Medicine and Health Sciences Commons^™

Increasing Breast Cancer Screenings In The New American Population, Tuhina Venkatayogi Mph, Bs, Rn, Erin Leighton Dnp, Aprn, Fnp-Bc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Breast cancer poses a significant health risk globally, with routine screenings pivotal for early detection. The New American population in Vermont face many barriers to accessing mammogram screenings and have a 0% participation rate in breast cancer screening, thus necessitating targeted interventions. The purpose of this project was to improve mammogram participation among New Americans by at least 15% by January 2024.

Methods: The intervention at a New American clinic included an educational infographic presented during initial health center visits, supplemented by tangible pamphlets. Patient understanding was assessed through teach-back questions. Appointment scheduling was facilitated during the visit, with …

Probabilistic Modeling Of Disease: Addressing Uncertainties In Within-Host And Population-Level Dynamics, Mariah Boudreau

Graduate College Dissertations and Theses

Mathematical modeling of disease dynamics provides powerful tools to understand, predict, and evaluate emerging diseases. These insights aid public health officials, along with other modelers. With a plethora of models to choose from, it is important to consider a model that encapsulates the stochastic nature of disease dynamics. Stochasticity not only conveys chances of stochastic extinction, but provides probabilistic outcomes, essential for capturing the stochastic nature of the real world. In this thesis, three stochastic models are presented, each addressing uncertainties in mechanisms and interpretation of these models, to aid other modelers and decision makers.Starting with the source of infection …

Evaluation And Modeling Of Factors Associated With Urine Drug Testing Appointment Absences, Sherry Xu

Graduate College Dissertations and Theses

Why doesn’t a patient show up for their appointment? Is it too far? Are there too many appointments? Or something else? Urine drug testing clinics often observe patient scheduled visit absenteeism, and this can be used as a data source to answer our questions and explore other potential correlations between factors. With a well-developed electronic health data system, a retrospective study was performed on a large data set collected between January 2019 and December 2021 across the U.S. and more than half a million patient encounters; it contained nearly a year of quarantine, and pandemic status was also analyzed as …

Evaluation And Modeling Of Factors Associated With Urine Drug Testing Appointment Absences, Rui Xu

Graduate College Dissertations and Theses

Why doesn’t a patient show up for their appointment? Is it too far? Are there too many appointments? Or something else? Urine drug testing clinics often observe patient scheduled visit absenteeism, and this can be used as a data source to answer our questions and explore other potential correlations between factors. With a well-developed electronic health data system, a retrospective study was performed on a large data set collected between January 2019 and December 2021 across the U.S. and more than half a million patient encounters; it contained nearly a year of quarantine, and pandemic status was also analyzed as …

Evaluation And Modeling Of Factors Associated With Urine Drug Testing Appointment Absences, Rui Xu

Graduate College Dissertations and Theses

Why doesn’t a patient show up for their appointment? Is it too far? Are there too many appointments? Or something else? Urine drug testing clinics often observe patient scheduled visit absenteeism, and this can be used as a data source to answer our questions and explore other potential correlations between factors. With a well-developed electronic health data system, a retrospective study was performed on a large data set collected between January 2019 and December 2021 across the U.S. and more than half a million patient encounters; it contained nearly a year of quarantine, and pandemic status was also analyzed as …

Integrating A Functional Assessment Tool For Chronic Pain In Primary Care, Amanda Blanche Parent

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Chronic pain is prevalent in the United States. Frequently, rural primary care providers must manage patients’ chronic pain and any associated long-term opioids. Best evidence-based practices recommend, and in some cases state guidelines require, periodic functional assessment, for which the CDC endorses the PEG assessment scale.

Purpose: To integrate the PEG assessment scale into a rural, primary care practice and evaluate sustainability in following best evidence-based practice guidelines.

