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Full-Text Articles in Medicine and Health Sciences

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West Sep 2024

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …


Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego Sep 2024

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …


The Effect Of Blood Flow Restriction Training On Quadriceps Activity After Anterior Cruciate Ligament Reconstruction: A Preliminary Randomized Controlled Trial, Florian Forelli, Camille Nguyen, Jean Mazeas, Georgios Kakavas, Timothy E. Hewett, Andreas Bjerregaard, Vasileios Korakakis, Alexandre Jm Rambaud Jul 2024

The Effect Of Blood Flow Restriction Training On Quadriceps Activity After Anterior Cruciate Ligament Reconstruction: A Preliminary Randomized Controlled Trial, Florian Forelli, Camille Nguyen, Jean Mazeas, Georgios Kakavas, Timothy E. Hewett, Andreas Bjerregaard, Vasileios Korakakis, Alexandre Jm Rambaud

Marshall Journal of Medicine

Background

After anterior cruciate ligament reconstruction, a crucial priority is restoring knee muscle strength, especially the quadriceps, to reach the pre-injury strength levels as fast as possible. A feasible alternative to heavy loading might be blood flow restriction training that may elicit quadriceps muscle strength adaptations using low external loads. This study assessed whether quadriceps strengthening using low load blood flow restriction (LL-BFR) would enhance electromyographic (EMG) activity of the vastus medialis (VMO), vastus lateralis (VLO), and rectus femoris (RF) similar to quadriceps strengthening using heavy loads resistance training (HLRT). The secondary objective was to assess intra-quadriceps regional EMG differences …


Exploring Gender Variation In Medical Student Professional Identity Development: A Longitudinal Study Through The Career Eulogy Perspective, William J. Crump, Sarah M. Fisher, Ronald R. Gilley, Whitney T. Gilley, Craig Ziegler Jul 2024

Exploring Gender Variation In Medical Student Professional Identity Development: A Longitudinal Study Through The Career Eulogy Perspective, William J. Crump, Sarah M. Fisher, Ronald R. Gilley, Whitney T. Gilley, Craig Ziegler

Marshall Journal of Medicine

Background

Empathy towards patients is a key component of a physician's professional identity. In longitudinal studies at their campus, the authors of this study observed that women had higher empathy scores as measured by a standard Likert scale survey; however, the differences were insignificant in most training years.

Methods

In this larger study, the authors confirmed this finding and used a career eulogy projective exercise to explore gender differences in professional identity formation more deeply than a Likert scale score. The study included 76 medical students from all 4 years of training at a rural, regional medical school campus in …


A Case Of Herpes Zoster In An Immunocompetent 19-Year-Old Female, Martin Nguyen, Jennifer Read, Emma Filary, Aaron Mcguffin Jul 2024

A Case Of Herpes Zoster In An Immunocompetent 19-Year-Old Female, Martin Nguyen, Jennifer Read, Emma Filary, Aaron Mcguffin

Marshall Journal of Medicine

This case report describes the unusual presentation of herpes zoster in a fully vaccinated teenage patient and highlights management considerations. The patient is a 19-year-old female who presented with pain in her left lower back, side, and upper thigh for approximately 3 days, which was then followed by the eruption of a vesicular rash along the L2 dermatome consistent with herpes zoster. Herpes zoster is predominantly observed only in elderly and immunocompromised individuals, primarily due to the widespread use of the varicella-zoster virus vaccine for children since 1995, when it became part of the routine immunization schedule. However, this case …


Management Of Multiple Infantile Hemangiomas In A Preterm Infant: A Clinical Case Report, Erin Reese, Wyatt Grimm, Aaron Mcguffin Jul 2024

Management Of Multiple Infantile Hemangiomas In A Preterm Infant: A Clinical Case Report, Erin Reese, Wyatt Grimm, Aaron Mcguffin

Marshall Journal of Medicine

Infantile hemangiomas (IH), the most prevalent infantile tumor, are benign vascular tumors arising from proliferation and dysregulation of angiogenesis. Hemangiomas are present after birth and undergo 3 stages: proliferation, plateau, and involution. IH are further categorized into superficial, deep, and mixed based on skin and internal organ involvement. IH are clinically diagnosed, and treatment options include active observation, corticosteroids, beta-blockers, pingyangmycin, vincristine, or laser treatment. Complications of untreated IH include ulceration, airway obstruction, and visual obstruction at sites of enlarging lesions. While most cases are benign, there are associated complications prompting a thorough investigation and proper management. Understanding a hemangioma …


"You Are Already A Leader": Lessons For A Successful Career In Medicine, Vineet Arora Jul 2024

"You Are Already A Leader": Lessons For A Successful Career In Medicine, Vineet Arora

Marshall Journal of Medicine

Vineet Arora, MD, MAPP, addressed the Medical School class of 2024, emphasizing leadership, clear communication, advocacy, and continuous learning. She shared personal experiences, highlighting gender equity, self-care, and combating burnout. Arora affirmed the graduates’ roles as leaders dedicated to improving health and healthcare for their patients and communities.


