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Introduction: There is currently a lack of industry-wide gold standardization in accelerometer study
protocols, including within sleep-focused studies. This study seeks to address accuracy of
accelerometer data in detection of the beginnings and ends of sleep bouts in young adults with
polysomnography (PSG) corroboration. An existing algorithm used to differentiate valid/invalid wear
time and detect bouts of sleep has been modified with the goal of maximizing accuracy of sleep bout
detection. Methods: Three key decisions and thresholds of the algorithm have been modified with three
experimental values each being tested. The main experimental variable Sleepwindow controls the
amount of time before and after a determined bout of sleep that is searched for additional sedentary
time to incorporate and consider part of the same sleep bout. Results were compared to PSG and sleep
diary data for absolute agreement of sleep bout start time (START), end time (END) and time in bed
(TIB). Adjustments were made for outliers as well as sleep latency, snooze time, and the sum of both.
Results: Only adjustments made to a sleep window variable yielded altered results. Between a 5-, 15-,
and 30-minute window, a 15-minute window incurred the least error and most agreement to
comparisons for START, while a 5-minute window was best for END and TIB. Discussion: Contrary
to expectation, corrections for snooze, latency, and both did not substantially improve agreement to
PSG. Algorithm-derived estimates of START and END always fell after sleep diary and PSG both,
suggesting either participants’ sedentary behavior beginning and ends were at a delay from sleep and
wake times, or the algorithm estimates consistently later times than appropriate. The inclusion of a
sleep window variable yields substantial variety in results. A 15-minute window appears best at
determining START while a 5-minute window appears best for END and TIB. Further investigation on
the optimal window length per demographic and condition is required.
protocols, including within sleep-focused studies. This study seeks to address accuracy of
accelerometer data in detection of the beginnings and ends of sleep bouts in young adults with
polysomnography (PSG) corroboration. An existing algorithm used to differentiate valid/invalid wear
time and detect bouts of sleep has been modified with the goal of maximizing accuracy of sleep bout
detection. Methods: Three key decisions and thresholds of the algorithm have been modified with three
experimental values each being tested. The main experimental variable Sleepwindow controls the
amount of time before and after a determined bout of sleep that is searched for additional sedentary
time to incorporate and consider part of the same sleep bout. Results were compared to PSG and sleep
diary data for absolute agreement of sleep bout start time (START), end time (END) and time in bed
(TIB). Adjustments were made for outliers as well as sleep latency, snooze time, and the sum of both.
Results: Only adjustments made to a sleep window variable yielded altered results. Between a 5-, 15-,
and 30-minute window, a 15-minute window incurred the least error and most agreement to
comparisons for START, while a 5-minute window was best for END and TIB. Discussion: Contrary
to expectation, corrections for snooze, latency, and both did not substantially improve agreement to
PSG. Algorithm-derived estimates of START and END always fell after sleep diary and PSG both,
suggesting either participants’ sedentary behavior beginning and ends were at a delay from sleep and
wake times, or the algorithm estimates consistently later times than appropriate. The inclusion of a
sleep window variable yields substantial variety in results. A 15-minute window appears best at
determining START while a 5-minute window appears best for END and TIB. Further investigation on
the optimal window length per demographic and condition is required.
