2020 Abstracts

Mark Langeveld (University of Utah)
Faculty Advisor: Langeveld, Mark (University of Utah, Engineering)

Introduction:

The risk of getting type 2 diabetes has been widely found to be associated with lower socioeconomic position across countries. Not only the financial burden but also the clinicians often having the long waitlists for one-on-one assessment of chronic disease patient's behavior makes it difficult for timely treatment and monitoring supplies. Among the top 10 diseases that are causes of death, Diabetes is the most self-manageable chronic disease. Type 2 diabetes patients often require insulin therapy as well as self-managing on eating well and exercising. A mobile app can be applied as a self-managing mechanism that treats chronic complications of diabetes. I will describe my work to analyze five commercially available mobile apps that are effective in improving diabetes-related outcomes.

Method:

I analyzed with technology reviews of iterative mobile app design of each mobile app(Glucose Buddy, Diabetes care4Life, Diabetes Diary, BlueStar Diabetes, Gather Health) and reviewing comments from peer and public review. I organized the findings by test process with diabetes patients through three categories for this report: 1. App features (on which platform that the app is available, what the app does, cost, etc.) 2. App usability and quality of tracking presented as an average of three scores given by the University of Utah healthcare researchers 3. Summary of the evidence from the evaluation of each category of patients who are motivated and who were not: monitoring glycemic control, glucose control, blood pressure, HbA1c improvement, weight, and diabetes treatment satisfaction

Result:

The record comprised 30 patients, of which 10 completed the mobile app module for 6 weeks. Demographics were similar for users and nonusers. Of the application users, the behavior improvement of pre-test and posttest scores were better for users compared with non-users (+1.8%). Of the users, 92% reported that the application had significant improvement (p < 0.05) in an outcome compared with HbA1c and glycemic control. The usability score of each app evaluated by healthcare researchers was (Glucose Buddy: 72.3 (out of 100), Diabetes care4Life: 45, Diabetes Diary: 16, BlueStar Diabetes: 85, Gather Health: 60) Without additional support from a health care provider, 5 mobile apps demonstrated an improvement in fasting blood glucose, 2-hour post-breakfast blood glucose, diabetes knowledge, and self-care behaviors compared with controls.

Conclusion:

I have analyzed and created a prototype of a mobile app that fills the gap between efficacy, cost, and features from the limited statistical evidence. Patients were satisfied with the use of the mobile health app for Diabetes, and the use of the program significantly improved their behavior and knowledge retention. Tailoring the traceable evaluation of mobile app to patient preferences and needs and updating the tools could empower and guide the patients to effective mobile apps in improving diabetes outcomes.

Gibbons, Andrew; Clingo, Kelly; Emmett, Darian; Fullwood, David; Bowden, Anton (Brigham Young University)
Faculty Advisor: Fullwood, David (Brigham Young University, Ira A. Fulton College of Engineering; Engineering and Technology); Bowden, Anton (Brigham Young University, Ira A. Fulton College of Engineering; Engineering and Technology)

Spine dysfunctions such as stenosis and herniated discs have traditionally been diagnosed using X-ray or MRI imaging techniques; but these methods capture a snapshot of the problem, without revealing the positional dependence of the causes and effects. In order to provide a richer dataset to physicians, an NIH-funded project has begun with the aim of tracking details of spinal motion for people with healthy and symptomatic backs. Novel nanocomposite strain gauges will be used to capture skin deformation during typical back motion, and correlate these data with back motions that are known to reveal chronic subcutaneous trauma. This paper focuses on the optimal placement of strain gauges for maximum resolution of the underlying biomechanics.

An array of reflective markers was placed on a healthy individual's lower back between the L5 and T10 vertebrae. A QUALISYS motion capture lab was then used to determine the coordinates of these markers during flexion, rotation, flexion with rotation, and side bending. These motions were repeated 3 times for 10 seconds. The distances between markers were calculated for each motion and the strain values between resting and flexed positions were determined. Initial validation was performed by comparing a maximum tensile strain of 0.54, between the L5 and L1 vertebrae in flexion, with a previously reported value of 0.5 in the literature.

This paper will report the development of an optimal arrangement of sensors for resolving the relevant biomechanics of the spine, based upon a detailed analysis of the optical marker results. Future work will utilize these results to develop a skin mounted, wearable sensor array that can measure the real-time kinematics of the spine and compare them with a database of healthy and low back pain subjects using a machine-learning paradigm. We hope to use the system to identify mechanical sources of low-back pain.

