Medicine and Health Sciences Commons^™

Hardness Removal By A Continuous Flow Electrochemical Reactor From Different Types Of Water, Shahad Fadhil Alrubaye, Naseer A. Al Haboubi, Hussein A. Al-Amili, Aiman H. Al-Allaq, Dhuha Ahmed Mohammed

Mechanical & Aerospace Engineering Faculty Publications

The present study focuses on the technique of hardness removal by using a novel reactor performing an electrocoagulation (EC) process. The variation of alkalinity is also recorded. Continuous flow experiments were conducted for Total Hardness (TH) removal using a transparent plastic reactor using aluminum plate electrodes that have holes so that the water flows through the plates in a zigzag way. The influence of various operating parameters such as the number of plates (two and four), flow rate (600, 1000 L/h), and water type (Tigris River & rejected water from Reverse Osmosis system RO) was investigated. The results showed that …

Mivt: Medical-Informed Vision Transformer For Early Epilepsy Diagnosis, Md Masum Rana

Dissertations and Theses

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, and early diagnosis is crucial for effective management and treatment. However, the diagnosis of epilepsy, particularly in its early stages, remains challenging due to the subtle nature of seizures and the complexity of brain activity patterns. In this research, we introduce the Medical-Informed Vision Transformer (MIVT), a deep learning architecture specifically designed to improve early epilepsy diagnosis from multimodal neuroimaging data. Our model integrates insights from both medical knowledge and state-of-the-art Vision Transformers (ViTs) to enhance the accuracy and interpretability of seizure detection and localization. The MIVT leverages the rich …

Exploring The Experience And Identity Of Associated Faculty Teaching In A Doctor Of Physical Therapy Program, Catherine A Bilyeu

Dissertations and Theses

Doctor of Physical Therapy (DPT) program faculty often enter academia as expert clinicians or researchers, but rarely as expert educators. Recommendations for faculty development exist, yet many physical therapy faculty still enter academia with little or no formal preparation for teaching and limited understanding of academe. This lack of preparation can impact faculty performance and identity, which ultimately can influence student outcomes. This is particularly true for associated faculty, who have very limited access to development opportunities due to the nature of their academic positions. Framed in social constructivism and transition theory, this study explored the experience and identity of …

Don’T Poke The Bear: Pheochromocytoma Unmasked By Covid-10, Taylor Virtue, Andrea Roast

Books, Presentations, Posters, Etc.

Introduction: Pheochromocytomas are tumors of the adrenal gland which produce excess catecholamines. The classic clinical triad is paroxysmal headache, diaphoresis, and tachycardia. The rare incidence makes this a challenging diagnosis which is even more challenging in the environment of the COVID-19 pandemic. Case Presentation: Setting: Establishing care visit at a primary care office Demographic: 42 year old male Medical history: Previously well-controlled hypertension, prediabetes HPI: • Weeks of profound, persistent fatigue and lightheadedness after the resolution of acute symptoms (fever, chills) from COVID-19 infection. Denies any headaches or palpitations. • Meticulously measuring vital signs at home. He has noticed that …

Tobacco Cessation Email Outreach In A Primary Care Setting, Katie Berry, Md, Meera Jain

Books, Presentations, Posters, Etc.

Background: . • Tobacco use remains the #1 cause of preventable death in the United States • Providence Health and Patient Education Program offers resources for tobacco cessation (eg. Virtual classes), but few patients access these services • Xealth® is a digital healthcare technology company contracted with Providence that aims to provide digital content to improve patient care and resources to analyze data • Study purpose: Assess if digital outreach to patients helps engagement in tobacco cessation services • Our clinic was a pilot clinic to develop the intervention and assess efficacy prior to roll out to all Providence Medical …

Assessing The Utility Of Breast Cancer Polygenic Risk Scores And Association With Clinical Factors In A Population Of Breast Cancer Patients, John L. Slunecka

Dissertations and Theses

INTRODUCTION: Breast cancer (BC) is the most common cancer among women and is classified as a complex disease. Advances in population genomics have led to the development of polygenic risk scores (PRSs) with the potential to enhance current risk models, but replication is often limited. OBJECTIVE: We sought to assess the predictive capabilities of two high-powered BC PRSs in a sample population selected for breast cancer. In addition, the capacity of the PRSs to predict clinical variables that could improve BC screening and treatments was explored. METHODS: Two published PRS algorithms (313 vs 3820) were used to score female subjects …

