Digital Commons Network^™

Reducing Sleep-Related Infant Deaths In Douglas County, Lauren J. Maskin

Capstone Experience: Master of Public Health

Douglas County, including the city of Omaha, covers 339.6 square miles along the border of the Missouri River in Nebraska with a population of 517,110 (https://www.douglascounty-ne.gov/) and is one of seven large urban counties in the state. There are approximately 8,000 infants born in Douglas County annually (Nebraska Vital Statistics Birth Dashboard). The Douglas County Health Department (DCHD), established in 1854, is one of the oldest county health departments in the state and manages multiple public health projects annually. In 2024-2025, a renewed focus for DCHD has been its infant mortality rate (IMR). In 2024, 44 infant mortalities occurred in …

Silent Cries: Analyzing The Psychological Profiles Of High School Shooters, Kayla N. Martinez

Honors Program Theses and Research Projects

Over the past two decades, school shootings have increased in frequency and severity in the United States, leaving schools, families, and communities with long-lasting trauma. Despite experiencing school shootings for more than 20 years, protocols put in place regarding school shootings seem to only be reactive rather than proactively identifying and preventing the occurrence. The purpose of this thesis was to analyze behavioral patterns high school shooters tend to exhibit using multiple factors and propose potential preventative strategies to reduce the number of incidents. This study relies on secondary data analysis in which behavioral, mental, and environmental factors were examined …

Rights, Contract, And Consideration In The Civil Law And Common Law Traditions, Stéphane Sérafin

UBC Law Review

No abstract provided.

Some Conditions Apply: Domesticating Aboriginal Title, Kerry Wilkins

UBC Law Review

No abstract provided.

The Unilateral Neuromuscular Effects Of Cross Education Eccentric-Focused Isokinetic Strength Training With Blood Flow Restriction In Sedentary And Recreationally Active Males, Bryan Mixumi

Theses and Dissertations

PURPOSE: The purpose of this study was to determine if BFR unilateral training protocols can elicit the same or greater cross-education effect as observed with HIGH protocols.

RESULTS: Significant time main effects and trained vs. untrained interactions revealed both training groups improved in isometric and isokinetic strength, work and power across limbs (P < 0.05). EMG analyses showed significant increases in vastus lateralis activation, with limb-specific neural adaptations but no group differences (P < 0.05) suggesting potential cross-education influence in the lower musculature.

CONCLUSION: With lower workloads, the BFR training protocols produced improvements in isometrics and isokinetic strength, work, power, and EMG that were comparable to those of the HIGH group across the trained and untrained limbs. The magnitude and limb-specific patterns varied across isometric, isokinetic, and EMG variables, but …

Performance Assessment Of Reconditioned Freight Rail Bearings Using Eddy Current Array For Enhanced Nondestructive Inspection, Eduardo Miranda

Theses and Dissertations

In North America, freight bearings removed from service must undergo a reconditioning process in accordance with Association of American Railroads recommended guidelines before reuse, with approximately 80% having been reconditioned at least once. This process includes bearing inspection, where repairable defects may be refurbished and returned to service with an extended performance range of 50,000 to 250,000 miles. Motivated by this extensive range in performance, researchers at the University Transportation Center for Railway Safety, in collaboration with MxV Rail, utilized a nondestructive evaluation method to enhance the reconditioning inspection process. An Eddy Current Array (ECA) was applied to bearing cup …

Hiring Expectations For New And Future Workers In Animal Genetics Careers, Meghan C. Wulster-Radcliffe, James N. Macleod, Robert J. Coleman, John S. Radcliffe, Rebekah B. Epps, Carol D. Hanley, Cheyenne S. Summers, Steven A. Zinn, Sarah A. Reed

Animal and Food Sciences Faculty Publications

To better align educational outcomes with workforce demands in animal and equine genetics, this study surveyed 65 industry professionals on entry-level competencies, hiring trends, and graduate preparedness of undergraduate students. The survey assessed employer ratings on the importance and perceived proficiency of seven core competencies: critical thinking, communication, teamwork, leadership, professionalism, career/self-development, and equity/inclusion, as well as technical knowledge and broader skills relevant to animal breeding and genetics. Results revealed oral communication, teamwork, and work ethic were rated as the most critical transferable skills, though notable proficiency gaps persist, particularly in leadership and professionalism. Foundational technical knowledge in genetics, molecular …