Methods: A one-year retrospective chart review determined the baseline quality and frequency of functional assessment. A pre-implementation survey was distributed to providers to assess knowledge of opioid prescribing guidelines and their …

Using Clinical Workflow Assessment Frameworks For Process Improvement Of Patient-Provider Communication In A Primary Care Office, Madeline Morris

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

The purpose of this project was to assess the current workflow for addressing the needs of patients between face-to-face healthcare visits at a primary care clinic in Northern New England. The assessment served as a framework to inform recommendations for process improvement interventions. Workflow was mapped using Lean’s value stream map (VSM) tool. Observational data and retrospective chart review were performed to collect information on time to complete tasks, equipment used, and personnel involved in each patient request. Key patterns in workflow variation, guided by theoretical frameworks of system constraints, were identified. Finally, a team brainstorming session was organized with …

Improving Communication Between Community Care Settings And Primary Care, Kristin Morgan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

In older patients with more complex and chronic health concerns, consistency and continuity of care is essential. Patients often live in assisted living residences or independently with support from programs such as Support and Services at Home (SASH), so nurses are available to address concerns and assist with certain aspects of care. Effective inter-professional communication is essential, but communication of assessments and coordinating care with participants’ primary care providers is complex.

Purpose

Improve efficiency and clarity of care-related communication for patient and care team by developing a system that standardizes and streamlines workflow and addresses current concerns.

Methods

At …

Examining The Feasibility Of Integrating An Alcohol Detoxification Protocol Within Primary Care, Emily A. Miller, Dnpc, Bsn, Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Medically supervised, in-home alcohol detoxification is safe, efficacious, cost-effective, and satisfying for patients. However, it remains underutilized within primary care practices. This feasibility study aimed to examine clinician perceptions of adopting a standardized outpatient alcohol detoxification protocol at a rural primary care clinic where no internal protocol exists.

Methods: An ambulatory alcohol detoxification protocol was created using the American Society of Addiction Medicine guideline on alcohol withdrawal management and presented to 38 providers and 11 nurses. Twelve participants (six providers and six nurses) completed a modified version of the Implementation Process Assessment Tool. The instrument measured stakeholder perceptions of …

Implementing The Tcare Protocol In A Memory Program, Meaghan E. Knakal

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: This project created a protocol for use of the Tailored Caregiver Assessment and Referral Evaluation (TCARE)® screening tool in a Memory Program for assessing for caregiver stress in informal caregivers.

Methods: The TCARE® screening tool was researched, and then a protocol for use by nurse practitioners was created. Approval from the academic and hospital organization was received and the TCARE ®protocol for use was implemented in a Memory Program. Two PDSA cycles were utilized to evaluate this intervention. Findings were analyzed for sustainability and contribution to the clinical setting.

Results: All caregivers (n = 5) who completed the TCARE® …

Community Transitions Of Care For Hospital Readmission Prevention, Lauren Fedorka

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Transitions of Care (TOC) occur whenever an individual moves from one healthcare setting to another. Older adults are higher utilizers of healthcare services, including inpatient and emergent visits, than the general population (Tian, 2016), and thus experience more TOCs. Due to risk of poor outcomes at discharge from the hospital, rehospitalizations are a concern. Standardized TOC protocols have been shown to be beneficial in reducing rehospitalizations for this vulnerable population.

Purpose: Use current best practices to design and implement TOC for a rural community organization to reduce unintended rehospitalizations for older adults.

Methods: Best practices in TOC were …

Low Birth Weight Status Combined With Socioeconomic Factors Influences Future Diagnosis Of Learning Disability, Sinead Donnelly, Nisagini Logendran, Anel Peco, Maris Sagamang, Elizabeth Sparks

Master of Public Health Culminating Projects

Objective: To determine if there is correlation between low birth weight and the development of learning disabilities in later stages of life.

Methods: Data from the National Child Health Survey from 2018-2020 was used with data from

59,963 U.S. households looking at children aged six to eleven years. A multiple linear regression model was used to assess the relationship between low birth weight (<2500g) and learning disabilities and developmental delays when controlling for ethnicity, family structure, and household income.

Results: The results indicate 7.2% of those surveyed reported a child with a diagnosed learning disability. In response to the low birth weight category, 8.2% of the children involved were in the category …

The Role Of Food Insecurity With Hunger And Physical Activity Level On Binge Drinking Among Vermont High School Students, Joe Stacy, Codi Williams, Zyakkiriah Rhoden, Han Naung Tun

Master of Public Health Culminating Projects

Objective: To determine the association of hunger, physical activity, Black Indigenous People Of Color (BIPOC) status , and BMI percentile on binge drinking among Vermont high schoolers.

