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Articles 23071 - 23100 of 27442
Full-Text Articles in Medicine and Health Sciences
Comparisons Of Impostor Phenomenon Among Nursing Faculty Across Teaching Levels, Teaching Experience, And Gender, Deborah E. Horvath
Comparisons Of Impostor Phenomenon Among Nursing Faculty Across Teaching Levels, Teaching Experience, And Gender, Deborah E. Horvath
Walden Dissertations and Doctoral Studies
Nursing faculty must be effective educators, active nurse researchers, and practicing nurse experts. Feelings of impostor phenomenon (IP), defined as emotions of fraudulence, can lead to faculty deficiencies both as educators and scholars. The purpose of this three-manuscript dissertation, guided by Weiner’s attribution theory, was to determine differences in IP by teaching level, teaching experience, and gender among nursing faculty. A two-tailed t-test was used to analyze data collected from 164 participants who completed the Clance impostor phenomenon scale. Data revealed instructors teaching at the undergraduate level had more feelings of IP than those teaching at the postgraduate and graduate …
Cross-Functional Team Collaboration For Enhancing Timely And Effective Emergency Department Care, Osaigbovo Osemwegie
Cross-Functional Team Collaboration For Enhancing Timely And Effective Emergency Department Care, Osaigbovo Osemwegie
Walden Dissertations and Doctoral Studies
AbstractMany US hospitals report overcrowding in the emergency department (ED) with increased ambulance diversion. Operating at overcapacity risks staff members' ability to provide timely and effective emergency care to patients, exposing them to poor health outcomes. The purpose of this quantitative study was to evaluate whether a correlation exists between cross-functional team collaboration and timely and effective ED care for patients who left 548 national hospital EDs before being seen between 2020 and 2021. The study's independent variable was cross-functional team collaboration, and the dependent variables were Centers for Medicare and Medicaid Services (CMS) Quality Measure scores: left before being …
Strategies To Improve Hospital Patient Satisfaction To Increase Performance-Based Reimbursements, Celso G. Silla Iii
Strategies To Improve Hospital Patient Satisfaction To Increase Performance-Based Reimbursements, Celso G. Silla Iii
Walden Dissertations and Doctoral Studies
Officials from the Centers for Medicare and Medicaid Services (CMS) created the hospital valued-based purchasing (VBP) program focused on controlling cost, inefficiencies, and quality-of-care. Hospital leaders are incentivized or penalized based on meeting quality outcomes and risk millions of dollars in reimbursement if they do not meet the quality-of-care standards specified in the CMS hospital VBP program. Grounded in the transformational leadership theory, the purpose of this qualitative multiple case study was to explore strategies hospital leaders used to improve patient satisfaction to increase VBP performance-based reimbursements. Participants included eight hospital leaders from seven hospitals in California who successfully implemented …
Maternal Folate Status And Risk Factors For Autism Spectrum Disorders, Michael M. Haniff
Maternal Folate Status And Risk Factors For Autism Spectrum Disorders, Michael M. Haniff
Walden Dissertations and Doctoral Studies
Autism spectrum disorders (ASD) are thought to be influenced by environmental, genetic, and maternal factors, including potential links to periconceptional folic acid. This quantitative case-control study, guided by the life course theory, explored the association of maternal risk factors (age, race, education, income, folate status, gestational diabetes, gestational hypertension, and MTHFR mutation) on the precipitation of ASD in offspring. The sample comprised 96 mothers of children with ASD and 143 mothers of children without ASD. Logistic regression analysis indicated no significant association between maternal folate status and ASD (OR = 1.00, 95% CI [1.000, 0.001], p = .755). Mothers with …
Parents’ Perceptions Of The Traits, Characteristics, And Circumstances Of Modern-Day Mass Shooters, Matt Talbot
Parents’ Perceptions Of The Traits, Characteristics, And Circumstances Of Modern-Day Mass Shooters, Matt Talbot
Walden Dissertations and Doctoral Studies
