Journal of Psychosocial Nursing and Mental Health Services

CNE Article 

Mantram Repetition Program Decreases Insomnia Among Homeless Women: A Pilot Study

Mary K. Barger, PhD, MPH, CNM; Sally Weinrich, PhD, RN, FAAN; Jill E. Bormann, PhD, RN, FAAN; Monique Bouvier, MSN, RN, PNP; Sally Brosz Hardin, PhD, RN, FAAN

Abstract

The current pre-/posttest pilot study recruited homeless women from “safe” car parks and transitional housing to evaluate the use of mantram in regard to insomnia. At baseline, study participants completed measures of cognitive function, depression, and the Insomnia Severity Index (ISI). In 40 minutes, women were taught three skills of the Mantram Repetition Program (MRP) in the natural environment: (a) silently repeating a mantram several times, several times per day; (b) repeating the mantram slowly every night before sleep; and (c) focusing full attention on the mantram during repetitions. One week later, participants completed a second ISI. Of the 29 women recruited, 83% completed 1-week follow up. After 1 week, 88% were using their mantram daily and one half were using it prior to sleep. Insomnia severity significantly decreased (p = 0.03), with a mean difference of 2.36 (SD = 4.75). The practice of MRP, an intervention that is portable and easy to teach, shows significant promise in decreasing insomnia in this unique population. [Journal of Psychosocial Nursing and Mental Health Services, 53(6), 44–49.]

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Abstract

The current pre-/posttest pilot study recruited homeless women from “safe” car parks and transitional housing to evaluate the use of mantram in regard to insomnia. At baseline, study participants completed measures of cognitive function, depression, and the Insomnia Severity Index (ISI). In 40 minutes, women were taught three skills of the Mantram Repetition Program (MRP) in the natural environment: (a) silently repeating a mantram several times, several times per day; (b) repeating the mantram slowly every night before sleep; and (c) focusing full attention on the mantram during repetitions. One week later, participants completed a second ISI. Of the 29 women recruited, 83% completed 1-week follow up. After 1 week, 88% were using their mantram daily and one half were using it prior to sleep. Insomnia severity significantly decreased (p = 0.03), with a mean difference of 2.36 (SD = 4.75). The practice of MRP, an intervention that is portable and easy to teach, shows significant promise in decreasing insomnia in this unique population. [Journal of Psychosocial Nursing and Mental Health Services, 53(6), 44–49.]

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Homeless women have a 10 times higher mortality rate than women who have stable housing, and those younger than 45 are at the highest risk (Chang et al., 2015). Their mortality seems to be higher than that for homeless men. Few homeless intervention studies have focused specifically on homeless women although they comprise more than one third of the homeless population and are the heads of households for 90% of homeless families (Homelessness Research Institute, 2013). The number of homeless households has not changed over the past 4 years except for an increase in the number of children who are homeless (Homelessness Research Institute, 2013). Approximately one in four homeless individuals lives in California at a rate of 35 per 100,000 individuals (San Diego County Regional Task Force on the Homeless, 2014). In San Diego County, one quarter of the 8,500 homeless individuals are families (San Diego County Regional Task Force on the Homeless, 2014), making the issue of homelessness an important health problem.

Insomnia, usually assumed to be inevitable among homeless women, frequently remains unrecognized and untreated with far-reaching ramifications. Psychologically, insomnia contributes to mental disorders such as depression, anxiety, posttraumatic stress disorder (PTSD), and suicide. Aside from the normal attention deficit and decline in cognitive functioning, new research shows that insomnia particularly affects creative problem-solving, especially related to emotional distress, something relevant to homeless women (Killgore, 2010). There is a paucity of literature on interventions aimed at decreasing insomnia in homeless populations.

The Mantram Repetition Program (MRP) is a mindful, portable, meditation-based program in which participants silently repeat a self-selected spiritual word or phrase repeatedly throughout the day for the purpose of eliciting a relaxation response, leading to a subjective and physiological state of calmness (Bormann et al., 2014). The MRP originates from the work of Sri Eknath Easwaran who developed it as a meditation practice for Westerners (Easwaran, 2008).

