• Improving Completeness of Follow-Up After Endovascular Aortic Aneurysm Repair Through a Patient Tracking and Appointment Reminder Program

      DeBoe, Joseph C.; Wilson, Stephanie Leigh; Ritter, Leslie S.; Ramaiah, Venkatesh G. (The University of Arizona., 2020)
      PURPOSE: The purpose of this quality improvement (QI) project was to identify the extent of loss of follow-up after endovascular aneurysm repair (EVAR) at a single vascular surgery practice and to eventually improve completeness of follow-up after EVAR by making a recommendation for an EVAR tracking and appointment reminder program.BACKGOUND: EVAR is the preferred method of abdominal aortic aneurysm (AAA) repair when anatomy allows due to the less-invasive nature of the procedure. Society for Vascular Surgery practice guidelines recommend 1-month, 6-month, 12-month, and lifelong annual follow-up imaging after EVAR to detect potential complications such as endoleak and sac expansion. However, studies show that less than half of patients are meeting the recommended surveillance guidelines. METHODS: This was a QI project using a retrospective, quantitative design to determine baseline attendance at follow-up appointments after EVAR and develop an EVAR tracking and reminding program to be recommended to the practice. RESULTS: There were 68 patients that underwent EVAR for AAA repair in the vascular surgery practice over a 21-month period. There were 57 males (83.8%) and 11 females (16.2%) with ages ranging from 31 to 89 years old (M = 73.8, SD = 9.68). Of the 25 patients that had surgery from January 2019 through September 2019, only three patients (12%) attended their recommended follow-up appointments. Ten of the 25 patients (40%) were completely lost to follow-up. A detailed EVAR tracking and reminding program was outlined and provided to the practice. CONCLUSIONS: Ultimately, loss of follow-up after EVAR is a problem at this vascular surgery practice. A plan for EVAR tracking and appointment reminders, such as the one outlined in this project, could be piloted at this practice. Loss of follow-up appears to be a widespread and well-documented problem in vascular surgery, and unfortunately, there are very limited recommendations available to remedy it. Lifelong surveillance remains important following EVAR, and there is much to be desired in the way of surveillance programs and long-term medical device tracking.
    • Implementation of an Educational Session on Family Engagement for Family Members

      Trinidad, David R.; Ritter, Leslie S.; Gates, Courtney; DeBoe, Joseph C. (The University of Arizona., 2020)
      Purpose: The purpose of this quality improvement (QI) project was to further improve the family component of the Society of Critical Care Medicine ICU Liberation ABCDEF bundle, by educating family members on techniques to better engage with their loved ones in the intensive care unit at the College of Nursing Telehealth Learning Center.Background: Delirium leads to higher mortality, increased lengths of stay, and long-term cognitive impairment. By involving families, there is a higher prevalence of interventions to reduce and treat patient delirium. The Society of Critical Care Medicine developed a bundle to mitigate these effects, which includes family engagement. This project aimed to improve the family engagement component through an online educational module. Methods: A thorough literature search was conducted utilizing PubMed and Scopus. Family members were recruited by the Telehealth Learning Center. Inclusion criteria included: being an adult over the age of 18 years old, voluntarily consenting to participate, having English as primary language, and the current presence of a loved one in the medical intensive care unit. A 20-minute educational session about family engagement techniques was completed through Zoom on one day. Pre- and post-test surveys were sent to participants before and after the intervention. There were four questions using the Likert scale and one demographic question. Results: There were 13 participants that attended the session, but only seven participants (58%) completed the post-test survey, which limited data analysis. The item regarding ICU rounds was found to be significant (p<0.003); however, all other items were not found to be significant. Conclusions: The results of this QI project indicate that family members are knowledgeable about delirium, participation with loved ones, and self-care; however, there is an opportunity to better educate family members about ICU rounds. Despite the limitations of this study, this QI project provides key lessons for future programs implementing the ICU liberation bundle. Future studies could include a larger sample size, actual family members of ICU patients, and a greater age range.
    • Educating Women of Childbearing Age on Pre-conceptual Counseling: Reducing Unintended Pregnancy

      Martin-Plank, Lorraine M.; Olson, Kristin Victoria; Kiser, Lisa; Goldsmith, Melissa (The University of Arizona., 2020)
      Purpose The purpose of this project is to educate women of childbearing age on appropriate pre-conception counseling content to incorporate into their family planning. This is necessary due to the many health disparities preventing equal resources and accessibility for women of childbearing age. Background The rates of unintended pregnancy are continually unstable across the nation, therefore, emphasizing need for pre-conception counseling in healthcare for women of childbearing age is essential to prepare them for a healthy, intended pregnancy. While this is typically managed by an obstetrics provider, it is also a responsibility of primary care providers as this is a health promotion intervention. Methods Recruitment was done via social media for women of childbearing age. They completed a 10-question pre-survey to assess baseline knowledge, watched a concise audiovisual presentation regarding pre-conception counseling content, and completed a 10-question post-survey to assess their learning and if the information presented will affect their reproductive family planning. Results There were 25 participants (n=25), all of whom gave consent through the disclosure form provided within Qualtrics. The pre-test had a mean score of 71.2%, while the post-test had a mean score of 98.8%, showing significant improvement in participants’ learning with the education provided, with a 100% “strongly agree” answer provided on the Likert-scale question assessing willingness to use this information in their own family planning. Conclusions While this project was conducted with a small sample size, the significant increase in understanding of pre-conception counseling in this project could be used for further research with other populations and settings.
    • Designing Right-Provisioned System Architectures for Edge Computing

