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Implementation of Evidence-Based Practices to Improve Treatment for Patients with Neck Pain: A Pilot Study
No full textPurpose: To determine physical therapists’ barriers to implementation and subsequent maintenance of evidence-based practices (EBPs) for treating neck pain from the American Physical Therapy Association (APTA) neck pain Clinical Practice Guideline (CPG) over the course of six months.
Materials and Methods: Participating physical therapists were trained on the EBPs of treating neck pain through a live 90-minute webinar followed by a hands-on, in-person 90-minute session. Clinics were supplied with all necessary equipment and reference guides. Assessment of participant maintenance to neck pain EBPs included data collection from a baseline Knowledge Check survey prior to educational sessions, an Implementation survey at two months post educational sessions, and a Maintenance survey at six months post educational sessions.
Results: 75% of the participants stated that they maintained the use of the recommended EBP guidelines six months after the educational sessions. When participants were asked how often they used the EBPs taught six months previously, 25% responded with, “about half of the time,” 50% responded with, “most of the time,” and 25% responded with, “always.”
The most commonly reported barriers were a high patient caseload, perception that patient outcomes were not improving, availability of one-on-one time with patients, and too short of patient treatment sessions to be able to implement EBP-related interventions for neck pain effectively. Participants who stated they had a high self- efficacy were more likely to perform mobilizations and use the recommended EBP modalities
Maltreatment and Resilience: Examining the Unique Roles of Threat and Deprivation
No full textBackground and objectives: This study aimed to investigate the involvement that maltreatment type, specifically threat and deprivation, play in a child’s life. We examine how threat uniquely contributes to resilience and how deprivation impacts resilience. Literature has highlighted differences in the effects of deprivation and threat in recent research that shows the impact on various neurological systems.
Methods and approach: Participants included youth aged 11-17 years in the Department of Family Services (DFS) custody following removal from their home after substantiated child maltreatment and were assessed. 90 of the youth in the sample reported that they have experienced threat-based maltreatment, and 62 reported that they had experienced deprivation based maltreatment. Maltreatment history was gathered using the DSM-5 Posttraumatic Stress Disorder Reaction Index (PTSD-RI)4. Interpersonal functioning was measured using the Sense of Relatedness subscale of the Resiliency Scales for Children and Adolescents (RSCA)5.
Results: In the sample of maltreated youth, those who had experienced neglect compared to those who had not experienced neglect demonstrated no differences across variables of the resiliency scales. This suggests that despite differences in neurological effects, among multiple scales of the RSCA assessment, nothing significant was found in the maltreatment type of neglect, however, significance was found among maltreated youth. For youth with a history of abuse, there are lower relatedness scores compared to youth without a history of abuse but had experienced some form of maltreatment. This suggests that threat-based maltreatment has a greater impact on relatedness factors than deprivation-based maltreatment.
Conclusion & broader implications: Deprivation-based maltreatment has an impact on relatedness factors that goes above and beyond the effects observed in maltreated youth as a whole whereas threat-based maltreatment has a direct impact on resiliency scales as a whole. The neurological effects of maltreatment have been found to mediate the relationship between maltreatment and resilience factors. However, limited research has investigated the unique impacts of threat and deprivation based treatment on resilience. Understanding these differences is crucial for tailoring interventions and support services to address the unique needs of children who have experienced different forms of adversity.https://oasis.library.unlv.edu/durep_posters/1251/thumbnail.jp
Measuring the Impact of Reduced Free-play Offers on Casino Loyalty Behavior
No full textPerformance data from a tribal casino operating in the Western United States indicated a general insensitivity to free-play (FP) offer reductions. This finding addresses considerable industry-wide concerns regarding the potential for negative customer reactions to conspicuous offer reductions. Further, FP campaigns are costly annual investments representing the lion’s share of casino marketing budgets in many jurisdictions. A within-subjects design featured the random assignment of 100 loyalty program members from a common offer tier to each of four groups, with the experimental groups receiving different yet substantial reductions in FP during the post-demotion period. The results demonstrated a lack of significant differences in gaming spend and visitation, across the pre- and post-demotion periods. Our findings generally failed to indicate support for social inequity theory, aligning more with the literature on force-of-habit behavior. Additionally, the growing body of FP research was meaningfully extended
The Role of Surfactant Adsorption in Boiling Dynamics
