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Title: Increasing cervical cancer screening in a rural population through a multifaceted educational intervention
Creator: Boss, Whitney
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: The purpose of this quality improvement (QI) project was to design and implement a multicomponent evidence-based educational intervention for the patients and providers in a rural health clinic in Mid-Michigan with the goal of increasing the proportion of CCS performed and increasing the amount of CCS appointments being made in women ages 21-64.

Title: Virtual reality as complementary treatment after spinal fusion
Creator: Krueger, Emily (Emily Ann)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Significance: The number of lumbar spinal fusion patients increases each year nationwide. The amount of opioid pain medication used can affect the outcomes, patient satisfaction, and quality of recovery. In this project, emphasis was placed on implementing and using non-pharmaceutical interventions to assist in the management of postoperative pain. Purpose: The purpose of this project was to implement the use of virtual reality to supplement the current postoperative care...
Show moreBackground and Significance: The number of lumbar spinal fusion patients increases each year nationwide. The amount of opioid pain medication used can affect the outcomes, patient satisfaction, and quality of recovery. In this project, emphasis was placed on implementing and using non-pharmaceutical interventions to assist in the management of postoperative pain. Purpose: The purpose of this project was to implement the use of virtual reality to supplement the current postoperative care protocol to minimize the length of stay, increase pain control, and lower opioid usage. Methods: The project was implemented in a neurological unit at a midwestern trauma two hospital. All patients admitted after lumbar spinal fusion surgery performed by the employed neurosurgeons were included in the intervention. Evaluation: Pain scores, length of stay, readmission rates, and morphine milligram equivalencies were documented and compared to patients who had undergone similar surgical procedures before the addition of postoperative virtual reality.
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Title: A project plan : healthy work environment and unit culture
Creator: Woltschlaeger-Brooks, Susanne A.
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Review of Literature: A Healthy Work Environment (HWE) has broad implications impacting wellness and retention of team members, recruitment, quality and safety of care delivered, and the overall organizational culture. A review of the literature demonstrates various factors contribute to the presence or absence of a HWE. Purpose: The purpose of this evidence-based quality improvement project is to improve the HWE and ultimately decrease team member churn, increase team member...
Show moreBackground and Review of Literature: A Healthy Work Environment (HWE) has broad implications impacting wellness and retention of team members, recruitment, quality and safety of care delivered, and the overall organizational culture. A review of the literature demonstrates various factors contribute to the presence or absence of a HWE. Purpose: The purpose of this evidence-based quality improvement project is to improve the HWE and ultimately decrease team member churn, increase team member belonging and engagement as well as likelihood to recommend on a neuroscience clinical unit within a large midwestern Magnet ® designated hospital. Methods: Key interventions were implemented focusing on the fundamental core components of the IHI Framework for Improving Joy in Work: camaraderie and teamwork, choice and autonomy, meaning and purpose, and physical and psychological safety. Implementation Plan / Procedure: Following the IHI Framework for Improving Joy in Work, "What matters to you?"208Aconversations to identify impediments to joy at work were held with team members. Targeted strategies to address impediments were developed and implemented. Results/Interpretation: Effectiveness of the IHI Framework for Improving Joy in Work was evaluated by comparing pre and post implementation data for rolling twelve month transfer and churn percentage, engagement and belonging scores, and likelihood to recommend. The twelve month rolling transfer and churn percentage decreased from August 2021 to January 2022. Belonging and engagement scores decreased from July 2021 to November 2021. Likelihood to recommend decreased from August 2021 to January 2022. Implications/Conclusion: The COVID-19 pandemic impacted the implementation of the IHI Framework for Improving Joy in Work as it proved to be a significant disruption impacting overall stress, staffing levels, and tested the resilience of healthcare organizations across the nation. It is recommended that the neuroscience clinical unit consider continued application of the IHI Framework for Improving Joy in Work as a strategy to recover from the COVID-19 pandemic.
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Title: Intraoperative blood glucose management : a quality improvement project
Creator: Baker, Jake (Nurse)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Perioperative hyperglycemia is associated with a myriad of post-surgical complications including an increased incidence of surgical site infections and prolonged hospital stays. The use of an evidence-based perioperative blood glucose management protocol reduces morbidity and mortality in adult patients undergoing surgical procedures. The project team describes a cost-effective quality improvement initiative aimed at improving protocol adherence by integrating an easy-to-use protocol...
Show morePerioperative hyperglycemia is associated with a myriad of post-surgical complications including an increased incidence of surgical site infections and prolonged hospital stays. The use of an evidence-based perioperative blood glucose management protocol reduces morbidity and mortality in adult patients undergoing surgical procedures. The project team describes a cost-effective quality improvement initiative aimed at improving protocol adherence by integrating an easy-to-use protocol algorithm, order sets, and practice reminders into an existing electronic health record system.