Passey, Abigail; Domyan, Eric (Utah Valley University)
Faculty Advisor: Domyan, Eric (Utah Valley University, Department Of Biotechnology/Biology)

In the United States approximately 3 million people are living with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Approximately 75,000 of those patients represent pediatric cases. We aim to create a new drug delivery system with the intention of establishing a more feasible, stable, and effective form of administering treatments to those with the aforementioned autoimmune diseases, specifically attempting to provide a more ideal treatment for juvenile patients. We are focusing on first providing a rudimentary proof of concept. For the project, we will attempt to engineer mammalian cells that will produce the fusion protein CTLA4-Ig, commonly known as abatacept, a current treatment for RA, and a potential treatment for SLE. Thus far, we have completed and verified success of the molecular cloning necessary to create the recombinant molecule. We have successfully induced expression of the fusion protein in mammalian cell lines COS-7 and B16F10 via lipofections. We are currently working to optimize lipofection conditions and test for successful cellular production of CTLA4-Ig. Ideally, we aim to engineer red blood cells (RBCs) to produce the molecule. If we can complete our proof of concept, we will then attempt to reprogram myeloid and lymphoid progenitors into induced hematopoietic stem cells (iHSCs), and culture the cells ex vivo to allow for massive expansion of these iHSCs, which can then be genetically engineered. Additionally, the iHSCs will be cultured in such a way that, once in vivo, will result in them committing explicitly to erythroid lineages, and secreting the target protein as they mature into fully functional, adult RBCs. Causing RBCs to secrete CTLA4-Ig throughout the body would eliminate the need for regular injections of the drug, and thus potentially improve the quality of pediatric patients' lives.

Mehr, Judd; Alvarez, Eduardo; Cardoza, Adam; Ning, Andrew (Brigham Young University)
Faculty Advisor: Ning, Andrew (Brigham Young University, Mechanical Engineering)

Wind power is an attractive alternative energy source because it is sustainable, clean and cost effective. However, wind energy is difficult to harvest because wind is irregular, seasonal, and often far away from urban areas. Several organizations have sought to solve this problem by designing wind harvesting aircraft, called windcraft. Windcraft are aircraft that are tethered to the ground, propel themselves into the air, enter steady flight in a crosswind, and allow the propellers to spin freely. The wind keeps the windcraft aloft and forces the propellers to turn backwards, turning them into turbines. Power generated from the turbines is sent down the tether and stored. Windcraft provide several advantages beyond those of conventional wind turbines, including high portability due to its smaller weight.

This research employs aerodynamic analysis to determine the forces on the turbines and lifting surfaces of a windcraft modeled after the Makani M600, an 8-rotor prototype produced by Makani Technologies. The analysis is a combination of modeling methods with varying fidelity, including the vortex lattice, vortex particle, and blade element momentum methods. The vortex lattice method models the lifting surface as a sheet of vortices that have the same capability to push on the oncoming flow as the lifting surface would. The vortex particle method uses a set of discretized fluid motion equations in a form that allows for the solution of the strength of the vortex at each point in the flow. The blade element momentum method uses two theories, the blade element theory and the momentum theory, to calculate the power, thrust and axial air velocity of a propeller or turbine. The modeling methods are validated by using experimental data from The Mexico Project and NASA. We implement basic design space exploration to display this model's compatibility with design optimization.

Swomitra, Mohanty; Willis, Christina ; Larson, Shaylee (University of Utah)
Faculty Advisor: Mohanty, Swomitra (Engineering, Chemical Engineering)

The World Health Organization has cited tuberculosis (TB) as a global health emergency. As this is a disease that mainly affects those in developing countries, it is important to provide a rapid and affordable means of diagnosis. Emerging work has shown breath biopsy to be a promising resource for diagnosing a variety of diseases, but is particularly promising for TB, as it negates the need for sputum collection that can cause many problems in young or ill patients and can provide results at point of care.

The breath of a patient diagnosed with TB contain volatile organic biomarkers (VOBs) that are given off by the bacteria that cause the disease. Detection of VOBs with via metal-functionalized titanium dioxide sensors has been successful in very sick patients, however it is limited in its ability to detect low analyte levels and has unknown specificity in a complex human breath matrix. Preliminary results indicate that the use of an engineered electroactive solution (EAS), a liquid-phase complex which utilizes a functional metal in solution, can improve the current sensing platform by simplifying the electrode configuration and allowing the use of more complex electrochemical techniques (in this case square wave voltammetry (SWV)). Because the margins of detection can be quite small, successful optimization of SWV parameters is vital. The proposed project will explore a means of optimizing these parameters by collecting a variety of sample data in order to determine how the electrochemical activity of the EAS is altered when biomarkers are introduced.

