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Item A Comparison of BMI Percentiles and Predictor Variables for Two Head Start Childhood Obesity Prevention Programs(2010-06-04T13:53:25Z) Goldberg, Patricia; Goldberg, Patricia; Moore, Jean B.A Head Start program enhancement, "I am Moving, I am Learning" (IMIL), is intended to 1) increase the amount of time per day that children participate in moderate to vigorous physical activity (MVPA); 2) improve the quality of structured movement activities that are led by teachers and other adults; and 3) promote and model healthy food choices for children. A quantitative study was conducted to determine if IMIL was effective in maintaining a healthy BMI in 354 four-year-old preschool children. Head Start secondary data were used to analyze and compare two groups of children: one group received the IMIL intervention; the control group received a standard Head Start nutrition program. T-tests, regression, and Chi-square analysis were conducted to compare improvement of BMI scores from baseline for the two groups. Results indicated that there was no significant improvement in BMI scores between (t= -25, df= 109.88, p= .81) and within the two groups of preschool children (IMIL group: t= -1.61, df= 257, p= .11; Control: t= -.70, df= 95, p= .49). Although there were several significant correlations between some of the variables, regression analysis for program variables indicated that the overall model did not significantly predict for BMI percentile change scores (R2 = .001, R2 adj. = -.007, F(3, 350) = .17, p = .91). Chi-square analysis for demographic variables indicated that only race/ethnicity had a significant relationship with BMI percentile scores (X2 = .011). Future studies of the IMIL obesity intervention should be conducted using a larger sample size composed of several Head Start regions in the U.S.Item A PRELIMINARY EFFICACY AND FEASIBILITY OF AN OBSTRUCTIVE SLEEP APNEA EDUCATIONAL INTERVENTION IN OMAN(2017) Al Mezeini, Khamis Abdallah; Al Mezeini, Khamis Abdallah; Mallinson, Kevin RBackground: Obstructive sleep apnea (OSA) is chronic disorder that contributes to multiple physiological and psychological conditions. Obstructive sleep apnea contributes to high rates of morbidity and mortality and has substantial impacts on both health care costs and the quality of life for affected individuals and their families. Healthcare providers–particularly primary health care nurses –are ideally situated to interrupt the cascading consequences of OSA if they are equipped with evidence-based knowledge about the disease process and appropriate methods for screening, education, and preventive interventions. Purpose: The purpose of the study was to test the preliminary efficacy and feasibility of an online health educational intervention on the knowledge and attitudes ofOSA among primary health care nurses in Oman. Methods: This study was designed to assess the preliminary efficacy and feasibility of an online educational program on OSA by randomly assigning subjects to either a treatment (OSA content) or attention control (diabetes content) group. At baseline, the OSA knowledge and attitudes of both groups were assessed by the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire; both groups also completed the Diabetes Basic Knowledge Test (DBKT) to use for control comparisons. Following randomization, the intervention group viewed a 15-minute narrated video on "Brief Introduction to OSA for Omani Nurses"and the control group viewed a similarly formatted15-minute narrated video on diabetes. The intent was for the subjects in both groups to complete a posttest that included both the OSAKA and DBKT instruments; however, due to a programming error, the software did not present the DBKT to the intervention subjects and did not present the OSAKA instrument to the control subjects as intended. Therefore, the results describe the findings from a one-group, pretest-posttest intervention study to assess the preliminary efficacy and feasibility of the educational intervention. Feasibility data were also collected with face-to face interviews with a convenience sample of nurse administrators who oversee primary health care nurses in health centers in the Al-Batinah governorate in Oman. Results: Overall, the baseline OSA knowledge scores for the entire sample (N=156) were very low (M=8.87, SD=2.91; median=9, range 0-15 out of possible 18 points). There were no significant relationships between OSA knowledge and any of the demographic variables. There was no significant difference in the mean OSA knowledge scores (p=0.80, t=0.26) between the intervention group (M=8.90, SD=2.68,n=73) and the control group (M=8.84,SD=3.12,n=83) at baseline. Primary health care nurses in the intervention group(n = 73)had a significant improvement in posttest knowledge scores on the OSAKA as compared to pretest scores (p=.037, t= −2.1). After the online OSA educational intervention, 91.8% (n=67) of participants (n=73) indicated they were “likely” or “very likely” to recommend the online video to other health professionals. Although posttest attitudes were higher than baseline for the intervention group, the difference did not reach statistical significance. Implications for Practice: The low levels of OSA knowledge in this sample of primary health care nurses may indicate that their ability to identify patients at risk for OSA, assess at-risk patients appropriately, or refer as needed to physicians is limited. Nursing educators may consider integrating content about sleep disorders –and OSA –into the baccalaureate nursing curricula. Continuing education programs might offer focused programs on sleep disorders and OSA to raise awareness among practicing nurses. Conclusion: Primary health care nurses in Oman are expected to assess patients, identify health risks, and refer as necessary to physicians or other practitioners. In this sample of primary health care nurses, knowledge about OSA waslimited; low knowledge of risk factors, symptoms, and treatment options may undermine the nurses’ ability to assure that patients who may have