Scholarship & Research
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Item Implementation of a mental health pre-visit process in a rural primary care clinic: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Kaufman, Tori Rae; Chairperson, Graduate Committee: Jamie M. Besel; This is a manuscript style paper that includes co-authored chapters.Background: United States rural residents have limited access to mental healthcare. Nearly half of Montana's population is designated rural. Maximizing resources in resource-deficient regions requires creative strategies and process implementation to streamline workflow to achieve sufficient care. Local Problem: A rural Eastern Montana primary clinic has attempted to address its rural community's limited mental health resources by employing a psychologist. There is no new mental health patient pre-visit process at the project site. The purpose of the project was to implement a pre-visit process to improve the psychologist's ability to effectively care for the patient population. Methods: The Iowa Model Revised guided this quality improvement (QI) project. Process changes evaluations occurred at week three, week six, and postintervention. Interventions: A new mental health patient pre-visit process and packet were created, including a standardized Mental Health History Questionnaire (MHHQ). Educational in-services and staff completion checklists were performed to promote adherence to the process change. Results: The project goals were achieved: 95% of the new mental health patient pre-visit packets were mailed within two days of referral acceptance, 75% of new mental health patients returned their MHHQs, and 100% of staff reviewed and signed the new mental health patient pre-visit process. Conclusion: The project improved the psychologist and staff's new mental health patient workflow process. The psychologist noted an increase in patient preparedness and satisfaction, a decrease in time to diagnosis/treatment, and a slight decrease in the initial mental health evaluation duration.Item Illuminating dynamic phenomena within organic microstructures with time resolved broadband microscopies(Montana State University - Bozeman, College of Letters & Science, 2024) Hollinbeck, Skyler Robert; Chairperson, Graduate Committee: Erik Grumstrup; This is a manuscript style paper that includes co-authored chapters.Materials derived from organic chromophore subunits are currently at the forefront of academic and industrial interest. This strong interest is driven in part by the tunability of their extant properties through engineering of both the intra-molecular and inter-molecular structure. The structure of organic materials affects optoelectronic properties because organic chromophores are sensitive to dipole-dipole and charge-transfer coupling interactions. This sensitivity presents both opportunities for tuning functional properties through designing specific packing geometries, and liabilities arising from the disruptive effects of structural disorder. Many organic materials are built from weak noncovalent interactions between chromophores, leading solid-state deposition, and crystallization to be susceptible to microscopic variations in environmental conditions. Structural heterogeneity is regularly intrinsic to organic materials, and even self-assembled systems of covalently linked chromophores exhibit defects. Ergo, in order to disentangle the effects of structural heterogeneity from the inherent properties of the material, the study of organic materials must be anchored with techniques that are capable of correlating optoelectronic properties and excited state evolution with microscale morphological characteristics. We have employed broadband pump-probe microscopies, in conjunction with steady-state and time resolved fluorescence techniques, to examine the effects of structure and coupling on excited state dynamics in solid-state organic microstructures. The study of perylene diimide (PDI) materials revealed that kinetically trapping PDI (KT-PDI) enhanced long-range ordering and led to distinct excited state evolution, delocalized charge-transfer states and long-lived charge separated species. In the MOF PCN-222, excitation energy dependent excited state behavior was observed. Pumping the first excited state (Q-band) led to immobile excited states that were relatively unaffected by local defect densities, whereas pumping the second excited state (Soret-band) led to mobile subdiffusive excited state species whose lifetimes are significantly impacted by morphologically correlated defect sites. Finally, we present progress made toward the construction and utilization of a frequency modulated-femtosecond stimulated Raman microscope, yielding spectra that resolve the location of photoinduced anion formation in KT-PDI. The work presented herein highlights broadband time-resolved microscopy as a potent tool for studying the structure-function relationship and photophysical behavior in molecular solids, deepening our understanding of how structural characteristics influence excited state evolution.Item Pain management of buprenorphine patients in the perioperative setting(Montana State University - Bozeman, College of Nursing, 2024) Hildner, Kate Ella; Chairperson, Graduate Committee: Julie Ruff; This is a manuscript style paper that includes co-authored chapters.Background: Buprenorphine is an FDA-approved medication for the treatment of opioid use disorder and a useful tool in helping patients recover from opioid addiction. Due to the mechanism of action of buprenorphine on opioid receptors, treatment of acute pain in the perioperative setting can be challenging. Local problem: At the facility site, buprenorphine patients who present for surgery have