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2018

Mental and Social Health

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Articles 1 - 30 of 697

Full-Text Articles in Medicine and Health Sciences

Altered Domain Functional Network Connectivity Strength And Randomness In Schizophrenia., Victor M Vergara, Eswar Damaraju, Jessica A Turner, Godfrey Pearlson, Aysenil Belger, Daniel H Mathalon, Steven G Potkin, Adrian Preda, Jatin G Vaidya, Theo G M Van Erp, Sarah C Mcewen, Vince D Calhoun Dec 2018

Altered Domain Functional Network Connectivity Strength And Randomness In Schizophrenia., Victor M Vergara, Eswar Damaraju, Jessica A Turner, Godfrey Pearlson, Aysenil Belger, Daniel H Mathalon, Steven G Potkin, Adrian Preda, Jatin G Vaidya, Theo G M Van Erp, Sarah C Mcewen, Vince D Calhoun

Articles, Abstracts, and Reports

Functional connectivity is one of the most widely used tools for investigating brain changes due to schizophrenia. Previous studies have identified abnormal functional connectivity in schizophrenia patients at the resting state brain network level. This study tests the existence of functional connectivity effects at whole brain and domain levels. Domain level refers to the integration of data from several brain networks grouped by their functional relationship. Data integration provides more consistent and accurate information compared to an individual brain network. This work considers two domain level measures: functional connectivity strength and randomness. The first measure is simply an average of …


Community Pharmacists And Substance Use Disorders: Attitudes, Knowledge And Practices, Deepika Rao Dec 2018

Community Pharmacists And Substance Use Disorders: Attitudes, Knowledge And Practices, Deepika Rao

Electronic Theses and Dissertations

Background: Substance use disorder (SUD) is a serious health concern affecting a large proportion of the US population. Community pharmacists are well-positioned to prevent, screen, and provide appropriate treatment for SUD. Stigma towards these patients and SUD results in reduced quality of care as well as poor treatment outcomes. It is imperative that pharmacists have the appropriate knowledge of and attitude towards prevention, harm reduction and treatment to develop therapeutic relationships and improve their delivery of pharmacy services

Objective: To assess knowledge, practices (with an emphasis upon screening), stigma and general attitudes of community pharmacists towards SUD and evaluate the …


Sensory-Based Programming In Mental Health: Sense Of Self, Nikki Yeckel Dec 2018

Sensory-Based Programming In Mental Health: Sense Of Self, Nikki Yeckel

Electronic Theses and Dissertations

The doctoral experiential component (DEC) for this Capstone was completed at the Veterans Affairs Healthcare System (VA) in Pittsburgh, Pennsylvania. The program, called Sense of Self, was implemented with the Veteran mental health (MH) population in an inpatient psychiatric rehabilitation unit at the VA. Sense of Self was a three-day educational program that educated Veterans on the sensory systems and sensory processing, provided calming or alerting strategies with use of sensory materials, and assisted the Veterans in creating sensory home programs based on personal goals. The goals of this Capstone were to inform the staff of the Veteran demographic population …


Trends In Opioid Use In Pediatric Patients In Us Emergency Departments From 2006 To 2015, Daniel M. Tomaszewski, Cody Arbuckle, Sun Yang, Erik J. Linstead Dec 2018

Trends In Opioid Use In Pediatric Patients In Us Emergency Departments From 2006 To 2015, Daniel M. Tomaszewski, Cody Arbuckle, Sun Yang, Erik J. Linstead

Pharmacy Faculty Articles and Research

Importance The use of opioids to treat pain in pediatric patients has been viewed as necessary; however, this practice has raised concerns regarding opioid abuse and the effects of opioid use. To effectively adjust policy regarding opioids in the pediatric population, prescribing patterns must be better understood.

Objective To evaluate opioid prescribing patterns in US pediatric patients and factors associated with opioid prescribing.