      Adegbija, Tosiron; Limaye, Ankur Milind; Akoglu, Ali; Lysecky, Roman (The University of Arizona., 2020)
      The growth of the Internet of Things (IoT) technology is transforming various industry sectors. Millions of smart devices, sensors, and actuators collaborate to monitor and manage the physical environment and human systems in the IoT paradigm. The traditional IoT is designed as a distributed system, with low-power edge devices collecting data and transmitting it to the centralized high-performance head nodes. The head nodes analyze the data, help with data visualization, and generate actionable information. However, significant challenges and overheads like bandwidth bottleneck and latency increase arise from the continuous data transmission between the edge and head devices. Edge computing is an emerging solution to the problems associated with traditional IoT. In edge computing, the computation is moved closer to the edge devices by equipping them with sufficient computation capabilities. Edge computing spans a wide variety of applications, application domains, and devices. In this dissertation, we focus on developing efficient system architectures for the edge devices. The first step in optimizing the system architectures is to understand the requirements of the target applications. We need to characterize the applications on a system to understand the computational requirements and derive insights about the system provisioning and identify potential optimization opportunities. It is essential to characterize a variety of applications and benchmark suites since each application has different computational demands, can stress different system components, and help us better understand the system requirements. In this dissertation, we choose one of the high-impact IoT application domain suitable for edge computing, the Internet of Medical Things (IoMT), as a use-case. We propose a benchmark suite consisting of representative IoMT applications and analyze them for different execution characteristics to derive insights into their compute and memory requirements. We also present workload characterization studies of two well-known and diverse benchmark suites: SPEC CPU2017, which aims to assess the systems' high-performance computing capabilities, and GAP, which comprises of memory-bound graph applications that are critical components of data analytics workflows. Edge computing devices will typically have strict area and power budgets, and hence, employ low-energy microprocessors with fewer computing resources. Moreover, the current generation of microprocessors has hit performance and power walls due to technology scaling slowdown. Current microprocessors' inability to sustain the historically observed performance scaling has resulted in finding alternatives to improve the target application's execution efficiency. Domain-specific architectures that efficiently utilize hardware acceleration to improve the target application's execution are a good fit for edge computing. As such, we present a domain-specific architecture for an electrocardiogram-based biometric authentication application that improves the performance and energy, compared to the baseline processor, and mitigates timing-based side-channel attack vulnerabilities. The major obstacle in designing domain-specific architectures is that we need to modify application codes to access the accelerators. To address this issue, we propose a programmer-agnostic LLVM-based methodology for generating domain-specific accelerators. Our methodology identifies and ranks the recurrent and similar code blocks within a set of applications that would benefit the most from hardware acceleration, and then integrates the corresponding accelerators into the system to generate domain-specific architectures. Using the methodology, we present a performance and energy-efficient domain-specific architecture for the IoMT applications.
    • Enhancing Youth Vaping Knowledge and Self-Efficacy

      Bouchard, Lindsay; Apperson, Chelsea Dawn; Pacheco, Christy; Nair, Uma (The University of Arizona., 2020)
      Purpose: This quality improvement project was developed and implemented to increase knowledge and self-efficacy related to vaping behaviors for youth at Valle del Sol, an integrated outpatient community health organization in Phoenix metropolitan area. Background: The youth vaping epidemic has been a significant and growing public health problem over the past 10 years, which can lead to a variety of mental and physical health consequences. Educating youth on vaping can help them make informed health decisions. Methods: Youth aged 11-18 enrolled in Valle del Sol substance use or transition to young adulthood programs were recruited for participation in CDC’s Know the risks: A youth guide to e-cigarettes presentation. Demographic data on vaping behaviors was collected prior to intervention. Before and after intervention, vaping knowledge and perceptions of self-efficacy were assessed via survey data. Additionally, free response items were collected via survey data on perceptions of vaping self-efficacy and intervention satisfaction. Paired t-tests were utilized to assess knowledge and self-efficacy gained from vaping presentation. Results: 23 out of 28 participants completed pretest/posttest survey data. Baseline demographic data revealed that average age of participants was 15.8 years (range=13 to 18 years), with 61% male and 39% female participants. 57% of participants reported not vaping nicotine and 54% reported not vaping THC in past 30 days. Of participants who did report vaping in last 30 days, 25% reported vaping nicotine 20+ days per month and 21% reported vaping THC 0-10 days per month. Polysubstance use was reported by 14 out of 28 youth. Paired t-tests revealed vaping knowledge scores increased by 7.8 points (out of 100 possible; p = 0.06) and self-efficacy scores increased 0.6 points (with a range of 6 - 30 possible; p = 0.6). Approximately one half of participants (52%) increased vaping knowledge and self-efficacy. Although not statistically significant, results support use of this intervention to address identified clinical problem and improve health outcomes for Valle del Sol youth. Conclusions: The majority of youth participants increased their vaping knowledge and self-efficacy from pretest/posttest. Youth reported that presentation was informative and expressed interest in changing their vaping behaviors to improve health.
    • Examining the Associations Between Post-Stroke Cognitive Function and Recurrent Stroke Risk Factors that Include Co-Morbid Conditions

