Julie McCardell Capstone

Comprehensive Outpatient Cancer Treatment + Living Center Julie McCardell | Capstone 2020

TABLE OF CONTENTS

01

PROGRAMMING

02

SCHEMATIC DESIGN

03

DESIGN DEVELOPMENT

- PROJECT INSPIRATION + INTRODUCTION - PROBLEM STATEMENT - GOALS + TRENDS - CANCER RESEARCH - CANCER FACTS + STATISTICS - CANCER TREATMENT OPTIONS - DESIGN CONSIDERATIONS - CASE STUDIES - LOCATION

- CONCEPT - SITE ANALYSIS - SPACES INCLUDED - BUILDING ORGANIZATION - CIRCULATION

- FLOOR PLANS - ATRIUM DESIGN - MAIN LOBBY DESIGN - HEALTH CAFE DESIGN - INFUSION AREA DESIGN - SOCIAL/GAMING AREA DESIGN - GUEST ROOM DESIGN - BUILDING SECTIONS

PROGRAMMING

PROJECT INSPIRATION + INTRODUCTION Cancer is among the leading causes of death worldwide, but survival rates are increasing due to increased knowledge and vast treatment resources. Growing up, cancer had quite the impact on my family. I watched a number of relatives battle cancer, and unfortunately all of them passed away. Some of them fighting the cancer battle not once, but twice.

Some of them even suffered through multiple types of cancer. While cancer is especially difficult for the person who has been diagnosed, it also takes a toll on the family members and friends involved. Depending on the severity, treatment can last months or years, and it can consist of long days spent in the treatment center. I was inspired to create a comforting, peaceful, and uplifting cancer treatment and living center after seeing the sterile and cold environments that my relatives spent so much of their time in. In addition, these relatives had to travel in order to receive treatment from the best recommended facilities. This meant that they needed somewhere to stay for a number of days, and lodging was often miles away and required travel to and from the cancer treatment center. For this reason, there was a need for a center that provided comprehensive cancer treatment, as well as temporary lodging for the patients and their families.

Waves of Hope is a unique 88,475 square foot center that combines comprehensive outpatient cancer treatment and temporary lodging for patients and their families. Many cancer patients must travel in order to receive treatment, and multiple rounds of treatment can last many consecutive weeks, or even months. A comprehensive facility that has both treatment and living facilities will allow the sensitive needs of cancer patients to be met. The treatment center will provide services ranging from diagnostic testing to counseling and screening during survivorship. The living center contains both guest rooms and apartment-style suites for patients and their families. This cancer treatment center is ideal for those that require supervision, but not the full services of a hospital setting.

6

PROBLEM STATEMENT In order to meet the need for a facility that combines cancer treatment with living services, this center is designed to serve the sensitive needs of adult cancer patients and their families by providing patient-centered care. The center will address the clinical, emotional, and spiritual needs of patients by offering a range of cancer services in one facility including diagnostic services, radiation oncology, infusion therapy, counseling, and healing gardens.

7

GOALS - Guide patients through their cancer journey from diagnosis through recovery - Provide a nature-oriented experience - Harness natural light and take advantage of the sunny location - Create a soothing interior that emphasizes relaxation - Offer psychological support for patients and family members - Promote an inviting and welcoming nature that makes the center feel anything but institutional - Utilize Universal Design concepts in order to create an accessible space for everyone of all abilities - Provide a facility that is open to growth and expansion, including proton therapy

TRENDS - Simple wayfinding - Versatile waiting areas that support family members - Exposure to natural elements through healing gardens, plant walls, views outside - Clerestory windows in interior exam and consultation rooms - Infusion areas with floor-to-ceiling windows - Array of colors, textures, depths that strive to be warm and welcoming - Spaces where patients can go to be contemplative and quiet - Encouragement walls where patients can write messages - Softer and “more humane� treatment spaces 8

CANCER RESEARCH Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells, and it can start any place in the body. If the spread is not controlled, it can ultimately result in death.

The cause for many cancers remains unknown, but some cancer causes can include: lifestyle, tobacco use, excess body weight, inherited genetic mutation, hormones, and immune conditions.

Cancer is a major public health problem worldwide, and it is the second leading cause of death in the United States. About 1.8 million people are diagnosed with cancer each year in the United States.