Design, Setting, and Participants This cross-sectional study used publicly available data from the National Hospital Ambulatory Medical Care Survey from January 1, 2006, to December 31, 2015. Analysis included the use of bivariate and multivariate models to …


As A Pediatrician, I Don’T Know The Second, Third, Or Fourth Thing To Do: A Qualitative Study Of Pediatric Residents’ Training And Experiences In Behavioral Health, Rachel Petts Phd, Jeffrey D. Shahidullah Phd, Paul W. Kettlewell Phd, Kathryn A. Dehart Md, Kris Rooney Md, Ilene G. Ladd Ms, Tyler Bogaczyk Bs, Sharon L. Larson Phd Dec 2018

As A Pediatrician, I Don’T Know The Second, Third, Or Fourth Thing To Do: A Qualitative Study Of Pediatric Residents’ Training And Experiences In Behavioral Health, Rachel Petts Phd, Jeffrey D. Shahidullah Phd, Paul W. Kettlewell Phd, Kathryn A. Dehart Md, Kris Rooney Md, Ilene G. Ladd Ms, Tyler Bogaczyk Bs, Sharon L. Larson Phd

International Journal of Health Sciences Education

Despite a mandated 1-month rotation in developmental-behavioral pediatrics (DBP), pediatric residents report inadequate training in behavioral health care. As a first step in much needed curriculum development in this area, this study sought to assess learner experiences regarding the management of behavioral health problems during residency. Four focus groups were conducted for residents in years 1-3 of training in 2 residency programs in a northeastern state. Transcripts were analyzed and coded by researchers through qualitative classical content analysis. The exploratory analysis revealed 9 key themes: time requirements, rapport building, resources and referrals for behavioral health, psychiatric medications, diagnosis vs. treatment, …


Syndemics Of Severity And Frequency Of Elder Abuse: A Cross-Sectional Study In Mexican Older Females, Mireya Vilar-Compte, Pablo Gaitán-Rossi Dec 2018

Syndemics Of Severity And Frequency Of Elder Abuse: A Cross-Sectional Study In Mexican Older Females, Mireya Vilar-Compte, Pablo Gaitán-Rossi

Department of Public Health Scholarship and Creative Works

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.

Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.

Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had …


Access To Veterinary Care: Barriers, Current Practices, And Public Policy, Access To Veterinary Care Coalition Dec 2018

Access To Veterinary Care: Barriers, Current Practices, And Public Policy, Access To Veterinary Care Coalition

Faculty Publications and Other Works -- Small Animal Clinical Sciences

Pets have become an integral part of our families with over 80% of pet owners reporting that they consider their pets to be a member of their family. An estimated 29 million dogs and cats live in families that participate in the Supplemental Nutrition Assistance Program. There are also middle-class families that live paycheck to paycheck, with limited funds for veterinary care. These families deserve the companionship of pets to enjoy the mental, physical, and emotional benefits that come from this human-animal bond.

Through a grant from Maddie’s Fund®, the Access to Veterinary Care Coalition (AVCC) commissioned a national …


Addicted To The Answer, Charumathi Raman Dec 2018

Addicted To The Answer, Charumathi Raman

Capstones

Hypochondria, which is now broadly known as health anxiety, is the fear of a serious illness that continues despite evidence to the contrary from laboratory tests and the reassurance of physicians. In the past people with this disorder would go from doctor to doctor seeking an answer, but now many people rely solely upon online information.

For people with health anxiety, the Internet provides a lot of fodder. Researchers have recently coined the term "cyberchondria" to describe the phenomenon of increased health anxiety due to online health searches.

Entering questions like “Who started World War Two?” or “Who was the …


Surviving A Death Sentence, Amy K. Mackinnon Dec 2018

Surviving A Death Sentence, Amy K. Mackinnon

Capstones

Diagnosed with HIV at the peak of the AIDS epidemic, Sean McKenna had planned to die. Now, decades after life-saving drugs were first released, he and other long-term survivors are still figuring out how to live.
https://amykmackinnon.wordpress.com/capstone/


Burden Of Proof: Insurance Companies Are Refusing To Pay For Mental Healthcare And Regulators Are Letting Them. Patients Are Left To Fend For Themselves., Graison Dangor Dec 2018

Burden Of Proof: Insurance Companies Are Refusing To Pay For Mental Healthcare And Regulators Are Letting Them. Patients Are Left To Fend For Themselves., Graison Dangor

Capstones

When their mental health claims are denied, patients who are supposed to be protected by state and federal law have a choice: Don’t get care or pay for the care themselves, then fight to get paid back.