      Morrison, Helena; McElroy, Melissa; Taylor-Piliae, Ruth; Rothers, Janet (The University of Arizona., 2020)
      Cognitive decline is a common yet elusive outcome following ischemic stroke. The immune system is believed to play a role in brain function and cognition, yet exactly how remains unclear. Following an ischemic brain injury, brain tissue is subject to both the deleterious effects of local inflammation and compromised structural integrity of the blood brain barrier, allowing circulating immune cells and inflammatory proteins to enter the brain and perpetuate neuroinflammation, tissue death and eventually neurodegeneration. Chronic inflammation in the brain and an injured blood brain barrier have been proposed as mechanisms of post-stroke cognitive decline. There is now an accumulation of evidence that suggest a number of cardiovascular-related comorbidities have also immune responses that contribute to systemic inflammation and thus, neuroinflammation mentioned above. The purpose of this secondary data analysis, collected from community-dwelling stroke survivors, was to evaluate the relationship between post-stroke cognitive decline and cardiovascular-related comorbid conditions, operationalized using a recurrent stroke risk score, the Stroke Prognosis Instrument-II (SPI-II). We then examined the relationship between SPI-II scores and measures of cognitive decline such as the Montreal Cognitive Assessment and the Mini-Mental State Exam (MoCA & MMSE, respectively) as well as differences in MoCA and MMSE scores according to stroke comorbidities. Our primary finding is that as total SPI-II score increased (our measure of comorbidity burden), MoCA and MMSE scores decreased (measures of post stroke cognitive decline; r = - 0.25, p = 0.01 and r = -0.22, p = 0.03, respectively). Participants with medium SPI-II scores had lower MoCA scores than those with low SPI-II scores (Dunn’s post-hoc test, p = 0.05, adjusted; Cohen’s d=0.43). On the other hand, MoCA and MMSE scores were similar when patients were stratified by singular comorbid conditions (e.g., those with & without hypertension). Interestingly, total SPI-II score correlated with a specific MoCA domain—delayed recall (p= 0.001). Lastly, in this data set, post-stroke cognitive decline was not influenced by gender. Although this secondary data analysis has inherent limitations, these data support the premise for studying comorbidity burden and its effect on post-stroke cognitive decline.
    • Language, Development, and Economic Market Transformation in Amman, Jordan

      Warner, Natasha; Zhang, Qing; Cotter, William Michael; Roth-Gordon, Jennifer (The University of Arizona., 2020)
      This dissertation investigates the relationship between language and development in Amman, Jordan. The three analytical chapters of this dissertation examine this relationship through analyses of institutional and state discourse in Jordan, alongside analyses of how residents of Amman use language to narrate and navigate the complexities of development in their daily lives. I show how the state uses chronotopes (Bakhtin 1981), representations of time and space in discourse, to craft a vision of Jordanian modernity. As I show, the state draws on aspects of Jordanian history, as well as broader Islamic cultural history in order to present Jordan as a free-market, progressive, and distinctly “modern” Middle Eastern state. At the same time, I show how the state and its development partners make use of elite discourses (Thurlow and Jaworski 2017a) which further specific ideologies of development and continued economic reforms. Contrasting with these institutional forms of language use, this dissertation shows how residents draw on legacies of failed development in Amman to craft a chronotope of developmental failure that is used to resist state intrusion into their daily lives. This dissertation shows how, as one moves from individual experiences with development to higher levels of institutional discourse, language is a continual thread that weaves together varied, often contradictory, experiences with development in Jordan. By examining how institutions use language as part of development in Amman, I show how they construct imaginaries about life in Jordan and produce the ideological frame of state history. At the same time, this work shows how the ideological underpinnings of development are resisted by residents through language use. Together, the analyses that constitute this dissertation illuminate how language plays a central role in our understanding of what development is, how it progresses, the forms it can take, and how we navigate its outcomes and effects in our daily lives.
    • Educating Patients on Long Acting Injectable Antipsychotics to Improve Medication Adherence

      Bouchard, Lindsay; Bracey, Jerri Latasha; Gallagher, Shawn; Williams, Deborah (The University of Arizona., 2020)
      Purpose: The purpose of this quality improvement (QI) project was to provide education forsimulated patients at the Telehealth Learning Center (TLC) with psychotic disorders on the advantages and disadvantages of utilizing long-acting injectable antipsychotics (LAIAs). Background: Despite the critical importance of medication in managing psychotic disorders, nonadherence with routine medication regimes continues to be a major issue in mental healthcare. Due to its negative impact on patients and the healthcare system, this problem has created the need for a method of administering medication that requires less maintenance. Alternative treatment options such as long-acting injectable antipsychotics can increase medication adherence but are infrequently discussed with patient taking oral antipsychotics. Methods: Standardized patients were recruited for this quality improvement project by the TLC coordinators using informational flyers. The project intervention was a 30-minute educational Zoom presentation. Participants were asked to complete a pre- and posttest to determine if the intervention increased patient knowledge about the use of LAIAs to manage psychotic symptoms. Results: There were 10 total participants; each participant completed the pre- and posttest and reported that the intervention was informative. The pre- and posttest findings indicate education regarding LAIAs increased participant willingness to utilize this treatment modality. Conclusions: Educational presentations provide an opportunity to improve patient knowledge. The educational presentation in this quality improvement project increased participant knowledge and acceptance of LAIAs. Due to the COVID-19 pandemic, a major limitation in this study is the use of standardized patients in a virtual clinic versus an in-person presentation with patients diagnosed with a serious mental illness. It is unknown if any of the standardized patients had psychotic disorders themselves; however, they offered valuable feedback about the effectiveness and feasibility of the project intervention.
    • Imperial and Colonial Economies of Trauma, Travel, and Knowledge in Guatemala