OSA are referred appropriately. Implications for basic nursing curricula and continuing education are offered.Item A Quasi-Experimental Trial of the Effects of Cholecalciferol Supplementation on Vitamin D Status Among a Diverse Population of Collegiate Basketball AthletesSekel, Nicole M; Sekel, Nicole M; Gallo, SinaBackground: Vitamin D is a fat-soluble micronutrient commonly found to be clinically deficient in a young, athletic, and otherwise healthy population. A gap remains in scientific literature pertinent to why this discrepancy exists, if particular modalities perpetuate this discrepancy and in what quantity vitamin D3 supplementation beneficially affects vitamin D status. Objective: To assess the prevalence of vitamin D insufficiency in a diverse sample of collegiate basketball athletes and to define the required dosage of vitamin D3 supplementation in order to beneficially affect serum 25-hydroxyvitamin D (25(OH)D), the major circulating metabolite in the human body indicative of vitamin D levels and consequently, one's current status. Design: This was a quasi-experimental vitamin D intervention trial. Participants were allocated to one of three groups based on their baseline vitamin D status as follows: insufficient (<75 nmol/L) were allocated to 10,000 IU of vitamin D3 daily, sufficient (75- 125 nmol/L) to 5,000 IU of vitamin D3 daily, and optimal (>125 nmol/L) to no supplementation. Baseline assessments were completed at the beginning of pre-season training and at ~5 months follow-up at post season. Demographics, body composition via dual x-ray absorptiometry, skin pigmentation via spectrophotometer and blood sampling for the assessment of serum 25(OH)D were completed. Results: The majority of participants (n) were allocated to the high dose supplementation group (10,000 IU daily) vs. n=5 allocated to 5,000 IU daily and n=2 to no supplementation. Overall, 77% of participants allocated to the high dose supplementation group (10,000 IU daily) were male (p=0.005), with olive to dark skin tone (p=0.022), and 85% self-reported as African American (p=0.027). Differences among groups were noted for whole body BMD Z-score (p=0.027) and lean body mass (p=0.004). A dose-response emerged in regard to the change of 25-hydroxyvitamin D concentrations from baseline to follow-up, wherein the 10,000 IU daily group exhibited the greatest change in 25(OH)D concentrations (35.01± 26.96 nmol/L) vs. the 5,000 IU daily group (-9.34± 9.62 nmol/L) and the no supplementation group (-41.57± 11.66 nmol/L, p<0.01). Among those allocated to 10,000 IU daily group, 3 (23%) remained insufficient, 9 (69%) climbed to sufficient status and 1 (8%) reached optimal status at follow-up. No participant in the 5,000 IU group reached optimal status and one of the two participants in the no supplementation group remained at optimal status at follow-up. A significant correlation between the change in 25(OH)D concentrations was observed with baseline 25(OH)D (rs=-0.78, p=0.01) as well as with lean and fat mass percent rs=0.83 and rs=-0.80 respectively, p=0.01). Conclusion: A dosage of 10,000 IU of vitamin D3 supplementation taken daily and allotted sufficient time to see marked improvement will help to mitigate the high prevalence of vitamin D deficiency among collegiate basketball players by beneficially impacting serum 25(OH)D levels. However, this dosage was not enough for all participants to reach vitamin D sufficiency. Further research encompassing a larger sample size of indoor, male and female collegiate athletes with varying degrees of adiposity is needed. Improving vitamin D status may have the potential benefits in maximizing sports performance and efficaciously reduce injury risk among collegiate athletes.Item A Study of Administrative Data Representation for Machine Learning(2022) Asadzadehzanjani, Negin; Asadzadehzanjani, Negin; Wojtusiak, JanuszAdministrative data, including medical claims, are frequently used to train machine learning-based models used for predicting patient outcomes. Despite many efforts in using administrative codes (medical codes) in claims data, little systematic work has been done in understanding how the codes in such data should be represented before model construction. Traditionally, the presence/absence of these codes representing diagnoses or procedures (Binary Representation) over a fixed period (typically one year) is used. More recently, some studies included temporal information into data representation, such as counting, calculating time from diagnosis, and using multiple time windows. However, these methods were not able to comprehensively capture temporal information in data and much of temporal information such as the exact time of the occurrence of an event, and the exact sequence of an event are missed. This dissertation presents the results of development and investigation of two additional methods of administrative data representation (Temporal Min-Max and Trajectory Representation) specific to diagnoses extracted from claims data before applying machine learning algorithms. It then presents a large-scale experimental evaluation of these methods by comparing them with traditional Binary Representation using four classification problems: one-year mortality prediction and high utilization of medical services prediction, prediction of chronic kidney disease and prediction of congestive heart failure. It was shown that the optimal way of representing the data is problem-dependent, thus optimization of representation parameters is required as part of the modeling.Item Acculturative Stress, Psychological Flexibility, and Cardiovascular Health Behaviors Among Second Generation Arab Americans in the Greater Washington DC Region(2019) Randa MerizianArab Americans are under-represented in cardiovascular (CV) research, but recent evidence reveals they are at disproportionate risk for poor CV health behaviors when compared to the overall United States of America population. The proposed study is designed to measure the impact of two factors, acculturative stress and psychological flexibility, on CV health behaviors among second