In addition to choosing a mantram, individuals learn to silently repeat the mantram with intention and commitment, and to practice repeating their mantram in times of relaxation first, and then later, during times of stress. The MRP can be taught in as short as 5 minutes, but studies using MRP as the intervention have typically taught and reinforced the method in group sessions of 60 to 90 minutes over 5 to 8 weeks (Bormann et al., 2014).

Studies have shown that with practice, repeating a phrase with focused attention results in the relaxation response, improved cardiovascular changes, and thickening of both white and gray matter in the brain, which improves executive functioning and affective processing (Lazar et al., 2011). MRP has been demonstrated to have positive effects on different health measures in more than 20 studies using different study designs from qualitative to randomized controlled trials (Bormann et al., 2014). The populations used in these studies included Veterans, nurses, caregivers, community-dwelling adults, couples preparing for childbirth, and children undergoing neuroblastoma therapy. On measures related to sleep and insomnia, qualitative studies of the MRP have reported improvements in falling asleep, managing nightmares, and reducing insomnia in adults with HIV and Veterans with PTSD (Bormann, Hurst, & Kelly, 2013). A recent study of the effect of the MRP on sleep disorders among Veterans with PTSD showed an improvement in insomnia, sleep effort, and pre-sleep arousal (Holt, 2014).

The purpose of the current pre-/ posttest pilot study was to measure whether the MRP taught in natural conditions could significantly decrease insomnia within 1 week among homeless women. A secondary aim was to assess the ability to recruit women who were homeless, either unsheltered or in transitional housing, as participants and to find out if they would return for follow-up assessments in 1 week. The current pilot study aimed at obtaining data for a larger study of a MRP intervention in homeless shelters. Because there have been few interventions among homeless women, who are generally the heads of their households, and therefore, their health affects the health of their children, and the fact that women and men are sheltered separately, the authors chose to limit this pilot study to women only. The study was approved by the university’s institutional review board.

Method

Study Instruments

Demographic information collected from women was limited to race/ ethnicity, age, education, number of children younger than 18, if children were living with them, approximate household income, current housing situation, and housing in the past 2 years. No attempt was made to obtain further information about their lives; however, participants, especially at 1-week follow up, shared some of their personal experiences about how the MRP helped them during the week.

To measure the study’s primary outcome, the Insomnia Severity Index (ISI; Morin, Belleville, Bélanger, & Ivers, 2011) was used. The ISI is a 7-item scale with scores ranging from 0 to 28, with higher scores indicating greater severity of insomnia. Scores >10 suggest the presence of insomnia (Morin et al., 2011). In a community sample, the ISI showed good sensitivity (86.1%) and specificity (87.8%) using a cutoff score of 10 and Cronbach’s alpha of 0.90 (Morin et al., 2011). In a clinical sample, a decrease of 8.4 points was associated with moderate improvement of symptoms (Morin et al., 2011).

Because depression is common among homeless populations, the authors used the well-validated Patient Health Questionnaire (PHQ)-9 (Kroenke, Spitzer, & Williams, 2001) to measure depression. Using a cutoff score ≥10, the PHQ-9 has a sensitivity of 88% and specificity of 89% in community populations, with Cronbach’s alpha of 0.86 to 0.89 (Kroenke et al., 2001).

Insomnia affects problem-solving, which is essential to improving one’s living condition, and is correlated with mental health function. Therefore, health-related quality of life was measured using scales from the Medical Outcome Survey (MOS; Hays, Donald, Shelbourne, & Mazel, 1992). Specifically, the cognitive functioning scale from the MOS, which has a reported Cronbach’s alpha of 0.88 and has been validated in community and disease-specific populations (Hays et al., 1992), and the 20-item short form (SF-20; Ware, Sherbourne, & Davies, 1992) whose total score and subscales of mental health functioning and health perception were also used. The SF-20 versus the SF-36 was chosen to decrease response burden in the current study population, especially as it was being administered in a setting with some distractions. All MOS scale results were transformed into a 0 to 100 scale, which has a T-score of 50 (median score; SD = 10).

Mantram use was measured by asking categorical questions about any mantram use, use for sleep, and use at times when “you do not need it.” If women responded affirmatively to any of these questions, they were asked for the number of days and nights they used mantram, how many sessions per day, and satisfaction with its use using a Likert scale with ratings from 0 (very satisfied) to 4 (very dissatisfied). In addition, researchers captured qualitative responses to the statement, “Tell me about your mantram use.”