      Casper, Monica J.; Freeman, Katherine E.; Green, Linda B.; Luibhèid, Eithne; Stryker, Susan (The University of Arizona., 2020)
      This dissertation examines the enduring representation and exploitation of Guatemala as a particular type of travel and research destination in the imperial and colonial imaginary. It is a place where trauma is engaged, managed, and/or commodified as an object of white supremacist, cisheteropatriarchal, and capitalist desires. Drawing from over a decade of research, including ethnographic fieldwork and archival analysis, I show that this exploitation depends upon and activates the embodied, psycho-affective, and socioeconomic regimes of control left in the wake of the European invasion of the Americas. To advance my arguments, I trace the inauguration and maintenance of Guatemala’s tourism sector against a carefully managed backdrop of colonial warfare, one that still targets Maya peoples as spatiotemporal and somatic markers of the “savage” and “pre-modern.” I reveal how military officials, oligarchic stakeholders, and venture capitalists continue to exploit this “nostalgic” representation to encourage and guard the intranational travels of European and Euro-American anthropologists, archaeologists, humanitarians, missionaries, sightseers, and other “benevolent” representatives of Empire. As I illustrate, genocide in Guatemala (past and present) has never fully impeded this travel because it remains a requisite for the production of imperial knowledge about the country and for the accumulation of power/capital. Alongside original research, my work builds on Indigenous, Black, Latinx, Third World, queer, working-class, and feminist scholarship. These perspectives and my own research findings demand a form of knowledge production that can sustain, uplift, and honor planetary life. This includes how to demolish the Invasion as a persistent, pernicious, geocultural project and philosophy.
    • Improving Tobacco Cessation Processes for Behavioral Health Professionals in Primary Care

      Shurson, Lauren; Prettyman, Allen; Floyd, Iesha R.; Bertsch, Matthew (The University of Arizona., 2020)
      Purpose. The purpose of this quality improvement project was to develop evidence-based tobacco cessation recommendations through a pre-program evaluation of current tobacco cessation processes at a Federally Qualified Health Center in Casa Grande, Arizona. The primary investigator explored tobacco screening and counseling practices within the behavioral health department. The project took place alongside two similar projects focused on the pharmacy and primary care departments. Together the three projects functioned together to develop evidence-based recommendations, for implementation by future Doctor of Nursing Practice student cohorts. Background. Healthcare professionals experience multifactorial barriers that impact consistent delivery of evidence-based tobacco cessation interventions. The U.S. Preventative Service Task Force endorses two clinical practice guidelines that highlight a system-based approach for treating tobacco dependence. Guideline recommendations help to ensure consistent documentation and delivery of cessation interventions for tobacco users at every clinical encounter. Unfortunately, literature demonstrates inconsistent documentation practices, which result in missed opportunities to deliver proven interventions. Methods. The project analyzed current tobacco cessation processes among the facility’s behavioral health professionals. The focused evaluation used a survey tool developed from literature. The survey identified current tobacco screening and counseling processes and informed comprehensive recommendations developed to improve future tobacco cessation processes. Results. Of the four potential participants, three behavioral health professionals completed the survey (N = 3). Participants varied how frequently they inquired about tobacco use. However, they all reported delivering cessation interventions and made appropriate evidence-based recommendations. Two participants referred tobacco users not taking FDA approved medication to primary care. All participants felt confident counseling tobacco users and found ways to stay current with tobacco cessation recommendations. Consistent with current literature participants identified patient motivation was the leading counseling barrier. Conclusions. The project successfully identified current tobacco cessation processes and the top perceived barriers of behavioral health professionals. It underlined the important role of behavioral health professionals in tobacco cessation and demonstrated they are engaged, confident, and knowledgeable about the topic. Although barriers exist, the integrated patient care model at the Federally Qualified Health Center provides an opportunity to design a comprehensive program to seamlessly move tobacco users through the continuum of care.
    • Improving Knowledge and Perception of Cardiovascular Disease Amongst African Americans

      Gregg, S. Renee; Curry, Teal Renee; Newton, Tarnia; Ewudo, Izunna V. (The University of Arizona., 2020)
      The purpose of this project was to evaluate and improve knowledge and perceptions ofcardiovascular disease through culturally sensitive education. African Americans remain disproportionately affected by cardiovascular disease despite advancements in treatment and therapies for this disease over the last few decades. Though there is an abundance of literature highlighting the disadvantage that African Americans have, very little has been done to evaluate the effectiveness of taking a culturally tailored approach to education in order to improve knowledge and perception of CVD in this population. A descriptive, quantitative approach was used for this project. African American patients with or at risk for heart disease were recruited from the St. John’s Well Child and Family Center in Los Angeles, California. These participants completed a 10-item pre-test survey to assess baseline knowledge and perception, and then was given a culturally tailored educational booklet on cardiovascular disease. A 12-item post-test survey was given after the booklet had been completed, and the results were compared to the pre-test survey to evaluate the effectiveness of the intervention. Data analysis of the multiple- choice questions resulted in a mean pre-test score of 46/100 or 46% and a mean post-test score of 76/100 or 76%, indicating increased knowledge of CVD. Data analysis of Likert scale questions assessing for confidence and intent to incorporate heart healthy lifestyle habits and self-perceived improvement in knowledge and perception of CVD following the program intervention revealed an average 66.5% improvement of perception. In conclusion, African American patients at St. John Well Child and Family Center in Los Angeles, California showed improved knowledge and perception of CVD after implementation of a culturally sensitive education booklet and thus could ultimately lower their risk for heart disease.
    • Quality Improvement Project to Increasing Employment Support Awareness Among Behavioral Health Staff