generation Arab Americans in the Greater Washington DC region. The outcome variable will be measured using the CV Health Behaviors Questionnaire adapted from the American Heart Association Life’s Simple 7 (LSS). Participants will be recruited from five local churches and mosques and George Mason University where Arab Americans attend. The expected sample size (~300) is based upon a power analysis. Correlational and multivariate analyses will be performed.Item An Analysis of Variance in Nursing-Sensitive Patient Safety Indicators Related to Magnet Status, Nurse Staffing, and Other Hospital Characteristics(2009-06-01T19:37:46Z) Solomita, Joy B.; Solomita, Joy B.The purpose of this research was to identify if there was a significant difference in the risk-adjusted rates for a subset of five of the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Indicators (PSIs) in relation to ANCC's Magnet® designation in U.S. hospitals. This exploratory, cross-sectional study involved the analysis of organizational characteristics, including magnet status, nurse staffing, bed size (categorical and number of operated beds), and other organizational characteristics in relation to 5 of 20 of AHRQ's PSIs. The five PSIs were selected based on previous research findings that showed associations between nurse staffing and complications of care. Data from AHRQ's Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) for Calendar Year (CY) 2006 were combined with CY 2006 American Hospital Association (AHA) data, and hospitals with ANCC Magnet® designation were identified. The study used descriptive statistics, comparison of means, and a multivariate analysis of covariance (MANCOVA) to answer five research questions in relation to the differences is ANCC Magnet® hospitals versus non-magnet hospitals. The research questions addressed the following: (a) describing the differences in organizational characteristics, (b) identifying the risk-adjusted PSI rates, (c) determining nurse staffing differences, (d) identifying the relationships between organizational characteristics and the five selected PSIs, and (e) determining if there was a difference in the risk-adjusted PSI rates while controlling for nurse staffing and bed size. Findings included the following: (a) preventable adverse event rates were not lower in magnet hospitals; (b) nurse staffing was better in magnet hospitals; and (c) magnet status was not associated with preventable PSIs, while controlling for RN staffing and bed size. Significant findings included the following: (a) nurse staff hours per adjusted patient day (APD), (t = 2.513, df = 1001, p = .012) and RN hours per APD (t = 4.132, df = 1001, p < .000) were significantly higher in magnet than non-magnet hospitals; (b) magnet hospitals had a significantly higher rate of postoperative deep vein thrombosis (DVT) / pulmonary embolus (PE), (t = 2.44, df = 914, p = .015); and (c) magnet hospitals had a significantly lower rate of death among surgical inpatients (t = -2.05, df = 64.15, p = .044). The MANCOVA analysis indicated that magnet and non- magnet hospital groups did not significantly differ on the combined variable created from the five PSIs considered to be sensitive to nurse staffing (p = .383, tested at p < .05), while controlling for RN staffing and number of operated beds. The multivariate analysis revealed a significant relationship between the combined variable created from the selected PSIs in relation to the covariates of RN hours per APD (p = .001, tested at p < .05) and number of operated beds (p < .000, tested at p < .05). The univariate analysis indicated that the covariates had a significant relationship with four of the selected PSIs and included: (a) number of operated beds with the PSIs of decubitus ulcer, postoperative respiratory failure, and postoperative DVT/PE; and (b) RN hours per APD with the PSI of death among surgical inpatients. The study findings were limited by the size of the magnet group (n = 43) and by using administrative and AHA data, which are not validated by medical record review. Generalizability of the findings may be limited, and studies with a larger magnet sample need to be conducted. Further research is needed to reveal organizational characteristics and care delivery processes that contribute to safety and quality outcomes. Preventable adverse events can cause unnecessary harm to patients, waste resources, and increase operational cost and charges to payers, and are an increasing concern to nurse and hospital administrators related to reimbursement changes for the Centers for Medicare and Medicaid Services (CMS) "never events". Chief nurse executives (CNEs) need evidence-based strategies that optimize quality outcomes in relation to resources expended for staffing plans, skill mix, capital expenditures, and other resource allocation decisions. In the future, designation as an ANCC Magnet® facility needs to ensure that evidence related to better patient outcomes exists, similar to the many years of evidence relating magnet designation to better work environments and nurses' satisfaction.Item Celiac Disease: Data from the National Health and Nutrition Examination Survey 2009 - 2014Habel, Lara; Habel, Lara; Slavin, MargaretBackground: Celiac disease is a gastrointestinal malabsorptive disorder characterized by intestinal villous atrophy and triggered by an autoimmune response to gluten, leading to malnutrition and secondary conditions including osteoporosis. There is still a scarcity of information on the nutritional intake of adults with celiac disease as it relates to their bone health. Objective: To evaluate differences in nutritional intake of calcium, vitamin D, and phosphorus; serologic concentrations of these nutrients; and bone health among adults with and without celiac disease. Design: Cross-sectional data was retrieved from the National Health and Nutrition Examination Survey (NHANES) cycles 2009-10, 2011-12, and 2013-14. Data including self-reported dietary and supplement intake from 24-hour recalls, serologic nutrient status, and dual x-ray absorptiometry (DXA) scans were collected from 50 