Digital Commons Network^™

Co-Clinical Fdg-Pet Radiomic Signature In Predicting Response To Neoadjuvant Chemotherapy In Triple-Negative Breast Cancer, Sudipta Roy, Timothy D Whitehead, Shunqiang Li, Foluso O Ademuyiwa, Richard L Wahl, Farrokh Dehdashti, Kooresh I Shoghi

2020-Current year OA Pubs

PURPOSE: We sought to exploit the heterogeneity afforded by patient-derived tumor xenografts (PDX) to first, optimize and identify robust radiomic features to predict response to therapy in subtype-matched triple negative breast cancer (TNBC) PDX, and second, to implement PDX-optimized image features in a TNBC co-clinical study to predict response to therapy using machine learning (ML) algorithms.

METHODS: TNBC patients and subtype-matched PDX were recruited into a co-clinical FDG-PET imaging trial to predict response to therapy. One hundred thirty-one imaging features were extracted from PDX and human-segmented tumors. Robust image features were identified based on reproducibility, cross-correlation, and volume independence. A …

Aging With Long-Term Physical Disability: Cohort Analysis Of Survey Sample In The U.S., Kerri A Morgan, Michelle Putnam, Sandra M Espin-Tello, Marian Keglovits, Margaret Campbell, Yan Yan, Aimee Wehmeier, Susan Stark

2020-Current year OA Pubs

BACKGROUND: Chronic health conditions, secondary conditions, and decreasing functional ability related to aging and/or changes in underlying impairment may influence participation for persons aging with long-term physical disability (AwD).

OBJECTIVE: To examine sample integrity and baseline findings through exploration of associations of sociodemographic, health, and disability factors with social participation for persons AwD.

METHODS: This is a longitudinal cohort study following persons AwD over three years, reporting baseline cohort study data. A convenience sample of 474 persons AwD aged 45-65 reporting physical disability of ≥5 years' duration was recruited through community organizations and social media. The cohort was majority female …

African American Women’S Perspectives On Mental Health, Kristine Smalls

PCOM Psychology Dissertations

African American women endure multiple stressors from such forms of social oppression as racism and sexism that impact their lives in many ways. Despite those stressors, several barriers impede African American women from seeking the professional mental health they need to cope. Instead, they rely on cultural and historical methods for managing stress, such as religious beliefs and the support of the church community, or they create their own. In this study, 25 women were interviewed to explore the barriers interfering with African American women seeking professional mental health treatment. This study specifically identified and examined three potential barriers: the …

Modeling The Effects Of Adverse Childhood Experiences Using A Mouse Model Of Neglect: Mechanisms Of Adiposity Expansion In Females, Jacqueline Leachman

Theses and Dissertations--Pharmacology and Nutritional Sciences

Adverse childhood experiences (ACEs) are an independent risk factor for chronic disease, including obesity and metabolic syndrome. We have previously shown that a mouse model of early life stress, maternal separation and early weaning (MSEW), exacerbates high-fat diet (HF)-induced obesity only in adult female mice. In agreement, the analysis of several cohorts of participants exposed to ACEs have shown that women are more susceptible to develop obesity than men. Therefore, the aim of this study was to investigate the link between early life stress and obesity in pre-clinical and clinical settings. Male and female MSEW mice fed 1 week a …

An Asian Case Of Combined 17Α-Hydroxylase/17,20-Lyase Deficiency Due To Homozygous Pr96q Mutation: A Case Report And Review Of The Literature, Qian Liao, Rufei Shen, Mingyu Liao, Chenxi Ran, Ling Zhou, Yuling Zhang, Guiliang Peng, Zheng Sun, Hongting Zheng, Min Long

Center on Aging Staff Publications

Background: Combined 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is a very rare form of congenital adrenal hyperplasia (CAH) caused by mutations in the CYP17A1 gene. Almost 100 different mutations of the CYP17A1 gene have been reported, including p.R96Q mutation, but no case of p.R96Q mutation has been described in Asian populations.

