Medicine and Health Sciences Commons^™

Empowering Providers To Empower Their Patients: One Model To Expand Knowledge, Competency, And Awareness For The Perinatal Substance Use Workforce, Jacqueline Jacobs

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Perinatal substance use (PSU) is a serious and growing public health concern. It is associated with a variety of adverse health outcomes for both mother and child and has been shown to negatively impact the parent-child relationship. Despite the growing prevalence of PSU, there are notable deficits in provider knowledge regarding, and comfortability with, PSU. Moreover, providers report feelings of judgment, resentment, fear, and hesitancy related to their work with women with PSU. Subsequently, women with PSU struggle to find appropriate, compassionate, and effective treatment for their substance misuse. Widespread and accessible training is needed to bolster provider knowledge base, …

A Phenomenological Inquiry Into Healthcare Professionals Who Are Experts In Cannabinoid Therapy And The Endocannabinoid System (Ecs), Courtney Collins

Electronic Theses and Dissertations

Cannabis is a prevalent alternative treatment for many symptoms and conditions given its medicinal qualities and few side effects. As legalization for both medical and recreational purposes continue to develop quickly across the United States of America, there is serious discrepancy between legalization and clinical research. Clinical data is difficult since the U.S. federal government still classifies cannabis as a Drug Enforcement Agency (DEA) Schedule I drug with no clearly established medical value. This lag in evidence-base data has affected cannabinoid therapy and endocannabinoid system education (ECS) for healthcare professionals. There are gaps in medical school and continuing medical education …

An Existential Punchline: How Humor Functions In A Young Adult Friendship Facing Advanced Cancer, Megan E. Solberg

Electronic Theses and Dissertations

Young adults (i.e., age 18-39) only comprise 4% of the total cancer population, yet cancers in this group are commonly found at more advanced stages due to situational factors influencing delayed diagnosis including access to healthcare, quality health insurance and competing life demands that may hinder prioritization of healthcare. Young adults with cancer also face unique challenges including higher rates of psychological distress, which may contribute to increased risk of social disconnection in response to cancer. Research suggests that humor may be a helpful coping approach and communication mechanism for mitigating distress and discussing difficult topics. Grounded within the frameworks …

Older Women’S Stories Of Covid-19 Loss: Communicated Narrative Sense-Making Through Photography, Anne Walker

Electronic Theses and Dissertations

The diverse array of challenges associated with the COVID-19 pandemic make it difficult to assess the full impact of this global health crisis. More than 300,000 older Americans died, leaving a nation of grieving survivors in their absence. This profound loss of life will undoubtedly inform the field’s understanding of grief and grieving for many years to come. Pre-pandemic, older women in the United States understood grief to be part of their life stage; COVID-19 amplified the grief experience through both cumulative losses and the isolation particular to the novel coronavirus response. However, few qualitative studies explore older women’s grief, …

The Shared Ethical Framework To Allocate Scarce Medical Resources: A Lesson From Covid-19, Ezekiel J. Emanuel, Govind C. Persad

Sturm College of Law: Faculty Scholarship

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, …

Protocol For The Promoting Resilience In Stress Management (Prism) Intervention: A Multi-Site Randomized Controlled Trial For Adolescents And Young Adults With Advanced Cancer, Alison O’Daffer, Liam Comiskey, Samantha R. Scott, Chuan Zhou, Miranda C. Bradford, Joyce P. Yi-Frazier, Abby R. Rosenberg

Psychology: Faculty Scholarship

Background

Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC).

Methods/design

The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC (“control” arm) or with PRISM-AC (“experimental” arm). PRISM is a manualized, …