serologically positive (EMA+) adults with celiac disease. The serologically positive (EMA+) participants were an average age of 42 years old (range 18-80 years). Results were compared with those of 15,176 control subjects using multiple linear regression modelling controlled for age, sex, and race/ethnicity. Results: Adults with celiac disease consumed significantly more total calcium (Ca) (1608 vs. 1152 mg Ca/day, p = 0.031) than the control group. They had significantly higher serum phosphorus concentrations (4.0 vs. 3.8 mg/dL, p = 0.002) than the controls. In the multiple-adjusted model, positive serologic (EMA+) status predicted a 344.2 kcal (95% CI: 6.6, 681.8) increase in daily caloric intake, -0.1 g/cm2 (95% CI: -0.2, 0.0) decrease in femur BMD, -0.4 g (95% CI: -0.6, -0.1) decrease in femoral neck BMC, and - 0.1 g/cm2 (95% CI: -0.1, 0.0) decrease in femoral neck BMD. Conclusion: Despite greater overall calcium intake, adults who tested positive for celiac disease (EMA+) had lower serum calcium concentrations and lower overall bone mass than adults without celiac disease.Item Cervical Cancer Screening Behavior among Nepalese Women(2013) Satyal, Kalpana Subedi; Satyal, Kalpana Subedi; Gaffney, Kathleen F.Even-though Nepal has the highest age-standardized incidence and mortality rates of cervical cancer (CC) in the world, no universal coverage is available for cervical cancer screening (CCS) despite its known effectiveness in preventing and detecting CC. Although availability, accessibility, affordability and awareness are identified in literature as common barriers for women to undergo CCS in low-resource countries, there are new programs emerging in Nepal that provide services eliminating these barriers. Even then, the utilization of these services are reported to be sub-optimal. Sub-optimal utilization of CCS when the services are available, accessible and free indicate the need for further examination of the belief factors associated with CCS behavior, especially considering the major crisis of CC and low resources to provide CCS in Nepal.Item Characterization of fatigability and cardiorespiratory function in people with chronic motor-incomplete spinal cord injury(2016) Gollie, Jared; Gollie, Jared; Herrick, Jeffrey EPurpose: Fatigue presents a major challenge for those living with spinal cord injury (SCI). Additionally, prolonged pulmonary oxygen uptake kinetics (VO2 on-kinetics) and reduced skeletal muscle oxidative capacity are experienced after SCI. These alterations may contribute to increased fatigability during walking if present in those with chronic motor-incomplete SCI (miSCI). The purpose of this study was to characterize fatigability, VO2 on-kinetics, and muscle oxygenation in individuals with chronic miSCI compared to an able-bodied reference group. Methods: Eight chronic miSCI participants and eight able-bodied participants completed a two constant work-rate walking bouts at a self-selected walking speed. Fatigability was calculated as the ratio of perceived fatigability and performance fatigability. VO2 on-kinetics was determined using a mono-exponential model in which a time constant (tp) and amplitude (∆VO2) was calculated during phase 2 of the biphasic kinetic response during bout 1 of walking. Concentration changes in resting deoxygenated myoglobin/hemoglobin capacity ([HHb]total) and halftime ([HHb] ½ time) were determined in the left lateral gastrocnemius during arterial occlusion using near-infrared spectroscopy (NIRS). Results: miSCI group experienced greater fatigability, perceived fatigability, and performance fatigability compared to the reference group (6.62 ± 4.86 vs 1.87 ± 0.98, p=0.017; 5.75 ± 0.71 vs 3.38 ± 1.77, p=0.006; and 1153.38 ± 529.47 vs 1800 ± 0.00 seconds, p=0.011, respectively). VO2 on-kinetic profiles of the miSCI were prolonged compared to the reference (41.2 ± 7.67 vs 23.3 ± 6.48; p<0.0001). Significant correlation was found between fatigability and (tp r = 0.56; p = 0.012). During resting arterial occlusion the miSCI group experienced slower [HHb] ½ time compared to the reference (185.9 ± 28.7 vs 157.9 ± 18.9 sec., p=0.047). Conclusion: These individuals living with chronic miSCI appeared to more fatigable as a result of higher levels of performance and perceived fatigability. The results suggest that poor cardiorespiratory function may be a mediator of fatigability and demonstrate that cardiorespiratory function measures can be used as physiological markers of fatigability in this population. Furthermore, reduced skeletal muscle oxidative capacity is implicated as a contributing mechanism to the observed slowed VO2 on-kinetics.Item Competition And The Provision Of Hospital Community Benefits(2021) Mehmet SariIn the first chapter, I investigate whether nonprofit hospitals increase(decrease) with more(less) market power using the 2010-2016 IRS Form 990 Schedule H, American Hospital Association Annual Survey, and Healthcare Cost Report Information (HCRIS) database at the national level. The results show that higher levels of hospital concentration lead to a higher provision of community benefits when total market fixed-effects are controlled for. When hospital fixed-effects are controlled, the association between hospital concentration and community benefits provision becomes negative. This suggests that hospital-specific and market-level characteristics might explain the provision of community benefits better than a hospitals’ market power. In the second chapter, I add insurer market concentration to the analysis by adding Decision Resource Groups (DRG) dataset. Using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), I also estimate hospital choice model of patients to calculate hospital competition to address endogeneity issues of traditional competition measure. As a trade-off, I investigate the same hypothesis for only the following states from 2012 to 2016: Florida, New York, Vermont, Massachusetts, Arizona, and Utah. The results show that, considering the insurer competition, nonprofit hospitals do have increased community benefit provisions with more market power; however, there