ESTIMATED NUMBER OF NEW CASES FOR 2020

9

CANCER FACTS & STATISTICS GENERAL CANCER FACTS & STATISTICS: - As of January 1, 2019, about 16.9 million individuals with a history of cancer were living in the United States - Roughly 1.8 million people in the United States diagnosed with cancer in 2019 - An estimated 606,880 people in the United States died of cancer in 2019 - Cancer is the leading cause of death for those under 65 years of age, and the leading cause of death worldwide - Approximately 38.4% of men and women will be diagnosed with cancer at some point during their lifetimes - Stages of cancer range from 0, I, II, III, IV (IV being the most advanced stage) - Survival rates are increasing due to increased knowledge and treatment resources CALIFORNIA CANCER STATISTICS: Cancer Statistics for California: - Nearly 1,492,000 Californians that are alive today have a history of cancer, whether they are currently undergoing treatment or have been treated in the past - In 2017, roughly 176,140 Californians were diagnosed with cancer, which is equivalent to 20 new cases every hour of every day - Cancer accounts for nearly 1 in every 4 deaths in California - Nearly 1 out of every 2 Californians born today will develop cancer at some point in their lives - It is likely that 1 in 5 will die of the disease *Statistics from the National Cancer Institute and American Cancer Society 10

CANCER TREATMENT

Cancer treatment facilities often have an operating model of providing diagnosis, treatment planning, support, and survivorship services, these allow the patients to have all of their needs met through the existence of one single facility.

CANCER TREATMENT OPTIONS: - Chemotherapy - Proton Therapy - Radiation Therapy - Targeted Therapy - Immunotherapy - Surgery - Stem Cell or Bone Marrow Transplant Services addressing almost every aspect of cancer care will be available at this center, including chemotherapy and medical oncology, radiation therapy, radiology and imaging services, surgical consultations and presurgery testing, neurology, screening services (including mammography), personalized medicine, genetic testing, support counseling, and follow-up care. An on-site laboratory provides quick blood and specimen testing. An on-site pharmacy allows patients to fill prescriptions before heading home.

11

CHEMOTHERAPY Chemotherapy treats cancer with drugs given orally or intravenously into the bloodstream to kill cancer cells, reduce tumor size, and relieve cancer symptoms. Treatment plans including chemotherapy often require multiple doses over several weeks or months. Doses, frequency, and combinations of drugs are personalized to each patient’s needs. Centers often provide services and resources that also help patients with the side effects they may experience.

During chemotherapy, patients are at risk for life-threatening reactions to their treatments. Patients are immunosuppressed, which means that infection control is a great concern. It is essential that patients and families feel comfortable during this process, emotionally and physically. Chemotherapy treatment sessions can last from minutes up to 8 hours. Patients that are well enough are encouraged to move around, walk, exercise, and socialize.

Patients sit in recliners, tethered to an infusion pump. During their treatment, the patients must be carefully monitored by clinicians. Medicine must be administered with great precision, and visual monitoring is imperative to check for side effects. While the patients need to be monitored, they also desire privacy because the process is intensely personal. Allowing family members to be present promotes privacy, intimate communication, and monitoring for changes in patient’s condition.

12

RADIATION THERAPY Radiation treatment directs invisible high energy, such as X-rays and electron beams, at cancer cells to kill them or limit their ability to grow. This treatment may be used alone or with other treatment methods.

Main Types of Radiation Therapy: - External-Beam Radiation - Internal Radiation - Systemic Radiation External-Beam Radiation Therapy treats cancer from outside of the body through the use of precise equipment. This treatment often requires several treatments per week, but the duration of the treatment is dependent upon the stage and type of cancer.

Internal Radiation Therapy delivers radiation by placing radioactive substances into or near a tumor. These therapy sessions are fairly quick, but require sessions for several days or weeks.

Systemic Radiation Therapy uses radioactive substances that travel through the body, either by pill or injection into a vein, to attack the cancer cells.