There is little research on parents’ perceptions about the traits, characteristics, and circumstances ascribed to mass shooters and the sources of information shaping these perceptions. Understanding parents’ beliefs about mass shooters and mass shootings can serve to inform approaches to training and education and recommendations for media reporting on such events. Evidence-based knowledge helps parents become more equipped to serve as early interventionists for those who may be moving along a pathway of violence. Application of Gerbner’s cultivation theory frames the process by which media sources shape perceptions. In this phenomenological qualitative study, semi structured interviews were conducted with 19 …
Religious Parents’ Awareness Of And Attitudes Toward Their Adolescent Children's Utilization Of Sexual Health Services, Ashley Thompson
Religious Parents’ Awareness Of And Attitudes Toward Their Adolescent Children's Utilization Of Sexual Health Services, Ashley Thompson
Walden Dissertations and Doctoral Studies
Parents are a key influence on their adolescent children's sexual health care decisions. Few researchers have considered the impact of religious environments and parental expectations on adolescents’ use of sexual health services, and research on religious parents’ awareness of adolescents’ use of sexual health services in Christian environments is scarce. The purpose of this basic qualitative study was to explore religious parents' awareness of and attitudes toward their adolescents’ use of sexual health services. The social ecological theory provided the conceptual lens for this study. Eight Christian parents participated in in-depth virtual interviews to discuss their encouragement or discouragement of …
Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker
Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker
Walden Dissertations and Doctoral Studies
Diabetes imposes a major burden on society, especially in the state of Florida, in the form of increased medical costs, lost productivity, early mortality, and intangible costs in the form of diminished quality of life. Access to diabetic care affects health administration in Florida by impacting the overall cost of treating the condition. Limited access to care can lead to an increased risk of complications resulting in a higher cost of treatment. The purpose of this quantitative study was to determine whether access to care dependent variables (access to doctors and length of time since last routine checkup) were associated …
Influence Of Behavioral Leadership Strategies On Employee Engagement In Hospital Departments, Callie Selner
Influence Of Behavioral Leadership Strategies On Employee Engagement In Hospital Departments, Callie Selner
Walden Dissertations and Doctoral Studies
Lack of employee engagement as a result of deficient behavioral leadership strategies has the potential for adverse business outcomes on productivity, business mission, and strategy. As a result of this qualitative single case study, hospital department managers who apply behavioral leadership strategies are more likely to promote an environment conducive to employee engagement. Grounded in the employee engagement theory, the purpose of this qualitative single case study was to explore behavioral leadership strategies hospital department managers use to promote an environment conducive to employee engagement. The participants were five hospital department managers who had been successful with employee engagement. Data …
The Court Experiences Of Survivors Of Interpersonal Violence, Angela Cartwright
The Court Experiences Of Survivors Of Interpersonal Violence, Angela Cartwright
Walden Dissertations and Doctoral Studies
AbstractInterpersonal violence (IPV) is a complicated public problem that requires collaborative and coordinated strategies in order to address this issue effectively and appropriately. Although the court system has a significant role in their response, IPV is a complex issue for the justice system to address alone. Court system experiences may significantly impact survivors’ outcomes overall health and well-being. There are a limited number of studies showing that survivor experiences in the court have a significant impact on victim outcomes. The purpose of this study was to describe the lived experiences of female IPV survivors who have encountered IPV, highlighting their …
Relationship Between Homelessness, Substance Use, Employment, Living On A Reservation And Tuberculosis Among Northern Plains Native Americans, Darla Mccloskey
Relationship Between Homelessness, Substance Use, Employment, Living On A Reservation And Tuberculosis Among Northern Plains Native Americans, Darla Mccloskey
Walden Dissertations and Doctoral Studies