Link to capstone: https://graisondangor.github.io/mental-healthcare-equality/


Art In The Stages Of Suffering And Death, Joanna Aramini Dec 2018

Art In The Stages Of Suffering And Death, Joanna Aramini

Visual Arts Department Student Scholarship

There has always been a strong link between art and the study of science and medicine, and one of the most iconic images of suffering and death in history to date is Christ suffering on the cross. In this thesis, I examine if and how art can make it possible to transcend human pain and overcome suffering, especially in our modern society where pain is seen as something we cannot deal with, and where we look to medicine and prescriptions to diminish it. I argue that art in the states of suffering and death, closely examining Michelangelo’s La Pieta and …


“A New Way Of Thinking”: Frantz Fanon’S True Opinion On Violence, Caroline D. Renko Dec 2018

“A New Way Of Thinking”: Frantz Fanon’S True Opinion On Violence, Caroline D. Renko

The Downtown Review

In an attempt to clear Frantz Fanon’s name, on account of his opinion on the role of violence in decolonizing a nation, this paper focuses on two important chapters in his last book, The Wretched of the Earth. By closely reading his articulation of the Algerian war and the wounds brought on by mental illness at such a time, Fanon’s true opinion concerning violence becomes clear. For too long, he has been seen and used as a proponent for inciting violence, but this is a misconception that has been perpetuated by devaluing the importance of his descriptions of the …


Island Of Harm Reduction, Trevor T. Boyer Dec 2018

Island Of Harm Reduction, Trevor T. Boyer

Capstones

New York City's Rikers Island has a medically assisted treatment (MAT) program for detainees who are addicted to opioids, providing buprenorphine or methadone. For many locked up there, though, Rikers is only a way station before a trip upstate to prison. Even now, over 30 years after its treatment program began, only six other correctional facilities in New York offer pilot opioid treatment programs, which are available only to limited segments of their respective populations.

So for those taking medication in the form or methadone or buprenorphine on Rikers Island pretrial and awaiting sentencing, they're tapered off their doses to …


Art That Heals, Christina Cardona Dec 2018

Art That Heals, Christina Cardona

Capstones

Beryl Brenner was a creative arts therapist for 40 years, and helped veterans heal from war traumas through art all across the city. For the past 11 years, she was at the Brooklyn Campus of the VA NY Harbor Healthcare system in Bay Ridge, where she developed the art therapy program. https://christinacardona1.wordpress.com


Climate Grief Hits The Self-Care Generation, Avichai Scher Dec 2018

Climate Grief Hits The Self-Care Generation, Avichai Scher

Capstones

As the effects of climate change intensify, emotional anguish over the future of the planet is emerging. This piece looks at a 10-step program to deal with climate grief "Good Grief."

At Uplift Climate, a conference on climate change for people under 30 held annually, the creators of Good Grief presented their program. The conference focused on climate justice for Native Americans, who have been dealing with climate grief for a long time.

The setting highlighted the class divide of who is affected by climate change. The effects of climate change are now so strong, that climate grief is hitting …


Dios, Drogas, Dinero: ¿QuiéN Gana Con El Traslado De Adictos De Puerto Rico A Ee.Uu.?, Claudia E. Irizarry Aponte, Eliana Y. Perez Dec 2018

Dios, Drogas, Dinero: ¿QuiéN Gana Con El Traslado De Adictos De Puerto Rico A Ee.Uu.?, Claudia E. Irizarry Aponte, Eliana Y. Perez

Capstones

For the last 25 years, evangelical leaders have been shipping off opioid addicts in Puerto Rico to cities in the mainland US, mainly New York City, Chicago and Philadelphia--under the promise they’ll receive state-of-the-art rehabilitation treatment, only to end up in unregulated transitional homes and flophouses where they don’t receive proper medical care or psychotherapy. In turn, many of these unregulated transitional homes, also run by evangelical leaders, may charge Medicaid kickbacks from their “patients.”

