Medicine and Health Sciences Commons^™

Effects Of Chronic Stimulation Of Nucleus Accumbens On Binge Drinking And Transcriptome, Dar'ya Pozhidayeva, Evan Firsick, Kayla G. Townsley, Dan Iancu, Angela Ozburn, A.T.D. Tran

Student Research Symposium

We previously found that stimulating activity in the nucleus accumbens (NAc) reduced binge-like alcohol drinking in mice. We manipulated the NAc using clozapine-n-oxide (CNO) and Designer Receptors Exclusively Activated by Designer Drugs (DREADDs). In a subsequent study, we tested the hypothesis that chronic administration of CNO (to stimulate excitatory DREADDs expressed in the NAc) could produce lasting reductions in binge drinking (as compared with mice receiving vehicle). We observed that 4 weeks of CNO administration resulted in reductions in binge-like drinking that lasted at least 1 week. Based on these results, we hypothesized that transcriptional changes may underlie the observed …

Reaching Those At Risk For Psychiatric Disorders And Suicidal Ideation: Facebook Advertisements To Recruit Military Veterans, Alan R. Teo, Samuel B.L. Liebow, Benjamin Chan, Steven K. Dobscha, Amanda L. Graham

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Younger military veterans are at high risk for psychiatric disorders and suicide. Reaching and engaging veterans in mental health care and research is challenging. Social media platforms may be an effective channel to connect with veterans.

Objective: This study tested the effectiveness of Facebook advertisements in reaching and recruiting Iraq and Afghanistan-era military veterans in a research study focused on mental health.

Methods: Facebook ads requesting participation in an online health survey ran for six weeks in 2017. Ads varied imagery and headlines. Validated instruments were used to screen for psychiatric disorders and suicidality. Outcomes included impressions, click-through rate, …

Oregon Medicaid Expenditures After The 2014 Affordable Care Act Medicaid Expansion: Over-Time Differences Among New, Returning, And Continuously Insured Enrollees, Rachel Springer, Miguel Marino, Jean P. O'Malley, Stephan R. Lindner, Nathalie Huguet, Jennifer E. Devoe

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—There is interest in assessing healthcare utilization and expenditures among new Medicaid enrollees after the 2014 Medicaid expansion. Recent studies have not differentiated between newly enrolled individuals and those returning after coverage gaps.

Objectives—To assess healthcare expenditures among Medicaid enrollees in the 24 months after Oregon’s 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured.

Research Design—Retrospective cohort study using inverse-propensity weights to adjust for differences between groups.

Subjects—Oregon adult Medicaid beneficiaries insured continuously from 2014-2015 who were either newly, returning, or continuously insured.

Measures—Monthly expenditures for inpatient care, prescription drugs, total …

Harnessing Social Media To Explore Youth Social Withdrawal In Three Major Cities In China: Cross-Sectional Web Survey, Lucia Lin Liu, Tim Mh Li, Alan R. Teo, Takahiro A. Kato, Paul W.C. Wong

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature.

Objective: The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China.

Methods: A cross-sectional open Web survey …

Is Therapy Going To The Dogs? Evaluating Animal Assisted Therapy For Early Identified At-Risk Children, Leah Faith Brookner

Dissertations and Theses

This study explores the historical context of human-animal relationships and examines the important ways that humans benefit from various types of interactions with domesticated animals. Therapeutic approaches that incorporate animals have been shown to have multiple benefits, including improved physical and mental health. Although this area of study is still largely overlooked in scientific fields of study, including social work, Animal Assisted Therapy (AAT) has become increasingly prevalent in various mental health settings. Despite its popularity and anecdotal support, research on the benefits of AAT with children is minimal; there are no studies examining the ways in which this approach …

Risk Thresholds For Alcohol Consumption: Combined Analysis Of Individual-Participant Data For 599 912 Current Drinkers In 83 Prospective Studies, Angela Wood, Carlos J. Crespo, Emerging Risk Factors Collaboration/Epic-Cvd/Uk Biobank Alcohol Study Group

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, …

Health Risks In Medical Homes And Their Effects On Emergency Department And Inpatient Expenditures: A Focus On Patient-Centered Primary Care Homes In Oregon, Kweku Nyameyepa Wilson

Dissertations and Theses

The fragmented approaches to delivering health care services in the United States, along with the associated structural inefficiencies and unsustainable increases in health care costs affecting all payers, compel the need for reform. Various federal and state-level delivery system reform models have emerged in response.

