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Full-Text Articles in Medicine and Health Sciences

Using Detection Dogs And Rspf Models To Assess Habitat Suitability For Bears In Greater Yellowstone, Jon P. Beckmann, Lisette P. Waits, Aimee Hurt, Alice Whitelaw, Scott Bergen Dec 2015

Using Detection Dogs And Rspf Models To Assess Habitat Suitability For Bears In Greater Yellowstone, Jon P. Beckmann, Lisette P. Waits, Aimee Hurt, Alice Whitelaw, Scott Bergen

Western North American Naturalist

In the northern U.S. Rockies, including the Greater Yellowstone Ecosystem (GYE), connectivity is a concern because large carnivores have difficulties dispersing successfully between protected areas. One area of high conservation value because of its importance for connecting the GYE to wilderness areas of central Idaho is the Centennial Mountains and surrounding valleys (2500 km2) along the Idaho–Montana border just west of Yellowstone National Park. The current expansion of grizzly bears (Ursus arctos) and other large carnivore populations outside protected areas of Yellowstone National Park and Grand Teton National Park has placed a greater emphasis on potential linkage zones …


Evaluation Of Vaccination Policies Among Outpatient Oncology Clinics In Utah: A Pilot Study, Karlen Beth Luthy, Sarah L. Stocksdale, Janelle L B Macintosh, Lacey M. Eden, Renea L. Beckstrand, Katherine Edmonds Dec 2015

Evaluation Of Vaccination Policies Among Outpatient Oncology Clinics In Utah: A Pilot Study, Karlen Beth Luthy, Sarah L. Stocksdale, Janelle L B Macintosh, Lacey M. Eden, Renea L. Beckstrand, Katherine Edmonds

Faculty Publications

Background: In Utah, all major hospital facilities have employee vaccination policies. However, the presence of health care worker vaccination policies in the Utah outpatient oncology setting was unknown.

Objectives: The objectives were to identify Utah oncology outpatient employee vaccination policies and to identify what consequences, if any, were present for unvaccinated employees.

Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics in Utah were asked, via questionnaire, to describe the clinic’s employee vaccination policy and the consequences for refusing the policy.

Findings: Most vaccination policies applied to employees primarily assigned to work in …


Incorporating A Robot In Intervention With Children With Asd: The Effect On Tantrum Behaviors, Tayler Bodon Whitmer Dec 2015

Incorporating A Robot In Intervention With Children With Asd: The Effect On Tantrum Behaviors, Tayler Bodon Whitmer

Theses and Dissertations

This study examined the effect of intervention involving a humanoid robot on challenging or tantrum behaviors of four children with low-functioning autism spectrum disorders (ASD). The current work was part of a larger study involving the effect of the robot on functional communication skills on a variety of different interactions with different communication partners. All participants took part in a single-subject, multiple-baseline design with various session types including baseline, traditional play-based treatment, treatment including the robot, and follow-up sessions. For the purpose of this study, only the sessions including treatment with the robot where the robot interaction occurred at the …


An Examination Of The Effectiveness Of Systematic And Engaging Early Literacy (Seel) With Children With Asd, Maren Hyatt Davis Dec 2015

An Examination Of The Effectiveness Of Systematic And Engaging Early Literacy (Seel) With Children With Asd, Maren Hyatt Davis

Theses and Dissertations

One population with challenges in learning to read is children with autism spectrum disorder (ASD). The purpose of this study was to examine the effects of using Systematic and Engaging Early Literacy (SEEL) intervention activities to improve phonological awareness and phonics skills with three children with ASD. Previous studies have looked at the effectiveness of using SEEL with other young children with diverse backgrounds; however, this is the first study to focus on using SEEL intervention with children with ASD. The study used a single-subject, multiple-baseline-across-behaviors design to compare performance on phonic patterns before and after intervention. Three young, male …


The Right Ear Advantage In Response To Levels Of Linguistic Complexity: A Functional Magnetic Resonance Imaging Study, Elizabeth Hyatt Dec 2015

The Right Ear Advantage In Response To Levels Of Linguistic Complexity: A Functional Magnetic Resonance Imaging Study, Elizabeth Hyatt