13

DESIGN CONSIDERATIONS - A comforting environment must also pay close attention to infection prevention - High light levels in work areas and lower light levels in lounges and other relaxing rooms - Patients can be sensitive to light, non-direct light sources with adjustable levels are recommended in patient areas - Avoid long corridors, which can present challenges for fatigued patients - Curved walls can make corridors appear shorter - Successful wayfinding systems that integrate multiple methods of communication serve as a distraction to help reduce anxiety and stress - Digital art should be integrated into the ceiling design of imaging rooms - The soil of live plants can present a hazard to immune systems of patients, so it is recommended to consult with an infection prevention professional - Floor-to-ceiling windows, glass curtain walls, and skylights reduce the need for artificial lighting and help improve patient and staff moods - Daylight exposure can serve as a natural disinfectant, specifically helping to kill bacteria commonly found in dust

FINISH + FURNITURE

- Floor patterns, ceiling design, and intriguing finishes can be psychologically positive - Neutral colors with accents, warmer color schemes provide a sense of comfort - Utilize wood-grain patterns in order to enhance natural environment - Carpet can be used in the sitting area, but hard flooring should be used in passages/corridors - Use antimicrobial coatings on finishes of hard surfaces and lighting (indigo LED) that fights the spread of disease - Furniture cannot be too soft because it makes getting up difficult, and it cannot be too hard because patients lose weight so sitting on hard cushions can be painful 14

CASE STUDY - CANCER TREATMENT CENTER Memorial Sloan Kettering Cancer Center Location: West Harrison, New York Designer: EwingCole 114,500 sq.ft.

Two Stories + Basement Services/Amenities: Garden Room, Welcome Desk, Infusion Therapy, Cafe, Radiation Therapy, Imaging, Consultations, Support Counseling, Rehabilitation Suite

15

CASE STUDY - LIVING CENTER American Cancer Society Hope Lodge Location: Omaha, Nebraska Designer: Trivers 34,543 sq.ft.

Three Stories Services/Amenities: Shared public spaces on the first floor (large living room with fireplace, movie room, family kitchen, large dining tables), and lodging facilities are located on the second and third floors

16

LOCATION CARLSBAD, CALIFORNIA

- Carlsbad, California is located in Northern San Diego County - Nearby attractions include: Carlsbad Lagoon, Flower Fields, Carlsbad Outlets, Carlsbad Beaches - 7 Miles from Tri-City Medical Center (hospital patients will use for surgery needs) - 32 Miles from Downtown San Diego - On average, there are 263 sunny days per year in Carlsbad (US average is 205)

17

SCHEMATIC DESIGN

CONCEPT This Cancer Treatment + Living Center studies both hospitality and residential environments to develop a therapeutic and restorative environment. A light and airy aesthetic will create an elevating experience, promote healing, and serve as a beacon of hope for the patients and families. The form and palette will be carefully developed from the healing elements of nature found within the surrounding landscape. The well-detailed design will signify a sense of precision, a key component in cancer treatment.

Cancer treatment is not a linear, streamline process. It is rather an organic process due to the variety of diagnosis, treatment options, and processes. Every individual has a different journey. These nearby rock formations are organically shaped, and they are all uniquely weathered by the wind, salt, and water.

20

SITE ANALYSIS - Views of the ocean to the west and south - Views of the lagoon to the north, west, and east - Views of the mountains to the east - Views of the flower fields to the south and east

Tri City Medical

Terramar Beach

Carlsbad Premium Outlets The Flower Fields

- Main lobby for the cancer center is on the second floor, main lobby for the living center is on the first floor - Drop-off circle is located by second floor entry for patients - Secured/locked entry into the cancer center for after hours - Each guest room/suite has keycard entry for security - Staff only spaces have keycard entry for security - All spaces require acoustical privacy

Parking

First Floor Entry (to access main lobby of living center)

PM Sun AM Sun

Second Floor Entry (to access main lobby of cancer center)

Parking

Drop Off Circle

N Parking

21

BUILDING ORGANIZATION

INFUSION + MEDICAL ONCOLOGY LOBBY + AMENITIES

CONSULT + COUNSELING

RADIATION ONCOLOGY TREATMENT CENTER LEVEL BLOCKING

GUEST ROOMS FAMILY SUITES LOBBY + AMENITIES

22

LIVING CENTER LEVEL BLOCKING

SPACES INCLUDED - CANCER TREATMENT CENTER SERVICES/AMENITIES: The center features a variety of advanced clinical spaces, as well as numerous amenities in order to provide visitors with a positive experience: - Main Lobby with receptionist, check-in/check-out, registration and scheduling services - Gift Shop and Educational Resource Center - Health Cafe and Juice Bar - Nutritional Education - Counseling and Consultation Rooms - Chapel/Reflection Room - Wellness/Flex Rooms for activities/events - Pharmacy for convenient prescription pick-up CLINICAL SPACES: - Exam Rooms - Nurses’ Stations - Laboratory for on-site testing - Blood draw stations - Staff support areas

