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Articles 31 - 60 of 183
Full-Text Articles in Community Health
Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta
Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta
Master's Projects and Capstones
Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …
Successful Application Of Craniosacral Therapy In A Case Of Colic In An 8-Week-Old Baby, Caro O’Neill, Angie Butterfield
Successful Application Of Craniosacral Therapy In A Case Of Colic In An 8-Week-Old Baby, Caro O’Neill, Angie Butterfield
Journal of Transformative Touch
This case study reports on the effectiveness of CranioSacral Therapy (CST) for an eight-week-old baby boy experiencing colic. A CST pediatric protocol was utilized during two sessions, a week apart, in May 2023. An improvement in symptoms was recorded after the first treatment. After the second treatment the baby was no longer presenting with symptoms related to infant colic. This case suggests that CST can be an effective support for babies experiencing infant colic.
Word count: 75
Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu
Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu
Journal of Mind and Medical Sciences
Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average …
Mhealth Intervention For Elevated Blood Pressure Among College Students: Single-Arm Intervention Study, Dieu-My T. Tran, Catherine E. Dingley, Roger Bonilla
Mhealth Intervention For Elevated Blood Pressure Among College Students: Single-Arm Intervention Study, Dieu-My T. Tran, Catherine E. Dingley, Roger Bonilla
Nursing Faculty Research
Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population.
Objective: The purpose of this study was to …
Sexual Well-Being And High-Risk Behaviors : An Exploratory Mixed Methods Study For Questionnaire Development, Stephan R Smith
Sexual Well-Being And High-Risk Behaviors : An Exploratory Mixed Methods Study For Questionnaire Development, Stephan R Smith
Covenant Nurses Week 2024
No abstract provided.
Supporting South Korea’S Aging Population: How Ai And Iot Acceptance Connects The Young And Old, Bobby Im
Supporting South Korea’S Aging Population: How Ai And Iot Acceptance Connects The Young And Old, Bobby Im
Master's Projects and Capstones
In 2024, South Korea surpassed every other nation by becoming the country with the lowest fertility rate (below 0.7%). Population decline will hinder future ability to care for their aging population and although the government and private corporations are investing millions of dollars on developing Artificial Intelligence-Internet of Things (AI-IoT) devices to support the aging, the acceptance levels and the amount of family support required is undervalued. By examining AI-IoT’s current use and role in South Korea’s public health system this paper shows how intergenerational support helps optimize existing procedures and equipment, increases the level of acceptance and use, and …
Exploring The Lived Experience Of Self-Care In Young Adults With Type 2 Diabetes, Holly Berry-Price
Exploring The Lived Experience Of Self-Care In Young Adults With Type 2 Diabetes, Holly Berry-Price
Electronic Theses and Dissertations
Introduction
The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM.
Purpose
The purpose of this research was to explore the self-care experiences of young adults living with T2DM.
Methods
Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults …
Medication Assisted Therapy And First Episode Psychosis: Evaluating Treatment And Readmission Rates, Kayla Sherea Williams Bsn, Rn, Hannah Lee Brenner Bsn, Rn, Madison Makenzie Yount Bsn, Rn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc
Medication Assisted Therapy And First Episode Psychosis: Evaluating Treatment And Readmission Rates, Kayla Sherea Williams Bsn, Rn, Hannah Lee Brenner Bsn, Rn, Madison Makenzie Yount Bsn, Rn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc
Doctor of Nursing Practice Projects
Background The Centers for Disease Control and Prevention (CDC) found that each day more than 140 U.S. residents die from drug overdoses, specifically due to opioids. Due to this, alternatives were created to reduce overdoses and ensure safety. Medication assistance therapy (MAT) is an effective form of treatment for people with substance use disorders and is defined as the use of medication in conjunction with counseling or therapy for the treatment of substance use disorders. The efficacy of MAT is used adjunctively with psychotropic medications compared to using no MAT and using psychotropic medications alone with individuals who are experiencing …
Police Versus Non-Police Response To 988 Crisis Calls, Miriam A. Maloney-Mattheisen Bsn, Rn, Latrina N. Blakemore Msn, Fnp-Bc, Janelle M. Scullark Msn, Fnp-C, Jacqueline Sharp Dnp, Pmhnp-Bc, Sharon Little Dnp, Fnp-Bc, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn
Police Versus Non-Police Response To 988 Crisis Calls, Miriam A. Maloney-Mattheisen Bsn, Rn, Latrina N. Blakemore Msn, Fnp-Bc, Janelle M. Scullark Msn, Fnp-C, Jacqueline Sharp Dnp, Pmhnp-Bc, Sharon Little Dnp, Fnp-Bc, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn
Doctor of Nursing Practice Projects
Purpose/Background
The 988 Suicide & Crisis Lifeline is a mental health-specific emergency line that became nationally available in July of 2022. This resource allows callers in crisis to connect with trained mental health professionals. Despite the initiation of this new dispatching service, there is still a significant shortage of trained mental health professionals to respond to these calls when they require emergency intervention. The present scoping review aims to determine whether non-police crisis responses correlate to improved outcomes when compared to police response as evidenced by reduced inpatient admissions, reduced arrests, and decreased presence of intrusive traumatic symptoms following intervention. …
Coping Strategies During The Covid-19 Pandemic Among The Undergraduate Nursing Students Attending Virtual Classes In Selected Nursing Institutions Of Udupi Taluk, Karnataka., Rohan Shettigar Mr, Karthik Gavalkar Mr, Jeeshpa Karkera Ms, Pooja P Ms, Swathi Shenoy Ms, Pratibha Kamath, Radhika R. R Pai Dr
Coping Strategies During The Covid-19 Pandemic Among The Undergraduate Nursing Students Attending Virtual Classes In Selected Nursing Institutions Of Udupi Taluk, Karnataka., Rohan Shettigar Mr, Karthik Gavalkar Mr, Jeeshpa Karkera Ms, Pooja P Ms, Swathi Shenoy Ms, Pratibha Kamath, Radhika R. R Pai Dr
Manipal Journal of Nursing and Health Sciences
Introduction
Psychological and sociocognitive behavior changes will occur during the Covid-19 pandemic, especially concerning students’ academic activities, which might impact one's health and well-being. As a result of this, it could result in dysfunctional behaviors and unhealthy lifestyles, which may indicate a shift in well-being that calls for quick attention and intervention.
Methods
A descriptive survey design was adopted for the present study to identify the coping strategies adopted by nursing students during COVID-19. The study was conducted among 60 fourth-year B.Sc. Nursing students using the purposive sampling technique. The data was collected using structured questionnaires on coping strategies adopted …
Epds-Us (English), Sara W. Moyer, Patricia Kinser
Epds-Us (English), Sara W. Moyer, Patricia Kinser
School of Nursing Publications
How we talk about perinatal mental health matters, even in the minute details of words on screening forms. Any shifts towards removing barriers to screening, reducing stigma, encouraging disclosures, raising awareness related to symptom prevalence and the breadth symptom related experiences, and creating opportunities for connecting with support and care are essential.
In the EPDS-US, we have adapted the wording of the original Edinburgh Postnatal Depression Scale (EPDS), using a respectful care and trauma-informed approach with a focus on optimizing patient experiences and clinical utility while maintaining reliability and validity of the 10 item scale. Many individuals report feelings of …
Promoting Parental Comfort To Facilitate Conversations On Adolescent Sexual Health And Behaviors, Angelina Jolie Banes, Lauren Liddell
Promoting Parental Comfort To Facilitate Conversations On Adolescent Sexual Health And Behaviors, Angelina Jolie Banes, Lauren Liddell
Nursing | Senior Theses
This thesis proposal will investigate the impact of a comprehensive digital sexual health education program on the comfort levels of parents and teens when discussing sensitive topics such as pregnancy and sexually transmitted infections (STIs). The research is guided by Orem’s Self-Care Deficit Nursing Theory, which emphasizes the need to assess and address individuals’ self-care deficits, including the ability to engage in safe and informed sexual behaviors. The research design is a quantitative, quasi-experimental study with a one-group pre and post-test design. The sample consists of 50 parents and 50 teens from Marin County, who will participate in an online …
The Education Prescription: Exploring The Potential Of Patient Education To Reduce Mental Health Issues In Hormonal Contraceptive Users, Maria Abraham
The Education Prescription: Exploring The Potential Of Patient Education To Reduce Mental Health Issues In Hormonal Contraceptive Users, Maria Abraham
Nursing | Senior Theses
