• Healthcare Utilization Analysis for Housing First Program in Anchorage Alaska

      Becker, Gandy (University of Alaska Anchorage, 2015-05-01)
      Homelessness, especially for the chronically homeless individual with substance abuse issues, often results in high use of emergency services, depression, loss of hope, increased victimization, poor medical care of chronic conditions, and intense suffering for the individual affected. Proponents of the Housing First model believe that housing is a human right, a need, and should be made available to all for basic human dignity. The primary purpose of this study was to answer the question of whether a Housing First model example in Alaska has impacted healthcare utilization for this specific population. Data on hospital visit numbers and hospital costs were collected from both a tenant and a control sample, for the 2011-2013 period, from three area hospitals. Initial findings indicated there was higher outpatient healthcare service use for the tenant sample after obtaining supportive housing. The control sample also showed statistical significance for an increase in emergency services costs, which was not evident for the tenant sample. Future Housing First programs in Alaska may provide improved healthcare for individual tenants by increasing utilization of outpatient services.
    • Healthy Alaskans 2020 Implementation Pilot

      Allen, Laila (University of Alaska Anchorage, 2016-05-01)
      Healthy Alaskans (HA), now in its third iteration (HA2020), is Alaska’s Statewide Health Improvement Plan (SHIP). HA2020 consists of an overarching framework of 25 health goals or Leading Health Indicators (LHIs), for the state to track and achieve by the year 2020. These goals have a broad span and were informed by input from over 3,000 Alaska residents. Building upon the 25 LHIs as well as identifying evidence-based strategies to help achieve these goals brought the initiative to its implementation phase. In order to advance the initiative, four individuals (known as Coordinating Partners or CPs) were chosen to coordinate and pilot action strategies for four of the LHIs: socioeconomic status, suicide, tobacco, and domestic violence. Assessing the CP experience will provide the HA2020 Core Team with feedback from its core partners as it moves forward with implementing strategies to improve all 25 Leading Health Indicators. This practicum consisted of interviews with the CPs about their initial experience, from which themes and recommendations were extracted to assist future outreach and implementation efforts. Consistently occurring themes include the need to explicitly explain the role of the Coordinating Partners and the expectations and timeline for success. CPs expressed lack of clarity and divergent understandings about their role and expectations. Another key component of this practicum project was an extensive environmental scan and an online survey to help identify and document community agencies and individuals actively working to achieve the 25 LHIs. The results were compiled in a searchable spreadsheet with individual tabs for each pilot indicator, and shared with the CPs to facilitate outreach.
    • How to Prolong the Career Life of a Practicing Physician: Assessing the Causes and Extent of Physician Burnout in a Primary Care Setting

      Tsigonis, Jean M. W. (University of Alaska Anchorage, 2016-05-01)
      Physicians report widespread burnout and job dissatisfaction. Institutional and personal changes are necessary for meaningful work and restoration of the joy of the practice of medicine. This practicum project conducted a survey to assess the causes and extent of physician burnout at Tanana Valley Clinic (TVC). The Areas of Worklife Survey-Maslach Burnout Inventory (AWS-MBI) was used to gather data on the causes and extent of physician burnout. Analysis of the AWS-MBI survey data produced by Mind Garden was done by the principal investigator. The Maslach Burnout Inventory (MBI) assesses the extent of physician burnout. The Areas of Worklife Survey (AWS) reveals causes of burnout and enables directed interventions to help decrease the physician burnout. The data indicate that burnout does exist in two of the three areas of burnout assessed: emotional exhaustion and depersonalization. Specific areas in the worklife were identified that cause burnout: workload, control, fairness and value. Suggestion for future direction includes interventions, analysis of those interventions, and an evaluation plan.
    • Idea to Invention Project Report

      Aicher, Dan (University of Alaska Anchorage, 2014-12-17)
      The United States Patent and Trademark Office (USPTO) estimates that 1-3% of patented inventions produce profits for the inventor. The cost of filing and examination for a non-provisional patent can range from $2,000 to $10,000 and beyond. ATC Company understands this uncertainty and will undertake a project to invent a new shelter product and determine its marketability, prior to investing in a non-provisional patent. The Idea to Invention project objective is to apply Project Management principles and develop a process for inventing an idea, measuring the idea’s utility and commercial viability as a product, conducting a patent search and producing a thorough Provisional Patent Application. Specifically, the project will deliver both a product line of ATC’s and a process for establishing first to invent rights to patenting the ATC’s function and method of operation. Unlike most recreational tent products available, ATCs do not require a flat or suitable site for setup; rather, ATCs deliver ultralightweight, highly adaptable weather protection and concealment nearly anywhere in the field.
    • Impacts of Fish Waste Piles in Alaska