RADIATION ONCOLOGY : - Two Linear Accelerator Vaults with control rooms and proper shielding - MRI Suite - Two PET/CT Simulation Rooms with a shared control room - Two Mammography Rooms - Radiography (X-Ray) Room - Radiologist Reading Room - Dosimetry Lab - Change Rooms with Sub-Wait INFUSION AND MEDICAL ONCOLOGY: - Two Private Infusion Rooms - Private Isolation Infusion Room - Semi-Private Infusion Pods - Social Infusion Pods - Nourishment - Nurses’ Station - Meds/Work Room

23

SPACES INCLUDED - LIVING CENTER AMENITIES: Patients often enjoy socializing with others or taking part in activities. The center will provide a variety of spaces for visitors to socialize or relax individually.

Some of the services and amenities provided include: - Kitchen/Dining area for families/visitors to cook - Social/Gaming area - Craft Room - Movie Theater - Library with attached quiet room - Large multi-purpose rooms for activities/events - Market for items that guests may need to purchase during their stay - Laundry facilities - Fitness center with equipment for light exercising - Business center that provides visitors with access to a computer and printer

24

GUEST ROOMS: For patients who are staying only a short period of time, or for smaller families, 17 guest rooms are available. These guest rooms provide a hospitality experience that allows them to have a pleasant and comfortable stay. Guest room options include: - One king size bed with lounge area - Two queen size beds FAMILY SUITES: These 9 suites accommodate larger families and families that may need to stay for a longer period of time. Separate bedrooms and bathrooms also help protect the immune systems of the patients. These suites feature: - Two bedrooms (one of which having an en suite bathroom) - Two ADA bathrooms - Family room/lounge - Dining area - Kitchenette