Examining The Tax Landscape Of Recreational Cannabis: Trends And Considerations From The Past 10 Years Of Policy, Thomas A. Norton, Amanda K. Thompson-Abbott, Raymond Keener Iii, Alberto Coustasse Jul 2024

Examining The Tax Landscape Of Recreational Cannabis: Trends And Considerations From The Past 10 Years Of Policy, Thomas A. Norton, Amanda K. Thompson-Abbott, Raymond Keener Iii, Alberto Coustasse

Accounting Faculty Research

This article aims to provide an overview of the taxation of recreational cannabis in states where it has been legalized for recreational purposes. By delving into the various approaches taken by different jurisdictions, analyzing the economic impacts, and examining the challenges and opportunities inherent in cannabis taxation, we seek to shed light on a topic that is rapidly shaping the future of the cannabis industry and the broader economy. From excise taxes to sales taxes and licensing fees to revenue allocation, the taxation framework surrounding recreational cannabis is a dynamic and evolving landscape. Potential federal excise taxes could further complicate …


The Impact And Potential Of Digital Health Technologies, Craig Kimble, Thomas Pile, Alberto Coustasse Jul 2024

The Impact And Potential Of Digital Health Technologies, Craig Kimble, Thomas Pile, Alberto Coustasse

Pharmacy Practice & Administration

Digital technologies and smart devices are now used in every aspect of our lives. Further innovation in the digital health realm is growing and has the potential to reduce inefficiencies in the health care system by sharing health data with providers, decreasing costs related to unnecessary health care visits and improving patients’ quality of life and clinical outcomes by better tailoring treatment to the individual’s health needs.


A Qualitative Exploration Of Well-Being In Cancer Survivorship: Implications For Counselors, Hallie M. Sylvestro, Lindsey K. Umstead, Heather Delgado, Christopher Lawrence, Keith Mobley, Kelly L. Wester, Andrew Wood May 2024

A Qualitative Exploration Of Well-Being In Cancer Survivorship: Implications For Counselors, Hallie M. Sylvestro, Lindsey K. Umstead, Heather Delgado, Christopher Lawrence, Keith Mobley, Kelly L. Wester, Andrew Wood

Adultspan Journal

Adult cancer survivors represent an important–and growing–population that could benefit from counseling services. This study employed consensual qualitative research to examine the well-being experiences of eight cancer survivors. Findings suggest a broad range of changes to individual well-being following cancer diagnosis and treatment, and indicate counseling can provide an ideal setting for processing such changes. Recommendations for counseling practice and future research are provided.


Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou May 2024

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …


2023 West Virginia Rural Health Conference Abstracts, Rich Sutphin Apr 2024

2023 West Virginia Rural Health Conference Abstracts, Rich Sutphin

Marshall Journal of Medicine

The mission of the West Virginia Rural Health Association (WVRHA) is to unite people, communities, and organizations to strengthen rural health in West Virginia. The WVRHA annual conference brought together healthcare professionals, community leaders, and researchers, showcasing their efforts to improve the quality of life and access to excellent healthcare in rural areas. The abstracts covered a wide range of topics, including innovative healthcare delivery models, community health interventions, policy analysis, and the impacts of social determinants on health. These contributions reflect the dynamic work being done and the future directions in rural health, underscoring the WVRHA’s commitment to advancing …


Observational Analysis For Predicting Initial Spikes In Testing Volume Of Cohorts Inside And Outside Of A Regional Covid-19 Screening Program, Adam M. Franks, Seth Bergeron, Tammy Bannister, Justin Spradling, Tamara Lowe, Paris Johnson, Rajan Lamichhane, Stephen M. Petrany Apr 2024

Observational Analysis For Predicting Initial Spikes In Testing Volume Of Cohorts Inside And Outside Of A Regional Covid-19 Screening Program, Adam M. Franks, Seth Bergeron, Tammy Bannister, Justin Spradling, Tamara Lowe, Paris Johnson, Rajan Lamichhane, Stephen M. Petrany

Marshall Journal of Medicine

BACKGROUND Containing the highly contagious SARs-CoV-2 pathogen requires a safe and effective screening program. The aim of this observational cohort study is to analyze a regional testing center and identify factors predicting testing rates that direct supply and staffing needs.