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Title: Improving pediatric influenza vaccination rates in the primary care setting
Creator: Kositzke, Channan M. (Channan Marie)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Significance: Caregiver vaccine hesitancy (VH) is a barrier to pediatric health. Current pediatric vaccination rates nationwide fall below the national recommendations. Understanding contributors to individualized hesitancy while employing motivational interviewing (MI) techniques can reduce caregiver hesitancy, improve influenza vaccination rates, decrease pediatric disparities, improve community health, and reduce healthcare costs. Purpose: The purpose of this quality...
Show moreBackground and Significance: Caregiver vaccine hesitancy (VH) is a barrier to pediatric health. Current pediatric vaccination rates nationwide fall below the national recommendations. Understanding contributors to individualized hesitancy while employing motivational interviewing (MI) techniques can reduce caregiver hesitancy, improve influenza vaccination rates, decrease pediatric disparities, improve community health, and reduce healthcare costs. Purpose: The purpose of this quality improvement (QI) project was to reduce caregiver influenza vaccine hesitancy through provider education and the use of MI techniques with the MOTIVE-Flu (Motivational Interview Tool to Improve Vaccination Adherence) algorithm point of care tool. The intended outcome goal was to increase seasonal influenza vaccination rates by 10% when comparing the participating providers 2020 (without the intervention) to the 2021 (with the intervention) vaccination acceptance rate. Methods: A literature review guided the selection of the tools and techniques selected, which substantiated the effectiveness of MI within the pediatric population in the primary care setting. De-identified aggregate data was reviewed and provided by the organizational data manager and the participating Medical Assistant (MA). Statistical analysis was provided via Michigan State University (MSU). To assist with MI techniques and the MOTIVE-Flu tool use education was completed by the participating MA's, provider, and nurse practitioner student. Implementation: Implementation occurred from October 2021 to December 2021 within peak influenza vaccine administration season. The intervention occurred during all pediatric primary care visits for children aged six months through seventeen years. The Knowledge into Action Framework guided the development and monitoring process with bi-weekly clinical staff progress, evaluation, and support. Implications: Practical implications include reducing pediatric influenza morbidity and mortality, reducing the spread of influenza within the community, and decreasing healthcare costs. Keywords: Vaccine, Hesitancy, Motivational Interviewing, Pediatric, Primary Care.
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Title: Utilization of a transitional care team for medication reconciliation in geriatric primary care
Creator: Brooks, Tanya
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Significance: According to the Institute of Medicine (IOM), medication-related errors lead to mortality and adverse effects such as allergic reactions, avoidable side effects, drug interactions, and unnecessary cost (IOM, 2000). Even with the predominant use of computerized provider order entry (CPOE) and clinical decision support systems (CDSS), medication discrepancies are still problematic today. There is substantial evidence available to demonstrate the benefits of using a...
Show moreBackground and Significance: According to the Institute of Medicine (IOM), medication-related errors lead to mortality and adverse effects such as allergic reactions, avoidable side effects, drug interactions, and unnecessary cost (IOM, 2000). Even with the predominant use of computerized provider order entry (CPOE) and clinical decision support systems (CDSS), medication discrepancies are still problematic today. There is substantial evidence available to demonstrate the benefits of using a transition of care (TOC) team for timely, appropriate medication reconciliation (MR) utilizing multiple intervention modalities. Purpose: This quality improvement (QI) project attempted to determine if the implementation of a TOC team utilizing a telephone-based MR system in a geriatric primary care setting improved identification of medication discrepancies and improved seven-day follow-up (FU) appointments following an inpatient admission. Methods: The TOC team at the geriatric primary care clinic was educated about the improved MR intervention tool and data collection process via a PowerPoint presentation. The data was collected via an Excel spreadsheet and analyzed for improvement upon identified medication errors and follow-through with timely FU appointments. The plan-do-study-act (PDSA) cycle was utilized for implementation. Results: A QI project was implemented in a geriatric primary care setting including 74 patients, 18 of which received the intervention. The implementation was carried out over a total of 12 weeks. Error identification increased from 0.71 errors per patient in the control group to 1.22 in the intervention group. Of the patients contacted via MR phone calls, 88.8% scheduled FU appointments; only 38.8% were within the goal time frame of seven days. The average time to FU during the implementation period was 9.1 days. Conclusion: The TOC team utilizing a telephonic MR improved identification of medication errors and overall FU rates. However, the TOC team did not positively impact the seven-day FU during MR from an inpatient hospitalization visit back to the outpatient setting. Results also indicated an improvement in the time spent per phone call. Keywords: care transition, transition of care team, medication reconciliation, seven-day follow-up, outpatient/ambulatory primary care.
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Title: A quality improvement project for post-COVID-19 patients through reminder phone calls
Creator: Sweeney, Danielle
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Review of Literature: COVID-19 is a devastating illness that has detrimental health, financial and emotional consequences. Healthcare providers are utilizing questionnaires such as the PROMIS-29 form to help guide management of long term symptoms. Calling patients prior to their appointment as a reminder to complete their forms has proven to increase patient compliance with form completion. Purpose: The purpose of this quality improvement project was to increase the PROMIS-29...