      Martich, Tara (University of Alaska Anchorage, 2015-12-01)
      The goal of this practicum project was to complete a meta-analysis and identify the location, size, and impact of fish waste piles on waterbodies in Alaska in one comprehensive report. Data collection for this project included obtaining secondary data from publicly available sources. Alaskan shorebased seafood processing facilities discharge water mixed with fish waste from an outfall(s). Once discharged, buoyant fish waste enters the water column and floats to the surface, while denser fragments sink. Fish waste accumulates on the seafloor and creates fish waste piles. A persistent fish waste pile depletes the oxygen from the water column, smothers benthic invertebrates, alters benthic habitat and creates dead zones, all which lead to changes in the overall ecosystem. As the deposited material breaks down, it produces hydrogen sulfide and ammonia, which may be released into the environment and affect aquatic ecosystem health. Less than fifty percent of the facilities in the data set are in compliance with the requirement to monitor their fish waste piles. At least 115 acres of the Alaska seafloor is covered by fish waste piles and the impacts of these 115 acres are not widely known. The recovery process of benthic communities is typically different than a simple reverse of the pattern observed during its decline. It is unlikely that any benthic community impacted by these fish waste piles will recover to its original state, even if the organic loading ceases.
    • Implementation and Evaluation of a Prescribed Exercise Program Led by a Nurse Practitioner

      Keefer, Leigh Aurora (University of Alaska Anchorage, 2016-12-01)
      Insufficient physical exercise contributes to many disease processes and increases mortality and morbidity rates worldwide. If the world population were to adhere to recommended levels of physical activity, health outcomes would improve. To that end, clinical practices need to consider exercise interventions to improve patient self-efficacy to adhere to recommended physical activity guidelines. A family nurse practitioner led such an intervention in a primary care clinic in Anchorage, Alaska. It evaluated a prescriptive-exercise program using the Exercise is Medicine® (EIM) guidelines of the American College of Sports Medicine. This pilot targeted healthy adults between 18 and 64 years old who were not exercising at least 150 minutes per week. From 20 applicants, eight participants qualified and entered into a 12-week prescribed exercise program. Seven completed the intervention and the subsequent post self-efficacy survey and measurement collection. Measured outcomes were self-efficacy, blood pressure, body mass index and participant’s commitment to follow through with continued exercise. Significant findings from this exercise intervention included (1) increased self-efficacy from “sense of accomplishment”, (2) reduced systolic and diastolic blood pressure and (3) indications that participants would continue physical activity level per recommended guidelines. It is conclusive that implementation of a prescription-exercise guideline in clinical practice can improve the population’s self-efficacy to adhere to the recommended levels of physical activity, and lower blood pressure. Meeting adequate physical activity levels mitigates disease development, improves health outcomes and reduces health care system costs.
    • Implementation of Nudges at a Food Pantry in Anchorage, Alaska

      Holland, Kiana (University of Alaska Anchorage, 2020-12-01)
      Food pantry clients experience many health disparities, including elevated incidence of diabetes, heart disease, and other nutrition-related conditions. Nutrition education interventions in the form of a nudge can be an effective method to increase nutrition knowledge and to positively influence nutrition-related behaviors and attitudes surrounding healthful eating. Attitudes refer to the emotions, or beliefs towards something, whereas behaviors are the actions taken. The goal of this project was to develop a nutrition intervention in the form of a nudge to increase the selection of nutritious foods by pantry clients. Objectives included creating a guidebook for the pantry to utilize when implementing the nutrition education materials that were developed in this project. The nutrition education materials include nudges, extended nudges, client handouts, and recipe cards. This intervention will be implemented at the St. Francis House Food Pantry, which is a part of Catholic Social Services in Anchorage, Alaska. This food pantry serves a broad demographic of clients on a monthly basis, in a client-choice distribution model. The intervention includes nudges, extended nudges, client handouts, recipe cards, and a guide binder. These will be reusable so the pantry can utilize the materials repeatedly in the future. There is limited existing research on implementing nudges in the food pantry setting. Therefore, in order to determine the efficacy of implementing a nudge intervention in Anchorage, Alaska food pantries further research is needed.
    • Implementation of Shared Medical Appointments to Address Cardiovascular Disease Risk in Patients With Metabolic Syndrome