An Exploration Of Clinical Reasoning Using Simulation-Based Learning In Physical Therapist Education, Susannah Steele

Dissertations and Theses

BACKGROUND: Clinical reasoning instruction and assessment are vital tasks of health professions educators yet execution lacks standardization among programs in physical therapy education. This broad variability in how clinical reasoning is taught and assessed within physical therapy education makes understanding current state and improving implementation challenging. PURPOSE: The purpose of this study was to explore whether simulation-based learning is useful in facilitating the development of clinical reasoning skills in novice physical therapist students, to explore potential correlations and performance trends between two assessments measuring elements of clinical reasoning skills, and to explore the impact of thoughtfully designed simulation learning experiences …

Screening For Unhealthy Alcohol Use: Implementation Of Screening And Brief Intervention (Sbi) In Primary Care Using The Audit-C, Sarah Bell

DNP Projects

Background: In 2021, the NIAAA reported that alcohol use disorder affected 29.5 million Americans. Alcohol Screening and Brief Intervention (SBI) is an evidence-based prevention strategy, recommended by the USPSTF, to reduce alcohol consumption. Unfortunately, less than 50% of patients receive advice from their provider about the harms of excessive alcohol use. This study aimed to implement an effective SBI process in a rural primary care setting utilizing the Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) tool while addressing known barriers to proper implementation.

Methods: Donabedian's Structure-Process-Outcome (SPO) framework for Quality Assessment guided this quality improvement design. Intervention planning included considerations …

Evaluation And Treatment Of Central Auditory Processing And Sound Tolerance Disorders, Aaliyah Gladney, Antony Joseph

AuD Capstone Projects - Communication Sciences and Disorders

Abstract 1

Introduction: Central auditory processing disorder (CAPD) affects how a listener understands speech even though their peripheral auditory system is intact. Case Presentation: An adult female was seen for a CAPD evaluation after experiencing recent listening difficulties following an automobile accident while 20 weeks pregnant. Results from a comprehensive audiological evaluation revealed audiometrically normal hearing in both ears. Results from the CAPD evaluation suggested a prosodic deficit. Discussion: Although results from testing were consistent with a prosodic deficit, the patient’s case history, original complaints, and recommendations were more consistent with an integration deficit. Conclusion: This case demonstrates that clinicians …

Guardians Of The Community: A History Of Provident Hospital, 1891-1950, Lenie Annoh Adolphson

Graduate Research Theses & Dissertations

Established in 1891 in Chicago, Illinois, Provident Hospital was born out of the urgent need to combat racial discrimination and segregation. Provident Hospital stood as a beacon of hope for nearly a century, serving as one of the few healthcare facilities open to Chicago’s Black population. Dr. Daniel Hale Williams’s vision of an interracial hospital was a powerful symbol of unity, brought to life through the collaborative efforts of Black physicians, White philanthropists, Black women’s clubs, and community members. However, this vision was continually challenged by interference from White donors, increasing spatial segregation, intensifying poverty following the Great Migration, and …

Kidney-Targeted Mrna Nanoparticles: Exploration Of The Mrna Loading Capacity Of A Polymeric Mesoscale Platform Employing Various Classes Of Excipients, Arantxa Roach

Biochemistry and Molecular Biology

Mesoscale nanoparticles (MNPs) for the therapeutic relief of renal ailments can be modulated to deliver various payloads – including biomolecules such as mRNA. In preparing mRNA loaded-MNPs, we observed a point of saturation for mRNA loading of these particles, when aiming to increase the payload per particle. Here, we aimed to circumvent this limitation by incorporating various excipients that interact with mRNA for increased loading. These interactions involved the reduction of mRNA electrostatic repulsion and improving mRNA stability during formulation and release. Thereafter, we tested the encapsulation efficiency of these modified particles and compared it to our original formulation. Further, …

Associations Of Social Isolation And Loneliness With Mci Among Older Adults From Underresourced Communities, Fang Fang, Tiffany Hughes, Yueting Wang, Erin Jacobsen

