Medicine and Health Sciences Commons^™

Hyperbaric Oxygen Therapy For Alzheimer’S Dementia With Positron Emission Tomography Imaging: A Case Report, Paul G. Harch, Edward F. Fogarty

Radiology Faculty Publications

A 58-year-old female was diagnosed with Alzheimer’s dementia (AD) which was rapidly progressive in the 8 months prior to initiation of hyperbaric oxygen therapy (HBOT). 18Fluorodeoxyglucose (18FDG) positron emission tomography (PET) brain imaging demonstrated global and typical metabolic deficits in AD (posterior temporal-parietal watershed and cingulate areas). An 8-week course of HBOT reversed the patient’s symptomatic decline. Repeat PET imaging demonstrated a corresponding 6.5–38% regional and global increase in brain metabolism, including increased metabolism in the typical AD diagnostic areas of the brain. Continued HBOT in conjunction with standard pharmacotherapy maintained the patient’s symptomatic level of function over an ensuing …

Ectopic High Endothelial Venules In Pancreatic Ductal Adenocarcinoma: A Unique Site For Targeted Delivery., Baharak Bahmani, Mayuko Uehara, Farideh Ordikhani, Xiaofei Li, Liwei Jiang, Naima Banouni, Takaharu Ichimura, Vivek Kasinath, Siawosh K Eskandari, Nasim Annabi, Jonathan S Bromberg, Leonard D. Shultz, Dale L Greiner, Reza Abdi

Faculty Research 2018

BACKGROUND: Nanomedicine offers an excellent opportunity to tackle treatment-refractory malignancies by enhancing the delivery of therapeutics to the tumor site. High endothelial venules (HEVs) are found primarily in lymph nodes or formed de novo in peripheral tissues during inflammatory responses. They express peripheral node addressin (PNAd), which is recognized by the monoclonal antibody MECA79.

METHODS: Here, we demonstrated that HEVs form de novo in human pancreatic ductal adenocarcinoma (PDAC). We engineered MECA79 coated nanoparticles (MECA79-NPs) that recognize these ectopic HEVs in PDAC.

FINDINGS: The trafficking of MECA79-NPs following intravenous delivery to human PDAC implanted in a humanized mouse model was …

The Interprofessional Exploration Of Occupational Deprivation (Od) In Intimate Partner Violence (Ipv) To Inform The Health Professional, Chane' Wray, Cheryl Mae Granada

OCCUPATION: A Medium of Inquiry about Health through Occupation

One of the most common forms of violence against women is intimate partner violence (IPV), a public health issue affecting one in three women globally and one in four in the nation (World Health Organization [WHO], 2016). IPV produces long-term impressions as it is defined as any behavior within an intimate relationship that causes physical, psychological or sexual harm (WHO, 2016). Women affected by IPV are inclined to isolate themselves socially decreasing their participation in daily routines (Gorde et al., 2004). The prolonged preclusion of women from necessary/meaningful occupations such as child rearing and social interaction is a conflict outside …

The Use Of Occupation-Based Interventions In Hand Therapy, Rajesh Malikayil, Justin Jameson

OCCUPATION: A Medium of Inquiry about Health through Occupation

Certified hand therapists (CHTs) provide therapeutic rehabilitative services after injury or illness of the upper extremity (Colaianni, & Provident, 2010). The approaches to interventions that CHTs utilize differ from those more typically used by occupational therapists (OTs) because the approaches to interventions are often primarily based in the medical model of physical disabilities (Robinson, Brown, & O’Brien, 2016). There is growing concern that OTs in hand rehabilitation are not using occupations as a method to intervention, leading the occupational therapy profession away from its foundational tenets (Grice, 2015). Furthermore, according to Colaianni, Provident, Lessa, and Wheeler (2015), there is a …

Survival Of Patients With Subglottic Squamous Cell Carcinoma, S D. Macneil, K Patel, K Liu, S Shariff, J Yoo, A Nichols, K Fung, A X Garg

Anatomy and Cell Biology Publications

Objective: Subglottic squamous cell carcinoma is a rare subsite of laryngeal cancer that behaves more aggressively and portends a worse prognosis. Using a population-based cancer registry, our objective was to report overall survival (OS) and laryngectomy-free survival (LFS) in patients diagnosed with subglottic squamous cell carcinoma, and to determine whether primary laryngectomy results in improved survival.