No full textBoiling processes play a substantial role in numerous commercial and industrial sectors, including electronic components, avionics, power plants, cooling systems, and water purification centers, for thermal management. The efficient heat transfer mechanism and high latent heat of evaporation inherent in water contribute significantly to bubble formation during boiling. Despite being widely employed as a heat transfer process, enhancing boiling presents challenges due to its non-equilibrium, dynamic, and unpredictable nature. One effective method to improve boiling heat transfer is through the use of surfactants. When added and dissolved in water, surfactants modify the liquid-solid and liquid-vapor interfacial properties, thereby altering boiling behavior, including bubble size, nucleation site density, departure frequency, and non-coalescence. Previous studies have indicated that surfactants are most effective in boiling water near the critical micelle concentration (CMC), a property in equilibrium that depends on the type of surfactant. However, conventional wisdom studies have primarily investigated a limited number of surfactants across narrow molar concentration ranges. The work presented in this dissertation broadens the scope by examining a wide array of ionic and nonionic surfactants over a wide concentration range. Surprisingly, we have discovered an optimal concentration range that operates independently of the critical micelle concentration (CMC). Our findings unveil that the effectiveness of surfactant-enhanced boiling is governed by two opposing factors: the dynamic adsorption of surfactants to interfaces and the increase of liquid dynamic viscosity at exceedingly high surfactant concentrations. Furthermore, this dissertation illustrates that dynamic adsorption operates as a diffusion transport-limited behavior, contending within a limited time window of a bubble lifetime and the timescale of diffusion necessary for surfactant adsorption to interfaces. With the right interplay between these two timescales, changes in boiling behavior are synchronous, quantified through the heat transfer coefficient (HTC) and the critical heat flux (CHF). This phenomenon unveils an HTC-CHF trade-off behavior, regardless of the surfactant type. Furthermore, we evaluate whether ionic liquid-based surfactants (ILBSs) of different chain lengths could break in the HTC-CHF trade-off behavior, as reported in recent literature. Overall, the results presented in this dissertation challenge conventional wisdom in the field, providing a fresh, practical perspective on how surfactants enhance the efficiency of boiling systems with the right amount of surfactant additives in the fluid. We also established general correlations to predict changes in aqueous surfactant boiling heat transfer. This novel scientific approach is applicable for any type of surfactant across a wide range of systems that rely on a boiling process to optimize heat transfer, particularly in energy-centric applications using surfactants, thus offering a new practical method to predict changes in aqueous surfactant
Improving Patients’ Readiness for Discharge: The Development of An Occupation-Based Group Therapy Protocol in Inpatient Rehabilitation
No full textThe literature showed a lack of studies involving occupation-based group therapy in an inpatient rehabilitation setting, with notable barriers including lack of time, space, and equipment. The barriers lead occupational therapists (OT) to pursue an impairment-based approach, steering away from occupation-based approaches, which is what makes up the core of OT. Current literature is also limited to patients\u27 perceptions of discharge readiness, with most research primarily concentrated on clinicians\u27 perspectives. This 14-week capstone experience will include developing an occupation-based group therapy protocol for inpatient rehabilitation that will be implemented at Dignity Health Rehabilitation Hospital. Through conducting occupation-based group therapy in an inpatient rehabilitation setting for six weeks, surveys were provided to evaluate the program and to view patient\u27s perceptions of readiness for discharge. The culminating experience provided Dignity Health Rehabilitation Hospital with additional resources for their OT department to conduct occupation-based group therapy. Patients\u27 perceptions of readiness for discharge were evaluated through pre- and post-group surveys to view whether participating in occupation-based groups impacted readiness for discharge in conjunction with their inpatient rehabilitation stay
Needs Assessment for Implementation of a Dedicated Admission and Discharge Nurse Position
No full textBackground: Patient turnover refers to when patients are admitted, discharged, or transferred to or from a clinical unit or another facility. Rapid patient turnover compels nurses to provide care in an environment where clinical demands exceed nursing care capacity. The excess of clinical demands can lead to rationing of nursing care and culminate in nursing stress and dissatisfaction. These negative effects on the nursing workforce subsequently have undesirable implications for patient and hospital outcomes. Implementation of a dedicated admission and discharge nurse (ADN) position can optimize patient flow, improve nursing satisfaction, and ultimately promote positive patient outcomes. Purpose: The purpose of this DNP project is to perform a needs assessment to determine if creation of a dedicated admission and discharge nurse position is needed for medical-surgical units at a 300-bed teaching hospital in Southern Nevada. Methods: The needs assessment consisted of a survey of nursing perception of admission and discharge practices as well as a retrospective assessment of patient flow data to evaluate unit performance. The admission and discharge survey was administered in July and August 2023. Retrospective data from May 2022-2023 was reviewed to identify opportunities for improvement in nine patient flow measures: ED boarding hours, ED rate of patients who left without being seen, unit rate of early discharges, unit discharge turnaround time (DTAT), unit length of stay (LOS), and unit discharge HCAHPS scores. Results: Only 17% (n = 4) of nurse respondents reported satisfaction with the admission and discharge process. Approximately 91% (n = 20) of nurse respondents believe that patient turnover