Research and Infrastructure Service Enterprise (RISE) Faculty Publications

Previous studies have shown social isolation and loneliness are associated with poor cognitive outcomes in later life, yet it is unclear if these findings could be confounded by selective attrition. This study examines longitudinal associations of social isolation and loneliness with incident mild cognitive impairment (MCI) accounting for informative drop-out due to death or disease. Data were from a population-based cohort study of older adults in Southwestern Pennsylvania, whose once-vibrant economy heavily relied on the steel industry until it collapsed in the 1970s and has not fully recovered. Participants (N=1,254) were followed for 12 years for the development of MCI. …

Risk An Protective Factors For Increasing Isolation And Loneliness Among Older Adults, Tiffany Hughes, Fang Fang, Yueting Wang, Erin Jacobsen

Research and Infrastructure Service Enterprise (RISE) Faculty Publications

Social isolation and loneliness are associated with poor health and quality of life as well as decreased longevity. This study examines patterns of change in self-reported isolation and loneliness, and factors associated with these patterns, using data from 1,474 cognitively normal participants followed annually for up to 12 years in a population-based cohort study of older adults. Composite measures of isolation and loneliness were created, and trajectory analyses were conducted to detect patterns of change in these composites over time. Multinomial logistic regression tested associations of baseline demographic, health, and lifestyle factors with patterns of change in isolation and loneliness. …

The Social, Mental, And Physical Health Impacts Of The Covid-19 Pandemic On People With Hiv: Protocol Of An Observational International Multisite Study, Yvette P. Cuca, Christine Horvat, Inge Corless, Craig Phillips, Álvaro José Sierra-Perez, Solymar Solís Báez, Emilia Iwu, Motshedisi Sabone, Mercy Tshilidzi Mulaudzi, Sheila Shaibu

School of Nursing & Midwifery, East Africa

As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; …

Rehabilitation Therapy Versus Drug-Only Therapy In Patients With Multiple Sclerosis, Florin Mihai Marcu, Doriana Ciobanu, Ioan Cosmin Boca, Elena Sirbu, Paul Alexandru Deme, Nicolae Catalin Hreniuc, Dorina Ianc

Turkish Journal of Medical Sciences

The treatment for multiple sclerosis (MS) does not cure the disease, but it is intended to reduce the intensity, duration, and frequency of symptoms. Rehabilitation therapy (RT), including an individualized physical therapy program (PTP) and adapted occupational therapy (OT), has benefits in terms of aerobic capacity, muscle strength, coordination, and ability to perform activities of daily living (ADL). The primary objective of this study was to examine the efficacy of RT comprising PTP, OT, and drug treatment (DT) versus DT alone in patients with MS. Another objective was to highlight the importance of continuing the PT and OT at home, …

The Relationship Between Trunk Control, Spinal Posture, And Spinal Mobility In Patients With Multiple Sclerosis: A Cross-Sectional Study, Taşkın Özkan, Nezehat Özgül Ünlüer, Mustafa Ertuğrul Yaşa, Buse Korkmaz, Gönül Vural

Turkish Journal of Medical Sciences

Trunk control, which plays a key role in balance and mobility, decreases in patients with multiple sclerosis (PwMS) and many parameters such as sensory, motor, and musculoskeletal systems affect trunk control. The aim of this study was to compare trunk control, spinal mobility, and spinal posture in PwMS with healthy controls and investigate the relationship between trunk control with spinal posture and spinal mobility in PwMS.Materials and methods: The study was completed with 38 PwMS and 38 healthy controls with matched age and sex. Trunk control was evaluated with the Trunk Impairment Scale (TIS). Spinal posture and mobility were evaluated …

The Role Of Technology In Online Health Communities: A Study Of Information-Seeking Behavior, Leann Boyce, Ahasan Harun, Gayle Prybutok, Victor R. Prybutok

Information Systems Faculty Publications

This study significantly contributes to both theory and practice by providing valuable insights into the role and value of healthcare in the context of online health communities. This study highlights the increasing dependence of patients and their families on online sources for health information and the potential of technology to support individuals with health information needs. This study develops a theoretical framework by analyzing data from a cross-sectional survey using partial least squares structural equation modeling and multi-group and importance-performance map analysis. The findings of this study identify the most beneficial technology-related issues, like ease of site navigation and interaction …