Methods: This retrospective population-based study considered patients with a new diagnosis of squamous cell carcinoma in the province of Ontario over a 15-year period (1995-2009). The Ontario Cancer Registry was examined for patients with the diagnosis of interest during the period …

Consensus-Based Care Recommendations For Adults With Myotonic Dystrophy Type 1., Tetsuo Ashizawa, Cynthia Gagnon, William J Groh, Laurie Gutmann, Nicholas E Johnson, Giovanni Meola, Richard Moxley, Shree Pandya, Mark T Rogers, Ericka Simpson, Nathalie Angeard, Guillaume Bassez, Kiera N Berggren, Deepak Bhakta, Marco Bozzali, Ann Broderick, Janice L B Byrne, Craig Campbell, Edith Cup, John W Day, Elisa De Mattia, Denis Duboc, Tina Duong, Katy Eichinger, Anne-Berit Ekstrom, Baziel Van Engelen, Belen Esparis, Bruno Eymard, Marla Ferschl, Shahinaz M Gadalla, Benjamin Gallais, Todd Goodglick, Chad Heatwole, James Hilbert, Venessa Holland, Marie Kierkegaard, Wilma J Koopman, Kari Lane, Daphne Maas, Ami Mankodi, Katherine D Mathews, Darren G Monckton, David Moser, Saman Nazarian, Linda Nguyen, Peg Nopoulos, Richard Petty, Janel Phetteplace, Jack Puymirat, Subha Raman, Louis Richer, Elisabetta Roma, Jacinda Sampson, Valeria Sansone, Benedikt Schoser, Laurie Sterling, Jeffrey Statland, S H Subramony, Cuixia Tian, Careniña Trujillo, Gordon Tomaselli, Chris Turner, Shannon Venance, Aparajitha Verma, Molly White, Stefan Winblad

Paediatrics Publications

Purpose of review: Myotonic dystrophy type 1 (DM1) is a severe, progressive genetic disease that affects between 1 in 3,000 and 8,000 individuals globally. No evidence-based guideline exists to inform the care of these patients, and most do not have access to multidisciplinary care centers staffed by experienced professionals, creating a clinical care deficit.

Recent findings: The Myotonic Dystrophy Foundation (MDF) recruited 66 international clinicians experienced in DM1 patient care to develop consensus-based care recommendations. MDF created a 2-step methodology for the project using elements of the Single Text Procedure and the Nominal Group Technique. The process generated a 4-page …

Phenytoin Activates Smad3 Phosphorylation And Periostin Expression In Drug-Induced Gingival Enlargement., Shawna S Kim, Georgia Nikoloudaki, Mark Darling, Michael J Rieder, Douglas W Hamilton

Paediatrics Publications

Drug-induced gingival enlargement (DIGE) is a fibrotic condition associated with systemic administration of the anti-epileptic drug, phenytoin. We have previously demonstrated that periostin, which is transforming growth factor-beta (TGF-β) inducible gene, is upregulated in various fibrotic conditions including gingival enlargement associated with nifedipine. The objective of this study was to assess periostin expression in phenytoin-induced gingival enlargement (PIGE) tissues and to investigate the mechanisms underlying periostin expression. Human PIGE tissues were assessed using Masson's trichrome, with cell infiltration and changes in extracellular matrix composition characterized through labeling with antibodies to periostin, phospho-SMAD 3, TGF-β, as well as the macrophage markers …

Assessment Of Interprofessional Team Collaboration Scale (Aitcs): Further Testing And Instrument Revision., Carole Orchard, Linda L Pederson, Emily Read, Cornelia Mahler, Heather Laschinger

Nursing Publications

INTRODUCTION: The need to be able to assess collaborative practice in health care teams has been recognized in response to the direction for team-based care in a number of policy documents. The purpose of this study is to report on further refinement of such a measurement instrument, the Assessment of Interprofessional Team Collaboration Scale (AITCS) first published in 2012. To support this refinement, two objectives were set: Objective 1: to determine whether the items from the data collected in 2016 load on the same factors as found for the 2012 version of the 37-item AITCS. Objective 2: to determine whether …