METHODS A drive-through SAR-CoV-2 regional testing facility was created. Number of tests and positive results were collected for eighteen months. Data for testing demand was compared to positive results, percent positive rates (PPR), known external factors, and county PPR. Dissimilarities were contrasted with dynamic time warp and a detailed agreement analysis. The Grainger’s test was utilized to assess the degree …


The Case For Using Composition Tomography To Evaluate Perirectal Necrotizing Fasciitis: Is It Really Necessary?, Tyler Bayliss, David Denning Apr 2024

The Case For Using Composition Tomography To Evaluate Perirectal Necrotizing Fasciitis: Is It Really Necessary?, Tyler Bayliss, David Denning

Marshall Journal of Medicine

Clinical reviews of Fournier’s Gangrene state that diagnostic protocol includes interpreting CT, MRI, or Ultrasound imaging along with clinical symptoms and lab findings. We think that the use of imaging techniques as a diagnostic tool is no longer needed as Fournier’s Gangrene is specific enough of a disease that clinicians can diagnose using labs and physical examination alone.

Cases of perirectal necrotizing soft tissue infection recorded at St. Marys Medical Center were reviewed. Results of physical exams and imaging were compared along with measurements of severity upon admittance and length of stay. Due to the COVID-19 pandemic, we investigated if …


Ocular Metastases In Breast Cancer: A Multidisciplinary Approach To Diagnosis And Management, Bridgette King, Mary Legenza, Diane Krutzler Apr 2024

Ocular Metastases In Breast Cancer: A Multidisciplinary Approach To Diagnosis And Management, Bridgette King, Mary Legenza, Diane Krutzler

Marshall Journal of Medicine

Introduction:

Breast cancer is a globally prevalent malignancy with diverse clinical presentations.

Understanding metastatic sites like ocular tissues is vital due to their impact on prognosis and treatment strategies. Ocular metastases from breast cancer, though rare, can contribute significantly to metastatic cases. They can even serve as the first sign of advanced disease, highlighting the need for vigilance.

Methods:

This study utilized a comprehensive literature review to analyze ocular metastases in breast cancer. Cases were examined for time intervals between initial diagnosis and ocular metastasis. The review also assessed manifestations during systemic progression. Methods included patient data analysis, …


Quetiapine Induced Agitation In A Hospice Veteran: A Case Report, Colton Kinderknecht, Kevin Mathews, Elizabeth Kane Apr 2024

Quetiapine Induced Agitation In A Hospice Veteran: A Case Report, Colton Kinderknecht, Kevin Mathews, Elizabeth Kane

Marshall Journal of Medicine

Quetiapine is an atypical antipsychotic that is used in many clinical scenarios; it has been approved and has shown to be effective in the treatment of schizophrenia and bipolar symptoms. Additionally, it has several off-label uses including the treatment of insomnia. In this case report, an elderly veteran was given quetiapine as a sleep aid. After the first dose, he demonstrated severe agitation. To the best of our knowledge, there have been limited reports of this reaction. Although there are limitations to this case report, it serves as a cautionary lesson when prescribing a medication like quetiapine and to consider …


Importance Of Mind-Body Medicine And Human Flourishing In The Training Of Physicians, Aviad Haramati Apr 2024

Importance Of Mind-Body Medicine And Human Flourishing In The Training Of Physicians, Aviad Haramati

Marshall Journal of Medicine

No abstract provided.


Multicultural Gerotranscendence: A Theoretical Approach To Working With Older Adults, Whitney George, Danielle Schlittler Apr 2024

Multicultural Gerotranscendence: A Theoretical Approach To Working With Older Adults, Whitney George, Danielle Schlittler

Adultspan Journal

With the growing number of the aging population, the call for counselors to understand the developmental processes of all clients is essential. The theories of gerotranscendence and multicultural counseling and therapy are central to the understanding of adult development in later life. The use of these two theories together provides a theoretical basis for counselors wishing to provide services to diverse older adults.