Jensen, Sally; Lignell, David (Brigham Young University)
Faculty Advisor: Lignell, David (Ira A. Fulton College of Engineering, Chemical Engineering)

Radiative heat transfer is central to many chemical engineering processes. Turbulent combustion accounts for 80% of the world's energy. Understanding radiative heat transfer is important for efficient design, regulating pollutant emissions, and doing hazard analyses of these processes. Radiation depends on temperature as well as local composition fields. It is important for combustion because it affects heat transfer to surrounding environments. This in turn impacts fire spread in wild fires as well as heat transfer in power plant boilers and other such applications. Radiation also directly affects the temperature field. The temperature field in turn feeds back to the radiation and impacts the formation of pollutants, such as soot, NOx and other species. Modeling is difficult because computing the absorption coefficient depends on the spectral properties of molecules. Computing these requires millions of spectral bands, which is too expensive to compute for normal applications. A common method that is currently used to predict radiation is the Weighted-sum-of-gray-gases model. Doctors Solovjov and Webb developed a new method called the Rank Correlated Integration of the Spectral Line Weighted-sum-of-gray-gases (rcSLW) model. It is a complex model that is difficult to implement, but it is accurate. It has been implemented in python and in C++. The model has been provided on github to allow for easy access by the community. We will present an overview of the rcSLW model and code interface as well as show selected results applied to systems of interest with respect to combustion.

United Nations Office on Drugs and Crime; U.S. Department of State; The Walk Free Foundation; The Borgen Project; Ling, Bonny; (Utah State University)
Faculty Advisor: Guo, Li (College of Humanities and Social Sciences; Languages, Philosophy and Communication Studies Department)

It is a historical fact that human trafficking for the purposes of sex and forced marriage has been a cancer in societies and civilizations throughout the history of the world. China has a well documented history of trafficking women for the purpose of forced marriage. The main objective of this research is to investigate trends found in the forced marriage markets of China from the rise of Mao Zedong in the mid-twentieth century until 2019. The author used interviews with victims of the forced marriage markets in China as well as secondary data collected from NGOs and watchdog organizations, government publications, and relevant journals. My findings are significant because they illuminate patterns and trends that governmental and non-governmental organizations can use to identify high risk populations and to take action on educating and protecting women who are at high risk of being forced into marriage in China.

Bundy, Brad; Crop, Tyler (Brigham Young University)
Faculty Advisor: Bundy, Brad (Ira A. Fulton College of Engineering, Chemical Engineering)

Cell-free protein synthesis (CFPS) has proven to be a novel and effective method for recombinant protein production. However, one key disadvantage in this process is the need to store the requisite cell extract and energy source for the reaction at below-freezing temperatures. Our lab has developed a lyophilization-based system to overcome this problem. We have shown that lyophilization of the cell extract and energy system needed for the reaction are possible while still maintaining equivalent protein production capabilities of the reaction. This lyophilization-based system provides a solution to the high costs associated with the storage of these reagents, increases the shelf-life of the reagents, and, when mixed with water, allows for on-demand protein production in remote locations around the world.

Cutler, James; Stanley, Andrew; Ning, Andrew (Brigham Young University)
Faculty Advisor: Ning, Andrew (Brigham Young University, Mechanical Engineering)

Wind farms are severely affected by negative wake interactions between turbines. By opti- mizing the tilt angle of the turbines in a farm, wakes may be deflected away from downstream turbines, increasing the overall energy production. In this study, we will optimize the tilt angle of turbines in a wind farm to maximize energy production. We will use an analytic wake model modified to consider wake deflection from tilt, and gradient-based optimization. We will consider optimizing the tilt angle of each turbine assuming that it will remain fixed for the lifetime of the farm. We will also consider active tilt control. Preliminary results with a simple five turbine row show that a large tilt angles of 35_ in the front upstream turbine increases the power production of the five turbines by about 20% compared to the power production with no tilt in the front turbine. Although these preliminary results only consider one wind direction and exaggerate the gains from wake deflection through tilt, we expect that considering a whole wind farm and wind distribution will still result in significant gains.