Case presentation: We describe a 22-year-old female patient of 46,XY karyotype, who presented with pseudohermaphrodism, primary amenorrhea, underdeveloped secondary sexual characteristics, delayed epiphyseal healing, hypertension, and hypokalemia. The diagnosis of 17-OHD was reached by measurement of steroid hormones and abdominal CT scan and confirmed by genetic sequencing, which revealed a homozygous p.R96Q …

Gabra5 Plays A Sexually Dimorphic Role In Pomc Neuron Activity And Glucose Balance, Zhou Pei, Yang He, Jonathan C Bean, Yongjie Yang, Hailan Liu, Meng Yu, Kaifan Yu, Ilirjana Hyseni, Xing Cai, Hesong Liu, Na Qu, Longlong Tu, Kristine M Conde, Mengjie Wang, Yongxiang Li, Na Yin, Nan Zhang, Junying Han, Camille Hs Potts, Nikolas A Scarcelli, Zili Yan, Pingwen Xu, Qi Wu, Yanlin He, Yong Xu, Chunmei Wang

Children’s Nutrition Research Center Staff Publications

Pro-opiomelanocortin (POMC) neurons are important for the regulation of body weight and glucose balance. The inhibitory tone to POMC neurons is mediated primarily by the GABA receptors. However, the detailed mechanisms and functions of GABA receptors are not well understood. The α5 subunit of GABAA receptor, Gabra5, is reported to regulate feeding, and we found that Gabra5 is highly expressed in POMC neurons. To explore the function of Gabra5 in POMC neurons, we knocked down Gabra5 specifically from mature hypothalamic POMC neurons using the clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 strategy. This POMC-specific knock-down of Gabra5 did not affect …

Maternal Feeding Styles And Child Appetitive Traits: Direction Of Effects In Hispanic Families With Low Incomes, Maria A Papaioannou, Nilda Micheli, Thomas G Power, Teresia M O'Connor, Jennifer Orlet Fisher, Sheryl O Hughes

Children’s Nutrition Research Center Staff Publications

Feeding styles of parents have been associated with dietary quality/intake and weight outcomes; however, much of the research to date has been cross sectional and the direction of influence unclear. This prospective longitudinal study evaluated the direction of effects between feeding styles and child appetitive traits over time in a sample of 129 Hispanic parent/child dyads that participated in a larger study. Data analyzed for the current study were collected when the children were 4-5 years old and again at ages 7-9 years. Parents (all mothers) reported on their feeding styles and children's appetitive traits using well-established questionnaires. Cross-lagged panel …

Associations Of Prenatal Phthalate Exposure With Neurobehavioral Outcomes In 45- And 75-Month-Old Infants, Jenna L N Sprowles, Kelsey L C Dzwilewski, Francheska M Merced-Nieves, Salma M A Musaad, Susan L Schantz, Sarah D Geiger

Children’s Nutrition Research Center Staff Publications

Phthalates are ubiquitous endocrine-disrupting chemicals, and research indicates that prenatal exposure to some phthalates may affect neurodevelopment. In a prospective birth cohort study, five first-morning urine samples collected across pregnancy were pooled and the following phthalate biomarkers assessed: sum of di-(2-ethylhexyl) phthalate metabolites (ΣDEHP), sum of diisononyl phthalate metabolites (ΣDINP), sum of dibutyl phthalate metabolites (ΣDBP), sum of anti-androgenic metabolites (ΣAA), monoethyl phthalate (MEP), and sum of all phthalate metabolites (ΣAll). The Ages & Stages Questionnaires® (ASQ), a standardized parent-reported, age-adapted screening tool, measured communication, personal-social, problem solving, and motor domains in infants at 4.5 and 7.5 months (n = …

Use Of A Simulated-Virtual Training Module To Improve Dental Hygiene Students' Self-Reported Knowledge, Attitudes, And Confidence In Providing Care To Children With Autism Spectrum Disorder: A Pilot Study, Kimberly F. Cenzon, Ann M. Bruhn, Denise M. Claiborne, Jonna L. Bobzien

Dental Hygiene Faculty Publications

Purpose: Autism spectrum disorder (ASD) is a developmental disorder affecting an individual's ability to communicate, interact, behave, and learn. The purpose of this study was to determine knowledge, attitudes, and confidence of dental hygiene students in providing care to children with ASD as a mechanism for evaluating dental hygiene curricula for patients with special needs.