Study Design and Population

The specific research questions for the current pilot study were:

  • Can MRP intervention be taught in a natural setting in a short 40-minute session?
  • Will women use and practice their mantram during the week after the teaching session?
  • Will women return in 1 week for follow-up assessments?
  • Can an MRP intervention decrease insomnia severity among homeless women?

In the current quasiexperimental pre-/posttest study, women were recruited from two different settings: (a) two “safe” car parks where individuals living in their vehicles could park safely overnight, and (b) a transitional group home for Veteran women at risk for homelessness. At the safe car parks, located in fenced parking lots of churches, individuals had access to bathrooms and, at a specified hour, gates were locked overnight so the areas were free from intruders. The study in these settings was conducted in the evening on steps available outside of the church. The areas were located near a freeway and in an airplane flight path. Similarly, the study was conducted in the dining room in the transitional group home after dinner but during a time when children were active or doing their homework. The study goal was to keep research procedures to a maximum of 75 minutes, as the study recruitment and protocol were being conducted in the evening after participants had been busy during the day.

There were no exclusion criteria except that participants needed to understand spoken English and be able to read English or understand translation into Spanish. After verbal and written consent, participants completed study questionnaires that included the previously discussed instruments. Three women understood English but had problems reading it, so their consents and questionnaires were translated by a bilingual research assistant who helped in filling out their questionnaires.

After completing initial questionnaires, participants received a 40-minute presentation on the MRP given by a single researcher trained in the MRP (S.W.). First, participants were given a handout with a list of 19 suggested mantrams, which included spiritual terms from all major religious traditions with pronunciation and meaning. A short discussion followed regarding how to choose a personally meaningful mantram. After participants chose their spiritual word or phrase to use throughout the week, they practiced repeating their mantram to themselves and then out loud as a group. They were instructed to silently repeat their mantram as often as possible throughout the day and prior to sleep every night. The evidence for the calming and relaxing effects of the MRP was presented. Three principles of the MRP were emphasized: (a) silently repeat your mantram several times, for several sessions every day; (b) practice repeating your mantram slowly when falling asleep; and (c) focus only on your mantram when you are repeating it; and if your mind wanders, gently bring it back. In addition to handouts about mantram use, participants were given a small, brightly colored laminated flip book containing a brief instruction on one aspect of the MRP for each day of the week. They were also given a rubber bracelet to wear as a reminder to repeat their mantram.

Follow up was conducted 1 week later at the same recruitment sites. Participants completed another ISI and were asked about frequency, timing, and satisfaction with mantram use. After the ISI data were gathered, a second 40-minute presentation on MRP was provided. At this time, participants were asked about successes and challenges in using their mantram, the three MRP principles were reviewed, and women practiced using their mantram quietly and then during a period of time when researchers created verbal and visual distractions. The session ended with further group discussion. At both sessions, women were given $15 (i.e., cash to be used for gasoline) for participation as well as a snack with water, fruit, and an energy bar.

Data Analysis

Descriptive statistics were calculated using percentages and means or medians. Bivariate analyses of continuous variables were calculated using Pearson’s correlation coefficient. A paired t test measured the difference between pre- and postintervention ISI scores. Due to the small sample, no attempt was made to adjust any measures by sociodemographic factors or other baseline measures. All analyses were performed using SPSS version 22.

Results

Twenty-nine women were recruited, eight from transitional housing and 21 from safe car parks; 13% were Veterans. The women’s race/ethnicity reflect the demographics of San Diego, with approximately one in four women Hispanic and one in seven Black, non-Hispanic, and a similar number mixed race or other (Table 1). Although the majority of women were unmarried (83%), approximately one half were living with children. More than one half of the women had an annual income of less than $12,000. The length of time women were in their current living situation (i.e., car or transitional housing) ranged from 0.8 to 18 months (mean = 5.7 months; SD = 5.5 months).

Study Participant Demographics, Insomnia Severity, Depression, and Health-Related Quality of Life (N = 29)

Table 1:

Study Participant Demographics, Insomnia Severity, Depression, and Health-Related Quality of Life (N = 29)

One half of the sample had a PHQ-9 score >10, indicating depression. However, on the whole, they rated their health quality of life as fairly good, well above the nationally normed mean of 50. For cognitive and mental health functioning, the current sample was more than 1 SD above the mean.