      Rife, Jill (University of Alaska Anchorage, 2016-12-01)
      Metabolic syndrome is a condition in which the components – central adiposity, insulin resistance, atherogenic dyslipidemia, and elevated blood pressure - confer increased cardiovascular morbidity and mortality. A pilot clinical practice improvement project was developed and implemented using shared medical appointments to address cardiovascular disease risk in adult patients at a rural health care clinic on the southern Kenai Peninsula, Alaska who met the diagnostic criteria for metabolic syndrome. Statistically significant improvement in self-reported minutes of exercise was demonstrated for the nominal group of participants. Participants were at least as satisfied or more satisfied with shared medical appointments compared to traditional medical appointments. Limitations aside, the Doctor of Nursing Practice (DNP) project demonstrated the feasibility of using shared medical appointments to address cardiovascular disease risk in this patient population. There is need for additional research into the “physiology,” or curricular and other structural and procedural elements of shared medical appointments for patients with metabolic syndrome that would afford decreased cardiovascular disease risk. The Doctor of Nursing Practice (DNP) project goals were in accordance with the overarching aims of the National Quality Strategy that build on the Institute for Healthcare Improvement’s Triple Aim – cost-effective, patient-centered, quality care that improves health.
    • Improving Emergency Airway Care at a Critical Access Hospital

      Mitchell, Kelly (University of Alaska Anchorage, 2020-12-01)
      Emergency airway care is of the highest priority in caring for patients arriving at the emergency department with critical injuries and conditions. Intubation via laryngoscopy is the gold standard for placing an endotracheal tube to manage ventilation. In rural areas, emergency airway care is often the responsibility of non-expert providers who rarely have the opportunity to perform this life-saving procedure. These less experienced providers often take a longer time and make more attempts at endotracheal intubation. Multiple attempts and increased time taken to secure an airway are associated with higher morbidity and mortality. A critical review of the literature supports that video laryngoscopy increases first pass endotracheal intubation success. Video laryngoscopy is associated with faster intubation times and an improved view of glottic structures. This evidence-based quality improvement project implemented training and simulation in the use of video laryngoscopy for non-expert providers. After implementation of this quality improvement project, findings demonstrated an improved confidence with use of video laryngoscopy, increased confidence that video laryngoscopy is associated with improved visualization of glottic area and increased confidence associated with first pass of the endotracheal tube in non-expert providers using laryngoscopy to perform endotracheal intubation.
    • Improving Teledermatology Utilization in an Alaskan Health Care System

      Rowen, Mary Anne (University of Alaska Anchorage, 2019-05-01)
      The consistent demand for dermatology services, within an Alaskan health care network, warrants an organized, collaborative approach to acquiring a higher capacity of teledermatology consultations. The lack of uniformity among providers for using telemedicine technology in dermatology can hinder cost-saving care. Understanding the obstacles and utilization practices surrounding teledermatology adoption is a crucial objective for a project conducted in an integrated health care system. Devising a protocol with supporting education may reinforce expectations for primary care providers and community health aides and practitioners to be consistent with the utilization of dermatology consultations. A Teledermatology Utilization Project was conducted in an Alaska urban facility to affect change throughout an integrated system. Results indicated a significant increase in teledermatology cases since implementing a protocol and supportive education.
    • Increasing Food Safety Compliance With Online Resources

      Novak, Amber Cristina (University of Alaska Anchorage, 2016-05-01)
      Food-borne illness is a top concern for public policy and public health in the U.S., causing nearly 48 million incidents yearly. The number of confirmed food-borne illness outbreaks has declined over recent years as regulation and control measures of the Food and Drug Administration have increased. However, despite increased regulations and decreased outbreaks, there are still a large number of food safety violations, and it is imperative that food service employers continue to encourage good food safety practices. Mandated training has produced varying results on the improved inspection scores of restaurant establishments, but understanding the barriers to food safety and employing food safety intervention measures has had positive results on improving the employees’ food safety compliance behaviors. There is an opportunity to explore new interventions and mediums to increase safe food handling behaviors. This project describes the development of a food safety resource, FoodSafetyKmowledge.org. The site exists as a singular location for managers to find all of the necessary safety and sanitation resources in one accessible and convenient place. The discussion and analysis includes feedback from other food service professionals, and I offer recommendations to improve the site for future use.
    • The Influence of Water Volume and Temperature on Hand Washing Time and Thoroughness: A Study on Factors Relevant to the Design of a Rainwater Catchment System for Rural Alaska