Native Americans in the Northern Plains have a long history of tuberculosis (TB) infections. There is limited research on the causes of latent TB infections (LTBI) and TB in this population. The purpose of this quantitative study was to assess the relationship between latent TB and factors of homelessness, substance use, employment, living on a reservation, and active or latent TB among this population using the eco-social theory as the theoretical framework. Data from 146 TB cases of Native Americans living in the Northern Plains and diagnosed with TB from 1999 to 2019 were analyzed using chi-square tests that showed …
The Relationship Between Chlamydia, Gonorrhea, Syphilis And Race, Gender, And Age, Johnny James Mcgrew
The Relationship Between Chlamydia, Gonorrhea, Syphilis And Race, Gender, And Age, Johnny James Mcgrew
Walden Dissertations and Doctoral Studies
The purpose of this quantitative correlational design using secondary data from Colorado Department of Public Health and Environment was to examine the relationship between different types of sexually transmitted infections (STIs), specifically, chlamydia, gonorrhea, and syphilis, and race, gender, and age in the United States. This study is significant because it could assist medical personnel to focus on more personally-based STI treatments. This study could also lead to a call for more research regarding sexual health programs across the nation, individuals’ willingness to share personal information regarding STIs, and how sexual health programs could increase testing for STIs. The study …
Lived Experiences Of Copd Patients With Exertional Hypoxemia Prescribed Supplemental Oxygen, Sarah Ann Evans
Lived Experiences Of Copd Patients With Exertional Hypoxemia Prescribed Supplemental Oxygen, Sarah Ann Evans
Walden Dissertations and Doctoral Studies
Patients with exertional hypoxemia are often prescribed supplemental oxygen therapy to alleviate their symptoms and maintain adequate arterial oxygen saturation; however, little is known about how chronic obstructive pulmonary disease (COPD) patients with exertional hypoxemia experience the addition of supplemental oxygen on their lives. The purpose of this descriptive phenomenological study guided by Roger’s science of unitary human beings was to explore the lived experiences of COPD patients with exertional hypoxemia and who require supplemental oxygen. Purposive sampling was used to recruit participants using a query from the electronic medical records to identify patients prescribed supplemental oxygen for exertional, not …
Pancreatic Cancer: Quantitative Study Investigating The Regional Risk Factors In North Carolina, Holly Marie Myers
Pancreatic Cancer: Quantitative Study Investigating The Regional Risk Factors In North Carolina, Holly Marie Myers
Walden Dissertations and Doctoral Studies
Pancreatic cancer is the fourth-leading cause of cancer-related deaths in the United States, killing more than 90% of individuals diagnosed within 5 years. Due to the lack of signs and symptoms, 82% of all pancreatic cancer cases are diagnosed in terminal stages. As such, the most powerful method to reducing the morbidity and mortality of pancreatic cancer is to further investigate the risk factors. According to the theoretical framework of the ecosocial theory, long-term exposure to exposures to unfavorable socioecological and environmental factors serve as a “web of causation” for adverse health outcomes. Using data from the North Carolina Department …
Nurses’ Perception Of Facilitators And Barriers To The Community College Faculty Role, Hallie Roselie Coppi
Nurses’ Perception Of Facilitators And Barriers To The Community College Faculty Role, Hallie Roselie Coppi
Walden Dissertations and Doctoral Studies
There is an increased nursing faculty shortage throughout the United States (U.S.) which can have a significant impact on student enrollment in nursing programs. The purpose of this descriptive qualitative study, which was guided by Herzberg’s two-factor theory, was to explore perceptions of nursing faculty about their role in community college associate degree nursing (ADN) programs in the western U.S. Data were collected via in-depth semi-structured interviews with 14 nurse educators to gain insights regarding experiences with role transition, work expectations, and plans in academia. Transcribed interview data were thematically analyzed to reveal seven overarching themes which were motivation, role …
Nursing Guideline For Specimen Handoff, Kathleen Marie Pearce
Nursing Guideline For Specimen Handoff, Kathleen Marie Pearce
Walden Dissertations and Doctoral Studies