a longer average length of stay in the post-anesthesia care unit (PACU). Nurses also expressed a need for further education and increased proficiency in caring for buprenorphine patients. Methods: The purpose of this project was to increase staff communication, provide specific education to staff about buprenorphine, and decrease the length of stay for buprenorphine patients in the PACU. Interventions: This project involved the implementation of three interventions. The first intervention involved adding chart documentation of buprenorphine status, allowing for notification to the operating room and PACU staff. The second intervention was the initiation of improved communication between the preoperative department and the PACU. The third intervention was an educational presentation and reference sheet that was provided to the PACU staff. Results: After implementation, 80% of buprenorphine patients had a note in their chart alerting the OR and PACU staff of their buprenorphine status, however direct communication between departments only occurred for 20% of patients. 100% of PACU staff nurses reported increased proficiency in caring for buprenorphine patients after education implementation. Conclusion: The QI project resulted in increased staff proficiency and interdepartmental communication, indicating improved care for buprenorphine patients in the perioperative setting.Item Superintendent efficacy and addressing community needs(Montana State University - Bozeman, College of Education, Health & Human Development, 2024) Kirchner, Derek Lee; Chairperson, Graduate Committee: Tena VerslandThe purpose of this intrinsic case study was to explore how a self-efficacious superintendent mitigates the challenges of addressing community needs. In previous literature on community dissatisfaction, superintendents who have neglected the needs of community members have lost their jobs. Despite being trained for and required to demonstrate knowledge on ways to identify and address the needs of the school district community, many superintendents fall short and end up being removed from their positions by the school board and community. Self-Efficacy theory postulates that individuals with a high degree of efficacy for their jobs seek out and are more receptive to innovations within their workplaces. This research study utilized a document review of school board meeting minutes, public voting data, and superintendent correspondence to determine instances of community needs. This information was utilized to conduct semiformal interviews with a superintendent to explore strategies he used to address needs in the community. The results of the document revealed that dissatisfaction occurred around four events: the Cougar's Cave playground structure, the Economic Development District, the High School project, and COVID-19. The analysis of the interviews indicated that the superintendent employed three strategies to mitigate community dissatisfaction: Developed a Culture of Learning within the District, Involved the Community, and Built Relationships. The strategies in this research echo what has already been written regarding successful superintendent leadership. Conclusions drawn from this project include the idea that both the superintendent and the school board should research each other prior to offering and accepting employment in a district to ensure superintendent skillsets match district needs. A second conclusion is the superintendent should develop a strong relationship with the school board but should remain open to feedback and concerns from the community. A final conclusion drawn from the research is that the superintendent should selectively choose mentors and be receptive to their advice.Item Improvement of cervical cancer screening in a rural primary care setting: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Kelleher, Katie Carla; Chairperson, Graduate Committee: Amanda H. Lucas; This is a manuscript style paper that includes co-authored chapters.Background: Cervical cancer (CC) is the fourth most diagnosed cancer among women. Cervical cancer screening (CCS) is a vital component of routine health care, as any individual with a cervix is at risk of developing cervical cancer, and nearly all diagnoses of aggressive cervical cancer are directly associated with a lack of screening, underscreening or inadequate follow-up of abnormal results. Unfortunately, the number of women overdue for CCS continues to increase gradually nationally and in Montana. Local Problem: At a rural primary healthcare clinic in northwestern Montana, 37.0% of patients have a current CCS completion documented, compared to Healthy People's 2030 benchmark of 84.3%. Methods: Participants included female patients ages 21-65 who presented to the clinical for an annual exam. Using the Plan-Do-Study-Act cycle, the intervention outcomes were measured biweekly throughout the six-week initiative. Measures assessed included: Adequate CCS eligibility determination, proper CCS documentation with the EHR, and the overall site CCS completion percentage. Data was collected over six weeks, de-identified, and analyzed using percentages and bar graphs. Interventions: Literature supported a multifactorial approach to standardize workflows and documentation practices among the nurses and medical assistants (MA) through the provision of educational material and a CCS clinical decision tree. Key process changes included offering of same-day CCS screening, follow-up scheduling prior to the patient leaving, and EHR alert creation if patient records were requested. Results: A total of 30 patients presented to the clinic. 100% of patients who presented to the clinic were assessed for CCS eligibility. 