The Medical Home (MH) is one of such reform models. In 2004 a national initiative entitled "The Future for Family Medicine Project" identified the lack of emphasis on comprehensive primary care, especially for chronic care patients, and proposed the introduction of MHs to improve comprehensive primary care delivery for every patient. Oregon's MH variant, the …

Social Network Correlates Of Ipv Acceptance In Rural Honduras And Rural Uganda, Holly B. Shakya, Jessica M. Perkins, Margaret Traeger, Alexander C. Tsai, David Bangsberg, Bernard Kakuhikire, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under …

Food Insecurity, Social Networks And Symptoms Of Depression Among Men And Women In Rural Uganda: A Cross-Sectional, Population-Based Study, Jessica M. Perkins, Viola N. Nyakato, Bernard Kakuhikire, Alexander C. Tsai, Sv Subramanian, David Bangsberg, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics.

Design: A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators.

Setting: In-home survey interviews in south-western Uganda. Subjects: All adult residents …

Use Of Quality Improvement Strategies Among Small To Medium-Size Us Primary Care Practices, Bijal A. Balasubramanian, Miguel Marino, Deborah J. Cohen, Rikki L. Ward, Alex Preston, Rachel Springer, Stephan R. Lindner, Samuel Edwards, John Mcconnell, Benjamin F. Crabtree, William L. Miller, Kurt C. Stange, Leif I. Solberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations.

The Dynamics Of Concussion: Mapping Pathophysiology, Persistence, And Recovery With Causal-Loop Diagramming, Erin S. Kenzie, Elle L. Parks, Erin D. Bigler, David W, Wright, Miranda M. Lim, James C. Chesnutt, Gregory W.J. Hawryluk, Wayne Gordon, Wayne Wakeland

Systems Science Faculty Publications and Presentations

Concussion, also known as mild traumatic brain injury (mTBI),1 is a significant public health issue responsible for a variety of cognitive, emotional, and somatic symptoms and deficits (3). It is unclear why some individuals appear to recover relatively quickly while others suffer prolonged symptoms and impairments (4–7). Robust clinical means of diagnosis, prognosis, and treatment are also lacking (8–11). Research is hindered by an inadequate classification system for traumatic brain injury (TBI) (12), “poor” study quality (13, 14), disagreement about appropriate inclusion and exclusion criteria for concussion (8, 15), and an incomplete understanding of underlying pathophysiology (16–18). The heterogeneity and …

Assessment Of Technology Adoption Potential Of Medical Devices: Case Of Wearable Sensor Products For Pervasive Care In Neurosurgery And Orthopedics, Liliya Stepanivna Hogaboam

Dissertations and Theses

Information and communication technologies hope to revolutionize the healthcare industry with innovative and affordable solutions with a focus on pervasive care. Wearable sensors products can provide monitoring in a natural environment with a constant stream of information, enriching healthcare practices and enabling better pervasive care.

Wearable sensor technologies could monitor patients' mobility, gait, tremor, daily activity and other health indicators in real time that could allow for simple, non-invasive, tracking of spine care that may lead to increased patient engagement, integration, feedback, post-surgery analysis, monitoring of patient's condition, patient's data extraction and analysis and possibly aiding in better diagnosis, intervention, …

Lessons Learned From The Implementation Of A Medically Enhanced Residential Treatment (Mert) Model Integrating Intravenous Antibiotics And Residential Addiction Treatment, Talitha Wilson, Devin Collins, Elena Phoutrides, Melissa B. Weimer, P. Todd Korthuis, Jessica Calcagni, Christina Nicolaidis

School of Social Work Faculty Publications and Presentations

BACKGROUND: Hospitalizations for severe infections associated with substance use disorder (SUD) are increasing. People with SUD often remain hospitalized for many weeks instead of completing intravenous antibiotics at home; often, they are denied skilled nursing facility admission. Residential SUD treatment facilities are not equipped to administer intravenous antibiotics. We developed a medically enhanced residential treatment (MERT) model integrating residential SUD treatment and long-term IV antibiotics as part of a broader hospital-based addiction medicine service. MERT had low recruitment and retention, and ended after six months. The goal of this study was to describe the feasibility and acceptability of MERT, to …

Help-Seeking On Facebook Versus More Traditional Sources Of Help: Cross-Sectional Survey Of Military Veterans, Alan R. Teo, Heather E. Marsh, Samuel B.L. Liebow, Jason I. Chen, Christopher W. Forsberg, Christina Nicolaidis, Somnath Saha, Steven K. Dobscha

School of Social Work Faculty Publications and Presentations

Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems.