Du Undergraduate Showcase: Research, Scholarship, And Creative Works, Caitlyn Aldersea, Justin Bravo, Sam Allen, Anna Block, Connor Block, Emma Buechler, Maria De Los Angeles Bustillos, Arianna Carlson, William Christensen, Olivia Kachulis, Noah Craver, Kate Dillon, Muskan Fatima, Angel Fernandes, Emma Finch, Colleen Cassidy, Amy Fishman, Andrea Francis, Stacia Fritz, Simran Gill, Emma Gries, Rylie Hansen, Shannon Powers, Jacqueline Martinez, Zachary Harker, Ashley Hasty, Mykaela Tanino-Springsteen, Kathleen Hopps, Adelaide Kerenick, Colin Kleckner, Ci Koehring, Elijah Kruger, Braden Krumholz, Maddie Leake, Lyneé Alves, Seraphina Loukas, Yatzari Lozano Vazquez, Haley Maki, Emily Martinez, Sierra Mckinney, Mykaela Tanino-Springsteen, Audrey Mitchell, Kipling Newman, Audrey Ng, Megan Lucyshyn, Andrew Nguyen, Stevie Ostman, Casandra Pearson, Alexandra Penney, Julia Gielczynski, Tyler Ball, Anna Rini, Christina Rorres, Simon Ruland, Helayna Schafer, Emma Sellers, Sarah Schuller, Claire Shaver, Kevin Summers, Isabella Shaw, Madison Sinar, Claudia Pena, Apshara Siwakoti, Carter Sorensen, Madi Sousa, Anna Sparling, Alexandra Revier, Brandon Thierry, Dylan Tyree, Maggie Williams, Lauren Wols

DU Undergraduate Research Journal Archive

DU Undergraduate Showcase: Research, Scholarship, and Creative Works

Environmental And Social Factors Associated With High Chronic Kidney Disease Mortality Rates In Municipalities Of Guatemala: An Ecological Study Of Municipal-Level Mortality Data, Alejandro Cerón

Anthropology: Faculty Scholarship

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009–2019 period for each of the country’s 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009–2019 period. Average crude mortality rate for …

Maternal Mortality In The United States: An Outlying Social Phenomenon In The Industrialized World, Whitney Buckendorf

Undergraduate Theses, Capstones, and Recitals

Maternal mortality rates claim the lives of over 300,000 individuals per year, with most of these deaths taking place in low to middle-income nations. Since 1990, maternal mortality rates have declined significantly with a global reduction from 385 to 216 maternal deaths per 100,000 births; an average decline of 2.9% per year. While this is an honorable reduction, there are outlying nations that experience higher than normal maternal mortality rates given their region and circumstance. While many studies focus on lower to middle-income nations for maternal mortality associated with lack of medical access and evolved care, there is also the …

Do Semantics Matter In Empathetic Person Perception Of Children Or Adults With Mental Illness?, Rylie Hansen, Caroline Polak, Emma Gries, Stevie Ostman, Gina A. Paganini, E. Paige Lloyd

DU Undergraduate Research Journal Archive

Experiences of stigma, discrimination, or aggression negatively affect the well-being of people experiencing symptoms of psychopathology. However, empathy is thought to undermine prejudice and discrimination and is linked with positive outcomes (e.g., greater well-being, more social support, etc.) among those with stigmatized mental illnesses. The current work investigates the influence of target age (adult or child) and language type (person-first or identity-first) on how much empathic concern perceivers report toward individuals with a hypothetical mental health condition. This research contributes to an ongoing debate about whether person-first or identity-first language carries stigmatizing or protective effects, while also considering a novel …

The Effect Of Language Type And Perceived Controllability On Stigma And Compassion, Maddie Leake, Christine Mcgrath, Trudy Mickel, Claire Shaver, Gina A. Paganini, E. Paige Lloyd

DU Undergraduate Research Journal Archive

Previous research suggests that mental health stigma creates significant barriers to treatment seeking and adherence, diminishes treatment outcomes, and motivates social rejection towards people experiencing mental illness; by contrast, compassion seems to offer protective effects, improving treatment outcomes and helping behavior. The current work extends the established literature by experimentally examining the independent and interactive effects of two factors theorized to influence stigma and compassion: controllability and language. Participants read vignettes about hypothetical mental illnesses explained with a genetic attribution (indicating low controllability) or a behavioral attribution (indicating high controllability) and completed measures of perceived controllability, stigma, and compassion. We …

Examining The Effect Of Physician Language On Physician Impressions, Kathleen L. Hopps, Anna H. Rini, Maggie E. Williams, Gina A. Paganini, E. Paige Lloyd