Theses and Dissertations

The right ear advantage (REA) phenomenon has been utilized in clinical and research settings to study auditory processing disorders and linguistic lateralization. Previous research has established that the REA is not reliable in its measures within or between individuals. This is likely due to the influence of other variables, such as neuromaturation and attention. One variable that has not been studied in depth in this context is linguistic complexity. It was hypothesized that stimulus conditions with levels of linguistic complexity would elicit corresponding levels of temporal lobe activity. Understanding and controlling the variables that affect the REA will increase the …


Changes In Acoustic And Kinematic Articulatory Working Space Across Three Intensity Levels, Panika Ellis Palmer Dec 2015

Changes In Acoustic And Kinematic Articulatory Working Space Across Three Intensity Levels, Panika Ellis Palmer

Theses and Dissertations

The purpose of this study was to compare changes in acoustic and kinematic measures of articulation across soft, comfortable, and loud speech conditions. There were 19 participants, 9 male and 10 female, with age ranging from 20 to 34 with a median age of 25. Each participant had electromagnetic sensors glued to their tongue, jaw, and lips. It was anticipated that the acoustic measures would accurately reflect the kinematic measures of speech as articulation changed across the intensity levels. Vowel space area (VSA) and vowel articulation index (VAI) were computed from the three corner vowels, /α, i, u/. Articulatory-acoustic vowel …


Story Generation In Five School-Aged Children With Language Impairment, Suzanne Tutt Jones Dec 2015

Story Generation In Five School-Aged Children With Language Impairment, Suzanne Tutt Jones

Theses and Dissertations

This project examined the story generations of five children with language impairment (LI) between the ages of 5;11 and 10;1 across the treatment sessions of a narrative-based intervention program designed to improve social communication. These stories were analyzed to find whether the participants would approach the task by describing the stimulus pictures or if their stories would reflect an episodic structure containing cause and effect relationships. Additionally, the stories were analyzed for inclusion of emotion words to discern the participants' awareness of the characters' emotions. There was a high degree of variability in the participants' performance; however, the majority of …


Neurophysiological Correlates Of The Critical Bandwidth In The Human Auditory System, Grace Ann Bentley Nov 2015

Neurophysiological Correlates Of The Critical Bandwidth In The Human Auditory System, Grace Ann Bentley

Theses and Dissertations

The critical bandwidth (CBW) is an auditory phenomenon that has been used to study various aspects of auditory processing, including auditory masking, complex tone processing, and loudness perception. Although the psychoacoustic aspects of the CBW have been well studied, the underlying neurophysiology of the CBW has not been as thoroughly examined. The current study examined the neurophysiology of the CBW in young adults, as well as loudness perception in response to the CBW. Auditory stimuli consisting of complex tones of varying bandwidths were presented to 12 individuals (6 male and 6 female, ages 18-26 years). Complex tones were presented around …


Understanding Anterior Knee Pain: Patellofemoral Pain Syndrome, Craig Nuttall, Blaine A. Winters Oct 2015

Understanding Anterior Knee Pain: Patellofemoral Pain Syndrome, Craig Nuttall, Blaine A. Winters

Faculty Publications

Patellofemoral pain syndrome (PFPS) is 1 of the most common causes of anterior knee pain and should be included in the differential diagnosis for anterior knee pain in every patient. PFPS is characterized as an overuse injury. The exact mechanism of injury is still under investigation, but it is believed to stem from maltracking of the patella. PFPS commonly presents in adults who complain of anterior knee pain with activity. This pain can lead to significant disability. When treated appropriately, disability and chronicity can be avoided or reduced.


Evaluation And Management Of Spinal Column Fractures In Adults, Blaine A. Winters, Craig Nuttall Oct 2015

Evaluation And Management Of Spinal Column Fractures In Adults, Blaine A. Winters, Craig Nuttall

Faculty Publications

Nurse practitioners working in many settings are faced with the challenge of diagnosing and managing patients with potential or actual spinal column fractures. In this article we provide nurse practitioners with the knowledge necessary to evaluate for and diagnose spinal column fractures in adults. We also provide guidelines for the appropriate management of injuries and identify when referral is recommended.


