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Item Risk mitigation focused on surgical care using process improvement methodologies in rural health systems(Montana State University - Bozeman, College of Engineering, 2023) Sitar, Nejc; Chairperson, Graduate Committee: Bernadette J. McCrory; This is a manuscript style paper that includes co-authored chapters.Rural healthcare is represented by approximately one-third of community hospitals in the United States primarily in the Midwest and Western United States. Due to the lack of resources and the demographic characteristics of rural populations, rural community hospitals are under constant pressure to meet Center for Medicare & Medicaid Services (CMS) quality requirements. Meeting CMS quality requirements is particularly challenging in surgical care, due to the lower volumes and research opportunities, in addition to a shortage of qualified surgical specialists. The perioperative surgical home (PSH) model was established as a health management concept in a rural community hospital located in the Northwest of the United States to improve the quality of care by providing a longitudinal approach to patient treatment. The main opportunities for PSH improvement were identified in the "decision for surgery," "preoperative," and "postoperative" stages of the PSH model. To improve PSH clinic performance this thesis proposes an improved National Surgical Quality Improvement Program (NSQIP) calculator User Interface (UI), as well as a new prediction model for predicting total joint arthroplasty (TJA) Length of Stay (LOS). The improved layout of the NSQIP calculator was developed based on two approved surveys by card sorting and Borda count methodology, while the new prediction model for predicting TJA patients' LOS was based on the Decision Tree (DT) machine learning model. A usability study of the NSQIP calculator UI identified opportunities for future improvements, such as the reorganized layout of postoperative complications and the addition of a supporting tool that would clearly define postoperative complications. The new DT prediction model outperformed a currently used NSQIP calculator in the prediction accuracy of TJA LOS, as it resulted in lower Root-mean-Square-Error values. Furthermore, the structure of the DT model allowed better interpretability of the decision-making process compared to the NSQIP calculator, which increased the trust and reliability of the calculated prediction. Despite some limitations such as a small sample size, this study provided valuable information for future improvements in rural healthcare, that would enable Rural Community Hospitals to better predict future outcomes and meet the strict CMS quality standard.Item Investigating high-risk biomechanics in agricultural work(Montana State University - Bozeman, College of Engineering, 2022) Doud, Devon Michael; Chairperson, Graduate Committee: Scott Monfort; This is a manuscript style paper that includes co-authored chapters.Statement of Purpose: Osteoarthritis, a debilitating disease resulting in cartilage degradation and loss of mobility, is often instigated by injury or excessive loading of unconditioned articular cartilage. Although agricultural laborers are especially at risk of developing osteoarthritis, quantitative characterizations of occupation-specific activities have not previously been established. Deep flexion movements common to these groups (e.g., squatting or kneeling) may cause excessive contact forces on unconditioned cartilage, potentially initiating osteoarthritis development. Additionally, although cognitive loads can significantly alter gait mechanics, the effects of dual-task conditions (e.g., visual Stroop tests while walking) on contact forces have not previously been established. The purpose of this thesis is to better understand potential factors of osteoarthritis development in agricultural laborers by investigating occupational-specific movement patterns and joint loading during common occupational tasks. Methods: The first study evaluated seasonal differences in activity levels for farmers and ranchers by measuring movement intensity via wearable triaxial accelerometers. We hypothesized that ranchers would exhibit consistently high activity levels and that both groups would show an increase in movement intensity in their respective high seasons. The second study sought to establish the effects of cognitive challenges on tibiofemoral contact forces during normal gait and kneel-to-stand transitions in healthy adults. We hypothesized that dual-task conditions would correspond with increased peak tibiofemoral contact forces and that these forces would be positioned farther from the joint center along the mediolateral axis during dual-task conditions. Results: The first study findings largely supported the hypothesis: increased movement intensity during high seasons were recorded for both groups, with farmers exhibiting a larger seasonal fluctuation for moderate intensity activities. The second study did not support the hypothesis: cognitive loading did not significantly affect the magnitude of peak contact forces, and peak contact forces occurred closer to the joint center during dual-task conditions than during single-task conditions. However, post hoc analysis suggested that other portions of the contact force time series during stance phase were affected by