Methods: A cross-sectional study was conducted on Vermont high school students aged between 12 to 18 years (n=18,540) using data obtained from the 2019 Youth Risk Behavior Survey of the Vermont Department of Health. Multiple logistic regression models were utilized to investigate the correlation between binge drinking status and hunger status, physically active status, BIPOC status, and Body Mass Index percentile.

Results: Binge drinkers had significantly higher levels of hunger …

Increasing Provider Use Of The Family Media Plan For Patients Ages 2-5, Christine Head

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

Currently in the United States, 56.1% of preschoolers use over one hour a day screen time, exceeding time recommendations set by the American Academy of Pediatrics (AAP) (Healthy People 2030, 2020). Excess screen use by preschoolers is detrimental to development, behavior, and increases the risk for obesity. The Family Media Plan (FMP) is an evidenced-based intervention developed by the AAP to reduce screen time use in pediatrics (Reid Chassiakos et al., 2016).

Purpose

To address preschoolers at risk for the overuse of screen time, this quality improvement project aimed to increase evidenced-based intervention for those ages 2-5 years old …

Implementing Social Determinants Of Health Screening Post Emergency Department Discharge, Grace Kenley

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Frequent emergency department use is defined as four or more visits a year. Individuals who frequent the emergency department often have social and health inequities, chronic illness, and live in rural settings. Healthcare complaints associated with frequent emergency department use can typically be managed in a primary care setting. Decreased emergency department use is a suspected outcome of addressing unmet social needs.

Purpose: Outcome measures include: 1) number of individuals seen in the emergency department on a weekly basis; 2) how individuals were called by the site RN and then subsequently screened for unmet social needs; 3) identified unmet …

Improving Access To Gender-Affirming Care: A Welcome Packet, Kelsey J. Rumley

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

BACKGROUND: Transgender and gender diverse (TGD) individuals face unique challenges in accessing healthcare such as stigma, bias, fear of rejection, limited access to providers, and lack of information on where to seek care. There is evidence that creating an inclusive clinic atmosphere improves access and leads to a more positive healthcare experience

AIMS: The global aim of this project is to improve access to gender-affirming care for students at a New England university. Specific aims were to assess stakeholder needs for content inclusion and develop a new patient welcome packet based on the needs assessment.

METHODS: The Plan Do Study …

Cardiovascular Disease Deaths Of Vermonters Aged 65+ Years By Rurality Status Of Residency, Francene Zavala, Katherine Rampone, Kailene Cruden, Tyler Flores, Mark Gauthier

Master of Public Health Culminating Projects

Objective: To analyze cardiovascular disease (CVD) mortality amongst individuals 65 years and older living in different areas of Vermont.

Methods: Using the state of Vermont's Electronic Death Registration System, the cross-sectional analysis compared the rate of CVD death for older Vermonters in urban and rural areas between 2015 and 2019.

Results: The binomial logistic regression model demonstrated statistically significant findings among the predictor variables: rurality (p

Conclusions: These findings suggest a need for increased research and awareness of the impact CVD mortality has among Vermonters 65 years and older in rural areas as this population continues to increase.

Timeseries Analysis To Characterize Complex Phenomena In Environmental And Human Health Applications, Jeremy Ernest Matt

Graduate College Dissertations and Theses

Studying and evaluating time series signals that emerge when monitoring complex phenomena requires fusing, visualizing, and often reducing the dimensionality of large amounts of data to reveal the patterns and relationships that appear at different scales. In this work, we develop methods for monitoring, visualizing, and identifying the complex relationships that appear in time series data collected from two very different domains – health care conversations and river networks – to facilitate large-scale understanding of these systems. Fostering connection between clinicians and patients and their families in the context of serious illness is a fundamental component of good clinical communication …

Investigating The Effects Of Medroxy-Progesterone And Hormonal Birth Control On Habit Behavior In Female Rats, Sarah Charlotte Von Doepp