Neurobiology Of Trauma, Julie L. Valentine, Linda Mabey, Leslie Miles Oct 2015

Neurobiology Of Trauma, Julie L. Valentine, Linda Mabey, Leslie Miles

Faculty Publications

  • The neurobiology of trauma can affect the functioning of the brain with lasting consequences.
  • The body's hormonal response to trauma affects the encoding of memory.
  • Acute stress disorder (ASD) can result following trauma and can develop into post-traumatic stress disorder (PTSD) if symptoms last for more than 1 month.
  • Trauma can cause immediate symptoms, such as tonic immobility and dissociation, and may lead to chronic symptoms oof depression and anxiety.
  • Exposure to trauma can cause physical health problems.
  • Evidence-based psychotherapy treatment options following traumatic exposure are available.
  • Providing compassionate, nonjudgmental care to victims of trauma helps their healing process.

Nurses …


Validation Of Accelerometer Thresholds And Inclinometry For Measurement Of Sedentary Behavior In Young Adult University Students, Neil E. Peterson, John R. Sirard, Pamela A. Kulbok, Mark D. Deboer, Jeanne M. Erickson Oct 2015

Validation Of Accelerometer Thresholds And Inclinometry For Measurement Of Sedentary Behavior In Young Adult University Students, Neil E. Peterson, John R. Sirard, Pamela A. Kulbok, Mark D. Deboer, Jeanne M. Erickson

Faculty Publications

Sedentary behavior (SB) is a major contributing factor to obesity and significant morbidity and mortality in adolescence and into adulthood, yet measuring SB is difficult. The purpose of this study was to assess the degree of construct validity of the ActiGraph GT3X+ inclinometer function and accelerometry metrics in objectively measuring SB and physical activity in young adult university students while performing semi-structured activities: lying, sitting, reading, playing seated video gaming, video watching, seated conversation, standing, stationary biking, and walking. These nine activities were objectively assessed using inclinometry and four output metrics from the ActiGraph based on the axis used to …


The Effects Of Laryngeal Activity On Articulatory Kinematics, Katherine Marie Barber Oct 2015

The Effects Of Laryngeal Activity On Articulatory Kinematics, Katherine Marie Barber

Theses and Dissertations

The current study examined the effects of three speech conditions (voiced, whispered, mouthed) on articulatory kinematics at the sentence and word level. Participants included 20 adults (10 males, 10 females) with no history of speech, language, or hearing disorders. Participants read aloud six target utterances in the three different speaking conditions while articulatory kinematics were measured using the NDI Wave electromagnetic articulograph. The following articulators were examined: mid tongue, front of tongue, jaw, lower lip, and upper lip. One of the target utterances was chosen for analysis (It's time to shop for two new suits) at the sentence …


Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences: Stories From The Last Frontier, Renea L. Beckstrand, Jonathan Rohwer, Karlen E. Luthy, Janelle L. B. Macintosh, Ryan J. Rasmussen Sep 2015

Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences: Stories From The Last Frontier, Renea L. Beckstrand, Jonathan Rohwer, Karlen E. Luthy, Janelle L. B. Macintosh, Ryan J. Rasmussen

Faculty Publications

Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles.

Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting.

Results: The lack of an ideal death (eg, the nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians.

Discussion: Rural emergency nurses often provide …


Addressing Parental Vaccination Questions In The School Setting: An Integrative Literature Review, Karlen Beth Luthy, Jana Burningham, Lacey M. Eden, Janelle L B Macintosh, Renea L. Beckstrand Sep 2015

Addressing Parental Vaccination Questions In The School Setting: An Integrative Literature Review, Karlen Beth Luthy, Jana Burningham, Lacey M. Eden, Janelle L B Macintosh, Renea L. Beckstrand

Faculty Publications

School nurses work in a unique environment with key opportunities to address parental concerns and questions regarding their child’s health. A common concern for parents during school enrollment is childhood vaccination safety and efficacy. As public health leaders, school nurses are well respected among parents, therefore school nurses are in a prime position to educate parents and promote childhood vaccinations while also dispelling common vaccination myths. The purpose of this integrative literature review is to synthesize evidence-based answers to common parental questions regarding childhood vaccinations.