      Edmund, Sara J.; Johns Caligiuri, Stacy Kit; Gallagher, Shawn P.; Parent-Johnson, Wendy (The University of Arizona., 2020)
      Purpose: This quality improvement (QI) project aimed to increase staff understanding of employment’s importance to mental health, comfort with and intention to refer patients to employment support services, and increase patient contact with vocational rehabilitation.Background: The Substance Abuse and Mental Health Service Administration (SAMHSA) has named employment an important step in mental illness recovery. Employment has been linked to social integration, improved mental health, and financial independence. Employment support services are offered in Arizona to those with a debilitating mental illness. However, of the public service mental health patients who report wanting to work, less than 2% are referred to employment support services. Low referral rates have been linked to a lack of knowledge and buy-in among the mental healthcare community. This project included administering a week-long employment support education intervention to staff at a psychiatric care facility. This education utilized approaches described in Adult Learning Theory (ALT) by tailoring the education to meet the learner’s needs and background. Methods: This project was implemented at a 12 bed, adult, inpatient, acute psychiatric care facility located in Prescott Valley, Arizona. A pre/posttest design assessed intervention efficacy on an 11-item numerical scale. The mean, minimum, maximum, and sum of the survey responses were calculated and compared. The project intervention was an educational video, a poster placed on the patient milieu, and information/application pamphlets for staff distribution. Patient contact of vocational support was tracked four weeks pre and post-intervention. The Institutional Review Board (IRB) approved this study. No conflicts of interest were identified. Results: Of the six screener staff volunteers, two submitted pre- and post-questionnaires. Post-intervention responses indicated increased appreciation for the importance of employment on mental health and comfort and intention to refer patients to employment support services. No patients from Pronghorn Psychiatry inpatient contacted vocational support pre- or post-intervention. Conclusion: Education may have increased employment support understanding and comfort with and intention to refer patients to employment support services. Low staff participation may have resulted in a lack of patient referral. Future interventions at Pronghorn Psychiatry may benefit from utilizing a personal approach to solicit medical staff buy-in pre-intervention.
    • Impacting Surgical Venous Thromboembolism Rates through Implementation of the Caprini Assessment Protocol

      Dowling, Evangeline M.; Adams, Kathleen; Davis, Mary P.; Brewer, Melanie A. (The University of Arizona., 2020)
      Purpose: HonorHealth Osborn aimed to optimize perioperative venous thromboembolism (VTE) prevention by implementing Caprini guided VTE reduction initiative. Initiative included Caprini assessment prior to surgery, provider ordered chemoprophylaxis based on Caprini score, mobilizing patients, and mechanical prophylaxis with sequential compression devices (SCDs). This project evaluated relationship between Caprini-guided VTE reduction initiative and perioperative venous thrombus embolism occurrence at an institution over first three months of implementation, December 17, 2019 to March 17, 2020. Background: Perioperative venous thrombus embolism (VTE) occurrence is leading cause of surgery-related preventable deaths. One evidence-supported intervention is application of risk stratification. Methods: This project was a retrospective formative evaluation. Age, gender, BMI, race or ethnicity, length of stay, type of surgery, length of operation, and surgical service was collected from EPIC charting system for both pre- and post-implementation cohorts. Application of sequential compression devices and distance ambulated were collected from EPIC during postimplementation period. Caprini percent completions, provider adherence with chemoprophylactic administration, PSI-12 excluding total joints were collected from post-intervention cohort through Microsoft Power BI. Implementation of Caprini assessment tool occurred December 17, 2019. HonorHealth Osborn is a 325-bed Level I trauma hospital and stroke center in Scottsdale, Arizona. Results: Pre-intervention data revealed 9.34 perioperative VTE occurrences per 1,000 inpatients. During post-intervention period there were 0.95 perioperative VTE occurrences per 1,000 inpatients. This program evaluation found significant reductions in perioperative VTE occurrences per 1,000 inpatients excluding total joints during December 17, 2019 to March 17, 2020 review period (P=0.0070). Revealing reduction in PSI-12 to below national 2019 AHRQ average of 3.45. Completion rates of Caprini assessment were 83.5%. Provider adherence with prophylaxis recommendations was 39.42%. Overall, there was 61.46% compliance with VTE reduction initiative protocol. Conclusion: The aims of this program evaluation were to assess Caprini assessment completion rates, provider adherence with prophylactic recommendations, mobilization, utilization of mechanical prophylaxis and review the relationship between VTE reduction initiative and VTE incidence. Although protocol compliance 61.4%, the statistically significant reduction perioperative VTE occurrence in population reveals importance Caprini based protocols have in prevention of perioperative VTE occurrence. Future research will be required to explore barriers in protocol compliance.
    • Bad Boys, Bad Boys, Who's Gotta Thing For You?: Examining the Sexual Appeal of the Bad Boy Archetype