Objective: This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help.

Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. …

Comparing Men Who Have Sex With Men And Transgender Women Who Use Grindr, Other Similar Social And Sexual Networking Apps, Or No Social And Sexual Networking Apps: Implications For Recruitment And Health Promotion, Christina J. Sun, Erin L. Sutfin, Laura H. Bachmann, Jason Stowers, Scott D. Rhodes

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: Researchers and public health professionals have increased their attention to GPS-based social and sexual networking applications (apps) tailored to gay, bisexual, and other men who have sex with men (MSM) and transgender women. These populations continue to be disproportionately affected by HIV in the United States; therefore, these apps, in particular Grindr, have become an important sampling venue for the recruitment of HIV-related research participants. As such, it is essential to identify differences among app users to avoid potential sampling bias. This paper seeks to identify differences in MSM and transgender women who use Grindr and those who …

Help-Seeking On Facebook Versus More Traditional Sources Of Help: Cross-Sectional Survey Of Military Veterans, Alan R. Teo, Heather E. Marsh, Samuel B.L. Liebow, Jason I. Chen, Christopher W. Forsberg, Christina Nicolaidis, Somnath Saha, Steven K. Dobscha

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems.

Objective: This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help.

Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking …

Community Engagement In Academic Health Centers: A Model For Capturing And Advancing Our Successes, Karen Vitale, Gail L. Newton, Ana Abraido-Lanza, Alejandra N. Aguirre, Syed Ahmed, Sarah Esmond, Jill Evans, Sherril Gelmon, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Academic health centers (AHCs) are under increased pressure to demonstrate the effectiveness of their community-engaged activities, but there are no common metrics for evaluating community engagement in AHCs. Eight AHCs piloted the Institutional Community Engagement Self-Assessment (ICESA), a two-phase project to assess community-engagement efforts. The first phase uses a framework developed by the University of Rochester Medical Center, which utilizes structure, process, and outcome criteria to map CE activities. The second phase uses the Community-Campus Partnerships for Health (CCPH) Self-Assessment to identify institutional resources for community engagement, and potential gaps, to inform community engagement goal-setting. The authors conducted a structured, …

Water Transport In The Lateral Line Canal Of The Intertidal Fish Xiphister Mucosus (Girard 1858) And Its Significance To Evaporative Water With Preliminary Observations Of The Metabolic Consequences Of Water Loss, Whitney Anne Gayer

Dissertations and Theses

The lateral line canal system is a sensory organ found in all teleost fish that has a wide range of morphological variation. Variation in morphology may often be the result of evolutionary necessity where the need for function dictates form. Xiphister mucosus is an amphibious Stichaeid fish that inhabits the rocky intertidal zone of the northeastern Pacific Ocean. The rocky intertidal is considered an extreme environment where crashing waves and ebbing tides may require the specialization of adaptations for surviving the many abiotic stressors encountered there.

The lateral line trunk canal of Xiphister is regarded as unique among teleosts with …

Mitigating Early Loss Of Community Participation In Early Psychosis Services: State Of The Science, Tamara G. Sale, Dora M. Raymaker, Mariam Rija, Veronica Gould, Christina Wall, Ryan P. Melton

School of Social Work Faculty Publications and Presentations

In the early stages of treatment for psychosis, community engagement and social networks are threatened through a combination of symptomology and negative messages and reactions from the environment which may result in internalized stigma, disempowerment, and prolonged isolation. While treatment programs attempt to mitigate these factors, ambivalence toward treatment and the basic concept of psychosis, along with difficulty engaging in conversation, make initial engagement more difficult. Self-determination theory and growing recovery literature point to the importance of maintaining a sense of community relatedness and connection, and developing a sense of agency and competence as important to active recovery and retention …