Dried Blood Spot Technique-Based Liquid Chromatography-Tandem Mass Spectrometry Method As A Simple Alternative For Benznidazole Pharmacokinetic Assessment, Danilo César Galindo Bedor, Noely Camila Tavares Cavalcanti Bedor, José Wellithom Viturino Da Silva, Giovana Damasceno Sousa, Davi Pereira De Santana, Facundo Garcia-Bournissen, Jaime Altcheh, Bethania Blum, Fabiana Alves, Isabela Ribeiro

Paediatrics Publications

Chagas disease (CD) is recognized as one of the major neglected global tropical diseases. Benznidazole (BNZ) is the drug of choice for the treatment of adults, young infants, and newborns with CD. However, the pharmacokinetics (PK) of BNZ have been poorly evaluated in all age groups, with consequent gaps in knowledge about PK-pharmacodynamic relationships in CD. The purpose of this study was to develop and validate a bioanalytical method to quantify BNZ levels in small-volume whole-blood samples collected as dried blood spots (DBS). The analysis was performed using high-performance liquid chromatography-positive electrospray tandem mass spectrometry. PK evaluation in healthy male …

Working Towards The Promise Of Participatory Action Research: Learning From Ageing Research Exemplars, Colleen E. Mcgrath

Occupational Therapy Publications

Within research addressing issues of social justice, there is a growing uptake of participatory action research (PAR) approaches that are ideally committed to equitable participation of community members in all phases of the research process in order to collaboratively enact social transformation. However, the utilization of such approaches has not always matched the ideal, with inconsistencies in how participation and action are incorporated. “Participation” within various research processes is displayed differently, with the involvement of community members varying from full participation to their involvement as simply participants for data collection. Similarly, “action” is varyingly enacted from researchers proposing research implications …

Algorithms For Left Atrial Wall Segmentation And Thickness – Evaluation On An Open-Source Ct And Mri Image Database, Rashed Karim, Lauren Emma Blake, Jiro Inoue, Qian Tao, Shuman Jia, R. James Housden, Pranav Bhagirath, Jean Luc Duval, Marta Varela, Jonathan Behar, Loic Cadour, Rob J. Van Der Geest, Hubert Cochet, Maria Drangova, Maxime Sermesant, Reza Razavi, Oleg Aslanidi, Ronak Rajani, Kawal Rhode

Bone and Joint Institute

© 2018 The Authors Structural changes to the wall of the left atrium are known to occur with conditions that predispose to Atrial fibrillation. Imaging studies have demonstrated that these changes may be detected non-invasively. An important indicator of this structural change is the wall's thickness. Present studies have commonly measured the wall thickness at few discrete locations. Dense measurements with computer algorithms may be possible on cardiac scans of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The task is challenging as the atrial wall is a thin tissue and the imaging resolution is a limiting factor. It is …

Ciliary Parathyroid Hormone Signaling Activates Transforming Growth Factor-Β To Maintain Intervertebral Disc Homeostasis During Aging, Liwei Zheng, Yong Cao, Shuangfei Ni, Huabin Qi, Zemin Ling, Xin Xu, Xuenong Zou, Tianding Wu, Ruoxian Deng, Bo Hu, Bo Gao, Hao Chen, Yusheng Li, Jianxi Zhu, Francis Tintani, Shadpour Demehri, Amit Jain, Khaled M. Kebaish, Shenghui Liao, Cheryle A. Séguin, Janet L. Crane, Mei Wan, Hongbin Lu, Paul D. Sponseller, Lee H. Riley, Xuedong Zhou, Jianzhong Hu, Xu Cao

Bone and Joint Institute

© 2018 The Author(s). Degenerative disc disease (DDD) is associated with intervertebral disc degeneration of spinal instability. Here, we report that the cilia of nucleus pulposus (NP) cells mediate mechanotransduction to maintain anabolic activity in the discs. We found that mechanical stress promotes transport of parathyroid hormone 1 receptor (PTH1R) to the cilia and enhances parathyroid hormone (PTH) signaling in NP cells. PTH induces transcription of integrin αvβ6 to activate the transforming growth factor (TGF)-β-connective tissue growth factor (CCN2)-matrix proteins signaling cascade. Intermittent injection of PTH (iPTH) effectively attenuates disc degeneration of aged mice by direct signaling through NP cells, …