Methods: A simulated-virtual training (SVT) intervention was developed as an interactive approach for educating dental hygiene students on providing care to a child patient with ASD. The SVT intervention consisted of a scenario in which the clinician "interacted" with a child with ASD who was …

Effect Of Early Treatment With Fluvoxamine On Risk Of Emergency Care And Hospitalisation Among Patients With Covid-19: The Together Randomised, Platform Clinical Trial, Gilmar Reis, Eric J Lenze, Angela M Reiersen, Et Al

Open Access Publications

BACKGROUND: Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19.

METHODS: This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice …

Perceived Physical Fatigability Predicts All-Cause Mortality In Older Adults, Nancy W. Glynn, Theresa Gmelin, Sharon W. Renner, Yujia Susanna Qiao, Robert M. Boudreau, Mary F. Feitosa, Mary K. Wojczynski, Stephanie Cosentino, Stacy L. Andersen, Kaare Christensen, Anne B. Newman

Open Access Publications

BACKGROUND: Perceived physical fatigability is highly prevalent in older adults and associated with mobility decline and other health consequences. We examined the prognostic value of perceived physical fatigability as an independent predictor of risk of death among older adults.

METHODS: Participants (N = 2 906), mean age 73.5 [SD, 10.4] years, 54.2% women, 99.7% white enrolled in the Long Life Family Study, were assessed at Visit 2 (2014-2017) with 2.7 [SD, 1.0] years follow-up. The Pittsburgh Fatigability Scale (PFS), a 10-item, self-administered validated questionnaire (score range 0-50, higher = greater fatigability) measured perceived physical fatigability at Visit 2. Deaths post-Visit …

Salaries, Degrees, And Babies: Trends In Fertility By Income And Education Among Japanese Men And Women Born 1943-1975-Analysis Of National Surveys, Cyrus Ghaznavi, Haruka Sakamoto, Lisa Yamasaki, Shuhei Nomura, Daisuke Yoneoka, Kenji Shibuya, Peter Ueda

Open Access Publications

BACKGROUND: While fertility rates have decreased during the second half of the 20th century in Japan, little is known regarding trends in the number of children that men and women have across birth cohorts and whether these differ by education and income.

METHODS: We used data from four rounds of the National Fertility Survey (1992, 2005, 2010 and 2015) and included men and women aged 40-49 years (16728 men and 17628 women). By 5-year birth cohorts, we assessed the distribution of number of children (0, 1, 2 and 3 or more) and total fertility (the mean number of children) at …

Assessment Of A Plasma Amyloid Probability Score To Estimate Amyloid Positron Emission Tomography Findings Among Adults With Cognitive Impairment, Yan Hu, Barry A. Siegel, David M. Holtzman, Et Al

Open Access Publications

Importance: The diagnostic evaluation for Alzheimer disease may be improved by a blood-based diagnostic test identifying presence of brain amyloid plaque pathology.

Objective: To determine the clinical performance associated with a diagnostic algorithm incorporating plasma amyloid-β (Aβ) 42:40 ratio, patient age, and apoE proteotype to identify brain amyloid status.

Design, Setting, and Participants: This cohort study includes analysis from 2 independent cross-sectional cohort studies: the discovery cohort of the Plasma Test for Amyloidosis Risk Screening (PARIS) study, a prospective add-on to the Imaging Dementia-Evidence for Amyloid Scanning study, including 249 patients from 2018 to 2019, and MissionAD, a dataset of …

Association Between Hospital Private Equity Acquisition And Outcomes Of Acute Medical Conditions Among Medicare Beneficiaries, Marcelo Cerullo, Kelly Yang, Karen E. Joynt Maddox, Ryan C. Mcdevitt, James M. Roberts, Anaeze C. Offodile

Open Access Publications

Importance: As private equity (PE) acquisitions of short-term acute care hospitals (ACHs) continue, their impact on the care of medically vulnerable older adults remains largely unexplored.