A Phenomenological Exploration Of Intracommunity Attitudinal And Experiential Barriers To The Utilization Of Psychotherapeutic Services In Bipoc Populations, Jade Turner

Calvert Undergraduate Research Awards

This study used Interpretative Phenomenological Analysis to explore the role that intracommunity attitudes and beliefs and negative mental healthcare experiences play in determining treatment-seeking behavior in BIPOC communities. Through in-depth semistructured interviews, five participants shared their perspectives and experiences, providing rich and nuanced insight into the subjective landscape of mental healthcare avoidance among racial and ethnic minority populations. The analysis revealed five overarching themes (pray it away, isolated and invisible, fear, perceived importance of racial matching, and therapeutic experiences profoundly impact treatment-seeking) shedding light on the nuanced ways in which BIPOC individuals make sense of and navigate mental health within …

Unlv Title Iii Aanapisi & Mcnair Scholars Institute Research Journal 2024, Jesica Godinez-Paredes, Kian Hassankhan, Apia Hickman, Robin Ruth Kee, Kevin Ayala Pineda, Briana Melendez, Kalli Ramos, Saturn L. Reyes, Fabian Leija, Selena Pepe, Silva Topchyan, Celeste Ainsley, Mayra Arzate, Jessica Balistreri, Zantana Ephrem, Mirella Jasso, Karl Panou, Nichole Pelaez, Miklo Alcala, Akshay Dave, Mey Mey Heng, Michael Finkle, Janessa Montenegro, Reynafe Naol Aniga, Victor Mejia, Angelica G. Diaz, Anayeli Flores-Garibay, Kari Lee Joe Goold, Samantha Hernandez, Lianelys Cabrera Martinez, Caitlin Reynolds, Kimberly N. Usbeck, Abdulrahman Alahdal, Angelica Diaz, Willaine Mae Kahano, Raquel Jackson, Cecia Ruiz-Hernandez, Kers Ung-Watson, Yessenia Henriquez, Vanessa Marie Booth, Alexia Brown, Darlyn Magana, Bianca Navarro, Nicholas Pereira, Gia Renemae Calip, Lucky Heng, Ralph Sagun, Lucas Abreu, Alexandra Maria Acosta, Tristan Benally, Cosset Hernandez Pena, Adrian Montenegro, Cierra Paaaina-Daquioag, Nicole Torosian, Tracy Fuentes, Julissa Martinez, Medina Mcallister, Michal Newhouse-Van Vlerin, Tiria Carr, Nima Abkenar, Isabella Aceituno, Yuhan Bi, Victoria Campos, Melika Cummings, Zachary J. Johnigan, Alexis Sotolongo-Marin

McNair Journal

Journal articles based on research conducted by undergraduate students in the AANAPISI, LSAMP, and McNair Scholars Program.

Table of Contents

About AANAPISI

Dr. Chris Heavey, Interim President

Dr. Keith Rogers, Vice President for Student Affairs

Ms. Zhanna Aronov, Associate Vice President for Retention & Outreach

The Right Ventricle Outflow Tract Systolic Function Could Predict The Severity Of The Cirrhosis, İbrahim Dönmez, Güray Can, Emrah Acar

Turkish Journal of Medical Sciences

The distinctive liver framework is converted into structurally abnormal nodules as a consequence of tissue fibrosis in cirrhosis. Cardiac dysfunction in cirrhosis was described, and the term “cirrhotic cardiomyopathy (CCM)” was coined to describe this syndrome. Recent research has shown that the contractile characteristics of the right ventricular outflow tract (RVOT) have a significant impact on right ventricular functions. The right ventricular outflow tract-systolic excursion is an important systolic function marker of RVOT (RVOT-SE). There has yet to be published research on RVOT function in cirrhotic patients. We looked at the relationship between cirrhosis severity and the RVOT-SE.Materials and methods: …

The Effect Of Parity, Breastfeeding History, And Duration On Clinical And Pathological Characteristics Of Breast Cancer Patients, Naziye Ak, Zeynep Tuz, Esra Aydin, Ferhat Ferhatoğlu, Murat Sari, Nail Paksoy, İzzet Doğan, Anıl Yildiz, Rian Di̇şçi̇, Pınar Mualla Sai̇p