Career Readiness Competencies Among First-Generation Undecided Students And Their Parents In The United States, Nicole M. Kotlan, Evan W. Faidley

Journal of Global Education and Research

The purpose of this study was to investigate the relationship between first-generation status and the value of career readiness competencies of first-generation undecided students (n = 106) and their parents (n = 178), explored through social cognitive career theory and Bourdieu’s theory of habitus and social and cultural capital. A non-experimental design using a non-random sample revealed, through an independent t-test, statistically significant differences in global/intercultural competency among students based on their first-generation status. The results of a multiple linear regression analysis suggest that parents’ values are associated with students’ values and professionalism/work ethic; however, no relationship was …

A Secret Society Of Readers: College-Age Mentors’ Literacy Experiences With Young Adolescent Mentees, Lindsay Persohn, Dulcey B. Hunter, Chelsea Rivera, Karyn Z. Mendez, Cheryl R. Ellerbrock, Lucy Monette

Journal of Global Education and Research

This study occurred within Year One and Year Two of an ongoing literacy initiative designed to build reader identities among underserved middle school students. Using a near-peer mentoring model, mentees were paired with college-student mentors to interact weekly around books and reading. Reader interests and identities are influenced by affective and relational approaches through mentored reading experiences and a variety of texts. This qualitative case study (n = 11 of 24 Year One and n = 13 of 37 Year Two mentors) aimed to identify the ways mentor/mentee relationships affect reader interests, attitudes, and skills, and to evaluate the …

Internationalization Of Indian Higher Education: Mapping The Origins And Academic Choices Of International Students, Sanjeev Kumar Jha

Journal of Global Education and Research

This study explores the geographical origins, academic preferences, and key factors influencing the enrollment of international students in Indian higher education institutions. Drawing on primary data from interviews with 25 international students and secondary data from All India Survey on Higher Education reports, it provides an in-depth analysis of student mobility trends and factors shaping their choices. The results indicate that the international student enrollment is significantly below the Indian government’s target of 500,000 by 2024. Students come from Nepal, Sri Lanka, Afghanistan, Bhutan, and Nigeria, with Karnataka and Punjab emerging as the most preferred states within India. Engineering, particularly …

The Transition Zone Hypothesis On Biodiversity Of The Indian River Lagoon System, Florida, Richard L. Turner

Ocean Engineering and Marine Sciences Faculty Publications

The Indian River Lagoon System (IRL) is regarded as having a high level of biodiversity. The level of biodiversity is often attributed in part to the 2-degree latitudinal span (251 km) of the IRL and to its position in a transitional zone between tropical and temperate biotic provinces. This hypothesis was tested for submerged aquatic vegetation (SAV) based on a recent treatise (Littler, Littler, and Hanisak, 2008). Five of seven species of seagrass are tropical, and two have either a broad or very narrow latitudinal distribution; the transition-zone hypothesis does not hold for seagrasses. Most macroalgae (131 spp.) are tropical/subtropical; …

Evaluation Of Ramp Instead Of Forage During Grain Adaptation And Different Sorghum Varieties On Enteric Methane Production From Cattle, Jack T. Fort

Department of Animal Science: Dissertations, Theses, and Student Research

Two experiments were conducted to evaluate the use of RAMP (Cargill Corn Milling, Blair, Nebraska) compared with traditional forage-based adaptations on methane (CH₄) and carbon dioxide (CO₂) emissions, performance, and carcass characteristics. Experiment 1, 64 yearling British × Continental steers (initial BW = 423 ± 6 kg) were adapted using 100% RAMP (RAMP) or a traditional forage diet (CON; 43% forage) before transitioning 22 d to a common finishing diet containing 65.6% steam-flaked corn. Emissions were measured in paired replications using a two-chamber indirect calorimetry barn. During adaptation RAMP did not affect CH₄ production (g/d; …

Integrating Innovative Sensing And Ground Measurements For Forage Mass Estimation In Rye Pasture, Pedro Henrique Jota Fernandes

Department of Animal Science: Dissertations, Theses, and Student Research

The United States beef industry relies on forages to provide up to 80% of total lifetime dry matter intake, making accurate forage mass estimation essential for determining stocking rates, improving grazing efficiency, and supporting economic sustainability. Traditional methods to quantify forage mass, however, are time-consuming and labor-intensive. This thesis presents research efforts to achieve accurate forage mass estimation in cereal rye pasture by integrating novel sensing technologies.