AbstractThe absence of clinical practice guidelines (CPGs) and collaboration with significant stakeholders may lead to gaps in the delivery of patient care. Specimen handoff in the endoscopy unit plays a critical role in patient diagnosis and treatment plans; errors can compromise patient safety. The purpose of this project was to provide endoscopy nursing staff with a CPG to improve the accuracy of the specimen handoff process during the endoscopy procedure. The practice-focused question addressed the feasibility of developing a quality and usable CPG to improve the accuracy and efficacy of handling the specimen handoff process during endoscopy procedures. Walden University …
Impact Of Family Health Outcomes And Work Balance On Health Services Organizations’ Workplace Attendance, Marcus Levinsky Wade
Impact Of Family Health Outcomes And Work Balance On Health Services Organizations’ Workplace Attendance, Marcus Levinsky Wade
Walden Dissertations and Doctoral Studies
Work-life balance (WLB) is employees’ ability to effectively manage between job obligations and everyday life activities involving family, health, and social life. Successful WLB has become increasingly important to healthcare administrators due to staff shortages and essentials of job performance, attendance, and satisfaction. The purpose of this quantitative study was to determine if there was a correlation between WLB, workplace stress, and employee workplace attendance. The two research questions were correlational; the dependent variable was workplace attendance, and the independent variables were workplace stress and WLB. The compensation theory served as the foundation for the study, in which both family …
Strategies To Mitigate Inappropriate Test Utilization By Physicians To Improve Efficiency In A Healthcare Setting, Christine C. Wood
Strategies To Mitigate Inappropriate Test Utilization By Physicians To Improve Efficiency In A Healthcare Setting, Christine C. Wood
Walden Dissertations and Doctoral Studies
Inappropriate test utilization by physicians for clinical decision-making in patient care is a significant problem facing some healthcare leaders. Healthcare leaders are concerned about inappropriate test utilization because it can increase healthcare costs and degrade patient outcomes. Grounded in the complex adaptive system and Lean Six Sigma conceptual frameworks, the purpose of this qualitative single-case study was to identify strategies seven hospital leaders in Maryland and Washington, DC. who implemented successful test utilization strategies for physicians. Data were collected from semistructured virtual interviews and organizational reports and analyzed using Yin’s 5 step process. Five themes emerged: (a) continuing physician education, …
Thirty-Second Mindful Body Scan Meditation For Bedside Nurses, Shruti Balwalli-Udyawer
Thirty-Second Mindful Body Scan Meditation For Bedside Nurses, Shruti Balwalli-Udyawer
Walden Dissertations and Doctoral Studies
Compassion fatigue, or secondary traumatic stress, is a state of physical and mental exhaustion caused by an inability to cope with the everyday environment that reduces the ability of the nurse to provide high-quality health care to a patient. The purpose of this staff education project, guided by Selye’s general adaption syndrome , was a 6-week, 30-second mindfulness exercise program to promote stress reduction for cardiac step-down and medical-surgical nurses. In this quantitative, pre- and posttest study, the Perceived Stress Scale was completed by a sample of 24 nurses who met the inclusion criteria. The practice focused whether educating nurses …
Nurses’ Perception Of Pain Assessment In Cognitively Impaired Older Residents In Long-Term Care, Abigail Owolabi
Nurses’ Perception Of Pain Assessment In Cognitively Impaired Older Residents In Long-Term Care, Abigail Owolabi
Walden Dissertations and Doctoral Studies
AbstractPain has been a significant problem in old age and is more problematic in cognitively impaired older residents (CIOR) because of their inability to express themselves. The goal of pain assessment in CIOR is to treat pain before it escalates to behavioral problems. This descriptive qualitative study aimed to explore nurses’ perceptions of pain assessment in CIOR in long-term care facilities. Watson’s theory of human caring was used to frame the study. A purposive sample of eight nurses was recruited from two long-term care facilities for interviews conducted using the telephone and continued until saturation was reached. Data was manually …
Food Environment As A Moderator In The Relationship Between Ultra-Processed Food Intake And Mortality In The United States, Brandon Jerod Grandy
