Programs and Communities

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

Phoenix is the sixth most populated city in the United States and the 12th largest metropolitan area by population, with about 4.4 million people. As the region continues to grow, the demand for housing and jobs within the metropolitan area is projected to rise under uncertain climate conditions.

Undergraduate and graduate students from Engineering, Sustainability, and Urban Planning in ASU’s Urban Infrastructure Anatomy and Sustainable Development course evaluated the water, energy, and infrastructure changes that result from smart growth in Phoenix, Arizona. The Maricopa Association of Government's Sustainable Transportation and Land Use Integration Study identified a market for 485,000 residential dwelling units in the urban core. Household water and energy use changes, changes in infrastructure needs, and financial and economic savings are assessed along with associated energy use and greenhouse gas emissions.

The course project has produced data on sustainable development in Phoenix and the findings will be made available through ASU’s Urban Sustainability Lab.

RESEARCH QUESTION: Does Online "Working Out Work" as a Treatment and Prevention for Depression in Older Adults? An Analysis of a Prescribed and Monitored Exercise Program Administered via the Internet for Senior Adults with Depression.
OBJECTIVE: The purpose of this study is to investigate and access the effectiveness of an online prescribed and monitored exercise program for the treatment of depression in Older Adults. The Dependent Variable for the study is Depression. The Independent Variable for the study is the Effects of Exercise administered via the Internet and the population is geriatric adults defined as senior adults aged 50 and older. Depression is defined by Princeton University Scholars (Wordnet, 2006) as a mental state characterized by a pessimistic sense of inadequacy and a despondent lack of activity.
METHODS: The presence and severity of depression will be assessed by using The Merck Manual of Geriatrics (GDS-15) Geriatric Depression Scale. Assessments will be performed at baseline, before and after the treatment is concluded. The subjects will complete the Physical Activity Readiness Questionnaire (PAR-Q) prior to participating in an exercise program three times per week.
LIMITATIONS OF RESEARCH: The limitations of this study are: 1) There is a small sample size limited to Senior Adults aged 50 - 80, and 2) there is no control group with structured activity or placebo, therefore researcher is unable to evaluate if the marked improvement was due to a non-specific therapeutic effect associated with taking part in a social activity (group online exercise program). Further research could compare and analyze the positive effects of a muscular strength training exercise program verses a cardiovascular training exercise program.

Hybrid system models - those devised from two or more disparate sub-system models - provide a number of benefits in terms of conceptualization, development, and assessment of dynamical systems. The decomposition approach helps to formulate complex interactions that are otherwise difficult or impractical to express. However, hybrid model development and usage can introduce complexity that emerges from the composition itself.

To improve assurance of model correctness, sub-systems using disparate modeling formalisms must be integrated above and beyond just the data and control level; their composition must have model specification and simulation execution aspects as well. Poly-formalism composition is one approach to composing models in this manner.

This dissertation describes a poly-formalism composition between a Discrete EVent System specification (DEVS) model and a Cellular Automata (CA) model types. These model specifications have been chosen for their broad applicability in important and emerging domains. An agent-environment domain exemplifies the composition approach. The inherent spatial relations within a CA make it well-suited for environmental representations. Similarly, the component-based nature of agents fits well within the hierarchical component structure of DEVS.

This composition employs the use of a third model, called an interaction model, that includes methods for integrating the two model types at a formalism level, at a systems architecture level, and at a model execution level. A prototype framework using DEVS for the agent model and GRASS for the environment has been developed and is described. Furthermore, this dissertation explains how the concepts of this composition approach are being applied to a real-world research project.

This dissertation expands the tool set modelers in computer science and other disciplines have in order to build hybrid system models, and provides an interaction model for an on-going research project. The concepts and models presented in this dissertation demonstrate the feasibility of composition between discrete-event agents and discrete-time cellular automata. Furthermore, it provides concepts and models that may be applied directly, or used by a modeler to devise compositions for other research efforts.