DU Undergraduate Research Journal Archive

Previous research provides evidence that stigma can be perpetuated through language with consequences for well-being and quality of care. For example, providers who use stigmatizing language transmit bias toward patients with implications for care provided by other healthcare professionals. The current work extends upon this research by investigating perceptions of physicians who use stigmatizing or humanizing language. The current work sought to document the negative consequences of providers’ indelicate language on impressions of the provider, thereby motivating thoughtful language choices. To this end, the current work experimentally manipulated the language (stigmatizing, identity-first and destigmatizing, person-first) that hypothetical providers used to …

Parental Misattunement And The Production Of Shame Of Existing: How To Address The Shame Of Existing Through An Intersubjective Systems Approach, Tal Ginsburg

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Shame is at the root of many commonly encountered psychopathologies. Its development has often been attributed to early childhood emotional misattunement. In severe cases, individuals can develop an extreme form of shame called the “shame-of-existing”. This paper primarily intends to contribute to the limited research about the shame-of-existing, which includes psychoanalytic perspectives from 1950-1990s, and theoretical analysis in 2014. The concept of shame of existence will be explored through an in-depth case study analysis of a 31-year-old, heterosexual, cisgender, white male who presented to psychotherapy with low-self-worth, and shame in acknowledging his own emotions and needs. This client was treated …

Fair Domestic Allocation Of Monkeypox Virus Countermeasures, Govind C. Persad, R. J. Leland, Trygve Ottersen, Henry S. Richardson, Carla Saenz, G. Owen Schaefer, Ezekiel J. Emanuel

Sturm College of Law: Faculty Scholarship

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; …

A Multicenter Weighted Lottery To Equitably Allocate Scarce Covid-19 Therapeutics, Douglas B. White, Erin K. Mccreary, Chung-Chou H. Chang, Mark Schmidhoffer, J. Ryan Bariola, Naudia N. Jonassaint, Govind C. Persad, Robert D. Truog, Parag A. Pathak, Tayfun Sönmez, M. Utku Unver

Sturm College of Law: Faculty Scholarship

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need. Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oralantiviral Paxlovid.

Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend …

Fair Allocation Of Scarce Therapies For Coronavirus Disease 2019 (Covid-19), Govind C. Persad, Monica E. Peek, Seema K. Shah

Sturm College of Law: Faculty Scholarship

The US Food and Drug Administration (FDA) has issued emergency use authorizations (EUAs) for monoclonal antibodies (mAbs) for nonhospitalized patients with mild or moderate coronavirus disease 2019 (COVID-19) disease and for individuals exposed to COVID-19 as postexposure prophylaxis. EUAs for oral antiviral drugs have also been issued. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (e.g., the Omicron variant) emerge, further rationing may be required. We identify relevant ethical principles (i.e., benefiting people and preventing harm, equal concern, and mitigating health inequities) …

Bringing People Back Into Public Health Data: Community Feedback On A Set Of Visualization Tools - Summary Report, Alejandro Cerón, Mia Glover, Quisi Rodriguez-Oregel, Dani Thompson, Tom Adams, Naomi Asakura, Kaela Belknap, Anna Block, Nicole Boehler, Hannah Boeve, Sarah Bomers, Sasha Borovok, Grace Bryan, Kate Buffington, Majesty Cain, Beth Carideo, Haley Chesno, Grace Connell, Jake Corbett, Camille Cruz, Chloe Dawkins, Anna Denniston, Lydia Dickens, Sophie Duplock, Samuel Dwinell, Avery Ess, Sam Ferman, Ellis Geis, Ethan Graupmann, Xander Hedrick, Angel Hernandez-Miramontes, Grant Huyghe, Sara Ibrahiem, Anna Jamieson, Ian Kang, Allie Kris, Erin Lawrence, Maddie Leake, Ryan Leary, Taylor Loh, Charlotte Monroe, Alexander Nguyen-Lopez, Henry O’Daffer, Cat Parish, Jaylee Recountre, Grace Rizzo, Noah Roseth, Grace Rothstein, Katie Sage, Marie Saltzmann, Stephen Shlain, Riley Shores, Mackenna Simson, Mark Teneza, Jack Weinmeister, Justin Weinzweig, Alison Wenman, Patch Whelan, Lea Zimmerman

Anthropology: Undergraduate Student Scholarship

This course-based study is a product of the University of Denver’s Spring 2022 The Social Determination of Health (ANTH 2424) class. The study aimed to understand how well a set of public health visualization tools tells the data stories about people in Colorado, and about important public health problems. For this, a team of almost sixty undergraduate students taking the class, coordinated by three graduate teaching assistants, and directed by the course instructor interviewed a total of fifty-six people from Colorado, qualitatively analyzed those interviews, and wrote reports that draw conclusions and recommendations.