Qualitative Analysis Of Student Perceptions Of Bachelor Of Science-To-Doctor Of Philosophy In Nursing Programs, Neil E. Peterson, Karen O. Moss, Gwyneth R. Milbrath, Jane R. Von Gaudecker, Eunhee Park, Mihee Chung Sep 2015

Qualitative Analysis Of Student Perceptions Of Bachelor Of Science-To-Doctor Of Philosophy In Nursing Programs, Neil E. Peterson, Karen O. Moss, Gwyneth R. Milbrath, Jane R. Von Gaudecker, Eunhee Park, Mihee Chung

Faculty Publications

Background: To address the shortage of PhD-prepared nursing faculty, universities in the United States of America offer direct entry BSN-to-PhD nursing programs. Little research has been done to explore students’ perceptions of these programs and formally evaluate the successes and opportunities for growth of this academic track. Methods: Focusing on the perceptions and experiential reflection of BSN-to-PhD education, a survey with open-ended questions was distributed among voluntary participants who are current BSN-to-PhD students or recent graduates (years) from various universities in the country. Textual data were analyzed using a qualitative descriptive approach with thematic analysis. Results: This article elaborates on …


Vitamin B12: Identification And Treatment Of Deficiencies, Max Mitchell, Donna S. Freeborn Sep 2015

Vitamin B12: Identification And Treatment Of Deficiencies, Max Mitchell, Donna S. Freeborn

Student Works

Vitamin B12 is essential for the proper functioning of all cells. A deficiency can cause serious hematologic and neurologic damage. Groups at high risk for developing vitamin B12 deficiency include the elderly, vegetarians, pregnant women, persons with pernicious anemia, and patients with a history of gastrointestinal (GI) surgery. The purpose of this article is to increase awareness of vitamin B12 deficiency and discuss its pathophysiology, symptoms, diagnostic testing, and management


Age-Appropriate Post-Reduction Care Of Anterior Shoulder Dislocation, Hans B. Ayres, Blaine Winters, Craig Nuttall Sep 2015

Age-Appropriate Post-Reduction Care Of Anterior Shoulder Dislocation, Hans B. Ayres, Blaine Winters, Craig Nuttall

Student Works

Background and Purpose: The shoulder is the most commonly dislocated joint in the body. This paper provides age-appropriate recommendations for post-reduction management of anterior shoulder dislocations. Methods: Literature was reviewed, limited to English language in the last five years. Appropriate articles were rated using the Levels of Evidence tool found in the Journal of Orthopaedic Trauma. Conclusion: We recommend aggressive treatment in younger patients, and increased screening for concomitant injuries in older patients. Implications for Practice: Age should be an important consideration when formulating a plan of care for the patient with shoulder dislocation.


Updating The Simulation Effectiveness Tool: Item Modifications And Reevaluation Of Psychometric Properties, Kim Leighton, Patricia K. Ravert, Vickie Mudra, Christopher Macintosh Sep 2015

Updating The Simulation Effectiveness Tool: Item Modifications And Reevaluation Of Psychometric Properties, Kim Leighton, Patricia K. Ravert, Vickie Mudra, Christopher Macintosh

Faculty Publications

AIM This study evaluated the psychometric properties of the modified Simulation Effectiveness Tool (SET) and the SET-M.

BACKGROUND The SET, developed in 2005, was updated to be consistent with INACSL Standards of Best Practice, QSEN practices, and American Association of Colleges of Nursing baccalaureate essentials.

METHOD Undergraduate nursing students from two nursing programs, one with multiple campuses, completed the SET-M following completion of a simulated clinical experience; 1,288 students took part in the study.