Objective: To investigate the association between PE acquisition of ACHs and access to care, patient outcomes, and spending among Medicare beneficiaries hospitalized with acute medical conditions.

Design, Setting, and Participants: This cross-sectional study used a generalized difference-in-differences approach to compare 21 091 222 patients admitted to PE-acquired vs non-PE-acquired short-term ACHs between January 1, 2001, and December 31, 2018, at least 3 years before to 3 years after PE acquisition. The analysis was conducted …

Increased Connectivity Among Sensory And Motor Regions During Visual And Audiovisual Speech Perception, Jonathan E. Peelle, Brent Spehar, Michael S. Jones, Sarah Mcconkey, Joel Myerson, Sandra Hale, Mitchell S. Sommers, Nancy Tye-Murray

Open Access Publications

In everyday conversation, we usually process the talker's face as well as the sound of the talker's voice. Access to visual speech information is particularly useful when the auditory signal is degraded. Here, we used fMRI to monitor brain activity while adult humans (

Understanding Contributors To Racial And Ethnic Inequities In Covid-19 Incidence And Mortality Rates, Karen E. Joynt Maddox, Mat Reidhead, Joshua Grotzinger, Timothy Mcbride, Aaloke Mody, Elna Nagasako, Will Ross, Joseph T. Steensma, Abigail R. Barker

Open Access Publications

BACKGROUND: Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts.

METHODS: We used a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data. We examined differences by race and ethnicity in raw population-based case and mortality rates. We used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity, controlling for comorbidities and other risk factors.

RESULTS: As of September 10, 2020 there were 73,635 confirmed …

Association Between Workplace Absenteeism And Alcohol Use Disorder From The National Survey On Drug Use And Health, 2015-2019, Ian C. Parsley, Ann Marie Dale, Sherri L. Fisher, Carrie M. Mintz, Sarah M. Hartz, Bradley A. Evanoff, Laura J. Bierut

Open Access Publications

Importance: Alcohol use disorder (AUD) is common and associated with increased morbidity. The degree to which AUD currently factors into workplace absenteeism needs further characterization in the US.

Objective: To examine the association between AUD and workplace absenteeism in a nationally representative sample.

Design, Setting, and Participants: This cross-sectional study used data from a nationally representative sample of noninstitutionalized US residents from the 2015-2019 National Survey on Drug Use and Health to examine the association of AUD with workplace absenteeism. Eligible respondents were aged 18 years and older who reported full-time employment. Data were analyzed from March to September 2021. …

Homeostatic Interferon-Lambda Response To Bacterial Microbiota Stimulates Preemptive Antiviral Defense Within Discrete Pockets Of Intestinal Epithelium, Jacob A. Van Winkle, Stefan T. Peterson, Elizabeth A. Kennedy, Michael J. Wheadon, Harshad Ingle, Chandni Desai, Rachel Rodgers, David A. Constant, Austin P. Wright, Lena Li, Maxim N. Artyomov, Sanghyun Lee, Megan T. Baldridge, Timothy J. Nice

Open Access Publications

Interferon-lambda (IFN-λ) protects intestinal epithelial cells (IECs) from enteric viruses by inducing expression of antiviral IFN-stimulated genes (ISGs). Here, we find that bacterial microbiota stimulate a homeostatic ISG signature in the intestine of specific pathogen-free mice. This homeostatic ISG expression is restricted to IECs, depends on IEC-intrinsic expression of IFN-λ receptor (

Intrinsic Mechanisms In The Gating Of Resurgent Na+ Currents, Joseph L. Ransdell, Jonathan D. Moreno, Druv Bhagavan, Jonathan R. Silva, Jeanne M. Nerbonne

Open Access Publications

The resurgent component of the voltage-gated sodium current (I

She Owns It: A Study Of White Women Landowners, Hannah Bullock

Electronic Theses and Dissertations

Southeast Missouri is home to some of the nation's most valuable farmland per acre on average. Just twenty-four percent of this agricultural land is in possession of female landowners. This study investigates the experiences of these female producers using Fuzzy Cognitive Mapping in order to understand their decision making process and the barriers that they are confronted with in their social field, as well as their relationship to capital, as women in agriculture. The findings of this study can serve as a needs assessment for this community and can be used to develop solutions that can help this community achieve …