ContributorsMartin, Logan Rhett (Author) / Buman, Matthew (Thesis director) / Toledo, Meynard John (Committee member) / Kurka, Jonathan (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-12
Description
In Western medicine, the hard sciences have generally been understood as the sole guiding force in patient care and treatment. However, both history and the present day suggest another strong influence on Western medicine: folklore. The term folklore can easily be dismissed as a term representing beliefs and stories of the past, but its relevance transcends time and continues to impact people daily. It “involves values, traditions, ways of thinking and behaving. It’s about art. It’s about people and the way people learn. It helps us learn who we are and how to make meaning in the world around us” (Sims & Stephens, 2011, pp. 1-2). With its wide range of influence, folklore exists as the umbrella term encompassing several categories. Folk beliefs are one of these categories and can develop from “observation, memory, testimony or inference” (Hutton, 1942, p. 83). Given that each of these forms are subject to some sort of error, folk beliefs become “a jumble of the true and the erroneous” (p. 84). Similarly, contemporary legends are narratives that often combine the physical and supernatural world to explain nuances or uncertainty present in the relevant experiences of a people. Folk beliefs can result in the formation of contemporary legends and they can also stem from contemporary legends. These two categories are often associated with subjects that promote fear and uncertainty, and thus play an essential role in navigating folklore’s application to biomedicine. This paper explores the historical and modern effects that folklore has had on two separate maladies: Hansen’s Disease (leprosy) and Major Depressive Disorder (depression). While these conditions do not resemble each other in physical presentations, Hansen’s Disease and Major Depressive Disorder patients both have faced and continue to face discrimination. Andrea Wiley and John Allen’s three-part definition of a malady: society’s perception (sickness), the individual’s experience (illness), and medical professionals’ diagnosis and treatment (disease); was utilized as a tool for analyzing the application of folklore to modern medicine. The way that a society views a particular malady often dictates the sick role expected of a diagnosed individual. Additionally, the public’s view can directly affect medical professionals’ understanding of a malady. This then can drastically shape a patient’s diagnosis, treatment, and prognosis. This anthropological analysis acts as an interdisciplinary bridge between medicine and the humanities.
ContributorsPeake, Ashley E (Co-author) / Peake, Ashley (Co-author) / Ellis, Lawrence (Thesis director) / Hoyt, Heather (Committee member) / Hruschka, Daniel (Committee member) / School of Molecular Sciences (Contributor) / Department of English (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
This thesis paper examines the effects of increased standing and light physical activity in the workplace on postprandial glucose. Sedentary behavior is detrimental to our health, affecting metabolic risk factors. An easy way to implement change is by decreasing sedentary time in workplaces where sitting is common, such as office workspaces. To consider how postprandial glucose is affected by decreasing sedentary time, participants ate a standardized meal for lunch and were asked to decrease their sitting time by replacing it with standing and light physical activity.
ContributorsChilders, Autumn Skye (Author) / Buman, Matthew (Thesis director) / Sears, Dorothy (Committee member) / Hasanaj, Kristina (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2020-12
Description
The purpose of this study was to examine the overall maintenance of behavior during the 12 to 24 month period of the Stand&Move@Work study and the impact of implementation factors (i.e., facilitators, advocate activity, and the amount of strategies used) on behavior change. The design of the study was a cluster randomized trial which was facilitated by researchers for the first 12 months of the study. The primary aim of the study was to examine the maintenance of behavior change (i.e., sitting time) at the 12 month and 24 month marks using objectively measured sedentary behavior (activPAL micro). The secondary aim of the study was to examine the impact of implementation factors (i.e., facilitators, advocate activity, and the amount of strategies used) on behavior change during the 12 through 24 months maintenance period. Participants (N=630) included full-time, caucasian, middle-aged office workers. For the primary aim, descriptive means were used to cluster for observations within-persons and were adjusted for age, gender, race, job-type, and ordering effects.. For the secondary aim, descriptive means adjusted for workplace culture and environment were computed. At the 24 month mark, participants spent 280.67 ± 87.67 min/8hr workday sitting and 161.94 ± 85.87 min/8hr workday standing. The top performing worksites displayed reductions in sitting time which largely translated into standing time by about 30 minutes per 8 hour workday at 24 months. Feasibility findings indicated that implementation strategies do not show differences between the top 25% and bottom 25% performing worksites. This study provides insight to implementation strategies for interventions in the workplace.