is no statistically significant evidence of the effect of hospital and insurer competition on the community benefit provision of nonprofit hospitals. In the third and final chapter, I argue that the IRS and the hospitals do not observe whether community benefit activities actually promote the communities’ health. I investigate this issue by examining how hospital market power affects the prevention quality indicators of uninsured patients — as an indication of community health. I use the data from IRS Form 990, HCRIS, and HCUP State Inpatient Database for six states from 2012 to 2016. The results show no significant evidence that nonprofit hospitals improve their communities through community benefit provisions in more concentrated markets. Unlike the hospital competition, there are supporting evidence that prevention quality indicators improve in more concentrated insurer markets.Item Continuous Access to Medication and Health Outcomes in Uninsured Adults With Type 2 Diabetes(2012-06-18) Toulouse, Cheryl Dillard; Toulouse, Cheryl Dillard; Milligan, Renee A.Background and Purpose: Achieving targets for HgbA1c, low density lipids (LDL), and blood pressure (BP) can improve outcomes in adults with diabetes. To meet targets, access to affordable and consistent medication is necessary. The Social Determinants of Health framework guided variable selection in this study that explored the relationship between continuous access to medication (CAM) and HgbA1c, LDL, BP, hospitalizations (HSPs), and emergency department visits (EDVs) in adults with type 2 diabetes who are uninsured and of low socioeconomic status. Hypothesis: CAM is related to improved HgbA1c, LDL, and BP, and reduced HSPs and EDVs. Methods: This within-subjects study was conducted in two steps using a sample that received healthcare on a mobile van and medications from a pharmaceutical program. Step1: Pre-Post (N = 65) exploratory analysis using Dependent t-Tests and McNemar’s tests. Step 2: Time-Series (N = 17) quasi-experimental analysis using RM-ANOVA. Pre-Post Results: CAM was related to improved HgbA1c (p = .003), LDL (p = .004), and systolic BP (p = .025). Time-Series Results: CAM was related to improved HgbA1c (p = .011) with a significant reduction in mean HgbA1c (-1.14%) from preintervention to postintervention (p = .014). Conclusions: Access to a consistent and reliable source of medication is essential to improving outcomes in adults with diabetes. In addition to providing excellent care, healthcare providers must foster opportunities to improve access to medication.Item Culture-Sensitive/Patient-Centered Assessment and Care Planning Skills in Home Health Nursing(2021) Mary NarayanIntroduction. Home health patients, who are members of minority and other vulnerable groups, suffer disparate outcomes. Culturally-competent care (CCC) and patient-centered care (PCC) aim to facilitate equitable, high-quality care. Both CCC and PCC share the same priorities and strategies, so they can be merged into one concept: culture-sensitive/patient-centered (CS/PC) care. No research about how home health nurses incorporate either CCC or PCC principles into their assessment and care-planning practices currently exist. This study explored “What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?”Methods: Using a multi-method grounded theory design, two subsamples were recruited. Sub-sample one consisted of transcultural nurses (n=9) who participated in a focus group and sub-sample two consisted of home health nurses (n=20) who participated in in-depth, audio-recorded interviews. The purpose of the transcultural group was to identify characteristics of CS/PC assessment and care planning, which were used to better understand home health nurses’ approach to CS/PC skills. Using a semi-structured interview guide, both sets of participants discussed questions such as, their understanding of CS/PC principles, how they developed their skills, how they instilled CS/PC principles into their assessment and care planning activities and the facilitators/barriers to CS/PC practice. Results. The grounded theory that emerged was that home health nurses learned CS/PC assessment skills along a journey, primarily through a trial-and error process by ‘the seat of their pants.” The journey began with caring attitudes and caring nurse-patient relationships, which formed the milieu for their experiences with diverse patient populations and their learning of their first CS/PC skills. Some nurses travel further and refine their skills through self-reflection and strong critical and creative thinking skills. However, many nurses felt stymied in their ability to practice their CS/PC assessment and care planning skills by agency and Medicare processes. They perceived these processes and policies as having a negative impact on their ability to practice their CS/PC skills. Only the most resilient nurses were able to continue their journey towards further developing their CS/PC skills in a changing home health care environment. The study also provided data to answer several other questions, such as what are the characteristics of a CS/PC nurse? These characteristics include: caring and humble attitudes/values; knowledge about self, uniqueness of persons, and norms of populations served; and skills related to forming a caring relationship with the patient, assessing to understand patients as unique cultural, valued persons, and planning care that enhances the patient’s health, well-being and quality of their lives from their perspectives. Additional questions can also be explored with the data collected, such as 1) what the is the relationship of caring to CS/PC care, 2) what are the specific, pragmatic, measurable CS/PC strategies that home health nurses can incorporate into their assessment and care planning skills, 3) how can academic and agency educators support the knowledge needed by nurses in a multicultural world, and 4) home health nurses’ perceptions of, and recommendations to ameliorate, barriers to CS/PC practice. Discussion. If we accept that CCC and PCC are key elements of high-quality, equitable