Liquid Biopsies To Occult Brain Metastasis, Asad Ur Rehman, Parvez Khan, Shailendra K. Maurya, Jawed A. Siddiqui, Juan A. Santamaria-Barria, Surinder K. Batra, Mohd W. Nasser

Journal Articles: Biochemistry & Molecular Biology

Brain metastasis (BrM) is a major problem associated with cancer-related mortality, and currently, no specific biomarkers are available in clinical settings for early detection. Liquid biopsy is widely accepted as a non-invasive method for diagnosing cancer and other diseases. We have reviewed the evidence that shows how the molecular alterations are involved in BrM, majorly from breast cancer (BC), lung cancer (LC), and melanoma, with an inception in how they can be employed for biomarker development. We discussed genetic and epigenetic changes that influence cancer cells to breach the blood-brain barrier (BBB) and help to establish metastatic lesions in the …

Caregiver Willingness To Give Tpt To Children Living With Drug-Resistant Tb Patients, V. Rouzier, M. Murrill, S. Kim, L. Naini, J. Shenje, E. Mitchell, M. Raesi, M. Lourens, A. Mendoza, F. Conradie, N. Suryavanshi, M. Hughes, S. Shah, G. Churchyard, Susan Swindells, A. Hesseling, A. Gupta

Journal Articles: Infectious Diseases

Pediatric household contacts (HHCs) of patients with multidrug-resistant TB (MDR-TB) are at high risk of infection and active disease. Evidence of caregiver willingness to give MDR-TB preventive therapy (TPT) to children is limited.METHODS This was a cross-sectional study of HHCs of patients with MDR-TB to assess caregiver willingness to give TPT to children aged <13 years.RESULTS Of 743 adult and adolescent HHCs, 299 reported caring for children aged <13 years of age. The median caregiver age was 35 years (IQR 27-48); 75% were women. Among caregivers, 89% were willing to give children MDR TPT. In unadjusted analyses, increased willingness was associated with TB-related knowledge (OR 5.1, 95% CI 2.3-11.3), belief that one can die of MDR-TB (OR 5.2, 95% CI 1.2-23.4), concern for MDR-TB transmission to child (OR 4.5, 95% CI 1.6-12.4), confidence in properly taking TPT (OR 4.5, 95% CI 1.6-12.6), comfort telling family about TPT (OR 5.5, 95% CI 2.1-14.3), and willingness to take TPT oneself (OR 35.1, 95% CI 11.0-112.8).CONCLUSIONS A high percentage of caregivers living with MDR- or rifampicin-resistant TB patients were willing to give children a hypothetical MDR TPT. These results provide important evidence for the potential uptake of …

Machine Learning Analyses Of Highly-Multiplexed Immunofluorescence Identifies Distinct Tumor And Stromal Cell Populations In Primary Pancreatic Tumors, Krysten Vance, Alphan Alitinok, Seth Winfree, Heather Jensen Smith, Benjamin Swanson Md, Phd, Paul M. Grandgenett, Kelsey Klute, Daniel J Crichton, Michael A. Hollingsworth

Journal Articles: Eppley Institute

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a formidable challenge for patients and clinicians.

OBJECTIVE: To analyze the distribution of 31 different markers in tumor and stromal portions of the tumor microenvironment (TME) and identify immune cell populations to better understand how neoplastic, non-malignant structural, and immune cells, diversify the TME and influence PDAC progression.

METHODS: Whole slide imaging (WSI) and cyclic multiplexed-immunofluorescence (MxIF) was used to collect 31 different markers over the course of nine distinctive imaging series of human PDAC samples. Image registration and machine learning algorithms were developed to largely automate an imaging analysis pipeline identifying distinct cell …

Nutrition Support Practices For Infants Born <750 Grams Or <25 Weeks Gestation: A Call For More Research, Melissa K. Thoene, Ann Anderson-Berry

Journal Articles: Pediatrics

With advances in medical care and efforts to care for continually smaller and younger preterm infants, the gestational age of viability has decreased, including as young as 21 or 22 weeks of gestation [...].