At baseline, ISI scores ranged from 1 to 28, with a mean of 14.9 (SD = 8.2). Using a cut-off score of 10 for insomnia, 67% experienced insomnia at baseline. A strong correlation was noted between baseline insomnia severity and depression, and a strong negative correlation was noted with cognitive and mental health functioning and health perception (Table 2).

Summary of the Correlations Between Insomnia Severity, Depression, Cognitive Functioning, Short-Form 20, Mental Health Functioning, and Health Perception

Table 2:

Summary of the Correlations Between Insomnia Severity, Depression, Cognitive Functioning, Short-Form 20, Mental Health Functioning, and Health Perception

At 1-week follow up, 83% of participants (n = 24) returned. At this time, 88% of women reported using their mantram daily and one half were using it at night prior to sleep. Fifty-eight percent (n = 14) were very satisfied or moderately satisfied with their mantram use, with 29% choosing a neutral position between very satisfied and very dissatisfied. Only three women said they were very dissatisfied or moderately dissatisfied. However, the qualitative comments of these women were not consistent with this assessment. The one woman who chose very dissatisfied noted she was not happy with her chosen mantram for the first 2 days, so she changed it. Then she started using it frequently and urged others to continue trying to use it because “it helped me to confront my fears.” Similar comments were generated by the two women choosing moderately dissatisfied because they stated it helped them “keep calm and focused,” and “decreased anger.”

A statistically significant difference was noted between pre- and postintervention ISI scores (mean difference = 2.36, SD = 4.75; p = 0.03). Of note, four women improved from the severe to moderate insomnia category, and two more improved from moderate to no significant insomnia with the MRP intervention.

Discussion

The current study demonstrated successful recruitment and 1-week retainment of a group of women who were homeless or at risk of homelessness. The study population was somewhat representative of the overall homeless population in San Diego County, with a higher rate of His-panic individuals (San Diego County Regional Task Force on the Homeless, 2014). Approximately one half of women were living with their children. Data regarding the proportion of women without permanent housing who live with their children is lacking. The current study sample may not reflect the typical population of homeless women, as their general level of health-related quality of life, as well as mental health functioning, was fairly high (1 SD above the mean), using general population normed scales.

The fact that MRP can be practiced anytime, anywhere, privately, without anyone knowing, makes it an ideal intervention with this target population of homeless women. More than 85% of women were using their mantram daily over 1 week after a relatively brief teaching on its benefits and use. Women reported many benefits of using their mantram and were satisfied with its use after only 1 week.

Baseline data documented that insomnia is a significant problem among this population, with 67% above the ISI cutoff (i.e., ≥10) for insomnia. This prevalence is considerably higher than the estimated 30% prevalence identified in different populations in several countries (National Institutes of Health, 2005). Women are known to have higher rates of insomnia than men, and insomnia is higher among those with comorbid psychiatric conditions, such as PTSD and depression. One half of the study participants had depression using the PHQ-9. The current study found a high correlation between insomnia and depression, which is similar to that found in the literature (Mai & Buysse, 2008).

After one brief exposure, under less than ideal circumstances, use of the MRP was highly successful in reducing insomnia severity in homeless women. This finding is consistent with the findings of two randomized clinical trials of MRP among Veterans that also measured insomnia severity using the ISI (Elwy & Plumb, 2015; Holt, 2014). These studies showed significant decreased insomnia severity with increasing time of use (i.e., 8 to 16 weeks). The mean difference of 2.36 (SD = 4.75) found in the current study after 1 week of MRP use is approximately identical to the slope of decrease found in the studies by Elwy and Plumb (2015) and Holt (2014). Future research needs to test if these observed MRP effects are sustained over a longer period of time or continue to improve with increased use as shown in other studies, as well as examine other potential MRP benefits, such as improved cognitive functioning.