Graduate College Dissertations and Theses

Recent research has shown that there is a significant sex difference in the rate of habit acquisition in rats, with intact females acquiring the behavior with fewer action-outcome reinforcer pairings than intact males. This difference is shown to be related to the presence of cyclic estrogen and progesterone during habit behavior acquisition training. Specifically, the presence of progesterone has been shown to be crucial in early habit acquisition. However, the mechanism of action through which progesterone is influencing this behavior is unknown. Additionally, this project explores the impacts of long-term hormonal (levonorgestrel - progestin based) birth control on habit behavior …

A Qualitative Study Of Rural Plant-Based Eaters’ Knowledge And Planning For Nutritional Adequacy, Michelle Leonetti

Graduate College Dissertations and Theses

Objective: To determine to what degree rural plant-based eaters engage in nutritional planning regarding nutrients commonly lacking in diets that exclude or limit animal-source foods (Vitamin B12, Vitamin D, omega-3 fatty acids, calcium, iron, iodine, zinc, and protein).

Design: Semi-structured interviews were completed via phone or video conference. Interview questions explored dietary choices and degree of knowledge and planning for nutrients on concern. A brief diet questionnaire was conducted online.

Setting: Vermont, USA

Participants: 28 rural Vermont residents aged 19-77 years who identified as flexitarian, pescatarian, vegan or vegetarian.

Results: Participants had a positive outlook about the healthfulness of a …

The Effect Of Tryptamine Producing Bacteria On Gut Motility In Mice, Emilia Sofia Norberg

Graduate College Dissertations and Theses

It has become increasingly clear that there is bidirectional communication between the microbes that exist in the lumen of the gastrointestinal (GI) tract and the nervous system. Research within the last 20 years has revealed GI bacterial metabolites to have a significant effect on gut motility, and some of these actions involve influencing serotonin signaling in the epithelial layer of the intestines. Serotonin, abbreviated as 5- HT, has many functions within the gut including propulsive and segmentation motility, vasodilation, and epithelial cell secretion. There are several bacterial species that have been discovered to synthesize one of 5-HT’s precursory molecules, including …

Quantifying Glial-Glial Interactions In Drosophila Using Automated Image Analysis, Gabriela Salazar Lopez

Graduate College Dissertations and Theses

Imaging is an immensely powerful tool in biomedical research. Technological advances in the last half century have led to the development of new tools for image analysis, with major strides being made in the last 20 years especially with machine and deep learning. However, researchers still often hit a bottleneck during the image analysis phase of their projects that often leads to delays and sometimes even limits the scope of their studies. In this thesis I demonstrate some of the issues that arise while quantifying images to answer a biological question by using a dataset of fly central nervous system …

Bayesian Experimental Design For Control And Surveillance In Epidemiology, Bren Case

Graduate College Dissertations and Theses

Effective public health interventions must balance an array of interconnected challenges, and decisions must be made based on scientific evidence from existing information. Building evidence requires extrapolating from limited data using models. But when data are insufficient, it is important to recognize the limitations of model predictions and diagnose how they can be improved. This dissertation shows how principles from Bayesian experimental design can be applied to surveillance and control efforts to allow researchers to get more out of their data and direct limited resources to best effect. We argue a Bayesian perspective on data gathering, where design decisions are …

An Exploration Of Reinstatement After Extinction Of A Conditioned Taste Aversion, Noelle Loren Michaud

Graduate College Dissertations and Theses

Taste aversion learning has sometimes been considered a special form of learning. The unique way in which the taste of a poisonous food and its gastrointestinal consequences may typically occur in nature might encourage the evolution of a unique and biologically adaptive learning system. Six experiments were designed to address whether reinstatement, a well-known effect that occurs after extinction, can be observed in taste aversion learning. After a conditioned stimulus (CS) is conditioned and extinguished, reexposure to the unconditioned stimulus (US) by itself sometimes reinstates the conditioned response (CR). Reinstatement has been widely studied in fear and appetitive conditioning preparations, …

The Evaluation Of The Prokinetic Action Of A Luminally Restricted 5-Ht4 Receptor Agonist In Mice, Emma Schoeling