cognitive challenges. Conclusions: This thesis provides foundational steps in understanding potential contributing factors of osteoarthritis development in agricultural laborers, directing future investigations towards transitional contact forces in movements simulating livestock handling.Item Introducing trauma-informed care in an acute inpatient psychiatric unit: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Thompson, Evan Robert; Chairperson, Graduate Committee: Julie RuffTraumatic experiences are common in society and are associated with an increased risk of development of adverse physical and psychological outcomes extending throughout the lifespan. Individuals accessing mental health services, such as inpatient hospitalization, are likely to have experienced interpersonal trauma at some point during their lives. Mental health professionals are well suited to provide supportive and effective trauma-informed care (TIC) to patients with trauma histories. TIC seeks to actively resist patient re-traumatization and caregiver secondary traumatic stress. An evidenced-based trauma-informed care training was presented to mental health professionals working on a psychiatric inpatient unit. The project involved a single group pre-post test design with a 1-month follow-up assessment. Staff attitudes towards trauma-informed care were evaluated by a psychometrically validated tool (ARTIC-35). Sums of the items on the ARTIC?35 for each participant were divided by the number of items, means and standard deviations for aggregate average scores for each time point were obtained, and percent change for participant average scores between time points were calculated. Additionally, participants were asked to share if they had incorporated trauma-informed care into their work with patients and if they experienced any barriers to implementing TIC since the training. Immediately following the training, ARTIC-35 scores increased on average by 11%, demonstrating that attitudes related to trauma-informed care improved as a result of the training. One month following the training, all six participants maintained their score on the ARTIC-35, representing a 12% increase from pre-training scores and 0.61% from immediately following training. Further, all participants indicated at the 1-month follow-up assessment that they changed their practice to incorporate trauma-informed care into their work with patients. A 1-hour TIC in-service training demonstrated the ability to improve psychiatric healthcare professional's attitudes toward trauma-informed care. Healthcare organizations serving patients with traumatic histories should consider TIC training for all personnel.Item Informing the construction of narrative-based risk communication(Montana State University - Bozeman, College of Engineering, 2019) King, Henry William; Chairperson, Graduate Committee: Clemente IzurietaThe current communication of flood risk by government agencies and the scientific community to the citizens living in the floodplain is ineffective. Using the Narrative Policy Framework (NPF), this communication can be enhanced through the use of Hero, Victim, and Victim to Hero character-based narratives. This thesis describes the methods used to inform users of the NPF to construct and test narratives using computational methods. Four natural language processing tasks are described; topic modeling, sentiment analysis, classification, and term frequencies. It was found that using the difference of transformed relative term frequencies produced an adequate vocabulary for each style of narrative. The narratives constructed from these vocabularies were used in work that sought to formalize the narrative construction process and in focus group studies which found that narrative-based scientific messages increased affective response versus traditional scientific messaging.Item Landslide morphology and its insight into the timing and causes of slope failure: case study of post-glacial landslides in Yellowstone National Park(Montana State University - Bozeman, College of Letters & Science, 2018) Nicholas, Grace Ellen; Chairperson, Graduate Committee: Jean DixonLandslides are ubiquitous to post-glacial landscapes worldwide. Withdrawal of glacier ice exposes over-steepened landscapes that may be unstable, and consequently susceptible to landsliding. Glacial debuttressing may directly destabilize slopes; however, seismicity and transitions to interglacial climates associated with greater effective moisture and subsequent degradation of permafrost may also play a role. Here, we explore disparate potential mechanisms of slope failure in a set of post-glacial landslides in northwest Yellowstone National Park. We quantify spatial relationships, topographic metrics, and relative age of eight landslides within the north entrance to the park, a system traversed by over 700,000 visitors every year. Analysis of high-resolution topography indicates increasing surface roughness of non-active landslides southward. These roughness values in ancient slides are roughly half those of the active Slide Lake Landslide, and suggest younging ages along the retreat path of the Yellowstone Ice Cap, consistent with glacial debutressing as the likely trigger for these slides. However, roughness values and their application for relative age dating are strongly confounded by topographic biases such as