Food Environment As A Moderator In The Relationship Between Ultra-Processed Food Intake And Mortality In The United States, Brandon Jerod Grandy
Walden Dissertations and Doctoral Studies
According to recent studies, the consumption of ultra-processed food is a major issue that leads to fatal outcomes within the United States, which is relevant because this type of food has become more accessible over the years. Using data from the National Health And Nutrition Examination Survey III (NHANES III), previous researchers found that frequent consumption of ultra-processed foods was associated with greater chances of all-cause mortality in U.S. adults, but little research has focused on factors that can impact ultra-processed food consumption, such as food environment. The purpose of this quantitative longitudinal study was to examine the effect of …
Black/African American Men’S Lived Experiences Of Workplace Colorism Bullying, Dr. Benjamin K. Spady Ph.D
Black/African American Men’S Lived Experiences Of Workplace Colorism Bullying, Dr. Benjamin K. Spady Ph.D
Walden Dissertations and Doctoral Studies
Bullying in the U.S. workplace is an ongoing issue that transcends industry boundaries due to perpetrators’ ineffectiveness in viewing all coworkers as equals. The purpose of this qualitative interpretative phenomenological analysis study was to explore the lived experiences of Black/African American men who endure workplace colorism bullying. Critical race theory provided the conceptual framework, which labeled racism as an omnipresent systemic force. Semistructured interview data were collected from six Black/African American men who resided in the United States and who were bullied in the workplace within the past 20 years. Data were coded via open coding to discover themes. The …
Staff Education Program To Reduce Burnout Among Health Care Professionals On A Long-Term Care Unit, Emelda Mati Che
Staff Education Program To Reduce Burnout Among Health Care Professionals On A Long-Term Care Unit, Emelda Mati Che
Walden Dissertations and Doctoral Studies
AbstractBurnout negatively impacts the performance of health care providers, decreasing the quality of care provided to patients and affecting patients’ experience. This problem is evident in health care staff on long-term care units (LTCUs) as they strive to meet their patients’ chronic and acute care needs. Health care professionals often lack adequate knowledge on how to manage work-related stress and reduce the issue of burnout in this work environment. The health care professionals working on the LTCU at the local continuing care retirement facility were identified as lacking knowledge to manage work-related stress and burnout. Addressing this problem is essential …
Addressing Sexual Violence On College Campuses—A Brief Review Of Existing Policies, Naa-Amy Wayne, Jackie Mesenbrink, Bettye Apenteng
Addressing Sexual Violence On College Campuses—A Brief Review Of Existing Policies, Naa-Amy Wayne, Jackie Mesenbrink, Bettye Apenteng
Eagles Talking About the Public’s Health
No abstract provided.
Examining The Oxidative Stress Effects In Rats Exposed To 2-Aminoanthracene In Utero And High Fat Diet Three Months After, Brianna A. Lanoix
Examining The Oxidative Stress Effects In Rats Exposed To 2-Aminoanthracene In Utero And High Fat Diet Three Months After, Brianna A. Lanoix
Honors College Theses
Polycyclic aromatic hydrocarbons are organic compounds that are created synthetically or found in partially burned oil, gasoline, and coal. 2-aminoanthracene (2AA) is a common example of a PAH and can affect lipid and carbohydrate metabolism and resulting in inflammatory problems and oxidative stress. The objective of the research project is to investigate oxidative stress in relation to diabetes in rats exposed to 2AA in utero and a high fat diet later in life. Pregnant dams were separated into treatment groups based on their dosages of 2AA; 0 mg/kg (control), 50 mg/kg (low), 100 mg/kg (high). During the gestation -postpartum period, …
Hospitalizations And Mortality With Alzheimer’S Disease And Related Dementias Diagnosis In Georgia, 2020, Chloe Hale
Hospitalizations And Mortality With Alzheimer’S Disease And Related Dementias Diagnosis In Georgia, 2020, Chloe Hale
Georgia Public Health Association Annual Meeting & Conference
More than 6 million Americans aged 65 and older are living with an Alzheimer’s disease or related dementia diagnosis (ADRD) in 2022. Data from the 2019 Behavioral Risk Factor Surveillance System report that in Georgia, 1 in 9 people aged 45 and older experienced confusion or memory problems that have been getting worse over the past year.
