Author Archives: Steven Okelley


Project Title: Implementing a Cardiac Rehabilitation Telehealth Program to Improve Access and Outcomes

Background: Cardiovascular disease is the leading cause of death in the United States. Regular participation in cardiac rehabilitation (CR) programs after a cardiac event has been shown to significantly reduce mortality and hospital readmissions while improving quality of life. Despite the documented benefits, nationally only 15-30% of eligible patients complete a CR program. Barriers to participation include lack of accessible programs, transportation difficulties, costs, and work or family constraints. Telehealth offers an innovative solution to expand access by allowing remote monitoring and participation in CR. More evidence is still needed on the efficacy and best practices of telehealth-based CR.

Project Goals: The goals of this capstone project are to:

1) Implement a telehealth-based CR program allowing remote participation and monitoring for patients at my clinic who are unable to attend onsite sessions.
2) Evaluate the impact of the telehealth CR program on outcomes including program adherence/completion rates, readmission rates, quality of life, and cardiac risk factors after 6 months.
3) Identify best practices and lessons learned from implementation to refine the telehealth CR program.

Methodology: This project will follow a quality improvement framework. In the planning phase, I will conduct a comprehensive literature review on telehealth-based CR. I will identify an evidence-based telehealth platform and prototype virtual sessions. In collaboration with CR nurses, exercise physiologists, and an IT specialist, we will develop protocols for remote monitoring, exercise prescriptions, education modules, and technical/user support.

In the implementation phase, I will train the CR team on the telehealth program. We will enroll 30 English and Spanish-speaking patients referred to CR but unable to attend onsite. Written consent will be obtained to participate and be evaluated. At baseline and 6 months, I will collect data on clinical variables, quality of life (Minnesota Living with Heart Failure and Short Form-36 surveys), and program usage/satisfaction through interviews. Virtual sessions will include exercise training, education on lifestyle/medication management, and peer/staff support twice weekly for 6-12 weeks. Continuous remote monitoring tools will track activity, vital signs, weight, and symptoms.

In the evaluation phase, I will analyze clinical and survey outcomes to assess the impact of telehealth CR compared to usual care. Readmission rates will be obtained from medical records. Patient interviews will identify barriers/facilitators. Using a predetermined analytic plan, I will evaluate if telehealth improved adherence rates by at least 10% and reduced readmission rates by 5% compared to usual care. If successful, qualitative findings will help determine best practices to refine and disseminate the program model. Limitations, unexpected findings, and implications for future research will also be discussed.

Anticipated Outcomes: This innovative capstone project has the potential to demonstrate telehealth is an effective strategy for increasing CR access and participation among underserved patients. If telehealth CR improves outcomes compared to usual care, it could serve as an evidence-based model for wider implementation. By addressing barriers and promoting remote support, more patients may experience the life-saving benefits of rehabilitation after a cardiac event. This work aligns with my goals as a cardiology nurse to advance quality, equitable care through application of research and technologies.


The word “unhumous” does not appear to be a standard English word according to most dictionaries. By breaking down the root words and analyzing the context in which the word was used, we can infer its potential meaning.

The root word “humous” does not appear to be a standard English word on its own either. By analyzing its linguistic structure, we can deduce that it is likely related to the word “humus”, which refers to organic matter in soil or a mixture of decomposed organic material in soil.

Given the root “humus” relates to decomposed organic matter, the prefix “un-” placed in front of “humous” would suggest a meaning related to the lack or absence of something connected to humus or decomposed organic matter.

The prefix “un-” is commonly used in the English language to indicate a negative or reversal of the action or state of the base word. For example, “happy” versus “unhappy”, “lock” versus “unlock”, “do” versus “undo”, and so on.

So placing “un-” in front of “humous” logically implies a meaning along the lines of “not humous” or “lacking humus/decomposed organic matter”.

To further analyze the potential meaning and confirm the context in which it was used, it would be helpful to understand more about the specific situation or text where the word “unhumous” appeared. Without that additional contextual information, we can only infer the likely meaning based on the morphemic analysis of breaking the word into its constituent parts.