Brad Bundy; Nelson, Andrew; Welton, Meagan (Brigham Young University)
Faculty Advisor: Bundy, Brad (Brigham Young University, Chemical Engineering)

Cell-free protein synthesis (CFPS) is the process of making proteins without the limiting environment of a cell. The CFPS system allows us to modify and engineer proteins in ways that have not been done before. This technology has the potential to significantly impact the fields of protein therapeutics, unnatural amino acid insertion, and biosensors. Our research looks into optimizing the process of CFPS. Specifically, we want to understand what the impact of adding bubbles to a cell-free reaction is on CFPS yields. We want to know if adding bubbles to the CFPS mixture prior to incubation will increase the oxygenation of the reaction and affect protein production rates. This knowledge will help us optimize the CFPS process for future applications.

Hunt, J. Porter; Barnett, R. Jordan; Robinson, Hannah; Wilding, Kristen; Bundy, Bradly C. (Brigham Young University)
Faculty Advisor: Bundy, Bradly (BYU Ira A. Fulton College of Engineering, Chemical Engineering)

Amino acid concentration assays assist both healthcare providers and patients in determining treatment plan options and diagnosis for diseases ranging from genetic conditions to eating disorders. Cell free protein synthesis provides a rapid, inexpensive platform where a single amino acid assay gives the concentration in that sample. As a biosensor, this assay has proven to provide sensitive and accurate results and has an extensive range of applications. Progress towards a simple product that anyone could use to test amino acid concentrations represents a major contribution to the healthcare industry.

Hunter, Jacob; Wood, Elizabeth; Jarman, Parker; Lindell, Stephen; Schwandt, Melanie; Goldman, David; Suomi, Stephen; Barr, Christina; Higley, James (Brigham Young University)
Faculty Advisor: Higley, James (Family Home and Social Sciences, Plant and Wildlife Sciences)

Rhesus monkeys (Macaca mulatta) are commonly used as a translational model to investigate human behavior and biology, largely due to shared evolutionary history and genetic similarities. Within rhesus monkeys, there are two distinct subgroups: Indian-derived and Chinese-derived monkeys. It is surprising that research has not compared the behavioral differences in these two subgroups. While there are anecdotal reports indicating that the Chinese-derived monkeys exhibit more aggression than the Indian-derived population, the only studies to investigate differences between them investigated infants, a limitation as infants rarely exhibit significant levels of aggression. This study investigates the relationship between DCA and several behavioral measures of aggression in adult subjects. We hypothesize that rhesus monkeys with higher DCA would exhibit more aggression than monkeys with lower DCA. The subjects were n = 130 adult female rhesus monkeys, housed in indoor-outdoor runs at the National Institutes of Health Animal Center, located in Poolesville, Maryland. Observations were made while the subjects were in their home cages, using five-minute focal observations, twice weekly for six months by trained staff. Subjects were behaviorally scored for a variety of behaviors that reflect rhesus monkey aggression. DCA was determined using genealogical data tracing each subject's ancestry back to the colony's founding in the 1940s. Based on the pedigree, the subjects were divided into pure Chinese-derived, pure Indian-derived, or hybrids. Repeated measures ANOVAs showed that 100% Chinese monkeys exhibited higher rates of aggression (F(2,125) = 14.02, p < .0001), when compared to the Indian-derived or hybrid monkeys. These results suggest that, consistent with anecdotal reports, monkeys with 100% DCA exhibit higher levels of aggression than Indian-derived or hybrid subjects. Aggression may have played a pivotal role in the evolutionary success of the Chinese rhesus, allowing them to cross the Himalayas, disperse throughout China, establish territory, and successfully compete with other species.

Schiek, Haley; Thompson, Audrey; Rugo, Kelsi (Westminster College)
Faculty Advisor: Rugo, Kelsi (Westminster College, Psychology)

Background. College students face a myriad of well-documented mental health issues, including anxiety (American College Health Association, 2018), depression (Ibrahim et al., 2013), and suicidal thoughts and behaviors (Yozwiak et al., 2012). Many of these mental health issues are laden with negative social stigma and go untreated (Corrigan & Kosyluk, 2013). While most college campuses offer free mental health resources for students, a striking number of college students are unaware of resources available on their campus (Michaels et al., 2015).

Research Aims. The Abnormal Psychology class at Westminster College hosts Wellness Screening Days (WSD) on campus once per semester to provide outreach, psychoeducation, and resources for students struggling with mental health issues in the campus community. In the near future, we plan to submit an IRB application to formally collect data at WSDs with the primary aim of increasing mental wellness on our campus.