Georgia Department of Public Health Injury Prevention Program creates a healthy Georgia through conversations and collaborations for change using data driven program building. The programs utilize Georgia’s established infrastructure, clear priorities, and the dynamic network of partnerships guided by a robust network of …
Eating Disorders: Barriers To Peer And Self Recognition And The Ability To Seek Or Give Help, Savannah Mcvey
Eating Disorders: Barriers To Peer And Self Recognition And The Ability To Seek Or Give Help, Savannah Mcvey
Honors College Theses
A lack of knowledge concerning eating disorders has been found to play a major role in self-recognition, peer recognition, and barriers to seeking treatment at all. More specifically, straight men were more often not able to identify these issues in themselves or others. Theories that have been presented involve the image of eating disorders being a “woman’s issue” and a possible obsession with weight lifting and changing one’s body to take on a more masculine build. Combatting this issue needs to begin in the form of basic education on college campuses due to the prevalence in this particular age group. …
The Daily Patterns Of Emergency Medical Events, Mary Elizabeth Helander, Margaret K. Formica, Dessa K. Bergen-Cico
The Daily Patterns Of Emergency Medical Events, Mary Elizabeth Helander, Margaret K. Formica, Dessa K. Bergen-Cico
Social Science - All Scholarship
This study examines population level daily patterns of time-stamped emergency medical service (EMS) dispatches to establish their situational predictability. Using visualization, sinusoidal regression, and statistical tests to compare empirical cumulative distributions, we analyzed 311,848,450 emergency medical call records from the U.S. National Emergency Medical Services Information System (NEMSIS) for years 2010 through 2022. The analysis revealed a robust daily pattern in the hourly distribution of distress calls across 33 major categories of medical emergency dispatch types. Sinusoidal regression coefficients for all types were statistically significant, mostly at the p < 0.0001 level. The coefficient of determination ($R^2$) ranged from 0.84 and 0.99 for all models, with most falling in the 0.94 to 0.99 range. The common sinusoidal pattern, peaking in mid-afternoon, demonstrates that all major categories of medical emergency dispatch types appear to be influenced by an underlying daily rhythm that is aligned with daylight hours and common sleep/wake cycles. A comparison of results with previous landmark studies revealed new and contrasting EMS patterns for several long-established peak occurrence hours--specifically for chest pain, heart problems, stroke, convulsions and seizures, and sudden cardiac arrest/death. Upon closer examination, we also found that heart attacks, diagnosed by paramedics in the field via 12-lead cardiac monitoring, followed the identified common daily pattern of a mid-afternoon peak, departing from prior generally accepted morning tendencies. Extended analysis revealed that the normative pattern prevailed across the NEMSIS data when re-organized to consider monthly, seasonal, daylight-savings vs civil time, and pre-/post- COVID-19 periods. The predictable daily EMS patterns provide impetus for more research that links daily variation with causal risk and protective factors. Our methods are straightforward and presented with detail to provide accessible and replicable implementation for researchers and practitioners.
The Clinical Inquiry Process Diagram (Version 4), Roy E. Brown
The Clinical Inquiry Process Diagram (Version 4), Roy E. Brown
VCU Libraries Faculty and Staff Publications
The purpose of the diagram is to provide a clear understanding of the clinical inquiry process and to highlight the similarities and differences between research, performance improvement, and evidence-based practice. While it is not meant to be comprehensive, it serves as a tool to facilitate a shared understanding of when a particular question may lead to one of these three areas of clinical inquiry.
The author would like to acknowledge the following for their ideas and willingness to provide feedback to improve this latest version of the diagram.
- Kady Martini, DNP, RN, EBP-CH, NEA-BC (The Ohio State University School of …
Digest Of The Philadelphia College Of Osteopathic Medicine (2023, No. 1), Philadelphia College Of Osteopathic Medicine
Digest Of The Philadelphia College Of Osteopathic Medicine (2023, No. 1), Philadelphia College Of Osteopathic Medicine
PCOM Digest 2020s
The 2023 Vol. 1 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:
- Updates
- Advancing Alumni
- Institutional Heritage: Founders’ Day 2023
- Digest Magazine Anniversary Series: 125 Years Through 125 Stories
- The Longest-Tenured Dean: Kenneth J. Veit, DO ’76, MBA, FACOFP, reflects on his historic distinction
- This Old House: The story of the Tudor Revival-style mansion that was renovated to become an administration building at the heart of the PCOM campus in Philadelphia
- Class Notes
Gamification For Consumer Loyalty: An Exploration Of Unobserved Heterogeneity In Gamified Esports Social Live Streaming, Tyreal Yizhou Qian, Bo Yu, Robbie Matz, Lei Luo, Chenglong Xu
Gamification For Consumer Loyalty: An Exploration Of Unobserved Heterogeneity In Gamified Esports Social Live Streaming, Tyreal Yizhou Qian, Bo Yu, Robbie Matz, Lei Luo, Chenglong Xu
Funded Scholarship
Esports has been boosted by the proliferation of gamified social live streaming (SLS) platforms over the past few years. While previous research has recognized the complexity of gamification, limited scholarship has examined gamification effectiveness in terms of consumer loyalty in esports. Through the lens of technology acceptance model (TAM), the current study surveyed esports consumers of two SLS platforms (n = 583) to explore the relationships between gamification dimensions, TAM determinants, and SLS platform loyalty. We examined the structural model on both aggregate and segment-specific levels and revealed the existence of unobserved heterogeneity in the model’s paths and observations. The …