Programs and Communities

While the COVID-19 pandemic continues to evolve, America’s nursing work force continue to work in the most challenging of circumstances. While expected to hold the fort and continue on, deep inside, they bury an unprecedented level of acute stress, anxiety and depression. Peer support groups have been posed as a possible coping behavior. This cross-sectional designed project was developed to assess the worth and feasibility of a virtual peer support group with a focus on healthcare provider wellness during a period of surge of the COVID-19 pandemic. Overwhelmed staff, technology/documentation changes and challenges, competing clinical demands, short-staffing and Zoom fatigue were identified as the limiting factors for this project’s completion within its given timeframe. These findings informed of current barriers, providing a basis for future program development to mitigate the impact of psychological distress among healthcare providers. Evolving literature on this topic supports recommendations for further study and action by individual health care providers, organizations and at the state and national levels.

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.

A short and thickened lingual frenulum characterizes tongue-ties. Infants with this condition are likely to have issues with their latch, weight gain, and the ability to breastfeed exclusively. Mothers typically struggle with nipple pain and trauma. Tongue-tie procedures have become increasingly more popular as families turn to this intervention when struggling with breastfeeding.

The purpose of this quality improvement project is to collect data on tongue-tie revision procedures to explore the benefits, risks, and patient satisfaction with the clinical process. Questionnaires were created to collect information on tongue-tie revisions. Participants were asked to identify symptoms related both to the mother and infant. The type of feeding was assessed before and after to identify if the tongue-tie revisions increased exclusive breastfeeding. Likert-type scales were used to address maternal nipple pain, overall improvements in breastfeeding, and patient experience.

A total of 36 participants completed the pre-op questionnaire, and 22 completed the post-op questionnaires over four months. The results found that this was a low-risk procedure that helped improve breastfeeding or maternal and infant symptoms. There should be continued efforts to find ways to continue to collect this data, as it will increase the awareness of tongue-tie’s effect on breastfeeding.