A Music-Therapy Robotic Platform For Children With Autism: A Pilot Study, Huanghao Feng, Mohammad H. Mahoor, Francesca Dino

Electrical and Computer Engineering: Faculty Scholarship

Children with Autism Spectrum Disorder (ASD) experience deficits in verbal and nonverbal communication skills including motor control, turn-taking, and emotion recognition. Innovative technology, such as socially assistive robots, has shown to be a viable method for Autism therapy. This paper presents a novel robot-based music-therapy platform for modeling and improving the social responses and behaviors of children with ASD. Our autonomous social interactive system consists of three modules. Module one provides an autonomous initiative positioning system for the robot, NAO, to properly localize and play the instrument (Xylophone) using the robot’s arms. Module two allows NAO to play customized songs …

Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

This paper seeks to articulate lessons learned from feedback received after a severe injury in order to help guide neuropsychologists provide effective feedback to patients. Given that there is no agreed upon conceptual framework for providing neuropsychological assessment feedback, parallels are drawn from what works in clinical psychology – the working alliance. I use personal examples to highlight how the working alliance, as well as other psychological principles, can help inform neuropsychologists provide the most effective feedback to patients.

Sources And Types Of Social Supports And Their Association With Mental Health Symptoms And Life Satisfaction Among Young Adults With A History Of Out-Of-Home Care, Rhiannon Evans, Colleen C. Katz, Anthony Fulginiti, Heather N. Taussig

Graduate School of Social Work: Faculty Scholarship

Young adults with a history of out-of-home care report poorer mental health and life satisfaction compared to non-care-experienced peers. Social support is a known protective factor for mental health. There is limited evidence, however, on the relationship between sources (e.g., family members) and types (e.g., information) of social support and mental health symptoms and life satisfaction in this population. Reporting cross-sectional survey data from 215 young adults aged 18–22 years with a history of out-of-home care, the current study conducted descriptive, bivariate, and linear regression analysis to examine the different sources and types of support young adults receive and their …

Molecular Biomarkers Of Adult Human And Dog Stress During Canine-Assisted Interventions: A Systematic Scoping Review, Jaci Gandenberger, Erin Flynn, Em Moratto, Ashley Wendt, Kevin Morris

Institute for Human-Animal Connection: Faculty Scholarship

Positive relationships, including those between humans and other animals, particularly dogs, may be a way to reduce stress in humans. However, research into this area is relatively new, and a comprehensive review of the impacts of these interactions on humans and dogs has not been conducted. A scoping review of the scientific literature was conducted to explore what is known about the impacts of canine-assisted interventions on molecular biomarkers (e.g., cortisol and oxytocin) and associated measures (e.g., heart rate and blood pressure) of human and canine stress. As reported across 27 identified studies, canine-assisted interventions have consistently been demonstrated to …

Effect Of Computer-Assisted Cognitive Behavior Therapy Vs Usual Care On Depression Among Adults In Primary Care: A Randomized Clinical Trial, Jesse H. Wright, Jesse J. Owen, Tracy D. Eells, Becky F. Antle, Laura B. Bishop, Renee Girdler, Lesley M. Harris, R. Brent Wright, Michael J. Wells, Rangaraj Gopalraj, Michael E. Pendleton, Shehzad Ali

Counseling Psychology: Faculty Scholarship

Importance Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression.

Objectives To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment.