Navigating The Future Of Healthcare: Big Data's Impetus For Inpatient Quality Enhancement, Lakyn Hyre, Brian Cox, Alberto Coustasse Apr 2024

Navigating The Future Of Healthcare: Big Data's Impetus For Inpatient Quality Enhancement, Lakyn Hyre, Brian Cox, Alberto Coustasse

Management Faculty Research

This study aims to explore the impact of big data utilization on quality improvement in inpatient facilities, specifically assessing its influence on readmission rates, patient outcomes, and potential cost savings. This study utilized mixed methodologies with a literature review complemented by semi-structured interviews to gain perspectives about big data utilization on quality improvement in inpatient facilities. The Marshall University Institutional Review Board (IRB) approved the interview. This study’s conceptual framework (Figure 1) was adapted from the research framework of Yao, Chu, and Li (Yao et al., 2010). The framework displays the reasoning of and approach to big data and machine …


Revolutionizing Revenue Cycle Management: Ai's Impact On Healthcare Organizations, Rachel Pennington, Alberto Coustasse Apr 2024

Revolutionizing Revenue Cycle Management: Ai's Impact On Healthcare Organizations, Rachel Pennington, Alberto Coustasse

Management Faculty Research

Revenue Cycle Management (RCM) stands as a cornerstone in healthcare, overseeing the intricate processes involved in capturing, managing, and collecting revenue generated from patient services. However, the landscape of RCM has long been plagued by inefficiencies. These inefficiencies underscore the urgency for innovative approaches, and the integration of AI emerges as a promising solution to streamline processes and optimize revenue capture.


Rural Hospital Closures Unraveling The Socioeconomic, Healthcare Access, And Community Impact On Local Communities, Jake Lestitian-Howard, Chase Ooten, Jay Poindexter, Colette Martin, Alberto Coustasse Apr 2024

Rural Hospital Closures Unraveling The Socioeconomic, Healthcare Access, And Community Impact On Local Communities, Jake Lestitian-Howard, Chase Ooten, Jay Poindexter, Colette Martin, Alberto Coustasse

Management Faculty Research

This study aimed to analyze the effects of rural hospital closures on employment level, economic indicators, and availability of care for communities. The research showed that rural hospital closures negatively impacted community economies and access to healthcare.


Ai-Driven Solutions Promote Medication Adherence, Eric Pulice, Alberto Coustasse Mar 2024

Ai-Driven Solutions Promote Medication Adherence, Eric Pulice, Alberto Coustasse

Management Faculty Research

A study conducted in 2019 showed that approximately 50% of the 187 million patients in the US health care system did not follow their medication plan as prescribed. This means they failed to adhere to the drug regimen or to take the medication for the entire prescribed duration. Adherence rates for most medications used to treat chronic conditions, such as diabetes and hypertension, usually fall in the range of 50% to 60%, even with patients who have good insurance and drug benefits. This rate of adherence leads to an estimated 125,000 avoidable deaths each year and $100 billion annually in …


Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson Jan 2024

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …


Overcoming Communication Challenges: Training Family Medicine Interns Amidst Covid-19, Ny'nika T. Mcfadden, Connie C. Leeper, Catanya G. Stager, Amanda H. Wilkerson Jan 2024

Overcoming Communication Challenges: Training Family Medicine Interns Amidst Covid-19, Ny'nika T. Mcfadden, Connie C. Leeper, Catanya G. Stager, Amanda H. Wilkerson

Marshall Journal of Medicine

Introduction

Assessing and addressing possible deficiencies in medical school training is important for residency programs. Due to virtual rotations and low patient volumes, the COVID-19 pandemic disrupted medical students’ opportunities to practice patient communication. Communication skills are essential for medical students and residents. Continuous participation in communication training can increase the self-efficacy of healthcare professionals. Due to the likely impact of COVID-19, we designed and implemented a tailored workshop that focused on increasing 16 incoming family medicine interns’ level of comfort communicating with patients and their families.

Methods

Sixteen incoming family medicine interns participated in the workshop during orientation in …


A Case Of Occlusive Myocardial Infarction Caused By Nephrotic Syndrome In A 26-Year-Old Type 1 Diabetic, Kyle Admire, Charlotta Jornlid, Chelsea Ryan, Rebecca Pauly Jan 2024

A Case Of Occlusive Myocardial Infarction Caused By Nephrotic Syndrome In A 26-Year-Old Type 1 Diabetic, Kyle Admire, Charlotta Jornlid, Chelsea Ryan, Rebecca Pauly

Marshall Journal of Medicine

Nephrotic syndrome is a rare condition distinguished by proteinuria exceeding 3g per day. Other associated characteristics include hematuria, hypoalbuminemia, edema, and hyperlipidemia. There is an array of complications of this syndrome, which are primarily due to the profound losses of protein in the urine. One such complication is thromboembolism, with most documented cases in the form of venous thromboembolism of the extremities which is in part due to urinary loss of antithrombin III and increased synthesis of prothrombotic factors. There are limited available data regarding arterial thrombi and especially few reports about coronary thromboses, which can be life-threatening. In this …