      Viator, Melissa (University of Alaska Anchorage, 2015-12-01)
      There are positive associations between respiratory and skin infections and the lack of in home piped water in rural Alaska, and such water-washed diseases are often attributable to insufficient water quantities for basic hygiene activities (e.g., hand washing, bathing, laundry services). Optimizing water sources could increase domestic household water availability, thus improving hygiene practices and reducing the risk of infection. Because household technologies designed to increase water availability can be extremely expensive to build, operate, and maintain in rural Alaska, it is important to understand minimum requirements for healthy water use practices (e.g., minimum heating and volume requirements). Thus, the study herein provides an assessment of the impact that washbasin water temperature and volume have on hand washing duration and thoroughness. In a controlled study of volunteer hand washers, it was found that while water temperature had no significant effect on hand washing time or thoroughness, water volume did have a positive association with both hand washing measures. The data suggest that attention and resources be focused on providing increased water quantities in the home, as opposed to heating water used for hand washing.
    • Integrated Application of Petrophysical and Geophysical Inversion Techniques for Reservoir Quality Prediction in the Cretaceous Nanushuk Formation, North Slope, Alaska

      Foreman, Jennafer L. (University of Alaska Anchorage, 2021-05-01)
      Recent Brookian discoveries on Alaska’s North Slope has re-focused petroleum exploration, redirecting industry interest towards pursuing younger, shallower, often stratigraphically trapped reservoirs of the Nanushuk and Torok formations. In order to effectively and continuously characterize the reservoir properties of these prospective reservoir formations, an advanced, integrated petrophysical and seismic interpretation workflow is needed. By infusing the post-stack model-based inversion workflow with the results of a detailed petrophysical, the resultant inverted acoustic impedance cube reveals quantifiable reservoir property information based on optimized log-measured data inputs at every trace location across the entire 3D seismic volume. This integrated workflow was applied to the Nanuq South 3D seismic volume to detect quantifiable variations in Brookian reservoir quality across the study area. The low frequency background model used to guide the inversion process was generated based on log-measured data from the Itkillik River Unit 1 well. Drilled in 1978, this well contains data of a quality consistent with the logging technology available at the time and is representative of the type of data available across much of Alaska’s exploratory basins. The integrated inversion workflow generated an inverted impedance volume that successfully detected the Narwhal Sand, a Nanushuk equivalent reservoir penetrated by the Putu 2 and Putu 2A wells, despite failing the majority of the blind well tests. By selecting a well with legacy or vintage data to train the background model, this project demonstrated that seismic inversion can yield meaningful results regardless of the vintage of well data chosen to train the background model.
    • Integrating Soft Skills With Technology in Online Postsecondary Career and Technical Education

      Canavan, Debra A. (University of Alaska Anchorage, 2015-05-01)
      International and U.S. economic need for postsecondary training and degree attainment has fueled the demand for online courses and programs to meet the requirements of busy adults. Rapidly changing businesses and technologies necessitate that workers continually update skills and industry credentials. Employers want to hire workers who possess both technical skills and soft skills—people skills, attitudes, and values—and who can adapt to a culturally diverse, collaborative team workplace. Higher education institutions must support faculty efforts to provide effective, quality programs and courses that prepare students for this work environment. Career and Technical Education (CTE) faculty are generally hired for their industry and workforce expertise and may need assistance transitioning to eLearning strategies. Thus, a condensed manual was created as a resource to assist new online postsecondary CTE instructors with identifying and selecting the most appropriate technology and tools for incorporating soft skills development into online courses.
    • Integrating Technology to Support and Maintain Glycemic Control in People With Diabetes

      Randall, Adam (University of Alaska Anchorage, 2016-08-01)
      Type II diabetes is a chronic disease state that leads to increased morbidity and mortality and impacts the lives of millions of Americans. This quality improvement project explored the use of a free smartphone application, Glucose Buddy, in aiding people with Type II diabetes to achieve and maintain glycemic control. The project was conducted through the involvement of patients at the Creekside Family Health Clinic in Ketchikan, Alaska over a three month time period. Pre-intervention hemoglobin A1c (HA1c) was compared with post-intervention HA1c. The project, due to the small sample size and high withdraw rate, was not statistically significant. However, there was clinical significance as it showed a decrease in HA1c levels in 60% of the participants.
    • The Integration of Career and Technical Education (CTE) and Academic Curricula: An Effective Model for Teachers