100% of eligible patients were offered CCS. 84.6% of patients had correct CCS documentation by the staff within the EHR, with four patients lacking proper documentation. A 4.1% increase was seen in the overall facility CCS completion percentage, reaching a total CCS completion percentage of 41.1%. Conclusions: Implementing education, standardized workflows, and the use of the CCS clinical decision tree improved CCS documentation and completion rates.Item String analysis and algorithms with genomic applications(Montana State University - Bozeman, College of Engineering, 2024) Liyana Ralalage, Adiesha Lakshan Liyanage; Chairperson, Graduate Committee: Binhai ZhuIn biology, genome rearrangements are mutations that change the gene content of a genome or the arrangement of the genes on a genome. Understanding how genome rearrangements occur in a genome can help us to understand the evolutionary history of extant species, improve genetic engineering, and understand the basis of genetic diseases. In this dissertation, we explored four problems related to genome partitioning and tandem duplication and deletion rearrangement operations. Our interest was focused on determining how difficult it is to solve these problems and identifying efficient algorithms to solve them. The proposed problems were formulated as string problems and then analyzed using complexity theory. In the first chapter, we explored several variations of F -strip recovery problem called XSR-F and GSR-F and their complexity under different parameters. We proved that the XSR-F problem is hard to solve unless we restrict the allowed block sizes to one size. We provided a polynomial time algorithm for GSR-F under a fixed alphabet and fixed F . In the second and third chapters, we introduced two string problems named longest letter- duplicated subsequence (LLDS) and longest subsequence-repeated subsequence (LSRS)-- formulated as alternative problem formulations for the tandem-duplication distance problem that allow to extract information about segments of genes that may have undergone tandem duplication-- analyzed the complexity of their variations and devised efficient algorithms to solve them. We proved that constrained versions of LLDS and LSRS problems are NP- hard for parameter d > or = 4, while general versions were polynomially solvable which hints that any variations closer to the original tandem duplication distance problem are still hard to solve. In the final chapter, we delved into two heuristic algorithms designed to compute genomic distance between two mitochondrial genomes and a heuristic algorithm to predict ancestral gene order under the TDRL (tandem-duplication random loss) model. We improved the previously studied method developed for permutation strings by tweaking heuristic choices aimed at calculating the minimum distance between two genomes to apply to non-permutation strings. These heuristic algorithms were implemented and tested on a real-world mitochondrial genome data set.Item An induced acceleration analysis of the barbell back squat(Montana State University - Bozeman, College of Education, Health & Human Development, 2024) Goodman, William Wesley; Chairperson, Graduate Committee: Dawn Tarabochia; This is a manuscript style paper that includes co-authored chapters.The barbell squat exercise is performed in settings ranging from rehabilitation through to developing muscle size, strength and power. Unfortunately, the lower extremity coordination producing the squat is not clearly understood. This thesis involves three studies evaluating how lower limb joints and muscles coordinate varied squat performance. Study one-three included 13 females who performed squats at three randomized depths (above parallel, parallel, below parallel) using 85% of their 1 repetition maximum at each respective depth. In study one, performance was evaluated by estimating the individual muscle force production and the individual muscle contribution to whole body acceleration using a musculoskeletal model. In study two, performance was evaluated by estimating the individual muscle force production and the individual muscle contribution to the lower body joint accelerations using a musculoskeletal model. In study three, knee joint contact loads were estimated using an advanced musculoskeletal model. Because muscles can accelerate all joints in the body, including a joint that it does not span, musculoskeletal models are necessary to determine muscle function. Varied coordination indicates that depth and load specificity is important and should be taken into consideration when programming based on the status and goals of the individual.Item Programming despair: post-9/11 American television show mirroring a too-familiar dark reality(Montana State University - Bozeman, College of Letters & Science, 2024) Holthaus, Nicholas Edwin; Chairperson, Graduate Committee: Daniel FloryThis work is an analysis of the phenomenon of wildly popular television shows airing since the 9/11 attacks, many of which appear to critique United States foreign and domestic policies and the morally and economically deprived environments those policies have created, all of which have led to correlative, disturbing psychological changes in US citizens. Television is a textual site, and, especially since 9/11, an indicator of national mood, temperament and consumption trends. "TV" is an increasingly important vehicle through which to examine how producers engage with consumers, as they sometimes "mirror," sometimes create, and occasionally criticize systemic ideologies and beliefs. Since 9/11 the qualitative content of shows has changed drastically, which poses new challenges for consuming viewers. Many of these shows reify the old critics' warnings, but some obliterate them with these new