      Floyd, Kory; Custer, Benjamin Everett; Bonito, Joseph A.; Rains, Stephen A. (The University of Arizona., 2020)
      Mass media messages transcending genres and generations lead many of us to believe that nice guys finish behind bad boys in the mate selection process, particularly in short-term contexts. However, evidence for the validity of that claim is elusive. This dissertation takes an interdisciplinary approach to testing the enduring stereotype by mapping communication behaviors onto underlying biological and psychological mechanisms. In an experimental research design, 189 young, straight cisgender women were presented with online dating profiles manipulated by the author and asked to evaluate the depicted men on their physical attractiveness and short- and long-term mate appeal. Results failed to substantiate the bad boy stereotype, although the means for each hypothesis were in the predicted direction. Nevertheless, a significant main effect of testosterone on physical attractiveness was found, which is noteworthy because although phenotypic signs of high testosterone are not exclusive to bad boys, they represent a signature characteristic of the archetype. Interpretations and implications of the results are discussed with an emphasis on exploring explanations for their nonsignificance and avenues for future research.
    • Assessing Nurse Practitioner Readiness to Educate Adult Patients with Depression on Benefits of Physical Activity

      Kahn-John, Michelle; Divakaran, Sheeba Kalappurakkal; Martin Plank, Lorraine M.; Shea, Kimberly D. (The University of Arizona., 2020)
      Purpose: Primary purpose of this quality improvement (QI) project was educating nurse practitioners (NPs). Each nurse practitioner is a member of a closed Facebook group titled “Indian FNP&PMHNP.” NPs received an educational intervention on current evidence indicating physical activity (PA) was adjunctive treatment for adults with depression. After educational intervention, knowledge, confidence, readiness, and willingness to recommend exercise as treatment option for adult patients with depression was assessed among participating NPs. Background: Depression affects people regardless of socio-economic status. Many treatment methods are available for treatment of depression in adult populations, but they may not always be accessible, or widely accepted by patients. The need for accessible, affordable, and least invasive treatment methods are important to address treatment gaps seen among adult patients experiencing depression. Data suggests physical activity is easily accessible, minimally invasive and an affordable adjunctive treatment for adults experiencing depression. Methods: This QI project used the Plan-Do-Study-Act, a model for healthcare improvement, as framework for implementation. The design was a pretest/posttest design offered before and after educational intervention, which was delivered using pre-recorded PowerPoint on benefits of physical activity as treatment option for adults with depression. Seven (N=7) NPs from closed Facebook group “Indian FNP&PMHNP Group” participated in an online education intervention. The pretest/posttest survey measured and compared participant perception on need for physical activity (PA), knowledge base, confidence level, readiness, and willingness to educate patients with depression on benefits of PA. All participants (100%) completed pretest/posttest survey after attending online educational intervention. Results: The difference between pre-/post-intervention survey response indicated increase of knowledge, confidence, readiness, and willingness to educate on PA in each of the participants when comparing pre-/post-survey results. Conclusions: The educational intervention was successful and increased NP knowledge, confidence, readiness, and willingness to educate patients depression on therapeutic benefits of PA. Results from this QI project emphasized importance of NPs having access to continuing education to support clinical practice. However, barriers for implementation of ongoing education for healthcare providers exist in busy clinic settings. High priority is ensuring new innovative strategies and continuing education opportunities are accessible to practicing clinicians.
    • An Evidence-Based Educational Intervention for Skin Cancer Screening in Primary Care

      Pacheco, Christy L.; Pieger, Karida; Godfrey, Timian M.; Daly, Patricia (The University of Arizona., 2020)
      Purpose: The purpose of this quality improvement project is to not only help prevent skin cancer through patient education and emphasize the significance of early skin cancer diagnosis but also to encourage routine skin cancer examinations into the primary care provider practice at the Wesley Community and Health Centers. Background: Skin cancer prevalence in Arizona and nationwide indicates the need for increased provider training and education on skin cancer screening in primary care. Primary care healthcare providers play a significant role in skin cancer education and screening; therefore, increased primary care provider education is crucial. This education should include up to date evidence-based guidelines by professional organizations along with resources for providers to aid in provider decision making. Methods: The design for this quality improvement project was an asynchronous webinar available over the course of 3 weeks, along with an educational pamphlet for provider education, followed by a survey post- webinar. All primary care healthcare providers at Wesley Community & Health Centers were invited to participate. Data was collected and analyzed via Qualtrics. Results: There was an 80% participant rate from the healthcare provider staff at this site. Data collected showed improved knowledge and confidence in providing skin cancer screening after the educational intervention. After the educational intervention, seven out of the eight respondents (87.5%) felt that they were above or far above standards with being informed of most up-to-date evidence-based skin cancer practices. A positive response to the educational intervention was noted from the participants. The asynchronous webinar format of this QI project facilitated increased provider participation, particularly given pandemic constraints during the COVID-19 crisis. Discussion/Conclusions: In conclusion, results overall showed improved knowledge, confidence, and intention for incorporation into practice after education. This project provided the Wesley staff with a unique opportunity for professional development and discussion of future professional development amidst a global pandemic. The asynchronous webinar and pamphlet will remain available to future provider staff at this clinic and aggregate data was shared with the providers via an executive summary.
    • Data-Driven Approaches for Assessing the Impact of Speed Management Strategies for Arterial Mobility and Safety