gullying, fluvial erosional contacts, and anthropogenic features (e.g., roads, structures). Once roughness biases are removed, we find roughness differences between landslides decrease, and do not support younging ages along the path of ice retreat. Thus, glacial debuttressing most likely only had a preparatory influence on slope failure, and was not the direct trigger. Analysis of subsurface soils at landslide toes indicate a >17 plasticity index, pointing to highly expansive clays that are sensitive to moisture addition. Stratigraphic relationships between post-glacial terraces and soil analyses suggest a late Pleistocene (~13 - 11.5 ka) timing for slide initiation, a period coincident with high available moisture. Stream power analysis indicates that Holocene incision of the Gardiner River is focused at a knickpoint locally coincident with the toe of the active Slide Lake Landslide, providing a mechanism for modern, local reactivation of the ancient slides. Together, our findings broadly show how quantifying the temporal and spatial patterns of landslides can be diagnostic of the controls on slope failure, and can be used to understand risk. They also highlight the importance of careful site calibrations and bias removals in roughness analysis.Item Taking creative risks in the high school writing center: how secondary writing centers foster the development of risk taking that ultimately leads to creative agency in high school student writers(Montana State University - Bozeman, College of Letters & Science, 2018) Juedeman, Elaina Renée; Chairperson, Graduate Committee: Michelle MileyThis thesis explores how high school writing centers foster the development of risk taking that ultimately leads to creative agency in high school students, which, I argue, works in opposition to the current neoliberal educational agenda. To explore this topic, I used a mixed-methods approach for data collection. Working with the frameworks of both teacher research and ethnography, I gathered data through observations, interviews, and surveys. The results of this research show that particular methods of writing centers grounded in sociocultural theory do foster the development of risk taking that ultimately leads to creative agency in high school students. The results also show that some of these methods transfer to other educational settings as well. This project concludes with a discussion of the value of research that explores educational environments that oppose the neoliberal agenda.Item Risky business: dealing with risk in a predator - prey community(Montana State University - Bozeman, College of Letters & Science, 2017) Droge, Egil Dag; Chairperson, Graduate Committee: Scott Creel; Scott Creel, Matthew S. Becker and Jassiel M'soka were co-authors of the article, 'Spatial and temporal avoidance of risk within a large carnivore guild - predator avoidance by predators' in the journal 'Ecology and evolution' which is contained within this thesis.; Scott Creel, Matthew S. Becker and Jassiel M'soka were co-authors of the article, 'Measuring the 'landscape of fear': risky times and risky places interact to affect the response of prey' in the journal 'Ecology and evolution' which is contained within this thesis.; Scott Creel, Matthew S. Becker, David A. Christianson and Fred G.R. Watson were co-authors of the article, 'Response of wildebeest (Connochaetes taurinus) movements to spatial variation in long term risks from a complete predator guild' which is contained within this thesis.The Liuwa ecosystem has several ecological properties that affect interactions among large predators, with lions and hyaenas as dominant species and African wild dog and cheetah as subordinate species, and between predator and prey. First, the vegetation structure is highly uniform and typified by open grasslands with good visibility over long distances. Secondly the prey community is heavily dominated by wildebeest, with much lower numbers of zebra, oribi and other species. These characteristics combined with GPS data on a fine spatial scale, and a large observational dataset on both predators and prey enabled us to focus on several little-studied questions about the effects of predation risk in the wild. Interspecific competition between predators can be a strongly limiting force for subordinate predators like cheetahs and African wild dogs. Both species use niche partitioning to reduce the risk of dangerous interactions in different ways that appear to have ramifications for coexistence. Wild dogs showed more dietary and temporal overlap with dominant competitors while cheetahs combine divergence in diet, temporal avoidance and reactive local spatial avoidance to coexist with lions and hyenas in areas of high prey density, even in open habitats. These results provide new insight into the conditions under which partitioning may not allow for coexistence of African wild dog, while it does for cheetah, with dominant predators making wild dogs more prone to competitive exclusion (local extirpation), particularly in open, uniform ecosystems with simple prey communities. Focusing on predator-prey relationships the overall the conclusion is that the assessment of risk by animals is a very fine-tuned process. Our results confirm that both the risky places hypothesis (LT risk) and the risky times hypothesis (ST risk) are important, leading to both reactive and proactive