ContributorsTong, Alyssa Taylor (Author) / Buman, Matthew (Thesis director) / Larouche, Miranda (Committee member) / Estabrooks, Paul (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Menstruation - a stigmatized topic and a social taboo- has led to a lack of menstrual hygiene awareness and improper practices impacting women’s health adversely over generations in India. Akshara aims to increase menstrual hygiene education and reduce stigma in India. A creative children’s illustrated book, and interactive workshop curriculum about menstruation were designed and published in Hindi and English. Menstrual hygiene workshops, utilizing the designed tools, were conducted in Delhi and Ghaziabad, India to over 230 students through NGO partnerships in December 2018. The response to the menstrual hygiene and stigma workshops was overwhelmingly positive, and a significant increase in the knowledge and awareness survey scores was observed after the curriculum teachings and classroom discussions. This evaluation highlights and provides a potential solution path to eradicate the root cause of the menstruation stigma in underprivileged women through education and open conversations on the topic starting at a pivotal young age. The main aim of the workshop was to help eradicate the stigma associated with menstruation and menstrual health in India through education.
ContributorsBhalla, Jahnavi (Co-author) / Dani, Advika (Co-author) / Schuster, Roseanne (Thesis director) / Hruschka, Daniel (Thesis director) / School of Molecular Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
More than 40% of all U.S. opioid overdose deaths in 2016 involved a prescription opioid, with more than 46 people dying every day from overdoses involving prescription opioids, (CDC, 2017). Over the years, lawmakers have implemented policies and laws to address the opioid epidemic, and many of these vary from state to state. This study will lay out the basic guidelines of common pieces of legislation. It also examines relationships between 6 state-specific prescribing or preventative laws and associated changes in opioid-related deaths using a longitudinal cross-state study design (2007-2015). Specifically, it uses a linear regression to examine changes in state-specific rates of opioid-related deaths after implementation of specific policies, and whether states implementing these policies saw smaller increases than states without these policies. Initial key findings of this study show that three policies have a statistically significant association with opioid related overdose deaths are—Good Samaritan Laws, Standing Order Laws, and Naloxone Liability Laws. Paradoxically, all three policies correlated with an increase in opioid overdose deaths between 2007 and 2016. However, after correcting for the potential spurious relationship between state-specific timing of policy implementation and death rates, two policies have a statistically significant association (alpha <0.05) with opioid overdose death rates. First, the Naloxone Liability Laws were significantly associated with changes in opioid-related deaths and was correlated with a 0.33 log increase in opioid overdose death rates, or a 29% increase. This equates to about 1.39 more deaths per year per 100,000 people. Second, the legislation that allows for 3rd Party Naloxone prescriptions correlated with a 0.33 log decrease in opioid overdose death rates, or a 29% decrease. This equates to 1.39 fewer deaths per year per 100,000 people.
ContributorsDavis, Joshua Alan (Author) / Hruschka, Daniel (Thesis director) / Gaughan, Monica (Committee member) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Cardiovascular disease attributed to about 800,000 deaths per year and is the leading cause of all-cause mortality in the U.S. Previous studies indicate that reducing sedentary time or increasing physical activity (PA) can independently reduce cardiometabolic risk (CMR). Further, studies have shown that higher levels of moderate-to-vigorous PA can attenuate the negative effects of sedentary behavior on CMR.
In this study, we evaluated the association between sedentary time, light-intensity PA (LPA), and moderate-vigorous PA (MVPA) and CMR biomarkers (high density lipoprotein level, low density lipoprotein level, triglycerides, fasting glucose, total cholesterol, blood pressure, and body mass index). Additionally, we examined if the detrimental association between sedentary time and CMR biomarkers is partially or fully attenuated by MVPA. Baseline objective physical activity and cardiometabolic risk data from a two-arm-cluster randomized trial (Stand&Move@work) were used in this study. Multilevel models clustered by worksite evaluated the fixed effects and interaction between MVPA and sedentary time on CMR. Data from 630 sedentary working adults (from 24 worksites) were included in the analysis. The sample was mainly middle aged (44.6±11.2) females (74%) with race distributions as follows; 70.5% white, 13.8% hispanic, 4.1% black, 5.1% asian, and 2.1% other. Our study showed detrimental trends consistent with previous studies between sedentary behavior and cardiometabolic outcomes including HDL, LDL, and total cholesterol. MVPA demonstrated beneficial associations with lipoproteins including HDL, LDL, total cholesterol, and triglycerides. We observed that high levels of MVPA may be able to partially attenuate the negative effects of highly sedentary behavior on fasting glucose, total cholesterol, and LDL levels. Overall, sedentary behavior indicated deleterious associations with cardiometabolic outcomes. Future directions for this study could examine a more at-risk population or a highly active population for further assessment of CMR biomarkers and the effects of behavior.