Genetic Variation Within Nicotine Addiction Pathways In Relation To Smoking Cessation And Smoking Relapse Throughout Adulthood: A Longitudinal Study Of Female Registered Nurses, Stephanie K. Jones

MUSC Theses and Dissertations

Cigarette smoking is a leading cause of premature death and preventable illness; more than 480,000 deaths annually in the U.S. are attributable to smoking. Of the more than 34 million U.S. adult smokers, more than half make a quit attempt each year but more than 90% will relapse within 6 months. Twin studies show that smoking cessation is more than 50% heritable, thus genetics plays a significant role in cessation. However, the understanding of genetic susceptibility to cessation failure is still in its nascent stages. Genetic studies of smoking cessation have typically used short-term follow-up or cross-sectional design, study design …

Predictors Of Homelessness Among Female Veterans And Civilians, Victoria Caridad Justiniano Quinones

Walden Dissertations and Doctoral Studies

Homelessness among female veterans is a problem that is likely to increase as growing numbers of women in the U.S. military reestablish themselves into their communities as veterans. There has been increasing concern about the greater risk for homelessness found among female veterans when compared to their nonveteran counterparts, so further investigation of homeless incidence by gender is also warranted. This quantitative, exploratory study was grounded in the social ecological theory, the Balshem and colleagues conceptual model of risk factors for veteran homelessness, and the Susser, Moore, and Link conceptual model which investigated causal pathways that are possible risk factors …

Transition Of Women Veterans From Active Duty To Adult Learner On Campus, Sheila Outlaw

Walden Dissertations and Doctoral Studies

AbstractA large percentage of women veteran students at a local 4-year university are transitioning from active duty to the role of adult learner on a college campus, and some have overcome barriers, such as inadequate childcare, lack of transportation, and financial aid issues and completed their educational goals. Unfortunately, some women veterans are not successful. The purpose of this study was to identify methods that self-identified women veteran students at the local study site use to successfully meet their educational goals. Adult transition and transformative learning theory are the conceptual frameworks for this study. A qualitative study collecting semistructured interview …

Experiences Of Rural Female Caregivers Of Loved Ones Diagnosed With Chronic Pain And Mental Health Care, Anne Banner Hatfield

Walden Dissertations and Doctoral Studies

AbstractThe complex diagnosis of chronic pain can include both physiological and psychological symptoms resulting in a need for caregivers to assist their loved ones and become involved in their mental health care treatment. As the aging population and the number of individuals diagnosed with chronic pain increases, the number of caregivers who assist them also increases. Critical to addressing the psychological symptoms of chronic pain is knowing how caregivers experience their involvement in mental health treatment. This research addressed the need for an understanding of caregivers’ experiences of caregiving and involvement with health care providers of mental health treatment for …

Crisis Intervention Team Training On Autism Among Female Cit-Trained Police Officers, Julie Hall

Walden Dissertations and Doctoral Studies

The problem addressed in this qualitative case study was the lack of documentation that supports the perceptions and experiences of crisis intervention team (CIT) trained female police officers related to their encounters with persons with mental illness (PwMI) with autism. Using Giles’s communicative accommodation theory (CAT), the purpose of this study examined the perceptions of CIT-trained female police officers of PwMI with autism during encounters. Giles’s CAT was aligned closest with the teachings of CIT training. Seven participants provided data which comprised of completed questionnaires and transcribed interviews. The method of analysis used was a combination of inductive coding and …

Leadership Relationships And Advancement Opportunities Among African American Female Nurses, Kendra Pitts

Walden Dissertations and Doctoral Studies

A healthy work environment for nurses is critical to staff recruitment, retention, patient safety, and the financial sustainability and viability of a healthcare organization. The specific research problem under study was whether a lack of advancement opportunity or a lack of good leadership has an impact on African American female nurses leaving the nursing profession. Researchers have investigated the impact of leadership and advancement opportunity on the general population, but there is a dearth of research specific to African American female nurses and their reason for leaving the profession. Secondary quantitative data analysis was performed using survey data from the …