Methods. At each Wellness Screening Day, Abnormal Psychology students erect tables at 2-3 highly trafficked locations on campus. WSD banners, balloons, and free snacks are placed around the screening area to draw student interest. Abnormal Psychology students are stationed near each table to assist their peers in completing, scoring, and interpreting their wellness screener. Wellness screeners are then returned to each student with a full page of resources printed on the back for students to utilize, if desired. Additionally, mental health professionals are stationed at each table for further support.

Discussion. We are proposing a poster to present our idea to turn the Wellness Screening Day into an IRB-approved research project on our campus at UCUR 2019 in order to garner scholarly feedback from colleagues in attendance. In particular, we plan to engage other professionals in discussions on (1) prioritization of constructs to screen, (2) risk management considerations, and (3) innovative ideas for institutional collaboration. We believe UCUR 2019 will offer a unique opportunity for us to interface with other professionals in the field to refine our research methodology.

Implications. Using the Wellness Screening Day to identify, connect, and track at-risk students on our campus has the potential to decrease negative mental health stigma in our campus community, improve mental wellness of our student body, and increase awareness of free mental health resources available on campus.

Kamhout, Sarah; Eddington, Hyrum; Orr, Taylor; Gilliat, Stephen; Hayward, Tyler (Brigham Young University)
Faculty Advisor: Lundwall, Rebecca (Family Home and Social Sciences, Psychology Department and Neuroscience Center)

Human stool contains microbiota that impact brain development and behavior through neuroendocrine and neuroimmune systems. Prior studies on adults with autism show differences in microbiota between autistic and control subjects. Since microbiota are normally established early in life, we wanted to know if infants with older siblings with autism had different microbiotal abundance and variety than infants with no first-, second-, or third-degree relatives with autism. We were also interested in sex differences as historically autism spectrum disorder (ASD) has been diagnosed more often in boys.

We collected fecal samples from 36 children ages 3-24 months. 18 control samples (no first-, second-, or third-degree relatives with ASD) were matched for age and sex with 18 samples from children with an older sibling diagnosed with ASD. Following triplicate PCR amplification of a single DNA extraction, QIIME software was used to assign operational taxonomic units to each strain. PCoA and PERMANOVA were completed in R. These tests showed gut flora of high-risk individuals was significantly different than controls (p = .008). PCoA showed segregation of experimental from control samples (p = .037), most pronounced in female sub-population (p = .006). A differential abundance test was done with ANCOM. Levels of B. fragilis were significantly lower in the at-risk females (W = 560). One of the taxa groups with the most abundance, Lachnospiraceae, was also significantly lower in the at-risk group (W = 48).

This suggests that microbial markers, including B. fragilis, may help identify individuals at risk for ASD, particularly girls. This is consistent with other research on B. fragilis and ASD. Further study is necessary to determine the predictive accuracy of ASD diagnosis based on biomarkers including B. fragilis. More detailed understanding of the microbiome of at risk individuals may lead to earlier detection, intervention, and ultimately improved outcomes for ASD patients.

Dinehart, Claire; Alvord, Margaret; Holdeman, Alexis (University of Utah)
Faculty Advisor: Kamimura, Akiko (University of Utah, Sociology)

Previous studies suggest uninsured individuals in poverty not only experience higher levels of stress than the general public, but also often have a hard time seeking positive coping strategies. If the exposure to an unsafe environment is prolonged, the individual is subsequently exposed to chronic stress as a result of their constant safety concerns. Yet, little is known how home environmental issues affect stress levels among underserved populations. The purpose of this research project is to examine the association between household environmental safety and stress among uninsured primary care patients who live in poverty. Data have been collected from patients of the Maliheh Free Clinic in Salt Lake City using a self-administered survey in Fall 2019. As of October 14, 2019, 195 patients participated in the survey. The preliminary results suggest that while higher levels of concerns about indoor air pollution, lead exposure, pesticide contamination, and water contamination were associated with higher levels of perceived stress, concerns about mold were not related to stress. None of the demographic characteristics such as educational attainment and marital status affected the association between environmental concerns and perceived stress levels. Identifying these stress-related household environmental safety concerns provides a basis from which stress-reducing interventions can be launched. Remedying household environmental issues can range from simple changes, like proper chemical storage, to large scale remodeling projects, like lead abatement. Providing education about household environmental safety and information about local resources to free clinic patients is the first step towards improving stress conditions in at-risk populations.