While this so-called “air bridge” from Puerto Rico to the U.S. goes back decades, it gained momentum from 2005 to 2014, when evangelical leaders joined …


The Art Of Couple Satisfaction, Kristy Koser Dec 2018

The Art Of Couple Satisfaction, Kristy Koser

Dissertations, 2014-2019

ABSTRACT

It is estimated 10-15% of women aged 20-45 or 1 in 4 to 6 couples are unable to get pregnant after one year of trying to conceive. This failure to conceive within 12 months without contraception meets the requirements for a diagnosis of infertility (Association for Reproductive Medicine [ASRM], 2014). With such a large percent of the United States population navigating the world of fertility treatment, the field of mental health must also evolve, offering new areas of specialty to address this specific client population. Couples face significant concerns while undergoing fertility treatment as they cope with complex decision-making, …


Finding The Narrative In Incident Reports, La'eeqa Aslam Dec 2018

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In …


Implementation Of A Delirium Protocol In A Community Living Center: A Short And Long-Term Care Facility, Marguerite C. Burch Dec 2018

Implementation Of A Delirium Protocol In A Community Living Center: A Short And Long-Term Care Facility, Marguerite C. Burch

Graduate Theses, Dissertations, and Capstones

Delirium is the most frequent complication associated with hospitalizations of older adults and is responsible for 17.5 million hospital days at a cost of more than $6 billion each year. It is estimated delirium occurs in approximately 14 – 56% of all hospitalized elderly patients. Outcomes associated with delirium in the adult population are prolonged hospital lengths of stay, increased mortality, and post-hospitalization cognitive impairment. Hospitalized patients diagnosed with delirium may be discharged to rehabilitation centers or nursing homes for recuperation, and/or for permanent residence.

Delirium is often misdiagnosed because the presentation of signs and symptoms mimic other medical conditions …


Practice And Lived Experience Of Menstrual Exiles (Chhaupadi) Among Adolescent Girls In Far Western Nepal. December 2018, Prabisha Amatya, Saruna Ghimire, Karen E. Callahan, Binaya Kumar Baral, Krishna C. Poudel Dec 2018

Practice And Lived Experience Of Menstrual Exiles (Chhaupadi) Among Adolescent Girls In Far Western Nepal. December 2018, Prabisha Amatya, Saruna Ghimire, Karen E. Callahan, Binaya Kumar Baral, Krishna C. Poudel

Public Health Faculty Publications

Background: Menstrual exile, also known as Chhaupadi, is a tradition of “untouchability” in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi. Methods: We collected data from 107 adolescent girls using a self-administered survey in two local schools in Achham. …


#Work2bewell Powered By Providence Health & Services, Robin Henderson, Mary Renouf-Hanson Dec 2018

#Work2bewell Powered By Providence Health & Services, Robin Henderson, Mary Renouf-Hanson

Books, Presentations, Posters, Etc.

Improving mental health and emotional well-being is the focus of many community health assessments and prevention efforts. This session will focus on innovative ideas that engage youth and their families where they are—in schools, communities and while seeking healthcare. Learn from healthcare leaders at Bellin Health, Cincinnati Children’s, Providence St Joseph Health and East London NHS Foundation Trust and their community partners as they share their successful efforts to change the conversation with today’s youth.