Impaired Object-Location Learning And Recognition Memory But Enhanced Sustained Attention In M2 Muscarinic Receptor-Deficient Mice, Carola Romberg, Susan Bartko, Jürgen Wess, Lisa M. Saksida, Timothy J. Bussey

Brain and Mind Institute Researchers' Publications

© 2018, The Author(s). Rationale: Muscarinic acetylcholine receptors are known to play key roles in mediating cognitive processes, and impaired muscarinic cholinergic neurotransmission is associated with normal ageing processes and Alzheimer’s disease. However, the specific contributions of the individual muscarinic receptor subtypes (M1–M5) to cognition are presently not well understood. Objectives: The aim of this study was to investigate the contribution of M2-type muscarinic receptor signalling to sustained attention, executive control and learning and memory. Methods: M2 receptor-deficient (M2−/−) mice were tested on a touchscreen-operated task battery testing visual discrimination, behavioural flexibility, object-location associative learning, attention and response control. Spontaneous …

The Psychological Science Accelerator: Advancing Psychology Through A Distributed Collaborative Network, Hannah Moshontz, Lorne Campbell, Charles R. Ebersole, Hans Ijzerman, Heather L. Urry, Patrick S. Forscher, Jon E. Grahe, Randy J. Mccarthy, Erica D. Musser, Jan Antfolk, Christopher M. Castille, Thomas Rhys Evans, Susann Fiedler, Jessica Kay Flake, Diego A. Forero, Steve M. Janssen, Justin Robert Keene, John Protzko, Balazs Aczel, Sara Álvarez Solas, Daniel Ansari, Dana Awlia, Ernest Baskin, Carlota Batres, Martha Lucia Borras-Guevara, Cameron Brick, Priyanka Chandel, Armand Chatard, William J. Chopik, David Clarance, Nicholas A. Coles, Katherine S. Corker

Brain and Mind Institute Researchers' Publications

Concerns have been growing about the veracity of psychological research. Many findings in psychological science are based on studies with insufficient statistical power and nonrepresentative samples, or may otherwise be limited to specific, ungeneralizable settings or populations. Crowdsourced research, a type of large-scale collaboration in which one or more research projects are conducted across multiple lab sites, offers a pragmatic solution to these and other current methodological challenges. The Psychological Science Accelerator (PSA) is a distributed network of laboratories designed to enable and support crowdsourced research projects. These projects can focus on novel research questions, or attempt to replicate prior …

Father–Daughter Bonds: A Comparison Of Adolescent Daughters’ Relationships With Resident Biological Fathers And Stepfathers, Cynthia G. Campbell, Elizabeth J. Winn

Psychological Sciences Faculty Publications and Presentations

Objective: To investigate whether the interpersonal dynamics of closeness are different in stepfather–stepdaughter versus father–daughter relationships during adolescence.

Background: Establishing a general process model of the relational factors contributing to greater closeness between fathers and daughters is a preliminary step toward examining variations in such processes.

Method: The data were from the National Longitudinal Study of Adolescent to Adult Health (ADD Health), a nationally representative sample of adolescents. Respondents were female adolescents who were living with either a biological father (n = 1,881) or stepfather (n = 273) and reported on the availability and involvement of their (step)fathers, …

"Integrated Science 3002a: Big Bike Giveaway: Changing London's Environment, Health, And Economy One Bike At A Time", Jermiah Joseph, Katelyn Melo, Devanshi Shukla, Tony Nguyen, Katherine Teeter

Community Engaged Learning Final Projects

There are significant benefits that manifest when an individual chooses to ride a bicycle as their primary mode of transportation. To investigate these benefits, the environmental, health, economic, and social impacts of biking were evaluated through research and data analyses. This revealed that numerous advantages can be obtained at an individual and local scale through citizens choosing to adopt a biking lifestyle. However, it was found that many Londoners are deterred from biking due to poor biking infrastructure. This paper calls into question the current cycling framework in London and it’s limitations on achieving the numerous benefits that biking offers. …

Epidemiological Studies Of Soybean Vein Necrosis Virus And Potential Resistance Mechanisms To Its Vector Neohydatothrips Variabilis (Beach), Jing Zhou