The many birth control options available impact a woman’s life, as hormonal contraceptives are commonly used but often misunderstood. These contraceptives, which contain progestin only, or estrogen and progestin combined, can come in various forms such as pills, implants, IUDs, injections, the vaginal ring, and skin patches. They offer benefits such as reduced menstrual cramps and ectopic pregnancy risk. However, they may lead to adverse side effects which can include increased blood pressure, nausea, headaches, breakthrough bleeding, and a higher risk of blood clots, with research indicating a potential link between oral contraceptive use and a decline in the user’s …
Guideline For Creating A Support Group For Adults With Down Syndrome Who Suffer With Prolonged Grief, Brandon Chace Warman
Guideline For Creating A Support Group For Adults With Down Syndrome Who Suffer With Prolonged Grief, Brandon Chace Warman
Doctor of Nursing Practice (DNP) Scholarly Projects - Archive
Adults with Down syndrome process and express their grief differently from the general population. There are a multitude of support groups and organizations for individuals grieving a loss and experiencing prolonged grief but there are none that exist for people with Down syndrome. This project develops a guideline for creating support groups aimed at adults with Down syndrome who experience prolonged grief. Fifty-one pieces of literature from all over the world were reviewed to formulate recommendations that were graded by seven stakeholders. These recommendations were then used to develop a guideline for creating support groups for this population. Analysis of …
Improving Discharge Education Quality In Urgent Care Settings: A Quality Improvement Project, Brielle N. Patscheider
Improving Discharge Education Quality In Urgent Care Settings: A Quality Improvement Project, Brielle N. Patscheider
Master's Theses and Capstones
BACKGROUND:
Effective discharge education is vital for improving patient care by enhancing health outcomes and reducing hospital readmission. When patients receive thorough and personalized discharge instructions, they are better able to manage their health, follow treatment plans, and identify symptoms needing further attention. This not only boosts patient satisfaction and safety but also reduces the strain on healthcare systems by decreasing preventable readmissions.
LOCAL PROBLEM:
Urgent care facilities serve diverse populations with a range of common, non-emergency ailments. The rapid service and walk-in availability often lead to a high volume of patients with diverse and complex medical needs. To eliminate …
Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia
Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia
Journal of Nonprofit Innovation
Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.
Imagine Doris, who is …
Navigating Transitions: Cranialsacral Therapy, Occupational Therapy And Neuroregulation Strategies For Adjusting To A New Home, Carol J. Reshan
Navigating Transitions: Cranialsacral Therapy, Occupational Therapy And Neuroregulation Strategies For Adjusting To A New Home, Carol J. Reshan
Journal of Transformative Touch
Report of working with a hyper-vigilant 9-year-old male with difficulty handling a transition to a new home. CST and sensory processing enhancement were utilized to help develop neuroregulation, enabling self-awareness, self-regulation, and personally directed life skills for maintaining a safe and alert state.
Policy Review And Recommendation For Secondary Education Np-Led Clinics In The Southeastern United States, Shiney Alex Jacob
Policy Review And Recommendation For Secondary Education Np-Led Clinics In The Southeastern United States, Shiney Alex Jacob
Student Scholarly Projects
Secondary-level education involves adolescent children aged 11-12 years to 18-19 with unique healthcare needs. Their healthcare is of significant importance as they are transitioning to adulthood, and a majority of them lack access to primary healthcare needs. Advanced Practice Registered Nurses/Nurse Practitioners (APRNs/NPs) provide high-quality, cost-effective, and evidence-based care to people across the lifespan, and there is minimal utilization of their services in meeting the primary care needs of adolescents at the secondary school level. The purpose of the policy project was to determine if current policies and practices related to school health services in three southeastern states of the …
Wellness Review 2023, Part 1, Brian A. Ferguson, Martin Huecker
Wellness Review 2023, Part 1, Brian A. Ferguson, Martin Huecker
Journal of Wellness
Introduction: The 2023 Part 1 summary reviews research on wellness in healthcare professionals published outside of JWellness from January 1, 2023 to June 30, 2023.
Methods: Editors conducted a Boolean search of titles and abstracts in PubMed utilizing keyword identifiers pairing healthcare personnel (providers, nurses, and other staff) with a well-being metric. Of 416 relevant articles, an intriguing and innovative 30 were selected for inclusion, with two additional articles manually curated.