Management Of Cryptogenic Stroke Secondary To Large Asd With Percutaneous Occluder Device And Antiplatelet Drugs., Riya Gupta, Naveed Iqbal Jan 2024

Management Of Cryptogenic Stroke Secondary To Large Asd With Percutaneous Occluder Device And Antiplatelet Drugs., Riya Gupta, Naveed Iqbal

Marshall Journal of Medicine

Atrial septal defects (ASD) represent the most common congenital heart disease diagnosed in adult population and can present with variable clinical findings. Recent literature emphasizes the importance of management of ASD especially if it is associated with structural right heart changes such as RV dysfunction, right ventricular enlargement, arrythmias or paradoxical embolism.

The decision between medical therapy versus surgical closure of ASD is a common clinical conundrum especially in the setting of cryptogenic stroke.


More Physicians Alone Won’T Solve Rural America’S Health Care Problems, Atul Grover Jan 2024

More Physicians Alone Won’T Solve Rural America’S Health Care Problems, Atul Grover

Marshall Journal of Medicine

Policymakers have voiced their hope that locating family doctors and other primary care physicians within rural communities would, by itself, improve the health status of rural residents. However, access does not necessarily translate to better health. Rural populations face disproportionately worse health outcomes and inequities compared to urban populations. To improve the health care of rural America, it is critical to define—and periodically reassess—the problem and identify varying targeted policies.


Mothers' Perceptions Of Stigma: Implications For Early Identification And Treatment For Children With A History Of Prenatal Opioid Exposure, Pamela Jane Holland Jan 2024

Mothers' Perceptions Of Stigma: Implications For Early Identification And Treatment For Children With A History Of Prenatal Opioid Exposure, Pamela Jane Holland

Theses, Dissertations and Capstones

There is a lack of research that specifies the long-term effects on a child’s language development when prenatally exposed to opioids (Fill et al.,2018; Rutherford et al., 2022). Despite this, children prenatally exposed to opioids are more likely to be referred for, qualify for, and receive therapy services secondary to developmental delays and speech/language deficits. (Kaltenbach et al., 2018). Stigma continues to be a barrier to the initiation of early intervention services for children prenatally exposed to opioids (Levickis et al., 2020; Livingston et al., 2011; Peacock-Chambers et al., 2020). This phenomenological study aims to understand the perceptions of the …


Bridging The Gap: Evaluating The Impact Of Buprenorphine-Based Prenatal Care On Neonatal Abstinence Syndrome And Maternal Health, Whitney-Lanae Crofcheck-Glenn, Jennifer Nethercutt Jan 2024

Bridging The Gap: Evaluating The Impact Of Buprenorphine-Based Prenatal Care On Neonatal Abstinence Syndrome And Maternal Health, Whitney-Lanae Crofcheck-Glenn, Jennifer Nethercutt

Theses, Dissertations and Capstones

Introduction: Neonatal Abstinence Syndrome (NAS), now known as Neonatal Opioid Withdrawal Syndrome (NOWS) by government authorities, is a severe postnatal withdrawal condition caused by opioid exposure during pregnancy. NAS is diagnosed every 25 minutes in the United States. Medication-assisted treatment (MAT) with buprenorphine was used to treat opioid use disorder (OUD) and NAS. The MOTHER trial found that utilizing buprenorphine to treat mother OUD during pregnancy led to significant decreases in LOS and length of therapy.

Purpose of the Study: The purpose of this study is to evaluate the effectiveness of a prenatal care program that integrates buprenorphine-based Medication-Assisted Treatment …


Burnout For General Surgeons, Luke Edwards, Lindsay Mckelvey Jan 2024

Burnout For General Surgeons, Luke Edwards, Lindsay Mckelvey

Theses, Dissertations and Capstones

Introduction: In the healthcare sector, burnout among surgeons has emerged as a critical issue, impacting both the well-being of medical professionals and the quality outcomes of patient care. Research has consistently shown that long hours, high workloads, demanding results, and mental fatigue make physicians more vulnerable to experiencing burnout than others. Studies have revealed alarming statistical rates, with a significant percentage of surgeons reporting physical exhaustion and mental health repercussions. This trend is further enhanced by the demanding nature of the medical environment, where work-related stress and burnout have become common concerns.

Purpose of the Study: The negative effects of …