care, the grounded theory process – Home Health Nurses’ Journey to CS/PC Assessment and Care-Planning Skills - may help home healthcare clinicians, administrators, educators and policy-makers identify impact points for enhancing CS/PC practices. For instance, nurse clinicians may use the CS/PC attitudes, knowledge, and skills as a blueprint for their professional development, educators my wish to highlight how nurses can incorporate CS/PC strategies into their practice, and administrators may wish to consider ways to minimize barriers and promote nurse resilience.Item Dashboard for Machine Learning Models in Health CareBagais, Wejdan H; Bagais, Wejdan H; Wojtusiak, JanuszPresentation of machine learning (ML) model results plays an important role in decision makers’ trust and use. Yet, there has been little agreement on how information should be visualized to present models' evaluations. The purpose of this thesis is to formulate an approach to visualize the results of classification model’s evaluation to increase decision makers’ trust. This work proposes a dashboard that visualizes supervised ML model performance in a dashboard which is split into three main sections: statistical measures, feature importance, sensitivity analysis. Three sample dashboards were generated and evaluated using a survey by ten faculty members and students from George Mason University most of which said that the dashboard provides useful information and gives a better understanding of the model behavior than other methods they have experienced. Model evaluation strategies differ based on the prediction problem considered. However, a consistent representation of evaluation results may increase decision makers’ trust in the models. The next step of this project is to visualize the difference between multiple models.Item Description of the Moderate Brain Injured Patient and Predictors of Discharge to Rehabilitation(2014-10-15) Rogers, Sandra; Rogers, Sandra; Richards, Kathy C.This retrospective, descriptive study characterized moderate traumatic brain injured patients between the ages of 18 to 64 years that were treated at level I and level II trauma centers within the United States and the predictors of discharge to rehabilitation after acute care using data reported in the National Trauma Data Bank (NTDB®). A literature review described the issues related to traumatic brain injury, examined conflicting results related to post-acute care discharge, and supported the need for further study of the moderate traumatic brain injured patient. The 2010 National Sample Project (NSP), part of the NTDB®, provided access to cross-sectional data with which to describe the moderate TBI patient and to explore the demographic, clinical, and financial predictors of discharge to rehabilitation within a sample of TBI patients. Multivariate logistic regression models revealed that demographic (age and region), clinical (injury severity score, Glasgow Coma score, and Abbreviated Injury score of the head), and financial (primary payment source and length of stay) characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare, longer length of stay (LOS), and trauma center locations in the Midwest and Northeast all increased likelihood of discharge to rehabilitation. Being younger, receiving acute treatment in the South, and self-pay all showed decreased likelihood of discharge to rehabilitation. The decision to discharge a person with a moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. More equitable access to post-acute rehabilitation services for moderate TBI patients is needed because of the risk for long-term disabilities and the potential to return to productive lives with treatment.Item Detection Models for the Early Diagnosis of Type 1 Hereditary Hemochromatosis(2020) Timothy CoffinzHereditary hemochromatosis (HH) is not only the most common genetic condition in persons of northern European descent (de Graaff et al., 2015), it also remains significantly misdiagnosed. The primary reason for this failure to diagnose the disease is that it lacks significant clinically apparent features. This problem is compounded by the fact that early and correct diagnosis is key to mitigating the effects of HH on patients. Untreated, HH can result in iron overload, which in turn may cause significant liver, heart, and endocrine damage. Therefore, this study will fill a gap in the research and in practice by developing an improved model of HH diagnosis and screening utilizing patient claims records and diagnosed comorbidities. This study utilized likelihood ratios and LASSO regression to reduce the feature set to develop manageable models. The results indicated effective models can be developed utilizing patient claims data to detect and diagnose Hereditary Hemochromatosis.Item Diet Quality and Nutritional Intake Differences Between Young Adult and Middle Aged Women with and Without Uterine Fibroids Participating in the National Nutrition and Health Examination Survey (NHANES) 2001-2006Gloede, Lise; Gloede, Lise; Gallo, SinaBackground: Uterine fibroids are a common condition for many premenopausal women with painful side effects and reproductive ramifications. Treatment options are limited and little is known about prevention. Dietary intake and food patterns are modifiable lifestyle factors which may play a role in this condition. Objective: To evaluate differences in dietary patterns, as measured using the Healthy Eating Index (HEI)-2010, and macronutrient intake between women with and without uterine fibroids. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2001-2002, 2003-2004, and 2005-2006 was obtained to examine a sample of young adult and middle aged women in the United States, excluding those who were pregnant or breastfeeding. Self-reported dietary intake from one day of 24-hour recalls, anthropometric measurements, reproductive health, and demographic information was collected as part of NHANES. Demographic and reproductive health characteristics were compared between groups using regression and chi-squared tests. HEI-2010 scores and energy adjusted macronutrient intake differences between groups were compared using linear regression adjusting for covariates of age, BMI, race, smoking status, marital status, and educational level. Results: This analysis included 87 women reporting previous uterine fibroid diagnosis and 743 women without a previous diagnosis. Women with fibroids were older (p<0.001), more likely to be college graduates (p=0.05) and be married (p=0.02). After adjustment, no differences in HEI-2010 scores or macronutrient intakes were noted between groups. Subgroup analysis, of women diagnosed only within the past five years, found fibroid diagnosis was associated with an increase in empty calories subcomponent score of 2.53 (95% CI: 1.12, 3.93, p=0.002)) and a decrease in whole fruit subcomponent score of 0.73 (95% CI: -1.44, -0.028, p=0.044) compared to women without a fibroids diagnosis. Conclusion: Women with fibroids did not have significantly different scores in HEI total and subcomponent scores as well as energy adjusted macronutrient intakes. However, women with fibroids diagnosed within the past five years had different scores suggesting differing dietary patterns may be present in women diagnosed more recently, though the subsample size was limited. Due to limitations in this study of use of 1-day of 24-hour recall data, potential misclassification of fibroids, and not controlling for health literacy, further research via prospective cohort studies to examine food intake patterns and possible relationships with uterine fibroids is warranted.Item Dietary Supplement Use in Transmasculine Spectrum PopulationsKalman-Rome, Eli; Kalman-Rome, Eli; de Jonge, ElisabethIntroduction: There are currently no dietary guidelines for the transgender community, and very little is known about the specific nutritional needs of this population. Previous studies suggest that transmasculine spectrum individuals may use dietary supplements in a way different from the general population due to cross-sex hormone therapy, struggles with gender dysphoria, and other elements of transitioning. Objective: To learn how the transmasculine spectrum population differs in its use of dietary supplements by comparing survey reports to the NHANES, 2007-2010 dataset. Methods: Forty-eight participants completed an online survey detailing their dietary supplement use and demographic information so that general trends could be determined. Findings: The rates of supplement use in the sample were significantly higher than the general population and although the participants reported good access to healthcare, the supplements were relied on heavily for overall wellness, specific complaints, and especially mental health. Medical transition status did not mitigate supplement use. There was no relationship between dietary supplement use and BMI or dietary supplement use and income. Conclusion: The transmasculine spectrum population uses dietary supplements in unique ways from the general U.S. population, and further research must be conducted to better understand how to provide proper nutritional guidance to transmasculine spectrum individuals.Item Diffusion of Innovation: A Descriptive Analysis of Pediatric Preparedness in Emergency Departments(2008-06-16T19:10:20Z) Huddleston, Kathi C.; Huddleston, Kathi C.The purpose of this study was twofold: First, to identify essential pediatric resuscitative equipment gaps in the nation's emergency departments; second, to identify associations among and between the domains of community and health care organizational structure as they related to hospital emergency departments' (EDs) adoption of the 2001 "Care of the Child in the Emergency Department: Guidelines for Preparedness" (Guidelines for Preparedness) published by the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP). Diffusion of Innovation (DOI) is the theoretical concept by which multiple characteristics within the domains of health care structure and community were examined. The study was conducted using extant data from the Center for Disease Control and Prevention (CDC) branch of the National Center for Health Statistics (CDC/NCHS). This descriptive study examined the relationships regarding the organizational and community characteristics of emergency departments with the adoption of the Guidelines for Preparedness. Characteristics of pediatric patient volume, pediatric subspecialty services, per capita income, urbanicity, and region were associated with the availability of pediatric emergency care essential equipment and services. Logistic regression was used to further explore variable relationships. The study identified hospital and community characteristics associated with pediatric emergency readiness and emergency medical care services essential for the care of critically ill or injured children. The study's community variables of per capita income and metropolitan status were significant, as were the structure variables of pediatric ED volume (size), pediatric trauma service, the presence of pediatric emergency medicine, and being a pediatric hospital. The DOI concepts of complexity and interconnectedness were drivers in both the adoption of the Guidelines for Preparedness and the compliance with pediatric essential emergency equipment. This study affirms that pediatric emergency equipment availability is a problem. Pediatrics continues to be an afterthought in emergency and disaster management, and as a nation we are not prepared for pediatric emergencies or pediatric disaster care.Item Disability and Perceived Social Norms Surrounding Intimate Partner Violence in Conflict-Exposed Communities in North Kivu, Democratic Republic of the CongoDeffenbaugh, Laurel A; Deffenbaugh, Laurel A; Gupta, JhumkaINTRODUCTION: Studies have shown that women living with a disability and women in conflict settings who are exposed to political violence are at higher risk for experiencing IPV, but more research is needed to examine IPV among women who have the combined vulnerability of living with a disability within a conflict setting. OBJECTIVE: This study examined the relationship between disability and perceptions of social norms