Chinese Herbal Medicine Therapy And The Risk Of Mortality For Chronic Hepatitis B Patients With Concurrent Liver Cirrhosis: A Nationwide Population-Based Cohort Study, Tzung-Yi Tsai, Tsung-Hsing Hung, Hanoch Livneh, I-Hsin Lin, Ming-Chi Lu, Chia-Chou Yeh

Counselor Education Faculty Publications and Presentations

Chronic hepatitis B (CHB) is increasingly recognized as a public health problem in Taiwan. After affected patients are diagnosed with contaminant liver cirrhosis (LC), adverse clinical outcomes, especially death, are common. This study aimed to investigate the effect of Chinese herbal medicine (CHM), an essential branch of Traditional Chinese medicine (TCM), on the mortality risk among CHB patients with contaminant LC. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 1522 patients 20–70 years of age with newly diagnosed CHB with LC during 1998–2007. Among them, 508 (33.37%) had received CHM products after the onset …

Gender Differences In Sexual And Reproductive Health Protective And Risk Factors Of Batswana Adolescents: Implications For Parent And Adolescent Interventions, Christina J. Sun, Esther S. Seloilwe, Mabel Magowe, Kefalotse S. Dithole, Kim S. Miller, Janet S. St. Lawrence

OHSU-PSU School of Public Health Faculty Publications and Presentations

Adolescents in sub-Saharan Africa and in Botswana in particular continue to bear the brunt of the HIV epidemic. This analysis assessed gender differences among theory-based sexual and reproductive health protective and risk factors in a cross-sectional sample of 228 Batswana adolescents. Incongruence between preferred and actual sources of sexual information and several important gender differences in parent-adolescent relationships, psychosocial influences, and adolescent sexual behaviors were identified. Parents were the fourth most common source of information about sex; yet, over three-quarters of adolescents preferred to have parents teach them about sex. Boys reported more positive relationships with their parents and girls …

Comparative Genetic And Genomic Analysis Of The Novel Fusellovirus Sulfolobus Spindle-Shaped Virus 10, David Andrew Goodman, Kenneth M. Stedman

Biology Faculty Publications and Presentations

Viruses that infect thermophilic Archaea are unique in both their structure and genetic makeup. The lemon-shaped fuselloviruses—which infect members of the order Sulfolobales, growing optimally at 80 C and pH 3—are some of the most ubiquitous and best studied viruses of the thermoacidophilic Archaea. Nonetheless, much remains to be learned about these viruses. In order to investigate fusellovirus evolution, we have isolated and characterized a novel fusellovirus, Sulfolobus spindle-shaped virus 10 (formerly SSV-L1). Comparative genomic analyses highlight significant similarity with both SSV8 and SSV9, as well as conservation of promoter elements within the Fuselloviridae. SSV10 encodes five ORFs with no …

The Relationship Between Hospital And Ehr Vendor Market Dynamics On Health Information Organization Presence And Participation, Sunny C. Lin, Julia Adler-Milstein

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs. Methods: 2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals …

Concerning Trends In Allopathic Medical School Faculty Rank For Indigenous People: 2014–2016, Erik Brodt, Amanda Bruegl, Erin K. Thayer, M. Patrice Eiff, Kelly L. Gonzales, Carlos J. Crespo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Trends in faculty rank according to racial and ethnic composition have not been reviewed in over a decade.

Objective: To study trends in faculty rank according to racial and ethnicity with a specific focus on Indigenous faculty, which has been understudied.

Methods: Data from the Association of American Medical Colleges’ Faculty Administrative Management Online User System was used to study trends in race/ethnicity faculty composition and rank between 2014 and 2016, which included information on 481,753 faculty members from 141 US allopathic medical schools.