Graduate Theses and Dissertations

Soybean (Glycine max (L.) Merrill) is one the most important crops in global agriculture with annual production of over 260 million metric tons. As the dependence of a growing global population to soybean has increased, so does the importance of soybean diseases and pests. Over 200 pathogens attack soybean; among them, viruses pose a major threat to the soybean industries accounting for approximately 10% of the annual yield reduction caused by diseases in the past two decades. Soybean vein necrosis virus (SVNV) is a relatively newly discovered virus causing the homonymous disease. The widespread occurrence of the disease in major …

2018 Fall Newsletter, Morehead State University. Nursing Department.

Nursing Department Publications Archive

2018 Fall Newsletter of the Department of Nursing at Morehead State University.

Stigma For Caring For Those With Mental Health Issues In The Student Nurse Community: A Survey, Matthew Boyd

Undergraduate Honors Theses

People living with a mental health issue is elevated both nationally and internationally, and the likelihood of a person interacting with someone who has a mental health issue is high. It is even higher for those who work in the health care profession, so understanding their attitudes on this matter is important. As a review of current literature reveals, there is not only stigma in the health care system, but there is also stigma among health care professionals and students. One of the groups of students that has not been researched to a great extent is nursing students and the …

Fuller Together: An Understanding Of The Nexus Between Disability And Food Security, Zach Curinga

Public Health, Food Studies, and Nutrition

American society is currently structured to function for those individuals bestowed with inherent abilities. As such, it ignores access to participate socially and culturally for those who are disabled. There is a trend that elected representatives often limit access of the socio-cultural rights of others who are unlike themselves, interpreted by their own personal, non-disabled, socioeconomic experience. This trend is the root of the problem for those who are disabled: they cannot access and participate in society fully, which makes them often disregarded by their representatives who do not face their same barriers.

In this thesis, I apply a human …

The Politics Of Abortion And Maternal Health: A Discussion Paper, Ihsan Ullah, Ayaz Ayub, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

Abortion should be legally allowed for women because it can save mothers from childbirth-related complications and death. Legal abortion is one of the safest methods to terminate a pregnancy when there is a risk to the mother’s health by childbirth or severe deformity of the fetus or it is unwanted. Unfortunately, approximately half of all abortions worldwide mostly in nations where abortion is severely restricted and are performed in dangerous settings. These risky abortions are a significant contributor to maternal morbidity and disability. Limiting a woman's access to an abortion does not stop abortion; rather, it just encourages more risky …

Characterizing Young Adult Exposure And Engagement With Social Media Tobacco And Nicotine Product Marketing And Messaging, Stephanie L. Clendennen

Dissertations and Theses (Open Access)

Tobacco use remains a critical public health issue in the United States. Young adults are disproportionately affected by high rates of tobacco use and heavily targeted by tobacco marketing. Social media has become an important source of exposure to tobacco and nicotine product marketing and messaging for young adults. This dissertation examined the prevalence and socio-environmental characteristics associated with young adults’ exposure to and engagement with tobacco-related social media (paper 1); the prospective associations between young adults’ exposure and engagement and tobacco and nicotine product use (paper 2); and young adults’ experiences with tobacco and nicotine product messaging on social …

Integrating Crash, Hospital, And Roadway Data To Investigate The Effect Of Cable Median Barriers On Injury Severity, Michael D. Singleton, Eric R. Green, William Nicholas Staats, I-Chen Chen

Kentucky Transportation Center Research Report

Executive Summary

• In median-involved crashes, the odds of a police-reported injury were estimated to be 42% lower on road segments with a cable median barrier (CMB) than on road segments with a concrete median barrier, and the difference was statistically significant [odds ratio 0.58, 95% confidence interval (0.43, 0.78)].
• In median-involved crashes, the odds of having an injury severity score of 8 or greater were estimated to be 34% higher on road segments with a CMB than on road segments with a concrete median barrier; however, the difference was not statistically significant [odds ratio 1.34, 95% confidence interval (0.67, 2.66). …

An Examination Of Entrainment In Typically Developing Children, Kiersten A. Pope

All Graduate Plan B and other Reports, Spring 1920 to Spring 2023

Purpose: Conversational entrainment describes the tendency for individuals to align their behavior with their communication partners and is essential for successful interaction. Evidence of entrainment in adults is robust, yet research regarding its development is sparse. Here, we investigate the effectiveness of a quasi-conversational paradigm for the purpose of identifying the speech rate entrainment abilities of children.