CIRCULATION - LEVEL 1

PRIVATE STAFF SPACES STAFF CIRCULATION

PUBLIC CIRCULATION 25

CIRCULATION - LEVEL 2

PRIVATE STAFF SPACES STAFF CIRCULATION 26

PUBLIC CIRCULATION

CIRCULATION - LEVEL 3

PRIVATE STAFF SPACES STAFF CIRCULATION

PUBLIC CIRCULATION 27

DESIGN DEVELOPMENT

OVERALL FLOOR PLAN - LEVEL 1 KEY

UP

2 3

1

1

ATRIUM ENTRY

2

ELEVATORS

3

FEATURE STAIR

4

CANCER TREATMENT CENTER ENTRY

5

LIVING CENTER ENTRY

6

ATRIUM/INDOOR HEALING GARDEN

7

JUICE/COFFEE BAR

4

TREATMENT CENTER

2

7

1

6

UP

3

1

RADIATION ONCOLOGY RECEPTION

2

CLINIC AREA

3

RADIATION AREA + SEE PAGE 33 FOR COMPLETE KEY

UP

2

LIVING CENTER

1

5

2 14 3 13

1

10

12

9

1

RECEPTION/LOBBY

2

MARKET

3

KITCHEN/DINING AREA

4

SOCIAL/GAMING AREA

5

LIBRARY

6

QUIET ROOM

7

LAUNDRY ROOM

8

FITNESS CENTER

9

MULTI-PURPOSE ROOM

10

BUSINESS CENTER

11

MOVIE THEATER ROOM

12

CRAFT ROOM

13

OFFICES

14

STAFF LOUNGE

11 4 5

9

6

7

8

30

NTS

N

OVERALL FLOOR PLAN - LEVEL 2 KEY

DN

7

8

7

8

8

5

9

10

10

5

4

15

15

11 12

1

MAIN ENTRY

2

ELEVATORS

3

FEATURE STAIR

4

CANCER TREATMENT CENTER ENTRY

5

LIVING CENTER ENTRY

11

6 3

1

2

14

13

12

TREATMENT CENTER 4

2

1

DN

3 DN

2 5

1 2

1

MAIN LOBBY/RECEPTION

2

GIFT SHOP/EDUCATIONAL CENTER

3

CHECK-IN/CHECK-OUT

4

REGISTRATION/SCHEDULING

5

FINANCIAL OFFICE

6

HEALTH CAFE

7

WELLNESS/FLEX ROOM

8

NUTRITIONAL EDUCATION

9

CHAPEL

10

CONSULTATION

11

COUNSELING

12

CONFERENCE ROOM

13

STAFF BREAK ROOM

14

STAFF COLLABORATION

15

STAFF RESTROOM

LIVING CENTER 1

LOUNGE

2

FAMILY SUITES

NTS

N 31

OVERALL FLOOR PLAN - LEVEL 3 KEY 9

2 5 6 3

3

8

4

7

14

15

1

ELEVATORS

2

CANCER TREATMENT CENTER ENTRY

3

LIVING CENTER ENTRY

5

10

TREATMENT CENTER

1 11

12 13

2

1

1 3

1 1

2

1

INFUSION RECEPTION

2

INFUSION AREA

3

PRIVATE INFUSION

4

PRIVATE ISOLATION INFUSION

5

NURSES’ STATION

6

NOURISHMENT

7

PHARMACY

8

MEDS/WORK ROOM

9

LABORATORY

10

PHLEBOTOMY

11

STAFF COLLABORATION

12

STAFF BREAK ROOM

13

EXAM ROOM

14

EXAM/PROCEDURE ROOM

15

INSTRUMENT CLEANING

3

LIVING CENTER 1

LOUNGE

2

GUEST ROOM - KING BED WITH LOUNGE

3

GUEST ROOM - TWO QUEEN BEDS NTS

N 32

CANCER CENTER FLOOR PLAN - LEVEL 1 - RADIATION ONCOLOGY KEY 1

ENTRY FROM ATRIUM

2

MECHANICAL

3

RESTROOM

4

RECEPTION

5

WAITING

6

CLEAN SUPPLY

7

SOILED

8

JANITOR

9

STAFF RESTROOM

UP

12 26 13 16

11 9

3

17

9 10 8

7

6

27

28

14

10

STAFF BREAK ROOM

11

STAFF COLLABORATION

12

EXAM ROOM

13

ADA EXAM ROOM

14

NURSES’ STATION

15

ELECTRICAL/DATA

16

PET/CT SIMULATION

17

PET/CT SIMULATION CONTROL ROOM

18

MRI

19

MRI CONTROL ROOM

20

MRI EQUIPMENT

21

DOSIMETRY LAB

22

RADIOLOGIST READING ROOM

23

RADIOGRAPHY (X-RAY)

24

LINEAR ACCELERATOR CONTROL ROOM

25

LINEAR ACCELERATOR VAULT

26

MAMMOGRAPHY ROOM

27

SUB-WAIT

28

CHANGE ROOM

4 3

15

18

19

3

23

5 3

21

2

20

22

24

25

1

UP

NTS

N 33

ATRIUM

34

GENERAL TILE FLOORING

WOOD CEILING + BENCHES

ACCENT TILE FLOORING

GENERAL CEILING + WALL PAINT

ACCENT PAINT

ACCENT UPHOLSTERY

The triple-height atrium functions as the main entry into center, as well as a welcoming and inviting area for socializing or waiting. The space not only functions as an atrium, but also as an indoor healing garden. Due to the sensitive immune systems of the patients, the soil of the plants is covered or substituted with rocks, and the plant selections should be approved by an infection prevention specialist. Surrounding the garden is a custom stair with built-in bench seating. A variety of seating provides visitors with options, and the juice bar allows visitors to grab a drink or a healthy bite to eat.

SECTION PERSPECTIVE

35

MAIN LOBBY - CANCER TREATMENT CENTER

36

GENERAL TILE FLOORING TILE ACCENT FLOORING

CASEWORK + WALL LAMINATE

COUNTERTOPS

GENERAL CEILING + WALL PAINT

ACCENT PAINT

GLASS CEILING ELEMENTS

CASEWORK TOE-KICKS

FINISHES

The use of light neutrals and subtle blue accents creates a soft atmosphere that allows patients and visitors to feel at peace. Light blue glass suspended panels hang from the ceiling and serve as a wayfinding element in order to lead visitors from the entry into the reception area. The lounge area features a illuminated white wall inspired by the nearby ocean waves. The main lobby also features the gift shop and educational center, as well as the check-in/check-out area.