Show moreBackground and Review of Literature: COVID-19 is a devastating illness that has detrimental health, financial and emotional consequences. Healthcare providers are utilizing questionnaires such as the PROMIS-29 form to help guide management of long term symptoms. Calling patients prior to their appointment as a reminder to complete their forms has proven to increase patient compliance with form completion. Purpose: The purpose of this quality improvement project was to increase the PROMIS-29 form response rate prior to the COVID-19 recovery care appointment, in hopes of improving care for patients living with post-COVID-19 conditions. Methods: This project was implemented at a large Midwest healthcare organization's primary care clinics. The Doctor of Nursing Practice (DNP) students called patients within 72 hours prior to their appointment, to remind them to complete the PROMIS-29 form on their MyChart portal. Implementation Plan/Procedure: The DNP students completed HIPAA training and utilized a script provided by the large Midwest healthcare organization when calling patients. A weekly report was provided by the community partner that includes a list of patients who needed to be called, according to the "post COVID follow up" visit type. The DNP students traveled to the large Midwest healthcare organization's administration building to conduct phone calls. Pre-intervention and post-intervention surveys were sent to the providers to determine the success of the intervention. Implications/Conclusion: Various project limitations impeded the ability to determine the success of the intervention however, the project proved helpful in determining that other reminder modalities may be of benefit to explore in the future. Keywords: Patient, Remind, Phone, Text, Email, Call, Form, Paperwork.
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Title: Assessment of self-care and education in patients with type 2 diabetes mellitus
Creator: Monroe, Kristen M. (Kristen Mae)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Significance: The annual cost of diagnosed type 2 diabetes mellitus (DM2) in the United States is $327 billion, with individuals with DM2 spending 2.3 times more on health care than individuals without DM2. Education, such as Diabetes Self-Management Education and Support (DSMES) programs, and self-care support, utilizing tools such as the Summary of Diabetes Self-Care Activities (SDSCA) Measure, are the cornerstones of improving care and outcomes for patients with DM2. Purpose...
Show moreBackground and Significance: The annual cost of diagnosed type 2 diabetes mellitus (DM2) in the United States is $327 billion, with individuals with DM2 spending 2.3 times more on health care than individuals without DM2. Education, such as Diabetes Self-Management Education and Support (DSMES) programs, and self-care support, utilizing tools such as the Summary of Diabetes Self-Care Activities (SDSCA) Measure, are the cornerstones of improving care and outcomes for patients with DM2. Purpose: The purpose of this quality improvement project was to implement a standardized self-care assessment and educational intervention for a mid-Michigan internal medicine clinic's adult patient population over 18 years of age with DM2 and hemoglobin A1c (HbA1c) greater than 9% and improve patient self-care. Methods: The Plan, Do, Act, Study (PDSA) Cycle and the Chronic Care Model were used as a framework to guide the project. Eligible participants were identified by clinic staff and received self-care education. Evaluation: The validated SDSCA tool was utilized to assess self-care pre- and post- educational intervention. A two-tailed paired t-test was then performed to compare pre- and post-intervention scores. Outcomes: Of 25 eligible patients in the clinic, 13 patients participated in the initial phase with 3 patients lost to follow-up, leaving 10 patients included in data analysis. A statistically significant improvement was seen in DM2 self-care with mean scores increasing from 4.1 days/week to 4.8 days/week (t = -6.5, p < 0.01). Implications/Conclusion: Identification of specific areas of patient educational needs can improve self-care in patients with DM2 and improve their overall health outcomes.
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Title: Reducing pediatric pain during immunizations
Creator: Bradley, Paul (Paul Michael)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background: Immunizations are often associated with pain and fear in the pediatric population. These negative emotions can have lasting effects on a patient's willingness to receive future medical care, including immunizations. Therefore, it is important to attempt to minimize the amount of pain and fear during all vaccination encounters. Purpose: A small West Michigan rural clinic had no formal process or tools for reducing pediatric pain during vaccinations. After an extensive literature...
Show moreBackground: Immunizations are often associated with pain and fear in the pediatric population. These negative emotions can have lasting effects on a patient's willingness to receive future medical care, including immunizations. Therefore, it is important to attempt to minimize the amount of pain and fear during all vaccination encounters. Purpose: A small West Michigan rural clinic had no formal process or tools for reducing pediatric pain during vaccinations. After an extensive literature review, it was decided to implement Buzzy®, a thermomechanical device, into the clinic's standardized practice for all pediatric immunizations. The goal was to improve the pediatric vaccination experience within the clinic. Methods: Using the PDSA model, two DNP students provided an in-service to the medical assistants on the use of the device. Education was also provided on the data collection tool that included an unvalidated survey assessing the parent/guardian's perception of their child's past and current vaccination experience, as well as the patient's pain level using one of three validated pain scales. Participants between the ages of 0-18 years and their parents/guardians had to be willing to use the Buzzy® device in order to enroll. Data was collected from October 2021 to January 2022. Results: Forty-five participants agreed to participate in this evidence-based practice (EBP) project. Participants' average pain score was mild with the use of Buzzy® at 2.9 out of 10. The average experience with Buzzy® was found to be significantly higher than the previous average vaccination encounter (p=.04). Finally, 95% of participants recommended continued use of Buzzy®. Conclusion: The implementation of Buzzy® during pediatric immunizations improved the immunization experience in a rural West Michigan clinic. These significant results support the continued use of Buzzy® at the clinic.