Results: The majority of medical school faculty were White, 62.4% (n = 300,642). Asian …

Biting The Hand That Heals: Mistreatment By Patients And The Well-Being Of Healthcare Workers, Aysegul Karaeminogullari, Berrin Erdogan, Talya N. Bauer

Business Faculty Publications and Presentations

Purpose The purpose of this paper is to explore the relationship between stress due to mistreatment by patients and caregivers’ own well-being indicators (anxiety, depression, and behavioral stress indicators). Based on predictions consistent with the job demands-resources model, it is anticipated that satisfaction with job resources would moderate the relationship between mistreatment by patients and well-being indicators. Design/methodology/approach Hypotheses were tested with a sample of 182 employees in a leading training and research university hospital in Istanbul, Turkey. Results were partially replicated for a separate sample of 122 healthcare workers. Data were collected using the survey methodology. Findings The findings …

United States State-Level Variation In The Use Of Neuraxial Analgesia During Labor For Pregnant Women, Alexander Butwick, Jason Bentley, Cynthia Wong, Jonathan Snowden, Eric Sun, Nan Guo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Importance Neuraxial labor analgesia is recognized as the most effective method of providing pain relief during labor. Little is known about variation in the rates of neuraxial analgesia across US states. Identifying the presence and extent of variation may provide insights into practice variation and may indicate where access to neuraxial analgesia is inadequate. Objective To test the hypothesis that variation exists in neuraxial labor analgesia use among US states. Design, Setting, and Participants Retrospective, population …

Role Of Survey Response Rates On Valid Inference: An Application To Hiv Prevalence Estimates, Miguel Marino, Marcello Pagano

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Nationally-representative surveys suggest that females have a higher prevalence of HIV than males in most African countries. Unfortunately, these results are made on the basis of surveys with non-ignorable missing data. This study evaluates the impact that differential survey nonresponse rates between males and females can have on the point estimate of the HIV prevalence ratio of these two classifiers.
Methods: We study 29 Demographic and Health Surveys (DHS) from 2001 to 2010. Instead of employing often used multiple imputation models with a Missing at Random assumption that may not hold in this setting, we assess the effect of …

Enriching Clinical Learning Environments Through Partnerships: Academic And Practice Partnerships To Strengthen Care For Older Adults In Residential And Assisted Living Settings, Juliana Cartwright, Diana L. White

Institute on Aging Publications

This report was prepared by Oregon Health & Science University (OHSU) School of Nursing and the Institute on Aging at Portland State University to describe an academic-community partnership using the Enriching Clinical Learning Environments through Partnerships (ECLEPs) model. This two-year project was conducted with 34 students in the RN-BSN program in eight assisted living (AL) communities and ElderPlace, a PACE program serving residents in assisted living and other residential settings. Quality improvement was the focus of the project. Features of the ECLEPs model include:

• An intentional partnership between academic and clinical organizations
• Relationship-based; shared decision making
• Long-term commitment between partners …

Intensity Inhomogeneity Correction Of Sd-Oct Data Using Macular Flatspace, Andrew Lang, Aaron Carass, Bruno M. Jedynak, Sharon D. Solomon, Peter A. Calabresi, Jerry L. Prince

Mathematics and Statistics Faculty Publications and Presentations

Images of the retina acquired using optical coherence tomography (OCT) often suffer from intensity inhomogeneity problems that degrade both the quality of the images and the performance of automated algorithms utilized to measure structural changes. This intensity variation has many causes, including off-axis acquisition, signal attenuation, multi-frame averaging, and vignetting, making it difficult to correct the data in a fundamental way. This paper presents a method for inhomogeneity correction by acting to reduce the variability of intensities within each layer. In particular, the N3 algorithm, which is popular in neuroimage analysis, is adapted to work for OCT data. N3 works …

Effect Of Metformin Exposure On Growth And Photosynthetic Performance In The Unicellular Freshwater Chlorophyte, Chlorella Vulgaris, Brittany M. Cummings, Joseph A. Needoba, Tawnya D. Peterson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Many pharmaceuticals have negative effects on biota when released into the environment. For example, recent work has shown that the commonly prescribed antidiabetic drug, metformin (N,N-dimethylbiguanide), has endocrine disrupting effects on fish. However, effects of metformin on aquatic primary producers are poorly known. We exposed cultured isolates of a freshwater chlorophyte, Chlorella vulgaris, to a range of metformin concentrations (0– 767.9 mg L-1) to test the hypothesis that exposure negatively affects photosynthesis and growth. A cessation of growth, increase in non-photochemical quenching (NPQ, NPQmax), and reduced electron transport rate (ETR) were observed 24 h after exposure to a metformin concentration …