      Wu, Yao-Jan; Karimpour, Abolfazl; Chiu, Yi-Chang; Head, Larry; Russo, Brendan (The University of Arizona., 2020)
      Arterials are the connector of the national transportation system to regional mobility. Arterials play a significant role in providing accessibility to residential and commercial neighborhoods. Therefore, they are essential to the regional economy and residents' quality of life. Through the Moving Ahead for Progress in the 21st Century Act (MAP-21), US Congress requires that all the state Departments of Transportation (DOTs) and Multimodal Planning Organizations (MPOs) monitor, improve, and maintain the mobility and safety performance of their jurisdiction’s road network. A simple and straightforward solution to improve arterial mobility and safety would be constructing new roads. However, due to the limited infrastructure and high construction cost, this solution is not always feasible. One viable solution to enhance the mobility and safety of arterials is using ITS technologies. Speed management strategies are one of the emerging ITS technologies that are currently been utilized by different state departments of transportation to improve the safety and mobility of their road network. This dissertation focuses on proposing comprehensive data-driven speed management strategies and evaluating their impact on the mobility and safety of signalized arterials. This dissertation consists of the following components. One important issue before conducting any traffic studies is validating traffic data quality. Low quality and incomplete traffic data will negatively impact traffic projects’ outcomes. This component of the dissertation aims to develop a data-driven hybrid model to impute the missing and incomplete values. The proposed model imputes missing values by considering the interaction, similarity, and differences of the data as well as incorporating available historical information. The application of the proposed model was used to impute missing truck travel time data in the National Performance Measures Research Dataset (NPMRDS). The analysis result showed that the proposed model is able to impute severe continuous missing data with high accuracy. The comparison results also showed the proposed model will outperform other conventional models while dealing with severe missing conditions. The clean and high-quality data achieved from the first component will be used for identifying the segments with speeding problems and then identifying appropriate speed management strategies. A considerable amount of research has demonstrated a direct relationship between speed and both crash frequency and crash severity. Therefore, speed management strategies to impose the speed limit and tackle speeding are important for transportation agencies to improve mobility and safety at the corridor level. In this component of the dissertation the effects of implementing several speed management strategies, namely speed feedback signs, periodic law enforcement, and speed feedback sign supported with periodic law enforcement on driver speed behavior and compliance was examined. To analyze the effectiveness of each strategy, nine locations in Pima County, Arizona, were selected in a cross-sectional framework. The results of this component showed that supporting SFS with periodic law enforcement could be a key speed management strategy that takes advantage of the strengths of both SFS and law enforcement. Further, the results showed the existence of periodic law enforcement could potentially modify drivers’ behaviors and increase the spatial effectiveness of speed feedback signs. When it comes to mobility and safety evaluation of speed management strategies, previous studies only focused more on the corridor level instead of breaking the evaluation into the link (the segment between two intersections) and the intersection levels. Furthermore, the majority of the studies used historical crash data to investigate the safety impact of speed management strategies. Collecting such data takes time and effort. Therefore, this component of the dissertation focuses more on evaluating the impact of speed feedback sign at both link and intersections levels. The application of this component was implemented on a west/east arterial in Pima County, AZ. The results of intersection level data analysis showed no statistically significant differences in either mean or variance of the signalized performance measures before and after disabling the speed feedback sign. Moreover, it was found that the impact of speed feedback sign on driver’s behavior is a function of their approaching speed. Finally, the benefit in dollar value per year associated with a reduction in severe crashes on the study arterial with active SFS showed promising safety enhancement. Traffic signal retiming is another effective speed management strategy that significantly impacts the overall mobility of signalized arterials. Implementing correct signal timing plans and periodically retiming them will result in direct and indirect benefits such as reduction in the delay and travel time as direct benefits, and reduction in fuel consumption, air pollution, pavement wear, and tear as indirect benefits. In this component of the dissertation, a systematic step-wise approach is proposed that can assists transportation agencies to frequently fine-tune their signal timing parameters, rather than retiming the whole corridor every three to five years. In addition, the proposed approach will allow transportation agencies to predict the intersection mobility performance prior to the field implementation. The application of the proposed approach was implemented on multiple intersections on a major corridor in Pima County, Arizona. The prediction results showed that by only fine-tuning the green split, we are able to achieve on average 10% improvement on the intersection simple delay. The outcome of this dissertation could help DOTs and MPOs to use ITS technologies, to monitor, improve, and maintain the mobility and safety performance of their jurisdiction’s road network. More specifically, the data-driven safety and mobility approaches conducted in this study could: 1-provide a framework for missing data imputation before conducting traffic studies, 2-help transportation agencies to use the high-quality data to identify the high-risk location and identify the appropriate speed management strategy, 3- analyze the impact of speed management strategies at the corridor and intersection level, and 4- help transportation agencies with a more efficient way for signal retiming, enhance arterial mobility and consequently save money and resources.
    • Community Engagement to Improve Advance Care Planning Knowledge with Healthy Adults