In this study, we evaluated the association between sedentary time, light-intensity PA (LPA), and moderate-vigorous PA (MVPA) and CMR biomarkers (high density lipoprotein level, low density lipoprotein level, triglycerides, fasting glucose, total cholesterol, blood pressure, and body mass index). Additionally, we examined if the detrimental association between sedentary time and CMR biomarkers is partially or fully attenuated by MVPA. Baseline objective physical activity and cardiometabolic risk data from a two-arm-cluster randomized trial (Stand&Move@work) were used in this study. Multilevel models clustered by worksite evaluated the fixed effects and interaction between MVPA and sedentary time on CMR. Data from 630 sedentary working adults (from 24 worksites) were included in the analysis. The sample was mainly middle aged (44.6±11.2) females (74%) with race distributions as follows; 70.5% white, 13.8% hispanic, 4.1% black, 5.1% asian, and 2.1% other. Our study showed detrimental trends consistent with previous studies between sedentary behavior and cardiometabolic outcomes including HDL, LDL, and total cholesterol. MVPA demonstrated beneficial associations with lipoproteins including HDL, LDL, total cholesterol, and triglycerides. We observed that high levels of MVPA may be able to partially attenuate the negative effects of highly sedentary behavior on fasting glucose, total cholesterol, and LDL levels. Overall, sedentary behavior indicated deleterious associations with cardiometabolic outcomes. Future directions for this study could examine a more at-risk population or a highly active population for further assessment of CMR biomarkers and the effects of behavior.
ContributorsMeyer, Emily Camille (Author) / Buman, Matthew (Thesis director) / Toledo, Meynard (Committee member) / Pereira, Mark (Committee member) / School of Life Sciences (Contributor) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
While type 2 diabetes (T2D) rates have soared, the number of Americans classified as ‘prediabetic’ has also increased. Despite this, current preventative approaches are costly and often not without undue side-effects. Instead, behavioral lifestyle approaches hold promise in reducing conversion rates of T2D as the latest treatment option that could mitigate and transform disease management. However, present interventions do not possess the scope necessary for implementation in a realistic, scalable way that can target the large at-risk population.
The application (app) “BeWell24” mitigates this diabetes risk through targeting sleep, physical activity, sedentary behavior, and diet, and is being delivered through mHealth technology to attenuate the higher-risk of the prediabetic Veteran population. In order for full scale dissemination, this thesis examines a provider perspective of the ‘Post-intervention interview guide’, performed with a Phoenix Veterans Affairs Health Care System (PVAHCS) provider. It then suggests revisions to the interview guide based on the provider’s interview and existing literature. This thesis also emphasizes the rationale behind these proposed changes to be organized in line with the iPARIHS framework (integrated Promoting Action on Research Implementation in Health Services).
Overall, the provider responded positively to BeWell24 and the ‘Post-intervention interview guide’, with constructive suggestions for each question in the interview guide. The main theme of the provider’s answers and comments were to prioritize efficiency and preserve standard clinical flow. A revised interview guide is provided, which prospectively presents as a more brief and focused interview organized by the iPARIHS framework. This revised interview guide could aid in the clarity of provider responses, specifically for the prospective interviews of the ongoing larger BeWell24 study and future studies.