      Gullett, Michael S. (University of Alaska Anchorage, 2015-12-01)
      The Carl D. Perkins Vocational and Career and Technical Education (CTE) Acts from 1990, 1998, and 2006 include federal directives for CTE programs and curriculum to be integrated with academic content. Each reauthorization and review of the Carl D. Perkins Act has provided a more inclusive and expanded definition of integration, with the intention that learning become relevant, rigorous, and effective in preparing students for a career and/or college. My CTE project examines the literature on integration, discusses its important role in CTE, outlines implications to education, and creates an integrated CTE curriculum guidebook and website for teachers. The objective of this project is that teachers will use the guidebook and accompanying website as instructional tools in their implementation efforts. The intended benefits include increasing teachers’ instructional abilities, enhancing student learning, and supporting ongoing integration efforts.
    • Integration of HeartSmart Kids into Clinical Practice: A Quality Improvement Project

      Lang, Sara (University of Alaska Anchorage, 2016-04-01)
      In 2009, the Centers for Medicare & Medicaid (CMS), established “Meaningful Use” regulations through an incentive program, as part of the American Recovery and Reinvestment Act of 2009 (Gance-Cleveland, Gilbert, Gilbert, Dandreaux, & Russell, 2014). Meaningful Use (MU) is tied to reimbursement and focuses on how the Electronic Health Record (EHR) is being used (Center for Disease Control and Prevention, 2012). The goal of MU is to transform the use of the EHR from a documentation tool, to a data reservoir which allows for meaningful reviews and interpretations of the quality of care (Gance-Cleveland et al, 2014).
    • Internal Audit of Juland Incorporated's ISO 9001 Management System

      Giedt, Susan H. (University of Alaska Anchorage, 2016-05-01)
      ISO 9001 is an internationally recognized quality management standard. The central component of this standard is a robust quality management system that provides a solid framework for organizations to create and maintain quality management within their processes and procedures. Many organizations elect to have their quality management system certified by an independent certification body. Certification has become an important discriminator to organizations when selecting potential suppliers. Existing research of the ISO 9001 quality management system suggests a relationship between the presence of a certified quality management system and improved operations, business practices, cost savings, and customer service. Juland Incorporated, an Alaskan based arctic logistics company, operates with an ISO 9001 based quality management system and this report examines the internal audit process, focusing on potential contributions to the Project Management Body of Knowledge. The report also includes a case study examining the business impact of Juland Incorporated’s decision to not pursue certification of the company’s quality management system.
    • Internet addiction: implications and assessment education for providers

      See, Marie Nicole (University of Alaska Anchorage, 2017-12-01)
      The proliferation of internet accessibility and electronic devices has allowed problematic internet use or internet addiction (IA) to explode worldwide in the past two decades. Popular Applications such as gaming, pornography, gambling, and social media are wildly popular internet pastimes with resulting high abuse potential. Social, occupational, fiscal, and interpersonal problems have been reported, as have high levels of co-morbid mental illnesses. In 2013, the American Psychiatric Association (APA) added Gambling Disorder to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the first behavioral addiction recognized by the APA. In light of the mounting evidence supporting IA as a serious threat to mental health, an IA educational webinar was developed for providers (nurse practitioners and physicians) to increase knowledge and screening for IA in the clinical setting.
    • Keep it Local: Resources for Farmers' Market Vendors

      Wedin, Alisa (University of Alaska Anchorage, 2015-03-31)
      Farmers’ markets are growing in Anchorage, Alaska and across the nation. Many of these markets sell more than produce and include non-produce farm goods, baked goods, cooked foods, craft items, and other products. Farmers’ markets provide a low-cost and low-risk opportunity for people to start their businesses. One way to support these new businesses is to provide these microentrepreneurs with the information and skills they need to succeed. This project describes the process undertaken to develop the Keep it Local program, a series of resources designed to provide information and teach participants the skills necessary to be successful at a farmers’ market. I developed a website to provide information related to general business and specific topic related to different types of vendors including farmers, food vendors, and craft vendors. Several classes were offered, including Business Basics, Growing for Market, Booth Basics, and Tips and Tricks: Expert Advice. Participant feedback from the workshops was positive. I offer recommendations to improve upon and expand the current program to support farmers’ markets throughout the state.