Limitations

The current study had a small sample size, which limits its generalizability. Nevertheless, it is important that in this small sample, a statistically significant difference in insomnia scores was detected. It must also be noted that these results were shown in a relatively “advantaged” population of homeless women, as they possessed a car, had money for gas, or were living in transitional housing. These results may not be generalizable to chronically homeless women. The cohort in the current study was without significant mental impairment, which is highly prevalent among chronically homeless women (Edens, Mares, & Rosenheck, 2011). Whether the homeless women studied accurately reported their insomnia levels may be questioned, but it seems reasonable that these mentally stable homeless women’s reports would be as accurate as other homeless reporting groups. The researchers were also able to confirm that the majority of homeless women would, indeed, return for posttest measures within 1 week. Future studies should describe how that return rate might change over a longer period of time.

Conclusion

The practice of MRP, which is portable and easy to teach, shows significant promise in decreasing insomnia in this unique population of homeless women. MRP is a mindfulness method with good evidence as to its effectiveness in lessening a variety of psychological symptoms that nurses can learn and easily teach to diverse populations.

References

  • Bormann, J.E., Hurst, S. & Kelly, A. (2013). Responses to Mantram Repetition Program from Veterans with posttraumatic stress disorder: A qualitative analysis. Journal of Rehabilitation Research and Development, 50, 769–784. doi:10.1682/JRRD.2012.06.0118 [CrossRef]
  • Bormann, J.E., Weinrich, S., Allard, C.B., Beck, D., Johnson, B.D. & Holt, L.C. (2014). Chapter 5 mantram repetition: An evidence-based complementary practice for military personnel and veterans in the 21st century. Annual Review of Nursing Research, 32, 79–108. doi:10.1891/0739-6686.32.79 [CrossRef]
  • Chang, H.L., Fisher, F.D., Reitzel, L.R., Kendzor, D.E., Nguyen, M.A. & Businelle, M.S. (2015). Subjective sleep inadequacy and self-rated health among homeless adults. American Journal of Health Behavior, 39, 14–21. doi:10.5993/AJHB.39.1.2 [CrossRef]
  • Easwaran, E. (2008). The mantram handbook: A practical guide to choosing your mantram and calming your mind (5th ed.). Tomales, CA: Nilgiri Press.
  • Edens, E.L., Mares, A.S. & Rosenheck, R.A. (2011). Chronically homeless women report high rates of substance use problems equivalent to chronically homeless men. Women’s Health Issues, 21, 383–389. doi:10.1016/j.whi.2011.03.004 [CrossRef]
  • Elwy, A.R. & Plumb, D.N. ( 2015, January 9. ). Treating Veterans with PTSD: Mantram meditation vs present-centered therapy: A VA randomized clinical trial. Paper presented at the VA Directors Conference, Edith Nourse Rogers Memorial VA Hospital. , Bedford, MA. .
  • Hays, R.D., Donald, C., Shelbourne, D. & Mazel, R.M. (1992). User’s manual for the Medical Outcome Study (MOS) core measures of health related quality of life. Santa Monica, CA: Rand.
  • Holt, L.C. (2014). Efficacy of mantram repetition program on sleep in veterans with post-traumatic stress disorder (PhD dissertation). Retrieved from http://search.proquest.com/docview/1544433435.
  • Homelessness Research Institute. (2013). The state of homelessness in America 2013. Retrieved from https://www.ncsha.org/resource/state-homelessness-america-2013
  • Killgore, W.D. (2010). Effects of sleep deprivation on cognition. Progress in Brain Research, 185, 105–129. doi:10.1016/b978-0-444-53702-7.00007-5 [CrossRef]
  • Kroenke, K., Spitzer, R.L. & Williams, J.B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x [CrossRef]
  • Lazar, S.W., Bush, G., Gollub, R.L., Fricchione, G.L., Khalsa, G. & Benson, H. (2011). Functional brain mapping of the relaxation response and meditation. NeuroReport, 11, 1581–1585. doi:10.1097/00001756-200005150-00041 [CrossRef]
  • Mai, E. & Buysse, D.J. (2008). Insomnia: Prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep Medicine Clinics, 3, 167–174. doi:10.1016/j.jsmc.2008.02.001 [CrossRef]
  • Morin, C.M., Belleville, G., Bélanger, L. & Ivers, H. (2011). The Insomnia Severity Index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34, 601–608.
  • National Institutes of Health. (2005). NIH state-of-the-science conference statement on manifestations and management of chronic insomnia in adults. Retrieved from http://consensus.nih.gov/2005/insomniastatement.pdf.
  • San Diego County Regional Task Force on the Homeless. (2014). 2014 San Diego regional homeless profile. Retrieved from http://www.rtfhsd.org/wp/wp-content/uploads/2014/09/RHP-2014_FINAL_9-24-14.pdf
  • Ware, J.E., Sherbourne, C.D. & Davies, A.R. (1992). Developing and testing the MOS 20-item short form health survey: A general population application. In Stewart, A.L. & Ware, J.E. (Eds.), Measuring functioning and well-being: The Medical Outcomes Study approach (pp. 277–290). Durham, NC: Duke University Press.