Barton, Melissa. (Utah Valley University)
Faculty Advisor: Anderson, Chris (Utah Valley University, Behavioral Science Department)

Sex is an important element in the building and maintenance of a successful marriage. The subject of marital sexual relations from a national perspective has been studied (Kinsey, 2010). There also exists much research data specific to conservative Christian populations on this subject (Crosby, 2008). Little research that looks specifically at the sexual beliefs, experiences, and expectations within the community of the active members of the Church of Jesus Christ of Latter Day Saints has been conducted. This research provides a baseline and will aid individuals and their clinicians in the support of the health and healing of marriages. This researcher will be presenting what has been discovered in regards to the sexual attitudes and practices among-st the active LDS population.

This research is intended to begin the process of creating a baseline of data that could ultimately change the conversations and even the conventions of the LDS community surrounding elements of sexuality in marriage. This data could assist Marriage Counselors and Sex Therapists in understanding the true nature of sex inside this culture, particularly in regards to LDS women.

This research will be conducted anonymously and with high regard to confidentiality utilizing a Qualtrics survey. This is the first step in a process this researcher is interested in exploring. This report illuminates the sexual attitudes, beliefs and behaviors of active LDS women ages 35-55, it is anticipated that 100 individuals will participate.

Crosby, Cindy. "The Best Sex (Survey) Ever!" Today's Christian Woman, 12 Sept. 2008, www.todayschristianwoman.com/articles/2008/september/best-sex-survey-ever.html.

Kinsey,"FAQs And Sex Information." Historical Report: Diversity of Sexual Orientation, Indiana University, 2010, kinseyinstitute.org/research/faq.php.

McClain Verdoes, Maryellen; Ha, Jennifer (Utah State University)
Faculty Advisor: McClain Verdoes, Maryellen (Emma Eccles Jones College of Education & Human Services, Psychology Department)

This research will assess whether there is a significant difference in the correlation of attention and reading levels of school aged children that have Autism Spectrum Disorder (ASD) and the correlation of attention and reading levels of school aged children that do not have ASD. I will be looking at data from two populations: school aged children with ASD and school aged children without ASD. Most of the participants for this study will come from Cache County, Utah, so that limiting factor of sample demographics should be taken into account.

Considering the meager amount of research that has been done on the attention and reading achievement of children with ASD, the purpose of this poster presentation is to (1) display the methodology, data, and findings of this research project and (2) discuss any implications this may have and where to go next. Depending on the results, if they are significant, this project may be built upon and further developed to examine possible factors that may affect or lead to significant results.

The CONNERS 3 assessment was administered to evaluate the attention levels of school age children six to twelve years of age. This assessment is generally used in helping diagnose ADHD (Connors, Pitkanen, & Rzepa, 2008;Pearson, 2008). It takes into account the social, home, and school setting of the child. The GORT 5 assessment was also administered to those same subjects to assess their reading ability at the time (Wiederholt & Bryant, 2012). SPSS was used to run analyses and results were exported in tables from the program.

Trumble, Tanner; Jensen, Francine (Utah Valley University)
Faculty Advisor: Jensen, Robert (Utah Valley University, Nursing)

Background: Individuals who experience homelessness lack the necessary components needed receive end of life care (EOL). However, due to personal and structural barriers such as cost of care, lack of insurance, addiction, and many who experience mental health and intellectual disabilities, homeless individuals are unable to receive palliative or hospice care. Because homeless individuals lack the necessary components of basic living such as food, water and shelter, their quality of life is significantly lower than that of the general population, and this affects their EOL experiences.

Purpose: To explore the factors that affect the homeless population and the barriers they face when accessing health care, including their needs at the EOL, and to provide recommendations for better EOL care.

Methods: A focused literature review was performed using the databases PubMed, Google Scholar and Science Direct using the keywords homeless, end of life, and palliative care covering the years 1985 to 2018.

Findings: Homeless individuals want to experience a "good death". Unfortunately, homeless individuals who seek medical treatment feel deterred due to unfair treatment and belittlement from previous health care experiences and the social stigma surrounding homelessness. This can delay their treatment of chronic or acute conditions and lead to long-term health consequences. One effort to aid in EOL care for homeless individuals is the Social Model Hospice, which provides holistic EOL care in home like setting. Social model hospice overcomes barriers to lack of insurance, social support and a location where EOL care can be delivered for homeless individuals.

Significance: Many barriers are limiting medical care for the homeless that should be available to them at the EOL. It is evident that healthcare providers need to be more aware of the needs of this population to help improve and provide the EOL care homeless individuals deserve.