Graduate College Dissertations and Theses

Serotonin (5-HT) is a neurotransmitter mainly produced in the enteric nervous system (ENS) of the gastrointestinal (GI) system. Serotonin has widespread function throughout the body including regulating mood, cognition, sleep, sex, and appetite. In the context of the gut, the monoamine modulates vasodilation, mucus secretion, pain, and peristaltic reflexes for motility. The 5-HT4 receptor is expressed on enteric epithelial cells and nerve terminals in the intestinal mucosa. The agonists available to act on these receptors are a favorable target to promote epithelial healing, recovery from colitis or constipation, and epithelial cell proliferation. The non-absorbable, luminally restricted, 5-HT4R agonist (5HT4-LA1; Takeda …

Nonlinear Relationships Between The Environment And Health, Levi N. Bonnell

Graduate College Dissertations and Theses

Relationships between the environment and health outcomes are complex and likely nonlinear in nature. However, until recently, most studies used ordinary linear regression to model these relationships. The overall goal of this research was to investigate nonlinear relationships between the environment and health. To accomplish this goal, we used several large, national datasets across varying populations and local environments.

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In the first study, we sought to determine the relationship between the density of nonresidential destinations (a proxy for walkability) …

The Role Of Dentate Gyrus Pituitary Adenylate Cyclase Activating Polypeptide (Pacap) In Contextual Fear Discrimination, Samantha Kelly Moriarty

Graduate College Dissertations and Theses

When dysregulated, neural systems important for fear behaviors can contribute to mental health disorders such as anxiety, phobias, and post-traumatic stress disorder (PTSD). In PTSD, a myriad of symptoms is possible, but a hallmark feature of the disorder is generalizing fear. This occurs when fear is experienced inappropriately in relation to the environment or circumstances. To study this behavior in rodent models, contextual fear conditioning is used. Contextual fear conditioning is a learning theory preparation where rodents are conditioned with an aversive stimulus such as foot-shock in one distinct context (A), while concurrently being exposed to a safe context (B). …

Towards A Food-Secure Future In An Era Of Uncertainty: Cultivating Resilience In Vulnerable Smallholder Food Systems, Maya Moore

Graduate College Dissertations and Theses

Smallholder food systems in sub-Saharan Africa and other tropical regions are at the crux of the “triple threat” of the Anthropocene: climate change, biodiversity loss and food insecurity. At the same time, they are considered pivotal to the global food system transformation needed to address these challenges. However, while there have been many proposed pathways to achieve desired outcomes, smallholders are often constrained in their ability to adapt and transform. Therefore, in this three-article dissertation, I use mixed methods to study traditional food security coping strategies and apply socio-psychological behavioral intention theories to understand the cognitive factors behind farmers’ decisions …

Impact Of Preexisting Autoimmune Disease On Outcomes Of Patients With Myelodysplastic Syndromes, Diego Andres Adrianzen Herrera

Graduate College Dissertations and Theses

Myelodysplastic syndromes (MDS) are a group of heterogeneous hematologic malignancies characterized by ineffective hematopoiesis and risk of progression to acute myeloid leukemia. MDS has been linked with immune dysregulation, as overly active immunity promotes inflammation and oncogenesis within the hematopoietic system. In recent years, autoimmunity has been defined as an important pathogenic pathway in patients with MDS and numerous studies have demonstrated high prevalence of autoimmune diseases among these patients. Despite this association, the clinical and prognostic implications of preexisting autoimmune disease for patients with MDS remains to be elucidated. An important gap in knowledge is defining the effect of …

Context, Goals, And Operant Behavior: The Role Of The Prelimbic Cortex And Associated Neural Circuitry, Callum Mark Piper Thomas

Graduate College Dissertations and Theses

Operant (instrumental) conditioning is a laboratory model of voluntary behavior. In its simplest form, performing a particular response, such as a lever press, leads to delivery of a reinforcing outcome (e.g., a sucrose pellet). Operant behaviors can be associated with preceding stimuli (“habits”) or outcomes (“goal-directed actions”). A factor that influences performance of operant behaviors is the context in which they are learned. Contexts can be defined as background stimuli that are present during behavior. For example, eating dessert may occur in the context of a restaurant and the sated feeling of a finished meal. The context for eating dessert, …