MAIN LOBBY FURNITURE

CHECK-IN/CHECK-OUT FURNITURE 37

HEALTH CAFE - CANCER TREATMENT CENTER

38

TILE FLOORING

TERRAZZO FLOORING ACCENT

WALL TILE

CEILING + WALL ACCENT PAINT

CEILING WOOD

SERVING LINE BAR + COUNTERTOP

TABLE TOPS

FURNITURE FINISH

FINISHES

A healthy diet is important for patients who are GLASS PENDANT OVER currently undergoing treatment, who have BOOTH recovered, and who are trying to prevent cancer.

The Health Café provide patients and visitors with healthy food options during their long days of treatment. The booth seating features a wave inspired wall-to-ceiling element. Wood is utilized in METAL PENDANT OVER the space in order to enhance the natural DINING TABLES environment and provide warmer accents that allow LIGHTING SELECTIONS visitors to feel a sense of comfort.

-

--

NTS

REFLECTED CEILING PLAN

N 39

INFUSION AREA - CANCER TREATMENT CENTER

40

SHEET VINYL FLOORING SHEET VINYL SHEET VINYL GENERAL PAINT ACCENT PAINT FIELD FLOORING ACCENT FLOORING ACCENT

CASEWORK + CEILING LAMINATE

COUNTERTOP NURSES’ STATION ACCENT TILE

INFUSION POD DIVIDERS

FINISHES

FURNITURE SELECTIONS

PRIVATE INFUSION + LOUNGE PENDANT

NURSES’ STATION PENDANT

-

---

During infusion therapy, some patients may receive treatment for eight hours a day. The Infusion Area is designed to be a comfortable and peaceful environment. This area contains a large nurses’ station that allows nurses to supervise all of the patients. Infusion bay options include semi-private, private, private isolation, and open for socializing. Each bay contains a comfortable recliner, guest chair, and infusion pod with supplies for the health professionals.

OPEN INFUSION AREA FLUSH MOUNT

LIGHTING SELECTIONS

NTS

REFLECTED CEILING PLAN

N 41

SOCIAL/GAMING AREA - LIVING CENTER

42

0' - 5"

0' - 3"

0' - 8"

0' - 2"

GYP. CEILING STAINED ASH SOLID WOOD SUPPORT MEMBER

STAINED ASH SOLID WOOD TOP RAIL

FINISHES

One of the many amenities provided by the Living Center is the Social and Gaming Area that allows individuals to gather, socialize, relax, and play games.

The lounge area features custom casework with an electric fireplace and television. The custom room dividers are created using alternating curved metal panels, and they are surrounded by a wooden frame.

SECTION PERSPECTIVE OF FEATURE WALL

0' - 2 1/2"

FEATURE WALL METAL

0' - 3"

CASEWORK STONE FIREPLACE

1" BRUSHED STAINLESS STEEL CURVED PANEL

STAINED ASH SOLID WOOD RAIL

STAINED ASH SOLID WOOD BOTTOM RAIL

STAINED ASH SOLID WOOD SUPPORT MEMBER

0' - 8"

ACCENT WALL PANEL

SCREW 1/4" WIRE CLAMP

10' - 2"

ACCENT PAINT

11' - 6"

CARPET

0' - 1" 0' - 1 1/2"

1' - 7" TYP

0' - 2 1/2"

STAINLESS STEEL METAL WIRE

FEATURE WALL DETAILS | NTS

43

GUEST SUITE - LIVING CENTER

44

CARPET

ACCENT PAINT

CASEWORK

COUNTERTOP

GENERAL PAINT

BATHROOM TILE

BATHROOM ACCENT TILE

FINISHES

Each guest room features a comfortable and relaxing environment. Custom casework allows guests to put their belongings in a dresser or closet. Nightstands are incorporated into the custom headboard. A bench allows visitors to have a convenient place to sit. One-bed guest rooms feature a lounge for guests to relax and watch television. The guest rooms are created to make visitors feel as though they are at home.

FURNITURE SELECTIONS

GUEST ROOM ELEVATION | NTS

45

BUILDING SECTION

NTS 46

BUILDING SECTION

NTS 47

Julie McCardell | Capstone 2020 | jmccardell1@live.maryville.edu