomposites in biomedical research. Moreover, it includes a perspective …

Shift Work As A Cardiovascular Disease Risk Factor: A Narrative Review., Ryan Wong, Alex Crane, Jay Sheth, Harvey N. Mayrovitz

HPD Articles

Shift work has emerged as a significant health concern in recent years, and research has revealed a link to circadian rhythm dysregulation and atherosclerosis, both of which can increase the risk of cardiovascular disease (CVD). Currently, there is a lack of updated reviews regarding the impact of shiftwork on CVD. Thus, the present narrative review aims to provide a comprehensive summary of the latest research on the relationship between shift work and CVD, identify potential gaps in the current knowledge, and highlight areas for future research. Database searches for peer-reviewed articles published between January 2013 to January 2023 on shift …

Rate And Magnitude Of Muscle Temperature Increase With Cycling At Various Intensities, Jennifer Ostrowski, James Scifers

Internet Journal of Allied Health Sciences and Practice

Purpose: Anecdotally, athletic training clinicians often have patients "warm up" on a stationary cycle prior to rehabilitation. No previous studies have evaluated the rate or magnitude of muscle temperature increase during a cycling task. Our objective was to determine the rate and magnitude of muscle temperature increase in superficial (2cm) and deep (4cm) muscle during cycling at various intensities. Methods: Randomized, counter-balanced crossover trial conducted at a University research laboratory. Sixteen healthy participants (male=7, female=9; mean age 26±4 years; height 170±10 cm; weight 77±8 kg; adipose thickness 1.4±0.9 cm; muscle thickness 5.1±0.7 cm). Participants performed cycling under 3 intensity conditions: …

Cryogels: Advancing Biomaterials For Transformative Biomedical Applications., Hossein Omidian, Sumana Dey Chowdhury, Niloofar Babanejad

HPD Articles

Cryogels, composed of synthetic and natural materials, have emerged as versatile biomaterials with applications in tissue engineering, controlled drug delivery, regenerative medicine, and therapeutics. However, optimizing cryogel properties, such as mechanical strength and release profiles, remains challenging. To advance the field, researchers are exploring advanced manufacturing techniques, biomimetic design, and addressing long-term stability. Combination therapies and drug delivery systems using cryogels show promise. In vivo evaluation and clinical trials are crucial for safety and efficacy. Overcoming practical challenges, including scalability, structural integrity, mass transfer constraints, biocompatibility, seamless integration, and cost-effectiveness, is essential. By addressing these challenges, cryogels can transform biomedical …

The Importance Of Gender-Neutral Terminology In Risk Evaluation And Mitigation Strategy Programs: A Call To Action., Colin Burnette, William Smithy, Daniel Strock, Torunn E. Sivesind, Robert Dellavalle

HPD Articles

The use of risk evaluation and mitigation strategy (REMS) programs is frequently required for prescriptions with potentially teratogenic effects, especially in the field of dermatology. Among these REMS programs, the most well-known example is isotretinoin, an oral retinoid that uses the iPLEDGE system. iPLEDGE has strict regulations and a lengthy approval process, and until recently, patients were grouped into 3 categories: male, female, or female of reproductive potential. This strict grouping has posed problems in the medical community, especially for gender-diverse individuals where their perceived gender conflates with their assigned grouping causing patient-specific distress. The distinction between gender-a multifactorial perception …

Periodontal Regeneration Risk Assessment In The Treatment Of Intrabony Defects., Robert A. Levine, Muhammad H A Saleh, Debora R. Dias, Jeffrey Ganeles, Maurício G. Araújo, Franck Renouard, Harold M. Pinsky, Preston D. Miller, Hom-Lay Wang

HPD Articles

BACKGROUND: Regenerative approaches performed in periodontics seems to be efficient in treating intrabony defects. There are, however, many factors that may affect the predictability of the regenerative procedures. The present article aimed to propose a new risk assessment tool for treating periodontal intrabony defects by regenerative therapy.

METHODS: Different variables that could affect the success of a regenerative procedure were considered based on their impact on (i) the wound healing potential, promoting wound stability, cells, and angiogenesis, or (ii) the ability to clean the root surface and maintain an optimal plaque control or (iii) aesthetics (risk for gingival recession).

RESULTS: …

Periodically Disturbing Biofilms Reduces Expression Of Quorum Sensing-Regulated Virulence Factors In Pseudomonas Aeruginosa, Laura Garcia-Dieguez, Gabriela Diaz-Tang, Estefania Marin Meneses, Vanessa Cruise, Ivana M. Barraza, Travis J.A. Craddock, Robert P. Smith

Biology Faculty Articles

Pseudomonas aeruginosa uses quorum sensing to regulate the expression of virulence factors. In static environments, spatial structures, such as biofilms, can increase the expression of these virulence factors. However, in natural settings, biofilms are exposed to physical forces that disrupt spatial structure, which may affect the expression of virulence factors regulated by quorum sensing. We show that periodically disturbing biofilms composed of P. aeruginosa using a physical force reduces the expression of quorum sensing-regulated virulence factors. At an intermediate disturbance frequency, the expression of virulence factors in the las, rhl, and pqs regulons is reduced. Mathematical modeling suggests that perturbation …