Study Participant Demographics, Insomnia Severity, Depression, and Health-Related Quality of Life (N = 29)

Variable n (%)
Race/ethnicitya
  White, non-Hispanic 13 (44.8)
  Hispanic 7 (24.1)
  Black, non-Hispanic 4 (13.8)
  Other 4 (13.8)
Not married 24 (82.8)
Living with children 14 (48.3)
Income less than $12,000 16 (55.2)
High school education or less 14 (48.3)
Mean (SD)
Age (years) 45.2 (11.7)
Months homeless or in transitional housing 5.7 (5.5)
Insomnia Severity Index/Score >10 (%) 14.9 (8.2)/67
Depression (PHQ-9)/Score ≥10 (%) 9.42 (0.60)/50
Health-related quality measures
  Cognitive functioning 67.82 (17.28)
  Short-Form 20 61.14 (21.71)
    Health perception subscale 60.56 (27.75)
    Mental health functioning subscale 58.28 (21.08)

Summary of the Correlations Between Insomnia Severity, Depression, Cognitive Functioning, Short-Form 20, Mental Health Functioning, and Health Perception

Measure 1 2 3 4 5 6
Insomnia Severity Index
Depression score 0.760**
Cognitive functioning −0.564** −0.546**
Short-Form 20 −0.442 −0.504* 0.478*
Mental health subscale −0.709** −0.708** 0.528* 0.674**
Health perception subscale −0.557** −0.630** 0.515** 0.848** 0.810**

Key Points

Barger, M.K., Weinrich, S., Bormann, J.E., Bouvier, M. & Brosz Hardin, S. (2015). Mantram Repetition Program Decreases Insomnia Among Homeless Women: A Pilot Study. Journal of Psychosocial Nursing and Mental Health Services, 53(6), 44–49.

  1. The Mantram Repetition Program (MRP) showed significant promise in decreasing insomnia in the 29 homeless women studied.

  2. The MRP is a mindful, portable, meditation-based method used for the purpose of eliciting a relaxation response.

  3. Insomnia contributes psychologically to depression, anxiety, posttraumatic stress disorder, and suicide.

Do you agree with this article? Disagree? Have a comment or questions?

Send an e-mail to the Journal at jpn@healio.com.

Authors

Dr. Barger is Associate Professor, Dr. Weinrich is Clinical Professor, Dr. Bormann is Clinical Professor, Ms. Bouvier is PhD Graduate Student and Jonas IV Nurse Leader Scholar, and Dr. Hardin is Dean and Professor, Hahn School of Nursing and Health Science/Bob and Betty Beyster Institute of Nursing Research, Advanced Practice, and Simulation, University of San Diego, San Diego, California. Dr. Bormann is also Associate Nurse Executive/Research, VA San Diego Healthcare System and VA Center for Stress and Mental Health; and Adjunct Associate Professor, San Diego State University, San Diego, California.

Dr. Bormann is employed by the VA. The authors have disclosed no other potential conflicts of interest, financial or otherwise. Research was supported by the Jonas Center for Nursing and Veterans Health and the University of San Diego Hahn School of Nursing and Health Science Faculty Research Incentive Fund. None of this work represents the views of the Department of Veterans Affairs or the United States Government.

Address correspondence to Mary K. Barger, PhD, MPH, CNM, Associate Professor, Hahn School of Nursing and Health Science/Bob and Betty Beyster Institute of Nursing Research, Advanced Practice, and Simulation, University of San Diego, 5998 Alcala Park, San Diego, CA 92110; e-mail: mbarger@sandiego.edu.

Received: January 13, 2015
Accepted: May 15, 2015

10.3928/02793695-20150526-03

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