Design, Setting, …

“We Are Doing The Absolute Most That We Can, And No One Is Listening”: Barriers And Facilitators To Health Literacy Within Transgender And Nonbinary Communities, C. Riley Hostetter, Jarrod Call, Donald R. Gerke, Brendon T. Holloway, N. Eugene Walls, Jennifer C. Greenfield

Graduate School of Social Work: Faculty Scholarship

Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged …

Cost Of Menstrual Hygiene Practices In Gujarat, India, Smruti Bulsari, Kiran Pandya, Jayesh Desai

International Review of Business and Economics

Menstrual cycles are an integral part of a nearly two-third of a woman’s life, and occur every month. Menstruation is a public health concern because irrespective of whether a woman can afford hygienic absorbents or not, she undergoes menstruation phase every month. Therefore, menstruation requires to be examined from public health policy perspective. Choice of menstrual products is not only subject to budget constraint but also to “other regarding preferences”, as can be explained by behavioural economics theories. This study therefore, seeks to get insights into the determinants of choice of menstrual product. The study attempts to devise a method …

The Intersection Of Traumatic Brain Injury And Homelessness, Stephanie A. Chassman

Electronic Theses and Dissertations

The rates of TBI are significantly higher among individuals experiencing homelessness compared to the general population. Up to half of individuals experiencing homelessness may have a TBI. Accurate prevalence rates of TBI among individuals experiencing homelessness are difficult to obtain due to different methods of sampling participants and differing definitions of TBI; therefore, estimates may be underrepresented. Despite past research that has examined the relationship between TBI and homelessness, there are specific gaps in knowledge such as correlates and risk factors of TBI among individuals experiencing homelessness. This three-manuscript dissertation attempts to address these gaps in knowledge.

The first manuscript …

Exploring The Potential For Therapeutic Art-Making In School Psychology Practice: A Single Case Study Of A Training Experience, Alexandra G. Manion

Electronic Theses and Dissertations

The purpose of this study was to investigate the impact of a training experience on the use of therapeutic art-making for school psychologists, with a focus on how to incorporate these concepts into their school-based mental health practice. Therapeutic artmaking includes the use of visual art activities (drawing, painting, clay, and collage) with specific therapeutic intent. Although there are examples of art therapists providing inschool therapeutic art-making services to support the mental health needs of students, there is far less information regarding the use of therapeutic art-making by school-based mental health providers, including school psychologists. This single case study explored …

Understanding And Supporting Asian American Youth’S Mental Health Within Cultural And Family Contexts, In Young Park

Electronic Theses and Dissertations

Mental health problems are a major health issue among East Asian American (EAA) youth. Although previous research has explored the risk and protective factors associated with mental health problems of EAA youth, many studies have employed Eurocentric perspectives, thereby excluding their unique cultural backgrounds, beliefs, and values. To better understand mental health needs and support these youth, further research that identifies different factors associated with mental health problems in their cultural context and assesses evidence-supported and culturally responsive interventions is needed.

This three-manuscript dissertation is presented in three papers. The first manuscript presents an integrative conceptual framework that uses two …

Organellar Zn2+ Homeostasis And The Role Of Trpml Channels In Neuronal Lysosome Physiology And Axonal Transport, Taylor Franklin Minckley

Electronic Theses and Dissertations

Zinc (Zn²⁺) is crucial for proper cellular function, and as such it is important to measure and track Zn²⁺ dynamics in living cells. Fluorescent sensors have been used to estimate Zn²⁺ content of subcellular compartments, but little is known about endolysosomal Zn2+ homeostasis. Similarly, although numerous sensors have been reported, it is unclear whether and how Zn²⁺ can be released from intracellular compartments into the cytosol due to a lack of probes that can detect physiological dynamics of cytosolic Zn²⁺. My dissertation started with comparing and characterizing different Zn²⁺ sensors including the …

Exploring The Relationship Between Historical Redlining And Place-Based Reproductive Health Inequities: A Qualitative Gis Approach, Kristi L. Roybal

Electronic Theses and Dissertations

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences …

Well-Being Development: Parents’ Perceptions Of Gifted Adolescents, Barbara Moncure Washington

Electronic Theses and Dissertations

The purpose of this study was to examine parents’ perceptions of well-being development in their gifted adolescents. This was a qualitative study that used Narrative Inquiry as a research approach. Cloninger’s (1993) Psychobiological Model of Temperament and Character the (TCI) and Clandinin and Connelley’s (2000) Three-Dimensional Narrative Inquiry Space were utilized to address the research questions: What are parents’ perceptions of temperament in their gifted adolescent? What are parents’ perceptions of character in their gifted adolescent? What are the parents’ perceptions of well-being development? Dabrowski’s Theory of Positive Disintegration (TPD) provided an analysis lens for the study.

The framework for …