Method: Data were collected from a total of 50 typically developing children from 5-14 years old. Participants completed an entrainment task to identify the presence of speech rate modification depending on the presence of “fast” or “slow” stimuli. The entrainment task utilized a …

Incorporating Waist Circumference Screenings To Initiate Preventative Lifestyle Modification Education: A Feasibility Study For A Clinical Practice Change, Tracy Stahl

Doctor of Nursing Practice Scholarly Project

INCORPORATING WAIST CIRCUMFERENCE SCREENINGS TO INITIATE PREVENTATIVE LIFESTYLE MODIFICATION EDUCATION: A FEASIBILITY PILOT STUDY FOR A CLINICAL PRACTICE CHANGE

An Abstract of the Scholarly Project by

Tracy Stahl MSN, FNP-C

The purpose of this study was to evaluate provider perceptions and willingness to incorporate adult gender-specific waist circumference screenings as a clinical practice change. The project was conducted at the 4-State Advanced Practice Nurses (APN) conference in March 2018. The study consisted of a two-part study that utilized a pretest, educational PowerPoint presentation, posttest, and eight-week posttest to determine self-reported provider practices. Part one of the study analyzed the pretest …

The Impact Of Whoop Technology On Sleep, Recovery, And Performance In Naia Baseball Players, Nolan Harms

Department of Teaching, Learning, and Teacher Education: Theses and Other Student Research

Many key factors – including but not limited to – sleep, nutrition, travel, stress, and practice influence the optimization of athletic performance. Although previous studies have investigated the use of wearable technology in sport to track several such factors, peer-reviewed research specific to WHOOP technology is limited at best. The purpose of this study was to examine the impact of WHOOP technology on sleep, recovery, and batting performance in healthy NAIA baseball players. Data was collected over the course of 4 weeks of in-season play on 10 varsity NAIA baseball players (20.40 ± 0.97 years). All games – 18 total …

Nursing News & Views - December 2018, Christine Klucznik Rn

Nursing Newsletters

No abstract provided.

Gene Therapy Reimbursement Models – A Stakeholder Assessment, Aaron Bholé, Matthew Luminais, Msc, B. A. Sillah, Md, Mba

Phase 1

Introduction: The first one-time curative gene therapy was approved in December 2017 with a list price of $850,000, and there is a historic increase in gene therapy clinical trials with 89 having reached phase III as of May 2018. Gene therapy’s high upfront cost will challenge the traditional reimbursement models which are well suited for common, chronic conditions.

Objective: This stakeholder assessment surveys groups to identify existing opinions and generate insights regarding gene therapies and their reimbursement models.

Methods: A 12 question survey was sent to 200 stakeholders with the list generated from author’s contacts. Stakeholder groups targeted were providers, …

Normalized Healthcare Utilization Among Refugees Resettled In Philadelphia, 2007-2016, Kaushal Desai, Mph, Colleen Payton, Phd, Mph, Ches, Kevin Scott, Md, Brandon George, Phd, Ms, Marc Altshuler, Md

Phase 1

Background/Purpose: About 70,000 new refugees are resettled in the United States each year, of which approximately 600 are resettled in Philadelphia. This project seeks to better understand the patterns of healthcare utilization, including primary care, emergency, and hospitalization, among refugees resettled in Philadelphia, PA, between 2007 and 2016.

Methods: Demographic and healthcare utilization data for 1,144 refugees seen at Jefferson Family Medical Associates were compiled from the Jefferson Longitudinal Refugee Health Registry. Descriptive statistics were used to describe the demographic characteristics of the refugee population. Negative binomial count regressions were used to test for significant correlations between major demographic variables …

Medication Assisted Treatment In The Primary Care Setting: A Prospective Review, Bridget M. Smith, Lara Weinstein, Md

Phase 1

Introduction: Project HOME Health Services (PHHS) initiated a Medication Assisted Treatment program for Opioid Use Disorder in a primary care setting that is the first of its kind in the city of Philadelphia. This study assesses the MAT program by evaluating the Quality of Life (QoL) of the participants as well as their perception of the program.

Objective: The purpose of this study is to assess the QoL of the participants in the MAT program at PHHS and to evaluate the participants’ satisfaction with the program.

Methods: The population includes patients enrolled in the MAT program at PHHS who consented …