FAMILY CHARACTERISTICS, STATE PROGRAM EFFECTIVENESS, AND REPORT OF INADEQUATE CARE AMONG FAMILIES OF YOUNG CHILDREN WITH HEARING LOSS

Approximately 1.6 per 1,000 newborns in the U.S. are born with hearing loss. Congenital hearing loss poses a risk to their speech, language, cognitive, and social-emotional development. Early detection and intervention can improve outcomes. Every state has an Early Hearing Detection and Intervention program (EHDI) to promote and track screening, audiological assessments and linkage to early intervention. However, a large percentage of children are “lost to system (LTS),” meaning that they did not receive recommended care or that it was not reported. This study used data from the 2009-2010 National Survey of Children with Special Health Care Needs and data from the 2011 EHDI Hearing Screening and Follow-Up Survey to examine how 1) family characteristics; 2) EHDI program effectiveness, as determined by LTS percentages; and 3) the family conditions of education and poverty are related to parental report of inadequate care. The sample comprised 684 children between the ages of 0 and 5 years with hearing loss. The results indicated that living in states with less effective EHDI programs was associated with an increased likelihood of not receiving early intervention services (EIS) and of reporting poor family-centered communication. Sibling classification was associated with both receipt of EIS and report of unmet need. Single mothers were less likely to report increased difficulties accessing care. Poor and less educated families, assessed separately, who lived in states with less effective EHDI programs, were more likely to report non-receipt of EIS and less likely to report unmet need as compared to similar families living in states with more effective programs. Poor families living in states with less effective programs were more likely to report less coordinated care than were poor families living in states with more effective programs. This study supports the conclusion that both family characteristics and the effectiveness of state programs affect quality of care outcomes. It appears that less effective state programs affect disadvantaged families’ service receipt report more than that of advantaged families. These findings are important because they may provide insights into the development of targeted efforts to improve the system of care for children with hearing loss.

Applications of Photoinduced Electron Transfer Chemistry: Photoremovable Protecting Groups and Carbon Dioxide Conversion

Traditional organic chemistry has long been dominated by ground state thermal reactions. The alternative to this is excited state chemistry, which uses light to drive chemical transformations. There is considerable interest in using this clean renewable energy source due to concerns surrounding the combustion byproducts associated with the consumption of fossil fuels. The work presented in this text will focus on the use of light (both ultraviolet and visible) for the following quantitative chemical transformations: (1) the release of compounds containing carboxylic acid and alcohol functional groups and (2) the conversion of carbon dioxide into other useable chemicals. Chapters 1-3 will introduce and explore the use of photoremovable protecting groups (PPGs) for the spatiotemporal control of molecular concentrations. Two new PPGs are discussed, the 2,2,2-tribromoethoxy group for the protection of carboxylic acids and the 9-phenyl-9-tritylone group for the protection of alcohols. Fundamental interest in the factors that affect C–X bond breaking has driven the work presented in this text for the release of carboxylic acid substrates. Product analysis from the UV photolysis of 2,2,2-tribromoethyl-(2′-phenylacetate) in various solvents results in the formation of H–atom abstraction products as well as the release of phenylacetic acid. The deprotection of alcohols is realized through the use of UV or visible light photolysis of 9-phenyl-9-tritylone ethers. Central to this study is the use of photoinduced electron transfer chemistry for the generation of ion diradicals capable of undergoing bond-breaking chemistry leading to the release of the alcohol substrates. Chapters 4 and 5 will explore the use of N-heterocyclic carbenes (NHCs) as a catalyst for the photochemical reduction of carbon dioxide. Previous experiments have demonstrated that NHCs can add to CO2 to form stable zwitterionic species known as N-heterocylic-2-carboxylates (NHC–CO2). Work presented in this text illustrate that the stability of these species is highly dependent on solvent polarity, consistent with a lengthening of the imidazolium to carbon dioxide bond (CNHC–CCO2). Furthermore, these adducts interact with excited state electron donors resulting in the generation of ion diradicals capable of converting carbon dioxide into formic acid.

THE INFLUENCE OF MOTIVATION ON EMOTION REGULATION AND MOTOR PERFORMANCE: EXAMINATION OF A NEURO-AFFECTIVE MODEL

Mental stress is known to disrupt the execution of motor performance and can lead to decrements in the quality of performance, however, individuals have shown significant differences regarding how fast and well they can perform a skilled task according to how well they can manage stress and emotion. The purpose of this study was to advance our understanding of how the brain modulates emotional reactivity under different motivational states to achieve differential performance in a target shooting task that requires precision visuomotor coordination. In order to study the interactions in emotion regulatory brain areas (i.e. the ventral striatum, amygdala, prefrontal cortex) and the autonomic nervous system, reward and punishment interventions were employed and the resulting behavioral and physiological responses contrasted to observe the changes in shooting performance (i.e. shooting accuracy and stability of aim) and neuro-cognitive processes (i.e. cognitive load and reserve) during the shooting task. Thirty-five participants, aged 18 to 38 years, from the Reserve Officers’ Training Corp (ROTC) at the University of Maryland were recruited to take 30 shots at a bullseye target in three different experimental conditions. In the reward condition, $1 was added to their total balance for every 10-point shot. In the punishment condition, $1 was deducted from their total balance if they did not hit the 10-point area. In the neutral condition, no money was added or deducted from their total balance. When in the reward condition, which was reportedly most enjoyable and least stressful of the conditions, heart rate variability was found to be positively related to shooting scores, inversely related to variability in shooting performance and positively related to alpha power (i.e. less activation) in the left temporal region. In the punishment (and most stressful) condition, an increase in sympathetic response (i.e. increased LF/HF ratio) was positively related to jerking movements as well as variability of placement (on the target) in the shots taken. This, coupled with error monitoring activity in the anterior cingulate cortex, suggests evaluation of self-efficacy might be driving arousal regulation, thus affecting shooting performance. Better performers showed variable, increasing high-alpha power in the temporal region during the aiming period towards taking the shot which could indicate an adaptive strategy of engagement. They also showed lower coherence during hit shots than missed shots which was coupled with reduced jerking movements and better precision and accuracy. Frontal asymmetry measures revealed possible influence of the prefrontal lobe in driving this effect in reward and neutral conditions. The possible interactions, reasons behind these findings and implications are discussed.