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Title: Improving perioperative nausea and vomiting prophylaxis protocol compliance
Creator: Franz, Allison
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Postoperative nausea and vomiting (PONV) is a significant concern in anesthesia practice. Evidence-based guidelines have sought to provide recommendations on identifying patients at risk for PONV and mitigating its effect with multimodal antiemetic strategies. An anesthesia department within a large teaching hospital uses the Anesthesiology Performance Improvement and Report Exchange guidelines to identify and manage patients at risk for PONV. These guidelines are intended to integrate best...
Show morePostoperative nausea and vomiting (PONV) is a significant concern in anesthesia practice. Evidence-based guidelines have sought to provide recommendations on identifying patients at risk for PONV and mitigating its effect with multimodal antiemetic strategies. An anesthesia department within a large teaching hospital uses the Anesthesiology Performance Improvement and Report Exchange guidelines to identify and manage patients at risk for PONV. These guidelines are intended to integrate best practices into anesthetic care and improve overall surgical outcomes. The anesthesia department currently has a PONV protocol in place that aligns with the guidelines but has not achieved their compliance benchmark. This evidence-based quality improvement project describes interventions proposed to increase compliance with the PONV protocol. To address poor PONV compliance, an anonymous survey was developed to assess anesthesia provider's current familiarity with the new PONV guidelines and identify misconceptions. A visual feedback system was implemented using a preliminary confidential list that anonymizes staff. This allowed individual providers to identify their own performance in relation to their peers in a non-punitive way. The results of this quality improvement project demonstrate that the proposed interventions increased departmental compliance.
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Title: Development and implementation of an enhanced recovery after surgery protocol for women undergoing a mastectomy
Creator: Braun, Michael
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: This evidenced-based practice initiative includes the development and implementation of an evidence-based enhanced recovery after surgery (ERAS) guideline with a specific focus on the incidence of postoperative nausea and vomiting (PONV) and opioid administration in the postoperative setting. The clinical question was in adult women, age 18 years or greater, undergoing a mastectomy procedure, does the implementation of an ERAS guideline lower the incidence of PONV and reduce morphine...
Show moreThis evidenced-based practice initiative includes the development and implementation of an evidence-based enhanced recovery after surgery (ERAS) guideline with a specific focus on the incidence of postoperative nausea and vomiting (PONV) and opioid administration in the postoperative setting. The clinical question was in adult women, age 18 years or greater, undergoing a mastectomy procedure, does the implementation of an ERAS guideline lower the incidence of PONV and reduce morphine milligram equivalent (MME) requirements in a post-anesthesia care unit (PACU)? Patients undergoing breast cancer surgery have multiple risk factors and the reported incidence of PONV reaches up to 80%. Over half of post-surgical breast cancer patients develop neuropathic pain syndromes. A mastectomy ERAS guideline was developed then applied to the perioperative course of 22 patients. It was found that following an ERAS guideline reduced the incidence of PONV by 17% and reduced the average MME by 13.5 equivalents. Project implications include potential cost savings, reduced PACU length of stay, and improved patient outcomes.
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Title: Increasing point of care testing for glycated hemoglobin A1c levels in a family health clinic
Creator: Wielgos, Elizabeth
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background: Adults with type 2 diabetes mellitus (DM) have and continue to increase significantly within the United States (U.S.). The current recommended glycated hemoglobin A1c (HbA1c) goal for a nonpregnant healthy adult is a value of 7% to lower the risk of DM-related complications (American Diabetes Association [ADA], 2021). Because a goal of 7% may not be feasible in many cases due to other variables, each person with diabetes should have an individualized goal and treatment plan based...
Show moreBackground: Adults with type 2 diabetes mellitus (DM) have and continue to increase significantly within the United States (U.S.). The current recommended glycated hemoglobin A1c (HbA1c) goal for a nonpregnant healthy adult is a value of 7% to lower the risk of DM-related complications (American Diabetes Association [ADA], 2021). Because a goal of 7% may not be feasible in many cases due to other variables, each person with diabetes should have an individualized goal and treatment plan based on their health history and age (ADA, 2021). Compared to a lab draw, which can take hours to days before the provider can see the results, point of care testing (POCT) is more convenient because it produces results in minutes. Purpose: The goal of this quality improvement project was to enhance patient outcomes by introducing an algorithm to ensure that patients with diabetes were effectively managed according to the American Diabetes Association's current recommendations using POCT. Results: The data were subjected to Chi-square and T-tests, but no statistical significance was found. However, analysis of the data revealed many findings consistent with clinical significance. Conclusion: After analysis of the data from this quality improvement (QI) project, findings showed there was a positive correlation between POCT for HbA1c and an increase in values <9%. It was recommended staff continue to apply the algorithm to analyze the long-term outcomes of utilizing POCT for HbA1c in the family medicine clinic.