Some possible inferred meanings of “unhumous” could include:

  • Lacking humus or decomposed organic matter content. This could refer to soil that has very little humus or organic material present.
  • Not related to or involving humus. For example, a substance or process that is “unhumous” would not be connected to or influenced by humus.
  • Deficient in or void of humus. Implying a lack of or very low level of humus or decomposed organic material.
  • Absence of humus-derived nutrients. Referring to a lack of important nutrients that are usually obtained from humus breakdown in soil.
  • Non-humic. Drawing a distinction from being humic, which relates to humus or substances containing humus derivatives.
  • Without humification. The process by which organic materials like plant debris are broken down into humus over time would not occur or be present.

While “unhumous” does not appear to be a standard English word, based on a morphological and contextual analysis, its most likely meaning relates to the state of lacking or being deficient in humus or decomposed organic matter content and derivatives. The exact intended sense would need to be understood within the specific context where the unorthodox word was used.

I hope this extensive etymological examination and inferred definition analysis of the non-standard word “unhumous” provided a sufficiently detailed response as requested.


A Paper Science and Chemical Engineering degree program provides students with an interdisciplinary education that incorporates both engineering and science. This major is designed for students interested in working in the paper, pulp, packaging, and related process industries. Through a combination of paper engineering, chemistry, and other technical courses, students gain an in-depth understanding of the science and technology behind the manufacture of paper, pulp, composite materials, bioproducts and new advanced materials.

The goal of a Paper Science and Chemical Engineering program is to prepare graduates for careers in research, development, production, process engineering, quality control, operations management, technical service, or environmental compliance within industries that harness wood, agricultural and plant fibers into everyday products. Specific career paths include working as a chemical, pulp, paper or process engineer involved in areas such as plant operations, manufacturing, process design and development, product development, technical support, or quality control. Graduates may also find opportunities in consulting, technical sales, research and development, or environmental health and safety roles. Some even use their skills and training to start their own businesses.

The technical coursework in a Paper Science and Chemical Engineering curriculum covers subjects such as wood science and fiber morphology, pulping and bleaching processes, papermaking and converting operations, pulp and paper testing and characterization methods, chemistry applied to pulping and bleaching, process design and control, mass and energy balances, fluid mechanics, heat and mass transfer, separations, reaction kinetics, process dynamics and control, and allied fields of chemistry, biology and microbiology. Students gain hands-on lab experience operating and performing experiments on modern pilot scale papermaking, pulping and converting equipment. Computer applications involving process modeling, simulation, and instrumentation and process control are also incorporated.

In addition to technical pulp and paper courses, the curriculum includes core engineering science classes in calculus, physics, statistics, and thermodynamics. Students also take general education courses in communications, economics, and the humanities to attain a well-rounded education. The program is engineered to provide students with opportunities for industrial internships which allow them to apply their classroom and lab knowledge and training to real-world production and process situations. Many employers seek out interns and co-op graduates to recruit as full-time hires after graduation due to their relevant work experience.

The educational emphasis on an interdisciplinary blend of science, engineering, technology and business/management uniquely equips Paper Science and Chemical Engineering graduates for success in industry. They are educated to seamlessly integrate technical, operational and business considerations for addressing the cutting-edge opportunities and challenges facing the pulp, paper and biochemical industries worldwide. Graduates have the versatility to work beyond traditional pulp and paper mills and find roles in new advanced materials, biorefinery and bioproduct sectors. Typical job functions include improving processes, developing and applying new technologies, managing operations, performing quality and environmental compliance activities, conducting applied research, adapting processes for new product development, implementing automation and control systems, undertaking capital project management, and supporting regulatory functions.