Literature in Review: This sample of the recent literature into healthcare professional wellness included multiple targeted interventions and studies of resilience. Main themes that emerged include: positive systematic healthcare …
Reducing The No Show Rates For Mental Health Appointments Among Young Adults, Johnnie Carrico
Reducing The No Show Rates For Mental Health Appointments Among Young Adults, Johnnie Carrico
Student Scholarly Projects
Practice Problem: Missed patient appointments have become an increasingly significant issue for healthcare organizations, private practices, and clinics. No show appointments can negatively impact the operational functions of these organizations including lost revenue. The clinical practice site’s pre-intervention no-show rate for young adult mental health appointments was 21%. The high percentage of missed mental health visits has resulted in both lost revenue for the clinic and disruptions in patient care.
PICOT: The PICOT question that guided this project was: In young adults 18-25 years with mental health appointments (P) how does patient preferred appointment reminders (I) compared to …
Community Health Worker Program: Chronic Non-Communicable Diseases In Children, Julia L. Newell
Community Health Worker Program: Chronic Non-Communicable Diseases In Children, Julia L. Newell
DNP Qualifying Manuscripts
Abstract
Background: Childhood obesity, asthma, and untreated mental health conditions, are three examples of chronic non-communicable diseases (CNDs) that pose a host of negative consequences later in life. Community health workers (CHWs) are in a unique position to address these negative health externalities by leveraging linguistic, cultural, and socioemotional connectedness within their communities.
Local Problem: Minority children in the Central Valley of California, face additional risk factors for the development of CNDs. CHWs working in this area require enhanced training on CNDs to improve their practice.
Methods: In partnership with Save the Children (STC), the University of San Francisco (USF) …
The Caregiver Of The Child With Cerebral Palsy: The Unnoticed Victim, Taylor Tusinski
The Caregiver Of The Child With Cerebral Palsy: The Unnoticed Victim, Taylor Tusinski
Dissertations
The purpose of this study was to better understand the overall quality of life (QoL) in the primary caregiver who provides care to the child or adolescent, aged 0-17 with mild, moderate, or severe Cerebral Palsy (CP). This study aligned with a nonexperimental or observational design and examined the severity level of CP and the QoL in the mother and/or father.
For research question 1, regression results indicated that the overall model did not significantly predict the mother’s and father’s QoL [R2 = .000, R2 adj = -.012, F(1,80) = .003, p = .957]. Regression results indicated that …
A Program Evaluation Of Domestic Violence Screening At A Large Urban Hospital., Taylor L'Heureux
A Program Evaluation Of Domestic Violence Screening At A Large Urban Hospital., Taylor L'Heureux
Doctor of Nursing Practice Papers
Domestic violence has been deemed a direct invasion and violation of human rights by the World Health Organization (2021). Due to the continuous rise in cases of domestic violence, national organizations like the United States Preventative Services Task Force (USPSTF) have recommended that healthcare providers screen patients for this abuse. The purpose of this study was to reinforce the current screening procedure and protocol to ensure that each patient was screened for domestic violence before being discharged from the hospital. This study evaluated a quality improvement project formed to promote the completion of a preexisting domestic violence screening form that …
Social Identities And Campus Belonging As Predictors Of Flourishing Among College Students, Christine Gilchrist
Social Identities And Campus Belonging As Predictors Of Flourishing Among College Students, Christine Gilchrist
Dissertations, Theses, and Capstone Projects
Annual data since 2012 shows college students’ flourishing (a measure of psychological well-being) in continuous decline, with 2022 showing the largest decrease. Since the knowledge base of the predictors of flourishing is limited, how college executives can best address this issue is unclear. Variations in flourishing have been observed in studies that examined the relationship between food insecurity (DeBate et al., 2021), race/ethnicity (Lipson et al., 2018, 2022; Nyunt et al., 2022; Parr, 2022), immigration status (Cadenas & Nienhusser, 2021), as well as gender identity and sexual orientation (Parr, 2022). The intersectional impact of demographic and social identities has not …
Burnout: An Examination Of How Human Services’ Cultures Impact Person-Centered Care And Job Satisfaction, Ebony Webb
Burnout: An Examination Of How Human Services’ Cultures Impact Person-Centered Care And Job Satisfaction, Ebony Webb
Master's Projects and Capstones