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Title: Improving advance care planning and advance directive rates in primary care through a multidisciplinary approach
Creator: Johnson, Vanessa N. (Vanessa Nichole-Castillo)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Review of Literature: Lack of advance care planning (ACP) leads to unwanted treatments and suffering for patients, along with increased healthcare costs. Certain vulnerable populations are at increased risk for unnecessary suffering, including those with high emergency department (ED) utilization rates and one-year prognoses. Providing ACP education to providers and utilization of the multidisciplinary team has been shown to increase ACP and advance directive (AD) rates in...
Show moreBackground and Review of Literature: Lack of advance care planning (ACP) leads to unwanted treatments and suffering for patients, along with increased healthcare costs. Certain vulnerable populations are at increased risk for unnecessary suffering, including those with high emergency department (ED) utilization rates and one-year prognoses. Providing ACP education to providers and utilization of the multidisciplinary team has been shown to increase ACP and advance directive (AD) rates in these vulnerable populations within primary care. Purpose: The purpose of this QI project was to increase the percentage of robust ACP conversations and the completion and documentation of ACP/ADs in the electronic medical record (EMR). Methods: The project was implemented at a primary care clinic in a midwestern Michigan community. DNP students attended an informational meeting regarding the organization's EMR-based ACP tool. An educational session regarding robust ACP was held for providers, a decision tree was developed to both guide ACP appointments with a specialist and ensure proper documentation into the EMR, and scripting was created to help guide ACP conversations. Implementation Plan/Procedure: Members of the multidisciplinary team utilized the intervention. Data collection included the percentage of empaneled patients with a durable power of attorney for healthcare (DPOAH) on file, the total number of robust ACP conversations completed, and the number of patients on the population health targeting list were collected. Post-intervention, an online survey was used to assess the provider's attitudes, knowledge, and confidence towards the decision tree. Implications/Conclusion: The intervention produced positive outcomes, which included an increase in completed and documented ACP/AD and provider knowledge regarding ACP.
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Title: Perinatal depression screening program evaluation
Creator: Murphy, Maeghan
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Perinatal mood and anxiety disorders (PMADs) are extremely common and can occur unpredictably during and after pregnancy. If left untreated, PMADs can be detrimental to the long-term health of both mothers and infants. The Edinburgh Postnatal Depression Scale (EPDS) is an effective and well-accepted screening method for identifying PMADs. The findings from a literature review emphasized the clinical importance of screening as well as the value of a quality improvement approach. The objective...
Show morePerinatal mood and anxiety disorders (PMADs) are extremely common and can occur unpredictably during and after pregnancy. If left untreated, PMADs can be detrimental to the long-term health of both mothers and infants. The Edinburgh Postnatal Depression Scale (EPDS) is an effective and well-accepted screening method for identifying PMADs. The findings from a literature review emphasized the clinical importance of screening as well as the value of a quality improvement approach. The objective of this Doctor of Nursing Practice (DNP) project was to analyze the PMAD screening practices at a busy women's health clinic in Metro Detroit by conducting an in-depth chart review. Data gathered from this evaluation was utilized by clinic leadership to better serve patients by addressing current screening deficits within the practice. Specific areas of improvement identified by this evaluation included the need to increase the percentage of EPDS screens completed at the initial obstetric (OB) visit and ensuring behavioral health referrals were being made when patients have a positive screen.
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Title: Essays in International Trade
Creator: Park, Jun-Tae
Date: 2022
Collection: Electronic Theses & Dissertations
Description: In chapter 1, I investigate how resource reallocation can affect the change of trade patterns and welfareeffect of trade. Specifically, trade liberalization can lead to a surge in the trade of intermediate goods. Increased accessibility to the critical intermediate goods through international trade can create an opportunity to initiate the expansion of capital-intensive industries, which can be referred to as specialization dynamics for developing countries. For this to occur, domestic...
Show moreIn chapter 1, I investigate how resource reallocation can affect the change of trade patterns and welfareeffect of trade. Specifically, trade liberalization can lead to a surge in the trade of intermediate goods. Increased accessibility to the critical intermediate goods through international trade can create an opportunity to initiate the expansion of capital-intensive industries, which can be referred to as specialization dynamics for developing countries. For this to occur, domestic resources must be reallocated toward high productivity sectors. In this paper, I capture the reallocation frictions in the labor market with sectoral wage differentials. A general equilibrium analysis explains the relationship between specialization dynamics and resource reallocation. I find that higher distortions in the skilled labor market negatively affect the productivity gain in the capital-intensive sector. This effect lowers overall welfare gains from trade for the countries with higher labor market distortions. In chapter 2, I improve the argument in chapter 1 by extending the model to dynamic structural model. Sluggish labor market response to trade liberalization can reduce the welfare gains from trade by impeding resource reallocation. I estimate sectoral labor switching costs for 30 countries in a dynamic discrete choice problem to derive welfare implications of labor market rigidity through comparative cross-country analysis. On average, workers have to give up approximately 4-years of income to switch to another sector. Compared with labor market flexibility measures, labor switching costs are low when the country has a flexible labor market and vice versa. In addition, I embed the switching cost estimates into a dynamic multi-country, multi-sector Eaton and Kortum model. In a counterfactual trade liberalization simulation with a 20% drop in trade costs, high switching costs lead to a slower response in the labor market, which in turn, negatively affect a country’s ability to achieve welfare gains from trade.