writers' critical examinations of cultural, economic and political problems we increasingly face. I look at what some show producers are telling us now that they've achieved that supposed "American Dream," that is, working toward and achieving some economic independence. They show a maturity in their earnest messages that the old dichotomies of "good guys and bad guys," are no longer believable. These shows in varying degrees to the discomfort and to the pleasure of a more discriminating and disenfranchised US public show this. I propose an approach to discern which shows are enlightening in many ways and those which only serve to obediently "take up consumers' time with meaningless entertainment" as pre-9/11 scholars had bemoaned. Not all TV shows are created arguably equal anymore, at least in regards to the agendas of the producers; some humanistic writers and producers have daringly scrutinized many institutional social governors and throttles inherent in the machinery of control over the public. Yet, no matter how enlightening some of these new visual vehicles are, some are not, and simply drain time. And with "bingewatching" also come new health problems. It is up to the individual reader/viewer to recognize the difference and to choose what benefits one's self, from how to choose their "leisure" time to becoming more active in eliminating the sources of their anxiety, alienation and dis-ease. This work hopefully offers a new way of looking at the changes we've encountered, especially those presented televisually the past twenty + years. Just as the creators of some of these new shows have heeded the old scholars' criticisms, so too is a need for new scholarship on television so that both can co-evolve, in the hopes that there grows enough consensus in how to pinpoint and then resolve the financial problems we've inherited.Item Studies in alternative theories of gravity and advanced data analysis(Montana State University - Bozeman, College of Letters & Science, 2024) Gupta, Toral; Chairperson, Graduate Committee: Neil J. Cornish; This is a manuscript style paper that includes co-authored chapters.The field of gravitational wave astronomy is generating groundbreaking findings, yielding unique insights on some of the most extraordinary phenomena in the universe and providing invaluable information on testing the principles of general relativity. All gravitational wave signals detected so far appear to come from compact binaries - black holes and neutron stars. We use information from these sources to probe strong fields of gravity and to constrain modified theories of gravity. However, solely relying on template- based searches for known astrophysical sources biases our gravitational wave signal search towards well-modeled systems, potentially overlooking unpredicted sources with limited theoretical models, hindering the extraction of new physics. Further work in this thesis focuses on building improved signal and noise models to enhance our capability of detecting gravitational signals of all within and beyond the constraints of theoretical predictions. This includes introduction of new basis functions with added modifications to develop a signal-agnostic waveform reconstruction model using Bayesian inference. Additionally, this study discusses improvements in the speed and performance of the BayesWave trans-dimensional Bayesian spectral estimation algorithm, which includes implementing a low-latency analysis and various enhancements to the algorithm itself. In essence, this study is centered on developing a comprehensive understanding, both theoretical and observational, of astrophysical objects along with the spacetime that governs their dynamics.Item Implementation of a multidose naloxone protocol in a rural volunteer emergency medical service: a safety-diven quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Overstreet, Riesa Rachael; Chairperson, Graduate Committee: Stacy Stellflug; This is a manuscript style paper that includes co-authored chapters.Background: Opiate overdose (OOD) deaths are increasing in Montana. Emergency medical technicians (EMTs) are the primary prehospital providers in rural areas and the first contact for many OOD patients. In the last ten years, many states have added naloxone administration to the EMT scope. Now, EMTs administer a third of the naloxone given nationally. Local problem: A rural volunteer EMS experienced patient contact times longer than the duration of naloxone's action. State protocols allowed EMTs to administer one dose of intranasal naloxone. Methods: The Iowa Model--Revised guided the quality improvement (QI) project, which aimed to provide standardized, evidence-based interventions to improve the identification and treatment of patients with OOD, expedite their arrival at definitive care, and ultimately improve patient survival. Interventions: The project team created an evidence-based multidose OOD protocol for the volunteer EMS based on the EMT, scope of practice, and the practice environment. Naloxone and protocol training, badge cards, and substance use identification training supported the protocol implementation. Results: Overall, EMTs reported protocol use for patients with any signs and symptoms of OOD 71% of the time, increasing throughout the implementation period. Fifty percent of patients with evidence-based OOD signs and symptoms received naloxone. Conclusion: The QI project demonstrated that volunteer EMTs could apply the protocol to identify and treat patients with evidence-based signs and symptoms of OOD with similar accuracy to EMS providers nationally. Interdisciplinary partnerships in resource-limited rural settings can support QI efforts and increase the representation of rural populations in the literature.