significantly contributes to workflow disruptions. About 86% (n = 19) of the nurse respondents felt that frequent admissions and discharges limit their ability to perform other priority nursing interventions and care for existing patients. Almost all nurse respondents (95%, n = 21) are in support of the creation of a dedicated admission and discharge nurse position. For May 2022 – May 2023, two medical-surgical units did not reach facility goals for unit LOS (\u3c 5.1 days), discharge turnaround times (\u3c 120 minutes), rate of early discharges before 1100 (25% of home routine), rate of early discharges before 1400 (50% of home routine) and have poor discharge HCAHPS scores. The ED did not reach facility goals for ED boarding time (\u3c 195 minutes) and ambulance diversion time (0 hours). Conclusions: The results of the nurse survey and patient flow data review support the need to implement a dedicated ADN position. Review of current patient flow performance has identified areas in which the ADN position can target. Specifically, there is potential for the ADN position to improve unit discharge turnaround time and rate of early discharge which may consequently reduce ED boarding times and unit LOS. The literature review indicates that the ADN position can enhance nursing productivity, bolster teamwork, and offset heavy nursing workload associated with patient turnover. Nurse leaders should consider implementing the ADN position which will enhance patient flow and improve the nursing team’s capacity to overcome increased work demands associated with rapid patient turnover
Shifting Employment and Perceptions of Household Responsibilities During Early Stages of the COVID-19 Pandemic in Nevada, USA
No full textBackground: Employment and household responsibility are critical health determinants. The COVID-19 pandemic altered the work and social landscapes in Nevada, USA through closures of workplaces and schools/childcare centers, changing patterns of employment, and household responsibilities. This study aimed to measure changes in employment status and perceived housework responsibilities among Nevada adults in December 2020, before widespread availability of COVID-19 vaccines in a pandemic-affected economy.
Methods: Using a cross-sectional telephone survey of 1,000 Nevada adults, this study compared respondent experiences and perceptions of employment and time spent on housework in December 2020 to pre-pandemic using multinominal logistic, proportional odds, and logistic models.
Results: 70.52% of participants experienced no employment change; roughly 24% reported being fired/laid-off, working reduced hours, or quitting. Chi-square analyses found participants of color more likely than Whites to report being fired/laid-off or working reduced hours (p-value = 0.0005), though these findings were not significant in our models. Participants in the lowest income bracket had higher odds of being fired/laid off (p-value = 0.0030), and participants aged 65+ were less likely to experience employment change (p-value\u3c 0.0001). 32.43% of participants reported more time spent on housework. Multivariate analyses showed age is significantly associated with changes in both employment status (p-value\u3c 0.0001) and housework time (p-value\u3c 0.0001); income is a significant factor for employment status change (p-value = 0.0024). Of those reporting their households spent more time on housework, females were 2.90 times (95% CI=1.66, 5.05, p-value = 0.0002) more likely to report taking on the additional work.
Conclusions: Results demonstrate a disproportionate burden in employment change and/or more perceived household responsibilities on lower income and younger respondents, and females reporting they are more likely to take on additional housework. Understanding systemic vulnerabilities related to employment status and household responsibilities is necessary to aid impacted communities and to plan for future emergencies
COVID-19: Change in Adjusted Gross Income from Net Migration in Nevada, 2020-2021
No full textThis fact sheet examines data on changes in taxable income and net average income as a result of net migration for each county in Nevada during the COVID-19 pandemic (from 2020 to 2021). The data illustrate which Nevada counties experienced increases in taxable income and average income, and which counties experienced losses. The data are retrieved from “Tax Data Reveals Large Flight of High Earners from Major Cities During the Pandemic,” an interactive data report by the Economic Innovation Group
Salary Needed to Live Comfortably in the Mountain West, 2024
No full textThis fact sheet examines data on the annual salary needed to live comfortably in selected cities in the Mountain West states of Arizona, Colorado, Nevada, and New Mexico as of February 2024. A report by Smart Asset titled, “Salary Needed to Live Comfortably – 2024 Study,” provided wage data for the 99 largest cities in the United States
A Phenomenological Exploration of Intracommunity Attitudinal and Experiential Barriers to the Utilization of Psychotherapeutic Services in BIPOC Populations
No full textThis 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 their communities and how that, in turn, determines welldocumented lower rates of mental health service utilization. Findings suggest that negative attitudes towards mental illness and treatment avoidance are prevalent in BIPOC communities, and adverse encounters with culturally incompetent providers perpetuate these attitudes and disparities in utilization. Improving BIPOC treatment outcomes and patient satisfaction could slowly mitigate intracommunity stigma and normative beliefs and significantly increase help-seeking behavior, especially for future generations. This research contributes to our understanding of this phenomenon and emphasizes the urgent need to equip all therapists with the competency skills essential for effectively addressing the diverse needs of BIPOC patients