Chapter 1 reviews the importance and evolution of forage mass estimation methods, from destructive clipping to indirect approaches based on canopy measurements. It then introduces remote sensing, from proximal tools to drone- and …

Investigation Of Changes In Exotic Bird Serum Vitamin D Levels Between Indoor And Outdoor Housing, Alexander J. Marley

Department of Animal Science: Dissertations, Theses, and Student Research

Vitamin D is a fat-soluble vitamin that is directly related to sunlight and is involved in multiple physiological processes including calcium metabolism, feather quality, and chick development. Most vertebrate species are capable of both absorption of exogenous vitamin D and internal synthesis of vitamin D, with vitamin D3 (cholecalciferol), being more accessible and bioactive in bird species. In exotic bird species, dietary requirements for vitamin D3 are largely unknown, and the ability to maintain adequate serum concentrations of vitamin D3 metabolites without direct sunlight exposure also requires evaluation. Concerns arise in situations where individuals may be housed indoors for extended …

Atheist Values And The Religious Other: Negotiating Morality In Indonesia, Malaysia, And The Philippines, Timo Duile, Prince Kennex R. Aldama

Antropologi Indonesia

As being religious is often seen in religious societies as a precondition for having values, atheists often face prejudice as they are seen as people without values. However, as they conceptualize and construct their values with and against the religious other, they are part of society as an arena in which what counts as values is constantly negotiated. Drawing on David Graeber’s concept of society as an arena for the realization of value production, this article sheds light on the values of atheists in religious plural societies in Southeast Asia, namely Indonesia, Malaysia, and the Philippines. It analyzes how atheism …

Genomic And Functional Characterisation Of Endophytic Bacterium Bacillus Cereus Strain E1 Alleviating Salt Stress And Enhancing Tomato Physiology And Spectral Indices, Balamurugan Sadaiappan, Tanveer Alam Khan, Qurban Ali, Sulamita Santos Correa, Mahideen Afridi, Soumaya Tounsi Hammami, Munawwar Ali Khan, Sunil Mundra

All Works

Mangroves in arid environments represent unique ecological niches that support a diverse range of microorganisms. Endophytic bacteria residing within host plants play a crucial role in promoting plant growth by enhancing pathogen resistance and alleviating environmental stress. Identifying novel stress-tolerant strains, specific to arid environments, is essential for expanding the repertoire of plant growth-promoting bacteria (PGPB). In this study, we investigated the saline tolerance of the endophytic bacterium strain E1, previously isolated from the root of Avicenna marina (grey mangrove). Whole-genome sequence (WGS), phylogenetics and average nucleotide identity (ANI) analysis were performed. The strain exhibited high salinity tolerance, growing in …

Breaking The Silence With Routine Genitourinary Syndrome Of Menopause Screening: A Quality Improvement Project, Ashley R. Noel

Electronic Theses and Dissertations

Affecting upwards of 87% of women in post menopause, genitourinary syndrome of menopause is greatly under-diagnosed, and consequently, under-treated. Genitourinary syndrome of menopause refers to health conditions impacted by hypoestrogenic state experienced in menopause. Common symptoms of GSM include vaginal dryness, irritation, clitoral or labial atrophy, dyspareunia, decreased libido, anorgasmia, dysuria, recurrent UTI, urinary incontinence (Kaufman et al., 2025). Despite the burdensome consequences of GSM, women are unlikely to vocalize their symptoms and seek treatment. Additionally, societal beliefs of shame surrounding sexual health impede patients and clinicians from addressing GSM specifically (Mili et al., 2021). As a result, the North …

Improving Intimate Partner Violence Screening In Telehealth Mental Health Settings, Marina Oliynyk

Electronic Theses and Dissertations

Intimate partner violence (IPV) is a pervasive yet frequently underrecognized public health concern, particularly within telehealth psychiatric care, where nonverbal cues may be absent. This quality improvement (QI) project aimed to improve the identification and response to IPV by implementing a standardized, evidence-based screening protocol in a private telepsychiatry practice. Guided by the Plan-Do-Study-Act (PDSA) framework, the validated E-HITS screening tool was introduced, along with structured trauma-informed care training, to six psychiatric-mental health nurse practitioners (PMHNPs). Six PMHNPs completed pre/post-confidence surveys (5-point Likert) and tracked screening activity across 100 telehealth encounters (98 of 100 visit were eligible). Over a three-month …