regarding male-perpetrated intimate partner violence (IPV) against women in conflict-affected settings. METHODS: The study used secondary quantitative data drawn from a baseline study of 2018 violence prevention program in North Kivu, eastern Democratic Republic of Congo (DRC), by the International Rescue Committee (IRC). Perceptions of social norms were measured through the Partner Violence Norms Scale (PVNS) which measures perceptions of social norms surrounding gender norms and violence against women (VAW) in the home. A woman’s disability status was assessed based on severity as a three-level categorical variable. Linear regression models were applied to examine the relationship of a woman’s disability status and her PVNS score as well as her male partner’s PVNS score. RESULTS: Ninety-eight heterosexual couples were included. Women with severe disability had a lower PVNS scores on average than women with no disability (mean difference = -1.36, 95%CI: -2.39, -0.23, p = 0.014) when controlling for demographic variables. No significant difference in men’s PVNS scores based on their female partner’s disability status was found. CONCLUSION: These findings suggest that women with severe disability may perceive their communities to be less accepting of IPV than women with no disability, highlighting the complexity of the relationship between disability, IPV, and social norms and the importance of further analysis where disability as recognized as spectrum. Understanding social norms that influence IPV through PVNS scores may be used to inform understanding of male perpetration of abuse and how women perceive their own social roles and protections against IPV.Item Disability, Depression, Opioids, and Suicide among Women of Reproductive Age: Four Different Studies of Nationally Representative Samples(2022) Booth, Edward J; Kitsantas, PanagiotaDisability adversely affects a substantial proportion of the United States (US) population and is a recognized major public health challenge. Despite established associations between disability and adverse health conditions, limited information exists regarding its effects among women of reproductive age. This dissertation consists of four different studies that examine depression, opioids, and suicide among US women of reproductive age with disabilities. Using data from the Pregnancy Risk Assessment Monitoring System, the first study in Chapter One examined disability, stressful life events, and postpartum depressive symptoms among women. Descriptive statistics, bivariate, and binary logistic regression analyses were conducted to estimate the effect of stressful life events on postpartum depressive symptoms among women with and without disabilities. Compared to their peers without disabilities, women with disabilities reported a higher number of stressful life events (87% to 67%) and post depressive symptoms (37% to 9%). Women with disabilities experiencing six or more stressful life events were more likely (odds ratio = 3.78, 95% confidence interval = [1.57-9.10]) to report postpartum depressive symptoms, compared to those with no stressful life events. Data from the National Survey on Drug Use and Health (NSDUH) were used in the second, third, and fourth studies. The analyses included descriptive statistics, bivariate analyses, and logistic regression to measure associations. All of the analyses were weighted to account for the complex survey design of NSDUH. The second study in Chapter Two examined disability and prescription opioids among pregnant women. Pregnant women with any type of disability had higher adjusted odds of using (adjusted odds ratio = 1.71, 95% confidence interval = [1.27-2.29]) and misusing (adjusted odds ratio = 2.00, 95% confidence interval = [1.22-3.28]) opioids within the past year compared to their peers without disabilities. The third study in Chapter Three assessed disability and prescription opioids among non-pregnant women of reproductive age. The findings of this study indicate that similarly to the pregnant population, non-pregnant women with disabilities had higher adjusted odds of opioid use (adjusted odds ratio = 1.59, 95% confidence interval = [1.50-1.67]) and misuse (adjusted odds ratio = 2.01, 95% confidence interval = [1.82-2.21]) than their peers without disabilities. The fourth study in Chapter Four examined disability and suicidal behaviors among non-pregnant women of reproductive age. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (adjusted odds ratio = 1.73, 95% confidence interval = [1.60-1.87]) than women without disabilities. Disability adversely affects women of reproductive age in multiple facets of life. Compared to their peers without disabilities, women with disabilities are at an amplified risk for stressful life events, opioid use and misuse, and postpartum depressive symptoms. Early prenatal screenings for disabilities, life stressors, and opioid use or misuse is critical for timely awareness and appropriate treatment to prevent associated adverse health conditions. Further postnatal screening for postpartum depressive symptoms and opioid use or misuse is vital to optimize favorable health outcomes for mothers and their children. Both pregnant and non-pregnant women with disabilities are at increased risk for prescription opioid use and misuse relative to their peers without disabilities. Furthermore, non-pregnant women of reproductive age with disabilities are at increased risk for suicidal behaviors, particularly suicide attempts, compared to their counterparts without disabilities. Effectively mitigating the effects of opioids prior to reproduction will prevent associated adverse consequences for prospective mothers, children, and families. Furthermore, this study’s findings elucidate the complexity of suicidal behaviors among women with disabilities and the influence of specific health determinants on such behaviors. Enhancing our knowledge of suicidal behaviors and associated health determinants among women with disabilities can preserve the wellbeing of future generations via enhanced prevention, detection, and intervention enterprises.