RESULTS Exploratory factor analysis was completed using unweighted least squares. Four sub scales were identified with acceptable internal consistency: Prebriefing (α = .833), Learning (α = …


Vaccination Policies Of Utah Family Practice Clinics, Levi R. Kohler Sep 2015

Vaccination Policies Of Utah Family Practice Clinics, Levi R. Kohler

Theses and Dissertations

The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. Data sources: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 155 family practice clinic managers. Analyses included frequencies and percentages for quantitative items and a content analysis for open-ended items. Conclusions: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients …


Use Of A Blog In An Undergraduate Nursing Leadership Course, Shelly Jensen Reed, Debra Edmunds Aug 2015

Use Of A Blog In An Undergraduate Nursing Leadership Course, Shelly Jensen Reed, Debra Edmunds

Faculty Publications

In this study, the use of a blog in a senior leadership clinical nursing course was analyzed qualitatively through two means; focus group interviews of those using the blog, and analysis of blog content. Initial feelings expressed by students were annoyance and intimidation concerning the blogging assignment. These feelings quickly dissipated, with students verbalizing many positive aspects related to the blog, including having a place to reflect, feeling connected as a group, valuing feedback provided by their peers, and learning from theirs and others' experiences. The mechanics of having to synthesize their thoughts in written form, in a shared venue …


Vitamin D Deficiency And Infertility: A Systematic Review, Susanne Stoddard Sollis Aug 2015

Vitamin D Deficiency And Infertility: A Systematic Review, Susanne Stoddard Sollis

Student Works

Vitamin D regulates calcium and phosphorus homeostasis in the body. In recent years, studies have been conducted examining the role vitamin D plays in reproduction. Vitamin D deficiency is associated with infertility, decreased pregnancy rates, and hormonal changes. Asians appear to have a reverse correlation with pregnancy rates and vitamin D levels. There are some conflicting studies regarding vitamin D levels in relationship to infertility. This paper reviews the most recent literature focusing on the relationship between vitamin D status and infertility. This review evidences vitamin D levels >30 ng/mL result in improved fertility outcomes.


Written Debriefing: Evaluating The Impact Of The Addition Of A Written Component When Debriefing Simulations, Shelly Jensen Reed Aug 2015

Written Debriefing: Evaluating The Impact Of The Addition Of A Written Component When Debriefing Simulations, Shelly Jensen Reed

Faculty Publications

Debriefing, the reflective period following a simulation, is said to be where the bulk of simulation learning takes place. Many expert opinions regarding debriefing exist, but evidence-based best practices have yet to be identified. Written debriefing is one of these practices; experts state learning can be extended through the addition of a written component to the debriefing process, but no evidence exists to support this. This study compares three debriefing types: discussion alone, and discussion followed by journaling or blogging. Undergraduate nursing students participating in a simulation were randomized as a simulation group to one of these three debriefing types. …


Evaluation Of Vaccination Policies Among Outpatient Oncology Clinics In Utah: A Pilot Study, Sarah Louise Stocksdale Aug 2015

Evaluation Of Vaccination Policies Among Outpatient Oncology Clinics In Utah: A Pilot Study, Sarah Louise Stocksdale

Theses and Dissertations

Background: In Utah, all major hospital facilities have employee vaccination policies. However, the presence of health care worker vaccination policies in the Utah outpatient oncology setting was unknown. Objectives: The objectives were to identify Utah oncology outpatient employee vaccination policies and to identify what consequences, if any, were present for unvaccinated employees. Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics in Utah were asked, via questionnaire, to describe the clinic's employee vaccination policy and the consequences for refusing the policy. Findings: Most vaccination policies applied to employees primarily assigned to work in …


Elevating Research: An Important Role For Nurse Leaders, Katreena Collette Merrill, Diane Andrews, Barbara B. Brewer, Diane Storer Brown Jul 2015

Elevating Research: An Important Role For Nurse Leaders, Katreena Collette Merrill, Diane Andrews, Barbara B. Brewer, Diane Storer Brown

Faculty Publications

As leaders, we recognize the importance of professional scholarship to provide the evidence needed to transform practice. One key initiative for the American Organization of Nurse Executives (AONE) is the elevation of nursing research and AONE competencies for nurse executives emphasize utilization, dissemination and participation in studies. However, given our current healthcare climate and competing priorities, nurse leaders must often focus efforts on fiscal responsibility and operational effectiveness, making time and resources to support nursing research challenging. Initiatives that do not directly impact patient care, such as research, may be given a lower priority. Given today’s pressures, nurse leaders may …