Turkish Journal of Medical Sciences

The study is aimed to determine the relationship between the delivery and breastfeeding history of the patients andthe clinicopathological properties of breast cancer.Materials and methods: A questionnaire was utilized for the study, which included the age of diagnosis, the number of children at thetime of diagnosis, the age of the children, and the breastfeeding period of each child.Results: The study included 828 patients. The median age at diagnosis was 47 years for parous women and 42 years for nonparouswomen (p < 0.001). The tumor size of the patients diagnosed within the breastfeeding period was significantly larger compared to theother patients. Estrogen and progesterone receptor positivity were lower in patients diagnosed during breastfeeding. Additionally, themean number of positive lymph nodes, dissected lymph nodes, and positive lymph node/dissected lymph node ratio in parous andbreastfed patients with a nonmetastatic disease were statistically significantly higher in multivariable analysis than those patients whowere nulliparous and have not breastfed.Conclusion: Breast cancer is seen at a later age in patients who are parous than those who have never given birth. Patients who areparous and have breastfed tend to present with a higher stage of the disease.

Dynamic Contrast-Enhanced Mammography And Breast Mri In The Diagnosis Of Breast Cancer And Detection Of Tumor Size, Muhammed Teki̇nhatun, Nuran Sabi̇r, Ergun Erdem, Sevda Yilmaz, Furkan Ufuk

Turkish Journal of Medical Sciences

The aim of this study is to evaluate the performance of contrast-enhanced mammography (CEM) and dynamic breast MRI techniques for diagnosing breast lesions, assess the diagnostic accuracy of CEM’s using histopathological findings, and compare lesion size measurements obtained from both methods with pathological size.Materials and methods: This prospective study included 120 lesions, of which 70 were malignant, in 104 patients who underwent CEM and MRI within a week. Two radiologists independently evaluated the MR and CEM images in separate sessions, using the BI-RADS classification system. Additionally, the maximum sizes of lesion were measured. Diagnostic accuracy parameters and the receiver operating …

Adjunctive Use Of Laser Biostimulation With Nonsurgical Periodontal Therapy: A Split Mouth, Randomized, Case-Control Study In Diabetic And Nondiabetic Periodontitispatients, Funda Akansel, Umur Sakallioğlu, Müge Lütfi̇oğlu, Feyza Otan Özden, Adil Karadağ

Turkish Journal of Medical Sciences

Laser biostimulation therapy (LBT) is suggested to have positive effects on periodontal healing. This study evaluatedLBT with nonsurgical periodontal therapy (NSPT) in diabetes mellitus (DM) and systemic health (SH) conditions.Materials and methods: Thirty periodontitis patients (15 with DM and 15 with SH) were included in the study, which had a split-mouthdesign, by applying LBT in the mouth of the same systemic condition. Thus, 4 study groups were formed, as 1) NSPT – DM: NSPT alonein DM, 2) NSPT + LBT – DM: NSPT + LBT application in DM, 3) NSPT – SH: NSPT alone in SH, and 4) NSPT + …

Medical And Advanced Heart Failure Therapies In Türkiye, Sanem Nalbantgi̇l, Emre Demi̇r, Ahmet Çeli̇k, İnci̇ Tuğçe Çöllüoğlu, Nai̇m Ata, Mehmet Bi̇rhan Yilmaz, Anil Şahi̇n, Di̇lek Ural, Mustafa Mahi̇r Ülgü, Emi̇ne Arzu Kanik, Lale Di̇nç Asarcikli, Yüksel Çavuşoğlu, Selda Murat, Şuayi̇p Bi̇ri̇nci̇

Turkish Journal of Medical Sciences

Background/aim: Effective management of heart failure involves evidence-based use of multiple medications and their combinations. Furthermore, dosage escalation of the recommended medications is advised. In cases of advanced heart failure, long-term mechanical assistance devices or heart transplantation surgery may be necessary. The socio-economic situation creates unequal chances for people to access these treatments.The study aimed to analyze and compare medical and advanced heart failure treatments recommended by guidelines across various regions in Türkiye.Materials and methods: About 85 million citizen medical treatment records were utilized between January 1, 2016, and December 31, 2022. Medical and heart replacement treatment opportunities used in …