A Multicase Study Exploring Women’S Narratives Of Infertility: Implications For Counselors, Staci L. Born, Christin L. Carotta, Kristine Ramsay-Seaner Dec 2018

A Multicase Study Exploring Women’S Narratives Of Infertility: Implications For Counselors, Staci L. Born, Christin L. Carotta, Kristine Ramsay-Seaner

The Qualitative Report

Infertility affects 6.7 million women in the United States (Chandra, Copen, & Stephen, 2013). Women’s experiences with infertility are not only influenced by biological health factors, but also by social, cultural, and personal variables. Given the prevalence and complexity of infertility, additional research is needed to further examine the nuances of women’s experiences. The purpose of this multicase study, as informed by four individual cases, was to explore how women construct their infertility narratives. Review of reflective journals found five common elements: (1) Emotional Rollercoaster, (2) Mind-Body (Dis)Connection, (3) Secret Identity, (4) Supportive vs. Constrained Communication Patterns, and (5) Fatalistic- …


Mental Health Problems Of The Youngest Generation Of American Veterans (Problemy Zdrowia Psychicznego Najmłodszego Pokolenia Weteranów Amerykańskich), Jaroslaw Richard Romaniuk Dec 2018

Mental Health Problems Of The Youngest Generation Of American Veterans (Problemy Zdrowia Psychicznego Najmłodszego Pokolenia Weteranów Amerykańskich), Jaroslaw Richard Romaniuk

Faculty Scholarship

Wartime activities determine the threats to a soldier’s life and health. To prepare soldiers for a new forms of warfare, one should know the challenges the soldier faces in the midst of battle and after returning home. From 2001 to 2015, 1.2 million American soldiers returning from Iraq and Afghanistan used the health care services of the Department of Veterans’ Affairs. An analysis of the resulting medical interventions makes possible a long term evaluation of the effects of war, some of which appear only after the soldier returns to civilian life. This study analyzes the research on the mental health …


Age-Tastic! An Evaluation Of An Evidence-Based Intervention For Older Adults, Manoj Pardasani, Jackie Berman, Mebane Powell Dec 2018

Age-Tastic! An Evaluation Of An Evidence-Based Intervention For Older Adults, Manoj Pardasani, Jackie Berman, Mebane Powell

Publications and Research

Background: Raising awareness of holistic health and safety among older adults is critical to enhancing their wellbeing in many cases, improving health outcomes and motivating positive behavioral changes. Age-Tastic! is a comprehensive health and safety promotion intervention that uses the concept of a competitive board game to entice older adults to participate and stay engaged.

Objective: The purpose of this study was to evaluate the impact of Age-Tastic! on the level of awareness, health literacy, self-efficacy and positive behavioral change among the participants.

Methods: A randomized control trial was conducted with 98 older adults assigned to an experimental and control …


Healthy Food Options At Dollar Discount Stores Are Equivalent In Quality And Lower In Price Compared To Grocery Stores: An Examination In Las Vegas, Nv, Courtney Coughenour, Timothy J. Bungum, M. Nikki Regalado Dec 2018

Healthy Food Options At Dollar Discount Stores Are Equivalent In Quality And Lower In Price Compared To Grocery Stores: An Examination In Las Vegas, Nv, Courtney Coughenour, Timothy J. Bungum, M. Nikki Regalado

Public Health Faculty Publications

Food deserts indicate limited access to and affordability of healthy foods. One potential mediator is the availability of healthy food in non-traditional outlets such as dollar-discount stores, stores selling produce at the fixed $1 price. The purpose of this study was to compare availability, quality, price differences in ‘healthier’ versus ‘regular’ food choices, price per each food item, and summary score in dollar-discount stores to grocery stores in Las Vegas using the NEMS-S; a protocol consisting of three subscores—availability, quality, price of healthier versus regular food, and a summary score. [...] see article for full abstract


The Role Of The Soldier In Civilian Life: Personal And Social Concerns That Influence Reintegration Processes, Matthew J. Ahlfs Dec 2018

The Role Of The Soldier In Civilian Life: Personal And Social Concerns That Influence Reintegration Processes, Matthew J. Ahlfs