Shame, Relational Aggression, And Sexual Satisfaction: A Longitudinal Study, Austin Ray Beck Jul 2015

Shame, Relational Aggression, And Sexual Satisfaction: A Longitudinal Study, Austin Ray Beck

Student Works

This longitudinal study examined the relationship between husband and wife shame and husband and wife sexual satisfaction one year later with husband and wife relational aggression as mediating variables. The sample included 353 heterosexual married couples who participated in the Flourishing Families Research Project, a longitudinal study of daily family life. Results showed that husband and wife shame was negatively related with husband and wife sexual satisfaction, respectively. Husband love withdrawal was negatively related with both husband and wife sexual satisfaction, while wife love withdrawal was negatively related with only husband sexual satisfaction. Each partner's use of social sabotage was …


Parent And Adolescent Attachment And Adolescent Shame And Hope With Psychological Control As A Mediator, Natasha K. Bell Jul 2015

Parent And Adolescent Attachment And Adolescent Shame And Hope With Psychological Control As A Mediator, Natasha K. Bell

Student Works

The purpose of this study was to determine if parent adolescent attachment is correlated with adolescent hope and shame two years later with parent psychological control in the year in between as a mediator. Data at wave four, five, and six for 308 families from the Flourishing Families Project were used. In previous studies attachment has been shown to be important in adolescent development. This study found that the adolescent's perception of the relationship is negatively correlated with shame and positively correlated with hope in the adolescent. Additionally the adolescent's perception of their relationship with both mother and father was …


Discovering Self: Childbearing Adolescents' Maternal Identity, Janelle L. B. Macintosh, Lynn Clark Callister Jul 2015

Discovering Self: Childbearing Adolescents' Maternal Identity, Janelle L. B. Macintosh, Lynn Clark Callister

Faculty Publications

Purpose: Adolescent pregnancy and motherhood have long been a topic of interest for many healthcare professionals. However, there are limited data on how childbearing adolescents incorporate motherhood identity into their sense of self. The purpose of this study was to explore how childbearing adolescents perceive motherhood as becoming part of their personal identity.

Study Design: This qualitative study using ethnographic data collection involved 7 months of observation, interaction, and interviews.

Methods: Data were collected from nine expectant adolescents during in-depth interviews. All participants were patients at a teen mother and child clinic staffed by certified nurse midwives and a pediatrician. …


The Moderating Effect Of Attachment Behaviors On The Association Between Video Game Use, Time Together As A Problem, And Relationship Quality, Stella Christine Dobry Jul 2015

The Moderating Effect Of Attachment Behaviors On The Association Between Video Game Use, Time Together As A Problem, And Relationship Quality, Stella Christine Dobry

Theses and Dissertations

The purpose of this study was to test whether video game use is associated with more problems with spending time together among married couples, whether problems with time together are associated with relationship quality, and whether attachment behaviors can moderate the association between time together as a problem and relationship quality. Previous studies have found a negative association between excessive video game use and couple relationship outcomes. Excessive video game use may negatively impact relationships by taking away from time spent on shared leisure and relationship maintenance activities. The Double ABCx model provided a theoretical framework for understanding how attachment …


Individual Personality And Emotional Readiness Characteristics Associated With Marriage Preparation Outcomes Of Perceived Helpfulness And Change, Megan Ann Rogers Jul 2015

Individual Personality And Emotional Readiness Characteristics Associated With Marriage Preparation Outcomes Of Perceived Helpfulness And Change, Megan Ann Rogers

Theses and Dissertations

Little is known about the role that personality and emotional readiness factors may play in participation and outcomes of premarital education programs in varying formats. Data collected via the RELATionship Evaluation Questionnaire (RELATE: Busby et al., 2001) was used to analyze how personality and emotional readiness factors affect perceived change and helpfulness in self-directed and workshop formats of premarital education for 384 individuals who participated in such interventions. Depression was significantly and negatively related to participant perception of positive change and helpfulness in a workshop setting. Kindness was positively and significantly related to perceived positive change in both workshop and …