The application (app) “BeWell24” mitigates this diabetes risk through targeting sleep, physical activity, sedentary behavior, and diet, and is being delivered through mHealth technology to attenuate the higher-risk of the prediabetic Veteran population. In order for full scale dissemination, this thesis examines a provider perspective of the ‘Post-intervention interview guide’, performed with a Phoenix Veterans Affairs Health Care System (PVAHCS) provider. It then suggests revisions to the interview guide based on the provider’s interview and existing literature. This thesis also emphasizes the rationale behind these proposed changes to be organized in line with the iPARIHS framework (integrated Promoting Action on Research Implementation in Health Services).
Overall, the provider responded positively to BeWell24 and the ‘Post-intervention interview guide’, with constructive suggestions for each question in the interview guide. The main theme of the provider’s answers and comments were to prioritize efficiency and preserve standard clinical flow. A revised interview guide is provided, which prospectively presents as a more brief and focused interview organized by the iPARIHS framework. This revised interview guide could aid in the clarity of provider responses, specifically for the prospective interviews of the ongoing larger BeWell24 study and future studies.
ContributorsWojtas, Abby Ann (Author) / Buman, Matthew (Thesis director) / Larouche, Miranda (Committee member) / Epstein, Dana (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Mobile health or "mHealth" defines a broad spectrum of medical or public health practice supported by mobile devices. The patient's perception of mobile health applications is the key point in confronting whether or not patients will utilize the tools at their disposal As such, the primary aim of this study was to examine participant feedback through quantitative and qualitative measures using the Therapy Evaluation Questionnaire and a patient interview, respectively, to further understand the patient rated acceptability of using BeWell24 and SleepWell24 for improving health outcomes. For BeWell24, it was hypothesized that patients who received the Multicomponent version would report higher acceptability scores than those randomized to the Health Education version. Furthermore, in regard to SleepWell24, it was hypothesized that the SleepWell24 patient would provide positive feedback and suggestions regarding their own experience with the SleepWell24 app. Data from this thesis was pulled from two ongoing randomized controlled trials currently being conducted at the Phoenix Veteran Affairs Health Care Service (PVACHS) and Mayo Clinic hospitals. Means, standard deviations, frequencies, and percentages were commuted to summarize demographics and TEQ scores. In addition, key concepts from a qualitative interview with a SleepWell24 participant were derived. The results showed a greater acceptability of the multicomponent versions of BeWell24 and SleepWell24 but a lower TEQ score of perceived usability. mHealth implementations pose a potential to become an important part of the health sector for establishing innovative approaches to delivering care, and while benefits have been highly praised, it is clear that the perceptions of mHealth must be positive if the technology is to transcend into a practical clinical setting.
ContributorsJimenez, Asael (Author) / Buman, Matthew (Thesis director) / Epstein, Dana (Committee member) / School of Nutrition and Health Promotion (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
In an increasingly interconnected world, the 17 Sustainable Development Goals are the United Nations’ framework for ensuring we continue to transform our world for the better, leaving no population behind. This study examines how the terminology of Sustainable Development Goal 17 for global partnership affects its implementation, focusing on “building capacity”—a widely referenced target in the development arena—and the involvement of the private sector. Key informant interviews with experts in the fields of conflict of interest, ethics, and development revealed a wide variety of (often conflicting) notions about partnership, frameworks for capacity development, and the interactions between public and private actors. A literature review of key policy documents examined the terminology and implementation of multistakeholder partnerships, and analysis offered considerations for risks and suggestions in policy terminology. Results indicate a need for increased attention to the use of partnership terminology as a catch-all term to encompass development work, and makes several recommendations for changes to combat misuse of the partnership label. Finally, this study acknowledges that there is a continued need for research-based evidence for effectiveness of the partnership-based development approach.
ContributorsThomson, Azalea Mae (Author) / Gaughan, Monica (Thesis director) / Hruschka, Daniel (Committee member) / School of Human Evolution and Social Change (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05