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Title: THE INTERACTION BETWEEN GENETICS AND CLIMATE ON CRANIOFACIAL VARIATION : EXAMINING THE CAUSATIVE FORCES OF MACROMORPHOSCOPIC TRAIT EXPRESSION
Creator: Plemons, Amber
Date: 2022
Collection: Electronic Theses & Dissertations
Description: Anthropologists have an extensive history using cranial form to measure group relatedness in past and present populations to answer a range of questions concerning population histories and cultural practices. However, most biological distance studies using skeletal remains do not consider extrinsic forces influencing modern human variation. Researchers have explored evolutionary and plastic responses in cranial form using measurements of the cranium and mandible, but these studies generally...
Show moreAnthropologists have an extensive history using cranial form to measure group relatedness in past and present populations to answer a range of questions concerning population histories and cultural practices. However, most biological distance studies using skeletal remains do not consider extrinsic forces influencing modern human variation. Researchers have explored evolutionary and plastic responses in cranial form using measurements of the cranium and mandible, but these studies generally drew inferences through population comparisons or using inadequate statistical and biological models that so often lead to conflicting findings or confounding interpretations. To fill this gap in our current understanding of modern human variation, I have combined global craniofacial morphological, climatic, and genetic datasets to measure the magnitude and directionality of several climate variables on craniofacial form, while controlling for population structure (e.g., microevolutionary forces and population history). Craniofacial morphological data from the Macromorphoscopic Databank (MaMD) are used in conjunction with microsatellite data from Pemberton (2013), representing populations that overlap in geographic space with those in the MaMD. Finally, climate data from the National Oceanic and Atmospheric Association (NOAA) and Climate Research Unit (CRU) websites were obtained for weather stations in close proximity to populations under study. This combined dataset is used to explore the interaction between climate and genetics on craniofacial variation across 11 geographic regions using a mixed model approach known as Bayesian Sparse Factor Analysis of Genetic Covariance Matrices (BSFG). Data analysis follows the methods described by Katz and colleagues (2016) but expands their study through the exploration of selection processes using additional climate variables, including coldest month and driest month averages and annual ranges of temperature and absolute humidity. Overall, the study found significant correlation between genetic and phenotypic data indicating MMS traits can serve as genetic proxies in biodistance analyses. Several traits had higher heritability estimates (malar tubercle, zygomaticomaxillary suture course, postbregmatic depression and anterior nasal spine). Features associated with the nasal complex and facial breadth, particularly anterior nasal spine, nasal bone contour, and interorbital breadth, had strong associations to climate. These climate findings correspond to previous research on nasal form and environment where cold-dry environments select for high, narrow noses. Further evidence of selective forces in MMS traits are apparent with the reduction of these features in more variable climates where the respiratory system experiences less stress. The evolutionary mechanisms behind craniometric data have been explored extensively. Such studies use a full suite of traits that capture overall size and shape of the human cranium; however, MMS traits focus on macroscopic assessments primarily in the midfacial skeleton. MMS trait data are particularly important for expanding our understanding of natural selection whereby a large portion of cranial evolutionary research has centered around the neutral evolutionary processes. The wealth of research demonstrating the nasal complex is highly responsive to climate due to respiratory stress emphasizes the importance of exploring the proportion of genetics and environments on MMS trait manifestation. This project provides an evolutionary foundation of the neutral evolutionary and selection processes controlling systematic patterns of global craniofacial variation in the Macromorphoscopic Databank (MaMD).
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Title: THE PROCESS OF LEAVING SEX TRAFFICKING : USING LIFE HISTORY CALENDAR METHODS TO UNDERSTAND THE ROLE OF FORMAL SYSTEMS AND SUPPORT
Creator: Vollinger, Lauren
Date: 2022
Collection: Electronic Theses & Dissertations
Description: Sex trafficking (ST) is a serious and hidden social problem affecting thousands of people in United States. ST is defined as “the recruitment, harboring, transportation, provision, or obtaining of a person for the purposes of a commercial sex act” or when that person “has not attained 18 years of age” (Trafficking Victims Protection Act, 2000). Given the violent, coercive, and economic tactics used to control victims of this crime, it is challenging for individuals to leave their trafficking...