Variability In Billfish Vertical Distribution And Fishing Interactions Driven By Environmental Conditions In The Eastern Tropical Pacific Ocean, H. E. Blondin, D. E. Haulsee, Ryan Logan, Mahmood Shivji, E. R. Hoffmayer, J. H. Walker, J. M. Dean, E. L. Hazen, L. B. Crowder

Biology Faculty Articles

Blue marlin (Makaira nigricans) and sailfish (Istiophorus platypterus) are ecologically important predators and valuable species throughout the world’s recreational, commercial, and subsistence fisheries. Comparing multi-species vertical habitat use can inform ecological uncertainties such as inter-species competition, as well as relative vulnerabilities to fishing activities. In this study, we identified key differences in both depth use and which environmental variables drive these selections, which highlights the variability in the catchability both as target species in recreational fisheries and bycatch in commercial fisheries. To understand these two species’ vertical habitat use, we examined depth profiles from 26 sailfish …

Understanding Mental Health As Public Health, Christi M. Navarro

Faculty Proceedings, Presentations, Speeches and Lectures

In this interactive workshop, we will utilize a multi-level public health framework to illustrate factors of risk and prevention that influence mental health and well-being. We will discuss shifting the narrative of mental health as an individual issue to the responsibility of society, culture, and environment. Participants will reflect on their role and level of influence in this model as well as their potential for action and positive impact.

Vulnerability And Resilience Of Living Marine Resources To The Deepwater Horizon Oil Spill: An Overview, Steven A. Murawski, Patrick T. Schwing, William F. Patterson, Tracey Sutton, Paul A. Montagna, Rosanna J. Milligan, Samantha B. Joye, Len Thomas, Joshua P. Kilborn, Claire B. Paris, Robin Faillettaz, David S. Portnoy, Sherryl Gilbert

Marine & Environmental Sciences Faculty Articles

The 2010 Deepwater Horizon (DWH) oil well blowout in the Gulf of Mexico (GoM) was the largest and perhaps most consequential accidental marine oil spill in global history. This paper provides an overview of a Research Topic consisting of four additional papers that: (1) assemble time series data for ecosystem components in regions impacted by the spill, and (2) interpret temporal changes related to the vulnerability of species and ecosystems to DWH and the ensuing resilience to perturbation. Time series abundance data for many taxa pre-date DWH, often by decades, thus allowing an assessment of population and community-level impacts. We …

Peeling Away The Taken-For-Grantedness Of Research Subjectivities: Orienting To The Phenomenological, Melissa Freeman, E. Anthony Muhammad

The Qualitative Report

Qualitative research is a multidisciplinary field of practice that acknowledges and values the situatedness and subjectivities of the researcher. Therefore, reflexively accounting for one’s subjectivities is a crucial part of a research report. Less discussed is how subjective understandings are historically, culturally, and socially mediated, often challenging researchers’ abilities to orient themselves critically to this self-reflective undertaking. Phenomenology is a philosophical approach investigating how phenomena such as subjectivity are constituted in experience. This makes phenomenology an essential resource for understanding how complex subjective responses manifest differently depending on one’s orientation to the situation. This paper aims to familiarize qualitative research …

Average Or Outlier? Introductory Statistics Adjunct Instructors’ Beliefs, Practices, And Experiences, Samantha Estrada Aguilera, Erica Martinez

The Qualitative Report

In recent years, the adjunct faculty phenomenon has grown steadily. This research focused on adjunct instructors teaching introductory statistics courses. The purpose of the study was to give a voice to adjunct instructors by allowing them to describe their experiences teaching statistics. We conducted a qualitative study with 15 adjunct instructors of introductory statistics through semi-structured interviews. The participants came from several fields: psychology, nursing, and business, among others. Thematic analysis was used to find themes of statistical anxiety, use of technology in the classroom, lack of curriculum flexibility, and connection to the host institution. Our findings can inform institutions …

Striving For Being In The Line Of Life: Personal Active Ageing Strategies In Iranian Seniors, Fatemeh Raeesi Dehkordi, Ahmad Ali Eslami, Fereshteh Zamani Alavijeh, Hossein Matlabi, Mehdi Nakhodaeezadeh

The Qualitative Report

Active ageing is a multidimensional, relative, and context-dependent concept with different paths and outcomes. This qualitative study aimed to explore personal active aging strategies in a specific context. Following a directed thematic analysis procedure, we conducted semi-structured individual interviews with 39 seniors (men and women) between the ages of 60-97 years selected with purposeful sampling, data collection and analysis were concurrent. We used directed content analysis to analyze the data from interviews, written narratives, and field notes. The reliability of data was fulfilled following Lincoln and Guba criteria. We stopped data collection when no new concepts were added, and data …