An Attack-Centric Approach To Security, Privacy, And Legal Challenges In Virtual Healthcare, Suvineetha Herath

Masters Theses & Doctoral Dissertations

As the U.S. healthcare sector continues to evolve, the adoption of virtual care delivery systems has expanded rapidly. This digital transformation has intensified concerns regarding the security and privacy of Protected Health Information (PHI). To address these challenges, this study employed a sequential, exploratory mixed-methods approach to examine the evolving threat landscape and to develop an attack-centric threat model for virtual healthcare environments. In the first phase, a qualitative analysis of regulatory enforcement and legal effectiveness was conducted to examine compliance gaps, privacy risks, and legal consequences within virtual healthcare systems. Building on the qualitative findings, the second phase quantitatively …

Heartmath: A Stress Reduction Program For Healthcare Providers In An Addiction Treatment Setting, Dihana C. Ruiz

Electronic Theses and Dissertations

Work-related stress significantly impacts the well-being of healthcare providers, specifically nurses and nurse practitioners, in addiction treatment facilities. This Quality Improvement (QI) project implemented the HeartMath Quick Coherence Technique to reduce stress and enhance resilience among staff, thereby improving the well-being of healthcare providers and the quality of care. The project utilized a pre- and post-intervention design with five participants, two registered nurses, and three nurse practitioners. Participants received training on HeartMath techniques, the EmWave Pro sensor, and the InnerBalance smartphone application. Over a six-week period, participants practiced Quick Coherence meditation for five minutes, twice daily, to achieve heart rate …

Safety In Stability: A Cdc-Guided Evaluation Of Hospital Fall Prevention Practices, Matthew C. Dougherty

Electronic Theses and Dissertations

Hospital falls remain a persistent and preventable cause of patient harm, emphasizing the need for continuous evaluation of fall prevention practices. This project assessed the effectiveness of AdventHealth Orlando’s fall prevention policy using the Centers for Disease Control and Prevention (CDC) Program Evaluation Framework. A mixed-methods design incorporated quantitative analysis of 12 months of fall data and qualitative feedback from frontline staff surveys and discussions. Results demonstrated a decrease in total falls from 549 in the previous year to 528 in the current year, indicating early progress despite the incomplete reporting period. Unit-level analysis showed a mean improvement of 16.9% …

Enhancing Provider Knowledge And Implementation Of Medication For Opioid Use Disorder (Moud) To Improve Treatment Outcomes: A Quality Improvement Project., Motunrayo Abigael Ibraheem

Electronic Theses and Dissertations

This quality improvement project sought to enhance healthcare providers' knowledge and attitudes toward Medication for Opioid Use Disorder (MOUD) at Galt Ocean Rehab Center to improve treatment outcomes for patients with opioid use disorder. Despite evidence supporting the efficacy of MOUD, significant knowledge gaps and stigmatizing attitudes among providers create barriers to optimal care. Sixteen healthcare providers participated in a comprehensive educational intervention grounded in Jean Watson's Theory of Transpersonal Caring and the Institute for Healthcare Improvement's Model for Improvement. The intervention consisted of a 4-hour workshop, six weekly reinforcement sessions, and the implementation of standardized buprenorphine management protocols. Pre- …

Enhancing Td Screening With The Aims Scale: A Quality Improvement Project, Dionne Smith

Electronic Theses and Dissertations

Tardive dyskinesia (TD) is a persistent, often irreversible movement disorder associated with long-term use of dopamine receptor–blocking agents. Early identification is critical to prevent progression and minimize functional impairment; however, routine TD screening remains inconsistent in many clinical settings despite the availability of the Abnormal Involuntary Movement Scale (AIMS), the evidence-based gold-standard tool. This quality improvement project aimed to enhance TD screening in an outpatient psychiatric setting through an educational intervention designed to improve provider knowledge of risk factors, diagnostic criteria, and screening guidelines. Data were collected retrospectively and prospectively from patient encounters, with 33 pre-intervention and 35 post-interventions. AIMS …

High-Risk Medications In Pediatric Dentistry: Patterns, Outcomes, And Clinical Implications, Yilei Liu, Kawtar Zouaidi, Colin C Hubbard, Muhammad F Walji, Matthew R Cooke, Donald B Rindal, Kristin N Ray, Elsbeth Kalenderian, Katie J Suda

Faculty, Staff and Student Publications

Background: High-risk medications such as opioids and benzodiazepines are frequently prescribed in pediatric dental care, yet their prescribing patterns and associated adverse outcomes remain poorly understood. The aim of this study was to determine the extent of such prescribing to pediatric patients and factors associated with adverse outcomes.