Show moreSex trafficking (ST) is a serious and hidden social problem affecting thousands of people in United States. ST is defined as “the recruitment, harboring, transportation, provision, or obtaining of a person for the purposes of a commercial sex act” or when that person “has not attained 18 years of age” (Trafficking Victims Protection Act, 2000). Given the violent, coercive, and economic tactics used to control victims of this crime, it is challenging for individuals to leave their trafficking situation. Thus, the purpose of this study was to understand how survivors exit from ST and use formal systems or services to facilitate that exit. This study presents findings from qualitative interviews with 34 survivors of domestic ST to understand the process of exiting the sex industry over time. Life History Calendar methodology was used to guide interviews about: 1) how participants conceptualized their experiences in the sex industry over time: 2) what formal systems participants had contact with during their time in the sex industry: and 3) the circumstances surrounding participants’ most recent exit from the sex industry. Results revealed that participants were in and out of ST multiple times over the course of their lives and had contact with many formal systems over time. However, what made the difference in most survivors’ last exit from the sex industry was the collaboration between formal systems to coordinate referrals and service provision. Findings from this study contribute to future research on exiting from sex trafficking and provide recommendations for policy and practice.
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Title: Novel methods for functional data analysis with applications to neuroimaging studies
Creator: Guha Niyogi, Pratim
Date: 2022
Collection: Electronic Theses & Dissertations
Description: In recent years, there has been explosive growth in different neuroimaging studies such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). The data generated from such studies are often complex structured which are collected for different individuals, via various time-points and across various modalities, thus paving the way for interesting problems in statistical methodology for analysis of such data. In this dissertation, some efficient methodologies are...
Show moreIn recent years, there has been explosive growth in different neuroimaging studies such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). The data generated from such studies are often complex structured which are collected for different individuals, via various time-points and across various modalities, thus paving the way for interesting problems in statistical methodology for analysis of such data. In this dissertation, some efficient methodologies are proposed with considerable development which have nice statistical properties and can be useful not only in neuroimaging but also in other scientific domains. A brief overview of the dissertation is provided in Chapter 1 and in particular, different kinds of data structures that are commonly used in consecutive chapters are described. Some useful mathematical results frequently used in the theoretical derivations in various chapters are also provided. Moreover, we raise some fundamental questions that arise due to some specific data structures with applications in neuroimaging and answer these questions in subsequent chapters. In Chapter 2, we consider the problem of estimation of coefficients in constant linear effect models for semi-parametric functional regression with functional response, where each response curve is decomposed into the overall mean function indexed by a covariate function with constant regression parameters and random error process. We provide an alternative semi-parametric solution to estimate the parameters using quadratic inference approach by estimating bases functions non-parametrically. Therefore, the proposed method can be easily implemented without assuming $\sqrt{?}$-convergence rate of the proposed estimator under the proper choice of bandwidth and establish its asymptotic normality. A multi-step estimation procedure to simultaneously estimate the varying-coefficient functions using a local linear generalized method of moments (GMM) based on continuous moment conditions is developed in Chapter 3 under heteroskedasticity of unknown form. To incorporate spatial dependence, the continuous moment conditions are first projected onto eigen-functions and then combined by weighted eigen-values. This approach solves the challenges of using an inverse covariance operator directly. We propose an optimal instrumental variable that minimizes the asymptotic variance function among the class of all local linear GMM estimators, and it is found to outperform the initial estimates that do not incorporate spatial dependence. Neuroimaging data are increasingly being combined with other non-imaging modalities, such as behavioral and genetic data. The data structure of many of these modalities can be expressed as time-varying multidimensional arrays (tensors), collected at different time-points on multiple subjects. In Chapter 4, we consider a new approach to study neural correlates in the presence of tensor-valued brain images and tensor-valued predictors, where both data types are collected over the same set of time-points. We propose a time-varying tensor regression model with an inherent structural composition of responses and covariates. This development is a non-trivial extension of function-on-function concurrent linear models for complex and large structural data where the inherent structures are preserved. Through extensive simulation studies and real data analyses, we demonstrate the opportunities and advantages of the proposed methods.
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Title: Disentangling the branched respiratory chain of Shewanella oneidensis MR-1
Creator: Duhl, Kody Lee
Date: 2022
Collection: Electronic Theses & Dissertations
Description: Bacteria possess a wide range of metabolic pathways, allowing them to adapt to an array of environmental changes. Focusing on these different metabolic pathways allows us to observe how bacteria catabolize substrate or use anabolic pathways to generate biomass. A more in-depth look shows that many of these pathways are redundant, meaning a single organism can conduct the same overall reactions differing only by the types of enzymes or intermediates used. Overlapping pathways are common in...