Adult Attachment As Moderating Variable For Parental Burnout, Janell Mccann

Graduate Research Theses & Dissertations

In recent years, research in family sciences has focused on the impact of stress on parents, leading to parental burnout risks. This study aimed to explore how adult attachment relates to parental burnout and if it moderates the link between parenting stress and burnout. Attachment theory suggests secure attachment can protect against parenting stress, while anxious and avoidant attachment may worsen its effects. In order to examine the effect of adult attachment in the development of parental burnout, parenting stress was measured using the Balance of Risks and Resources, parental attachment was measured using Experiences in Close Relationships (Revised), and …

Analyzing Sex Differences In Human Performance Through 3d Isotonic Resistance, Jacob M. Cunha

University of the Pacific Theses and Dissertations

Appraisal of scientific literature and understanding continues to grow in the domain of human performance. The effects of sex on concentric resistance training and power output are not well understood. Recent advancements in technology permit more precise measurements of force output and the kinematic changes elicited by training stress. A unique device in capturing kinematic performance output is Proteus Motion. The machine produces an external magnetic load through a protruding apparatus connected to a gyrosphere, which in turn captures concentric movement through all three planes of movement (sagittal, coronal, transversal). The aim of this study is to investigate power output …

Volume 15, Connor Thompson, Emily Steffenhagen, Emily Robertson, Luis Fernando Dos Reis, Emily Farmer, Samuel Villa, Robert Allison, Zachary Chessor, Megan Borden, Austin Burnett, Larry W. Grant Jr., Tristan Marowski, Emma Moore, Pearl Siff

Incite: The Journal of Undergraduate Scholarship

Introduction Dr. Amorette Barber, Director, Office of Student Research

From the Editor Dr. Hannah Dudley-Shotwell

Artist’s Statement Connor Thompson

On Mentorship Dr. John Miller

The Meat of the Matter: Alien, Human, and Animal in Terry Bisson’s “They’re Made Out of Meat” by Emily Steffenhagen

“Please REBLOG!”: An Ethical Analysis of Doxxing, Internet Vigilantism and Racists Getting Fired by Emily Robertson

Journaling: Paper Has More Patience Than People by Luis Fernando Dos Reis

The Effects of Climate Change on the Archaeological World by Emily Farmer

Lowered Seat Height Does Not Impair Wingate Performance in Untrained Cyclists by Samuel Villa, Robert Allison, …

Deconstruction Of Body Representation Of The Back In Healthy Back Pain-Free Individuals And People With Chronic Low Back Pain, Simon Pratt

Theses

Changes in various body representations have been increasingly investigated and subsequently posited to be potentially important factors in the development and maintenance of chronic low back pain. Three main domains of body representation are considered here: body model, body schema (comprising superficial and postural schema), and body image. Most studies informing our contemporary understanding of these body representations have been undertaken in areas such as the hand and forearm, with a comparative dearth of studies performed on the low back. Consequently, this thesis consists of a comprehensive investigation of body representation initially in healthy back pain-free individuals and then in …

Uncovering The Link Between Diabetes And Pulmonary Hypertension, Nishant Nundlall

Theses

Background

Diabetes is a common disorder in the general population with most studies focusing on its role on the left ventricle and coronary artery disease, however it effects on pulmonary hypertension (PH) have not been fully studied. There is a pressing need to more completely explore the cardiovascular impacts of diabetes. The impact of diabetes might vary according to the various forms of PH, their predominant contribution is likely to be in PH due to left heart disease (group II, the most common form of PH).

Thus far, most studies have offered a focussed perspective with data from specialised referral …

Optimising Care For Musculoskeletal Conditions To Reduce Burden On Hospital Emergency Department And Orthopaedic Services, Piers Truter

Theses

Worldwide health care systems are under increasing pressure due to aging amongst ever growing populations with increasing co-morbidity and treatment options (WA DoH, 2019). Furthermore, how people choose to engage with health care and access and literacy for health information is also changing, as is understanding of the factors associated with good health outcomes. These changes are driving evolution in health care delivery. There is a need for high quality and sustainable models of care accompanied by judicious evaluation of impact in terms of health services deliverables and the consumer experience of care. This thesis explores the feasibility and applicability …