With a growing global population and corresponding rise in consumption of paper and paper-based products, an aging workforce in traditional forest products industries, the emergence of new biobased materials and related advanced manufacturing opportunities, and the need to develop more sustainable processes, there exists significant demand and career prospects for Paper Science and Chemical Engineering graduates. Megathemes around the bioeconomy, circular economy and renewable/biobased materials are driving growth. The future looks bright for addressing technical and operational challenges through multidisciplinary problem solving with a systems perspective taught within these engineering programs. Graduates possess skills needed to transition industries to renewable resources and technologies while ensuring efficient, environmentally responsible operations well into the future. The combination of scientific rigor and hands-on training uniquely equips program alumni for strategic leadership roles that enhance both business viability and environmental responsibility within diverse technology-driven industries.


The death penalty has been a highly controversial issue throughout modern history. Supporters argue that it deters crime, correctly punishes the worst offenses, and protects society. Opponents maintain that it is an inhumane form of punishment that is cruel and unusual, irreversible if a mistake is made, distributed unequally, and supported through inherent bias and discrimination in the criminal justice system. This dissertation has thoroughly examined moral, practical and legal arguments on both sides of this debate.

While supporters claim the death penalty effectively deters murder rates by serving as an example of the ultimate sanction, the evidence does not conclusively prove this theory. Numerous empirical studies have found no correlation or have found a positive correlation between use of capital punishment and murder rates. Its deterrent effect is questionable considering that many other factors like imprisonment terms, probability of apprehension, the state of the economy, drug use, and demographics influence murder rates. The possibility of wrongful convictions threatens the rationale behind retribution and deterrence. While arguably few in number compared to valid convictions, the over 160 death row exonerations since the 1970s indicate that mistakes are made in the adversarial system. This reflects ongoing flaws that risk legalizing murder by the state.

The application of the death penalty also raises serious moral concerns regarding dignity, fairness, and inhumanity. Execution constitutes an intentionally imposed, irreversible denial of human dignity and life, violating fundamental human rights principles against cruel punishment. The lengthy process imposes mental suffering on inmates, while providing no benefit to victims’ families. The arbitrary nature of which killers receive death further erodes moral authority, since African American defendants are still more likely to be sentenced to death, especially for killing white victims. Income level and quality of legal defense also introduce unequal treatment. As the most severe sanction, it must be reserved for only the very worst crimes where the accused’s guilt and full culpability is certain without doubt. In practice, this high threshold is difficult for any legal system to meet in a wholly fair and impartial manner.

On the other hand, some arguments for retaining capital punishment deserve fair consideration. Certain very brutal murders that involve torture, multiple victims or the murder of children could reasonably merit society’s harshest punishment. Lethal injection as a method is designed to be humane and painless when carried out properly. For some, the death penalty’s enduring public support reflects a democratic consensus that deserves respect. Opinion polls also indicate public preferences may depend on other sentencing alternatives presented; support drops when life without parole is an option. Any policy that denies human dignity must be weighed very carefully in a civilized society that values due process and equal treatment under the law.

Upon considering all of these complex moral, legal and empirical issues, my view is that the risks and flaws inherent in the administration of the death penalty outweigh the potential benefits claimed by proponents. The concerns regarding wrongful convictions, unequal treatment, lack of clear deterrence, inhumanity, and erosion of due process standards cannot be dismissed or remedied. Even a single miscarriage of justice through a wrongful execution undermines the retributive aims of just deserts and outweighs all other practical considerations. Ultimately, the state should not be in the business of intentionally imposing the irreversible denial of life. The death penalty is an archaic and imperfect system that violates evolving standards of decency in a modern democracy that values dignity and rehabilitation over retribution at all costs. Given the lack of compelling evidence that it achieves legitimate social purposes better than available alternatives, the prudent course of action would be to abolish it in favor of life without parole sentencing in the most heinous murder cases. This conclusion maintains justice and community protection whilst avoiding the unacceptable moral risks inherent in state-sanctioned killing that cannot be reversed if errors are discovered later. A just, compassionate and progressive society should move on from using the premeditated and irreversible denial of human life as a form of punishment.


The diverse regions of Asia and Oceania showcase an array of geographic features, climates, and cultures across a hugely vast area that makes up nearly half the world’s population. From the icy mountains and steppes of Central Asia to the tropical rainforests and beach-lined coasts of Southeast Asia and the Pacific Islands, this region exhibits incredible geographic diversity. In this essay, I will examine key geographic aspects of Asia and Oceania, including physical landscapes, climate patterns, population distributions, and economic activities, showing how geography has strongly influenced the development of civilizations and nations across the area.