Show moreBacteria possess a wide range of metabolic pathways, allowing them to adapt to an array of environmental changes. Focusing on these different metabolic pathways allows us to observe how bacteria catabolize substrate or use anabolic pathways to generate biomass. A more in-depth look shows that many of these pathways are redundant, meaning a single organism can conduct the same overall reactions differing only by the types of enzymes or intermediates used. Overlapping pathways are common in bacteria and have become a focal point of metabolism research to determine the advantages of conserving redundant pathways throughout evolution. The metal reducing bacterium Shewanella oneidensis MR-1 is a practical model organism for metabolic studies, as it has substantial branching within its respiratory pathways. In this work, we focused on the extensive electron transport chain (ETC) of S. oneidensis MR-1 to understand the importance of seemingly redundant respiratory complexes and their functions during aerobic growth. The S. oneidensis MR-1 genome encodes four different NADH dehydrogenases (NDHs): a proton-pumping Type I NDH (Nuo), two sodium-pumping NDHs (Nqr1 and Nqr2), and one type II ‘uncoupling NDH (Ndh). NDHs oxidize NADH to move electrons into the ETC and generate ion-motive force that drives ATP synthesis, active transport, and motility. We determined that either Nuo or Nqr1 was required for aerobic growth in minimal medium. The presence of theoretically redundant complexes (Nqr2 and Ndh) did not rescue cell growth. Further, we determined that knocking out NDHs led to the inability to properly oxidize NADH. NADH build up inhibited the tricarboxylic acid cycle causing an amino acid synthesis defect and inhibiting growth of the S. oneidensis strain lacking Nuo and Nqr1. Recently, bacterial metabolic models have been developed to explain the use of energetically inefficient pathways during fast growth. Two standout models postulate that energetically inefficient pathways are used to reduce a cell’s proteome cost by eliminating thermodynamic barriers or to reduce dependence on the ETC as cells grow larger. We sought to uncover if these models applied to the respiratory chain of S. oneidensis MR-1 during aerobic growth, as the ETC can vary in energetic efficiency based on the combination of NDH and terminal oxidase used. Our findings indicate that the models apply to S. oneidensis MR-1 in the context of overflow metabolism during growth at higher growth rates, while the structuring of the ETC was not in agreement. Most importantly, determined that both carbon metabolism and the ETC were restructured for adaptive growth under differing conditions. As carbon metabolism became less efficient at faster growth rates, the NDH step of the ETC became more efficient, using complexes with higher coupling efficiencies.
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Title: ALGAL CULTIVATION AND BIOMASS UTILIZATION FOR SUSTAINABLE CARBON CAPTURE FROM THE POWER INDUSTRY
Creator: Cutshaw, Ashley
Date: 2022
Collection: Electronic Theses & Dissertations
Description: Anthropogenic climate change is a critical issue that must be addressed with a systems approach. Greenhouse gas (GHG) emissions, like carbon dioxide (CO2), are key contributors to the climate crisis and originate from several different sources. Namely, the power industry is responsible for approximately 30% of U.S. CO2 emissions and 45% of global CO2 emissions. These emissions result from the combustion of carbon-based fuels, like coal and natural gas, and are emitted into the atmosphere in...
Show moreAnthropogenic climate change is a critical issue that must be addressed with a systems approach. Greenhouse gas (GHG) emissions, like carbon dioxide (CO2), are key contributors to the climate crisis and originate from several different sources. Namely, the power industry is responsible for approximately 30% of U.S. CO2 emissions and 45% of global CO2 emissions. These emissions result from the combustion of carbon-based fuels, like coal and natural gas, and are emitted into the atmosphere in the form of flue gas. Being a large contributor of CO2 emissions has made the power industry the focus of research efforts to develop post-combustion carbon capture technologies. This work represents a comprehensive examination of microalgal cultivation and biomass utilization as methods for post-combustion carbon capture and replacement of fossil-dependent technologies and products. Optimized pilot-scale cultivation represents a sustainable post-combustion carbon capture technology with downstream economic value. An initial study of a 100 L photobioreactor (PBR) within a 100 MW power plant was conducted to optimize the long-term, continuous cultivation of the green microalgae Chlorella sorokiniana. The culture utilized flue gas as a source of CO2 and successfully operated continuously over a year long period. Insights from this study include the growth kinetics of C. sorokiniana, optimal cultivation conditions of the PBR, and an in-depth analysis of the microbial-microalgal assemblage throughout the study. The biomass produced during the 12-month study was stored and subsequently utilized to develop methods for cell disruption and protein recovery. This work investigated a mechanochemical method, using ball milling technology and chemically induced pH changes, to efficiently extract and recover microalgal proteins. The results of this study indicate that the mechanochemical method requires less energy than existing mechanical methods, while achieving similar levels of cell disruption. In addition to protein extraction and recovery, an alternate pathway for biomass utilization was explored. Microalgal biomass and microalgal proteins contain the foundational building blocks required for synthesis of chemicals like polyols. Polyols, used for polyurethane (PU) foam production, represent another value-added product that could provide the economic incentive to invest in microalgal cultivation for post-combustion carbon capture. Using biomass and recovered proteins as feedstocks, polyols were synthesized using a one-pot, two step method. Two microalgal polyols were selected based on their characterization and were evaluated using life cycle and techno-economic frameworks. The results elucidated the environmental and economic advantages when using microalgal biomass as an alternative to petrochemicals as a feedstock for polyol synthesis. Finally, this work evaluated a combined biological and chemical post-combustion carbon capture system using microalgal cultivation and a novel microalgal amino acid salt solution (MAASS). Life cycle and techno-economic frameworks were used to compare the MAASS to a standard amine-based solvent. The results of these assessments show that the MAASS capture system performs significantly better than an amine capture system, both in terms of environmental impacts and the cost of capture. This comprehensive collection of data and analysis represents advances in the field, as well as innovative methods and technologies that further demonstrate the viability of microalgal cultivation and biomass utilization for carbon capture from the power industry.
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