Methods: MarketScan data for patients younger than 18 years with a dental visit from 2014 through 2019 were analyzed. High-risk medications included benzodiazepines, barbiturates, and opioids. Composite outcomes included hospitalization, emergency department visit, or urgent care visit within 7 days after the dental visit. Opioid-attributable outcomes included opioid-related overdose within 7 days …

Alk5 Inhibitor Impact On Bleomycin-Induced Systemic Sclerosis Mouse Model Via Multifunctional Optical Coherence Tomography, Pavel V Nikitin, Harshdeep S Chawla, Jessica Gutierrez, Geethangili Madamanchi, Manmohan Singh, Salavat R Aglyamov, Minghua Wu, Jerry Alonso, Matthew Fronheiser, Juliana Coculo, Shuyan Du, Shervin Assassi, Kirill V Larin

Faculty, Staff and Student Publications

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis, vascular dysfunction, and immune dysregulation, leading to significant morbidity and mortality. Noninvasive imaging techniques are critical for monitoring disease progression and evaluating therapeutic interventions. This study investigates the technical feasibility of multifunctional optical coherence tomography (OCT)-based methods for longitudinal assessment of skin thickness, stiffness, and microvasculature in a murine SSc model as a translational, noninvasive, and quantitative method to study disease progression and treatment response. Our findings demonstrate significant structural, biomechanical, and vascular changes in the skin's stiffness, indicative of fibrosis, a hallmark of SSc. The application of SB …

Fam13a Polymorphism Is Associated With A Usual Interstitial Pneumonia Pattern In Patients With Systemic Sclerosis-Associated Interstitial Lung Disease, Elana J Bernstein, Francesco Boin, Brett Elicker, Yiming Luo, Yawen Ren, Meng Zhang, John Varga, Shervin Assassi

Faculty, Staff and Student Publications

Objectives: The MUC5B promoter single nucleotide polymorphism (SNP) rs35705950 has been associated with idiopathic pulmonary fibrosis (IPF) and RA-related interstitial lung disease (ILD), but not with SSc-ILD. We hypothesized that the MUC5B promoter polymorphism or other IPF susceptibility loci are associated with an increased risk for the uncommon SSc-usual interstitial pneumonia (UIP) endophenotype, rather than SSc-ILD in general.

Methods: We performed a cross-sectional study of SSc-ILD patients from four US Scleroderma Programs to investigate the frequency of MUC5B rs35705950 and 12 additional IPF susceptibility loci. SSc-ILD patients were stratified by high resolution chest CT (HRCT) imaging findings into UIP and …

Nocturnal Oxygen Therapy For Central Sleep Apnea In Patients With Heart Failure: A Multisite, Double-Blind, Sham-Controlled Randomized Clinical Trial (Loft-Hf), Susan Redline, Dongdong Li, Shahrokh Javaheri, Sanjay R Patel, Sairam Parthasarathy, James C Fang, Lee K Brown, Mark Dunlap, M Safwan Badr, Neomi Shah, Luqi Chi, Ruckshanda Majid, Mihaela Teodorescu, Garrick Stewart, Eileen Hsich, Tamar Polonsky, Justin Vader, Maryl R Johnson, Dennis Auckley, Henry Klar Yaggi, Andrew Kao, Ali Azarbarzin, Raichel Alex, Michael Rueschman, Lisa Wolfe, Daniel J Gottlieb, Scott A Sands, Phyllis C Zee, Reena Mehra, Babak Mokhlesi, Rami Khayat, Eldrin F Lewis, William T Abraham, Rui Wang

Faculty, Staff and Student Publications

Rationale: There are insufficient data to inform the management of central sleep apnea (CSA) in patients with heart failure with reduced ejection fraction (HFrEF). Nocturnal oxygen therapy (NOT) has been postulated to benefit CSA patients with HFrEF but has not been rigorously studied. Objectives: To compare NOT with sham NOT (control) in heart failure (HF) patients receiving guideline-based HF therapy on the composite outcome of first occurrence of either mortality due to any cause, a lifesaving cardiovascular intervention, or an unplanned hospitalization for worsening HF, together with other secondary outcomes.