Let us begin with the physical geography. Stretching from Western Asia all the way to the Pacific, Asia incorporates a wide range of climates and landscapes. In the north, Siberia experiences bitterly cold and long winters, with permanently frozen underground layers of soil called permafrost. Mountain systems such as the Himalayas and Tian Shan in Central Asia include some of the highest points on earth, with over 50 peaks exceeding 7,000 meters in elevation. Southeast Asia contains a mix of low-lying coastal plains as well as densely forested highlands and mountain interiors. Island nations in the Pacific range from low-lying coral atolls that are rarely more than a few meters above sea level to mountainous volcanic islands such as New Zealand.

The climates of Asia and Oceania broadly follow latitude-based patterns but are influenced by the predominant monsoon systems. Northern Asia has humid continental or subarctic climates with long, cold winters. Central and Western Asia experience dry, warm summers and mild to cold winters in an arid or semi-arid climate regime influenced by subtropical high pressure zones. South and Southeast Asia are dominated by tropical wet and dry climates under the alternation of the Southwest and Northeast Asian monsoon wind systems. Regions within the tropical zone like Indonesia receive abundant rainfall year-round while areas on the edges experience drier seasons. Oceania encompasses climates from tropical rainforest to cool temperate, with warm to hot and humid conditions dominating much of Melanesia and Micronesia.

In Asia, population density varies tremendously depending on climate, terrain, and economic conditions. Densely populated regions include Eastern China, India, and islands of Southeast Asia like Java and Luzon. Central Asia, Siberia, and interior portions of South and Southeast Asia have very low population densities due to their remoteness, high elevations and rugged terrain which pose geographic barriers. Coastal plains and major river valleys have historically seen high population concentrations due to their suitability for agriculture and transport links. In Oceania, most of the population lives in Southeast Melanesia, Micronesia and Polynesia islands and island groups rather than the sparsely inhabited areas like Papua New Guinea highlands and interior. Australia and New Zealand have populations concentrated in capital cities and coastal areas suitable for urban development and agriculture.

Geographic factors like climate, terrain and natural resources have heavily influenced patterns of economic activity across Asia and Oceania over the past centuries. For example, rice has long been a staple food crop throughout the humid tropics and subtropics of mainland and island Southeast Asia. Wheat and millet are important in the drier northern zones. Tea production is centered in mountainous regions of eastern China, northeast India and northern Vietnam. Petroleum and natural gas extraction now dominate the economies of West Asian nations like Saudi Arabia and the Gulf states. Fishing and fish/shellfish aquaculture are major industries for coastal communities throughout Asia and Oceania, especially in Southeast Asia, Japan and the Pacific Islands. Hydropower generation occurs in the Himalayan region utilizing glacier-fed rivers. Mining industries extract bauxite, tin, nickel, gold and coal from regions like Indonesia, Australia and Papua New Guinea. Tourism thrives in areas blessed with beaches, reefs, rainforests and cultural heritage like Thailand, Bali, Fiji and New Zealand. Manufacturing and electronics assembly are concentrated around major river deltas and port cities facilitated efficient transport links to raw materials and markets such as the Pearl and Yangtze river valleys in China. Geography has clearly influenced these patterns of economic specialization across countries and subregions.

The massive regions of Asia and Oceania demonstrate tremendous geographic diversity in landscapes, climates and natural environments that have profoundly shaped patterns of human settlement, culture and economic activity. Development trajectories have been heavily influenced by access to arable land and water resources, terrain suitability for agriculture or trade routes, climatic conditions, and endowments of natural resources. This interplay between human societies and their physical environment will doubtless continue to affect Asia-Oceania’s further economic evolution and challenges from issues like rising seas and changing rainfall patterns brought on by anthropogenic climate change. Geography remains a prime determinant of development opportunities and constraints across one of the most economically and culturally rich parts of our world.