responses. Critically, these effects do not act independently in their effects on the strength of antipredator responses. This interaction presents challenges for the design of research on risk effects. An effect of ST risk could be masked by unmeasured variation in LT risk (or vice versa), and an effect of ST risk might be caused by unmeasured variation in LT risk (or vice versa).Item Decreasing suicide among veterans(Montana State University - Bozeman, College of Nursing, 2014) Perry, Livia Csonka Marta; Chairperson, Graduate Committee: Polly PetersenEstimates are showing that approximately 22 veterans commit suicide per day. Those at highest risk for suicide are married, white males between the ages of 50-59 with a high school education or higher, located in specific western, central and eastern states. Research has shown that 45% of those who completed suicide have seen their PCPs in the month preceding their death, and 67% of those who attempt suicide receive medical attention as a result. Although PCPs may be in a strategic position to assess for suicide risk within the veteran population, research has shown that suicide screening is underutilized in the Primary Care Setting. A possible cause for this may be the inadequate training of practitioners in the area of suicide screening. Research has demonstrated that educating PCPs in this area resulted in an increase in suicide screening in their practice settings. To meet this educational gap, a podcast was created for the purpose of educating PCPs on the topic of veteran suicidality and suicide screening. To test the effectiveness of the podcast, Montana State University graduate students from the College of Nursing were invited to participate in listening to the podcast. Each participant completed a corresponding pre and posttest. Test results show an average increase of 21% in correct answers when comparing pre and posttest results, indicating that the podcast effectively served to convey intended information to participants.Item Effects of sample size on MOTAD and Target MOTAD solutions(Montana State University - Bozeman, College of Agriculture, 1984) Jones, Clark Thomas; Co-chairs, Graduate Committee: Daniel Dunn and Myles WattsThis study examines the effects of sample size on MOTAD and Target MOTAD solutions. Data sets based on historical observations are generated with a multi-variate normal random deviate generator. A representative Montana dry-land grain farm supplied the historical data. Ten data sets of each sample size (10, 20, 30, 40, 50, and 70 observations per activity) are generated and input into both of the linear risk models. All of the MOTAD models arrived at feasible solutions. Considerable instability was observed in the objective function values and basis activity levels for even the largest samples (at the lower deviation levels). However, as sample size increased the MOTAD results tended to be more stable. Several of the Target MOTAD models were infeasible due to the specified deviation and/or target income levels. In the feasible Target MOTAD models, stability of the objective function values and basis activity levels was noted when sample sizes were 30 observations or larger. Feasible Target MOTAD models resulted in considerably larger objective function values than comparable MOTAD models. The feasibility problems of the Target MOTAD specification serve to illustrate theoretical problems of the traditional MOTAD model.Item Cultural perceptions of American Indian women in Southcentral Montana regarding pre-diabetic education(Montana State University - Bozeman, College of Nursing, 2008) Hartford, Lori Ann; Chairperson, Graduate Committee: Christina SieloffTreatment of prediabetes includes education which provides the prediabetic person with information to help them make lifestyle modification choices regarding their nutrition, exercise and weight control; in order that they control their illness and delay or prevent the development of diabetes. American Indians have a high incidence of both prediabetes and diabetes as a group compared to other ethnic groups in the U.S. There is a lack of data in the literature about what American Indians from the Crow Tribe in Montana consider to be cultural information that they feel should be included in education for pre-diabetics. This qualitative ethno-nursing study was conducted through one-on-one interviews with six American Indian women of the Crow Tribe over a period of months to determine what they defined as culturally important for the health care provider to know when teaching about prediabetes. The data from these interviews were then analyzed using qualitative software by Ethnograph ®, and four primary themes were found. These themes were: extended family and elders, spirituality and traditions, culturally specific foods and activities and a feeling of inevitability of developing diabetes. As cultural competency is an area that is included in all schools of nursing and some schools of medicine, it is important that health care providers have an awareness of cultural specific health information. All the informants in this study reported that they felt more respected when their health care provider brought up the topic of how their culture affects their health habits, as well as how important to them it is that the health care provider be open to learning about the specifics of their culture.