In a world that demands the constant requirement of adaptability and technology, the need for ‘hands on the ground’ continues to persist, and perhaps even grow. This research project explores burnout in the healthcare and nonprofit settings, as a pre-existing and ongoing issue, that was brought to centre-stage during the Covid-19 pandemic. The researcher explores the intersections of burnout with workplace culture, person-centered care (PCC), sweat equity and duty-of-care, through expert interviews and literature reviews. Data collected provides an immediate understanding of current workplace cultures and environments for human service providers, in both healthcare and nonprofit sectors. While the data …
Therapeutic Gardening For Mental Health In Substance Use Recovery, Stephanie E. Schafer
Therapeutic Gardening For Mental Health In Substance Use Recovery, Stephanie E. Schafer
Master's Projects and Capstones
Abstract
As the clinical nurse leader (CNL) in this project, I used the “[CNL]
Essential 1: Background for Practice from Sciences and Humanities” (Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice, 2013) and its competencies to focus on designing nursing care for a clinical or community-focused population based on biopsychosocial, public health, nursing, and organizational sciences and to synthesize evidence for practice to determine appropriate application of interventions across diverse populations. With the help of the CNL competencies and collaboration with the healthcare team, we created and implemented a therapeutic garden for residents in a substance use …
Mental Health Navigators Bridging The Gap Of Care, Valentina Loreto-Ashley
Mental Health Navigators Bridging The Gap Of Care, Valentina Loreto-Ashley
DNP Qualifying Manuscripts
Individuals with schizophrenia are most vulnerable at time of discharge due to risk factors that lead to relapse, re-admission, suicide and/or danger to others. A successful discharge process can decrease overall care costs, promotes team collaboration, supports the therapeutic relationship between client and care provider, and helps the client to reach autonomy and self-efficacy. This DNP is a quality improvement project that aims at educating Mental Health Navigators about symptoms of schizophrenia, medications management, and community resources. Effectiveness of the educational intervention will be assessed as the differences between the pre- and post-test assessment score on insight or lack of …
Psychometric Evaluation Of Phq–9 And Gad–7 Among Community Health Volunteers And Nurses/Midwives In Kenya Following A Nation-Wide Telephonic Survey, Sabina Odero, Paul Mwangi, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar
Psychometric Evaluation Of Phq–9 And Gad–7 Among Community Health Volunteers And Nurses/Midwives In Kenya Following A Nation-Wide Telephonic Survey, Sabina Odero, Paul Mwangi, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar
Institute for Human Development, East Africa
Background: Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya.
Methods: Between June and November 2021, a national survey on mental well-being …
Tiny Tusk Internship: Barriers To Effective Breastfeeding Within Low Socioeconomic Populations, Catherine Johnson
Tiny Tusk Internship: Barriers To Effective Breastfeeding Within Low Socioeconomic Populations, Catherine Johnson
The Eleanor Mann School of Nursing Undergraduate Honors Theses
Tiny Tusk Breastfeeding and Infant Support is a program created to facilitate safe and quiet places for mothers to breastfeed at various events at the University of Arkansas. It serves as a platform to spread important and essential information about breastfeeding to mothers and reach various women all from different backgrounds and populations. The purpose of this review of literature is to identify barriers that women within low socioeconomic populations face that influence their decision to breastfeed. These barriers included lack of social support from family, friends, and healthcare providers; latch difficulty; and concerns of milk supply. Altogether, low-income women …
Clinical Decision Support System For Standardization Of Disease-Specific Education, Paul Nava
Clinical Decision Support System For Standardization Of Disease-Specific Education, Paul Nava
Student Scholarly Projects
The evidence-based, contextually relevant, disease-specific health education materials aim to provide strategies for improvement in health literacy, disease management comprehension, and medication adherence. The health education materials address difficulties many adults experience in understanding health information. The health education system must remain a contextually relevant, patient-specific reference for standardizing disease-specific education according to the patient's mental capability (Fereidouni et al., 2019). Nurse-driven education material system addresses equity, diversity, and inclusion, tailored for all literacy degrees.
Clinical decision-making is a complicated process influenced by a highly variable process that exponentially increases error rates, selection, or exclusion, unintended or not, by presenting …