Methods: A multisite, double-blind, sham-controlled randomized clinical trial was conducted …

Combining Pirfenidone With Mycophenolate Mofetil For Systemic Sclerosis-Related Interstitial Lung Disease (Scleroderma Lung Study Iii): An Investigator-Initiated, Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial, Dinesh Khanna, Cathie Spino, Donald P Tashkin, Elana J Bernstein, Jonathan Goldin, Eric C Kleerup, Airi Harui, Grace Ibrahim, Grace Hyun J Kim, Suiyuan Huang, Richard Mclain, Yi-Hsuan Tu, Vivek Nagaraja, Richard M Silver, Virginia D Steen, S Samuel Weigt, Joyce S Lee, Aryeh Fischer, Mary Beth Scholand, Jessica K Gordon, Paul F Dellaripa, Ivan O Rosas, Gary M Hunninghake, Marcin A Trojanowski, Robert W Simms, Jane E Dematte, Vivien M Hsu, Robyn T Domsic, Ganesh Raghu, Maureen D Mayes, Ryan D Boente, Michael D Roth

Faculty, Staff and Student Publications

Objective: Mycophenolate mofetil (MMF) can stabilize or improve lung function in systemic sclerosis-related interstitial lung disease (SSc-ILD). We hypothesized that combining MMF with pirfenidone (PFD) would produce a significantly more rapid and/or greater improvement in lung function.

Methods: A randomized (1:1), double-blind, placebo (PLA)-controlled phase 2 trial was conducted in SSc-ILD in which patients received PFD or PLA (801 mg three times daily) along with MMF (1,500 mg twice daily) for 18 months. The primary outcome was change in percent predicted forced vital capacity (FVC-%). Linear mixed-effects models assessed treatment differences in a modified intention-to-treat population.

Results: Only fifty-one of …

Revisiting Soluble Guanylate Cyclase Pharmacology: Additive Potential Of Stimulators And Activators, Alexandra Petraina, Mahmoud H Elbatreek, Christopher T Neullens, Theodora Saridaki, Vu Thao-Vi Dao, Rebecca D Szepanowski, Emil Martin, Wolfgang Sippl, Ana I Casas, Harald H H W Schmidt

Faculty, Staff and Student Publications

Nitric oxide (NO) is a key gasotransmitter that binds to soluble guanylate cyclase (sGC), thereby stimulating cGMP production. Under disease conditions, reactive oxygen species disrupt this signaling by either: (1) scavenging NO, or (2) promoting heme-free, NO-insensitive apo-sGC due to impaired heme incorporation or oxidative damage. To counteract these conditions, two pharmacological approaches have emerged: sGC stimulators, which allosterically enhance sGC sensitivity to low NO levels; and sGC activators, which directly activate apo-sGC (heme-free sGC) by binding to its empty heme pocket, inducing a conformation that mimics NO-bound sGC. Thus, sGC stimulators are thought to target only sGC. Instead, we …

A Urine-Based Point-Of-Care Test For Factor Xa Inhibitors In Acute Stroke Management, Prasen R Marella, Jacob A Sambursky, Kriti Bhayana, Asha P Jacob, Varsha Muddasani, Murli Mishra, Alexandra L Czap, James C Grotta

Faculty, Staff and Student Publications

Background: For stroke patients with history of possible Direct Acting Oral Anticoagulant use, clinicians must make treatment decisions without knowledge of whether the patient is therapeutically anticoagulated. A urine-based point-of-care test might help guide these emergency decisions.

Methods: We prospectively enrolled patients with suspected recent factor-Xa-inhibitor (Xai) use being evaluated for acute stroke therapy in an urban teaching hospital. We obtained the urine test and plasma anti-Xa level in parallel with usual clinical management; the treating clinician did not use test results for decision-making but recorded treatment they would have given had they known the urine test was accurate. The …