USF Tampa Graduate Theses and Dissertations

The intent and direction of this thesis is to recognize personal and social concerns that influence soldiers’ reintegration process. The missing element in current literature is capturing the soldiers’ lived experiences, ideas, perspective and knowledge of what it truly means to be a soldier and having to reintegrate back into the civilian life after being submerged the military culture for an extended period of time. One of the vital concerns to the soldiers is how civilians, specifically the community, politicians, scholars and mental health providers, are not necessary fully aware nor do they recognize the influential impacts of the experiences …


Clinician Identified Barriers To Treatment For Individuals In Appalachia With Opioid Use Disorder Following Release From Prison: A Social Ecological Approach, Amanda M. Bunting, Carrie B. Oser, Michele Staton, Katherine S. Eddens, Hannah K. Knudsen Dec 2018

Clinician Identified Barriers To Treatment For Individuals In Appalachia With Opioid Use Disorder Following Release From Prison: A Social Ecological Approach, Amanda M. Bunting, Carrie B. Oser, Michele Staton, Katherine S. Eddens, Hannah K. Knudsen

Sociology Faculty Publications

Background: The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.

Methods: A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals …


From The Household To Watershed: A Cross-Scale Analysis Of Residential Intention To Adopt Green Stormwater Infrastructure, Sarah Coleman, Stephanie Hurley, Donna Rizzo, Christopher Koliba, Asim Zia Dec 2018

From The Household To Watershed: A Cross-Scale Analysis Of Residential Intention To Adopt Green Stormwater Infrastructure, Sarah Coleman, Stephanie Hurley, Donna Rizzo, Christopher Koliba, Asim Zia

College of Engineering and Mathematical Sciences Faculty Publications

Improved stormwater management for the protection of water resources requires bottom-up stewardship from landowners, including adoption of Green Stormwater Infrastructure (GSI). We use a statewide survey of Vermont paired with a cross-scale and spatial analysis to evaluate the influence of interacting spatial, social, and physical factors on residential intention to adopt GSI across a complex social-ecological landscape. Specifically, we focus on how three GSI practices, (“rain garden (bio retention),” “infiltration trenches,” and “actively divert roof runoff to a rain barrel/lawn/garden instead of the street/sewer”) vary with barriers to adoption, and household attributes across stormwater contexts from the household to watershed …


Similarity Of Introduced Plant Species To Native Ones Facilitates Naturalization, But Differences Enhance Invasion Success, Jan Divíšek, Milan Chytrý, Brian Beckage, Nicholas J. Gotelli, Zdeňka Lososová, Petr Pyšek, David M. Richardson, Jane Molofsky Dec 2018

Similarity Of Introduced Plant Species To Native Ones Facilitates Naturalization, But Differences Enhance Invasion Success, Jan Divíšek, Milan Chytrý, Brian Beckage, Nicholas J. Gotelli, Zdeňka Lososová, Petr Pyšek, David M. Richardson, Jane Molofsky

College of Arts and Sciences Faculty Publications

The search for traits associated with plant invasiveness has yielded contradictory results, in part because most previous studies have failed to recognize that different traits are important at different stages along the introduction–naturalization–invasion continuum. Here we show that across six different habitat types in temperate Central Europe, naturalized non-invasive species are functionally similar to native species occurring in the same habitat type, but invasive species are different as they occupy the edge of the plant functional trait space represented in each habitat. This pattern was driven mainly by the greater average height of invasive species. These results suggest that the …


The Natural Capital Accounting Opportunity: Let’S Really Do The Numbers, James W. Boyd, Kenneth J. Bagstad, Jane Carter Ingram, Carl D. Shapiro, Jeffery E. Adkins, C. Frank Casey, Clifford S. Duke, Pierre D. Glynn, Erica Goldman Dec 2018

The Natural Capital Accounting Opportunity: Let’S Really Do The Numbers, James W. Boyd, Kenneth J. Bagstad, Jane Carter Ingram, Carl D. Shapiro, Jeffery E. Adkins, C. Frank Casey, Clifford S. Duke, Pierre D. Glynn, Erica Goldman

Rubenstein School of Environment and Natural Resources Faculty Publications

No abstract provided.