      Martin-Plank, Lorraine M.; Mrozinski, Yuiho; Davis, Mary P.; Elliott, Cynthia M. (The University of Arizona., 2020)
      Purpose. This quality improvement (QI) project aimed to improve advance care planning (ACP) knowledge and comfort level in end-of-life (EOL) discussions of healthy adults through an online community engagement session teaching ACP education and playing an EOL conversation game Hello.Background. ACP is highly underutilized, with only 25% of Americans having an advance directive (Weathers et al., 2016). ACP helps people receive care consistent with their values and preferences, which improves quality of EOL care (Weathers et al., 2016). It also reduces healthcare costs by the decreasing utilization of futile healthcare services and burdensome transitions of care (Institute of Medicine [IOM], 2015; Kelley & Bollens-Lund, 2018; Smith et al., 2012). Barriers to ACP include lack of awareness and the belief that it only applies to older, sicker individuals. The coronavirus 2019 (COVID-19) pandemic, however, gave reason for people of all health-states and ages to voice their healthcare priorities in the case of a life-threatening illness. This provided an opportunistic time to normalize ACP, especially for people living near the first COVID-19 outbreak. Methods. Participants were ages 18 to 45, lived within 45 minutes of Bothell, WA, and were self-identified as healthy. Flyers were posted at local businesses and on social media, and disclosure forms and the invitation to an online Zoom meeting were sent to those who volunteered. Pre and posttest surveys via SoGoSurvey were sent to assess baseline and post-engagement session knowledge and comfort level regarding ACP and EOL conversations and assess the stage of change from the transtheoretical model in regards to ACP behavior. Data analysis occurred on Excel. Results. The project was implemented over a 60-minute Zoom meeting. Data analysis showed an increase in ACP knowledge and comfort level discussing EOL, and a forward shift in the stage of change. Seminar evaluation revealed that participants viewed the seminar as worthwhile. Conclusions. Effective dissemination of ACP information and exposure to EOL conversations targeted towards healthy, community-dwelling adults can be successfully accomplished through an online engagement session for the community of Bothell, Washington. Future studies should include participants from a wider variety of locations and results from multiple online sessions.
    • Does Participation in the Community Integrated Healthcare Program Reduce Heart Failure Readmissions

      DeBoe, Joseph C.; Ritter, Leslie S.; Ward, Jennifer Lynn; Trinidad, David R. (The University of Arizona., 2020)
      PURPOSE: Perform a program evaluation of the paramedicine transitional care program, the Community Integrated Healthcare Program, to determine its effectiveness in reducing heart failure 30-day readmissions compared to usual care. BACKGROUND: Heart failure is the leading cause of 30-day readmissions in the country with a rate of approximately 21.9%. Heart failure affects 6.2 million Americans and the incidence is expected to grow to 8 million by 2030. Additionally, the cost of treating heart failure is 30.7 billion dollars annually and is anticipated to double by 2030. The complexity of managing heart failure and high rate of complications has prompted the development of transitional care programs aimed at reducing readmissions. METHODS: This is a program evaluation using a quantitative, retrospective design. Data was gathered from the Zoll ® EMS Mobile Health EHR to describe the demographics of the Community Integrated Healthcare Program population and discover the 30-day heart failure readmission rate of participants. This was compared to the readmission rates of the two hospitals that refer to the program (obtained from the Center for Medicare and Medicaid Services) using a two-sample t-test of proportions. RESULTS: There were 13 females (48%) and 14 males (52%) with a mean age of 81.7  2.846. The 70-79-year age bracket represented 33.3% of the sample, the 80-89 year age bracket represented 37%, and the 90-99 year age bracket represented 22.2%. Days from discharge to the first home visit varied from 3 to 22 days (median 6.5), and the number of visits within 30-days ranged from 3 to 8 (median 5). Participation in the Community Integrated Healthcare Program significantly reduced heart failure readmissions compared to the total readmission rate of the referring hospitals (p= 0.0477). CONCLUSION: This project shows encouraging results as to the effectiveness of the Community Integrated Healthcare Program in reducing heart failure 30-day readmissions. The program evaluation was able to identify areas of success, and areas for improvement in the program. Additionally, a new role for the Doctor of Nursing Practice prepared nurse practitioner has been identified.
    • DAST-10 Education with the Intent to Adopt at an Integrated Health Clinic

      Gallagher, Shawn P.; Badger, Terry A.; Tanis, David; Edmund, Sara J. (The University of Arizona., 2020)
      Purpose: The purpose of this quality improvement project was to educate MHC staff on the DAST-10 screening tool in an attempt to increase their knowledge and intent to adopt the DAST-10 tool into their SBIRT protocolBackground: Illicit substance use is one of the leading causes of morbidity and mortality in the United States, resulting in over 70,000 overdose deaths in 2017 alone. The identification of substance abuse is critical to its management and improved patient outcomes. The DAST-10 is a reliable and effective screening tool for the identification of problematic drug use. The author educated staff at an integrated health clinic on the DAST-10 substance use screening tool with the goal of increasing their knowledge, perceived benefit, and intent to adopt the DAST-10 into their SBIRT protocol. Method: The quality improvement project was designed using the Model for Improvement and PDSA cycle. Participants were recruited via email to view a live, web-based in-service educating them on the DAST-10 screening tool. Participants completed a pretest and post-test survey to measure any change in the areas of knowledge of the DAST-10, perceived benefit of the DAST-10, and intent to adopt the DAST-10 into practice. Results: Nine staff members from the behavioral health department participated in the project. All nine participants completed the pretest, but only seven participants completed the post-test. The results showed an increase in participant knowledge and perceived benefit of the DAST-10, as well as their intent to adopt it into practice. Conclusion: The results of the project show the implementation was successful. The project shows that knowledge, perceived benefit, and intent to adopt the DAST-10 can be increased by educating staff through a web-based educational session.