Students of the Ocean Research College Academy (ORCA), an early college Running Start program through Everett Community College, earn their associate's degree at the same time as their high school diploma. Students conduct boat-based research of multiple parameters in the local Snohomish River estuary system. Our study focused on using the historical data set to study the relationship between heavy metal concentrations and sediment size. Heavy metals can originate due to weathering and erosion from rainfall during storm events. Particles are deposited by size; finer sediments accumulate farther from shore while larger sediments remain closer to their point of origin. The hypothesis for our study was that the larger sediment sizes would retain more heavy metals, because of their larger surface area, which allowed for more absorption of the heavy metals. A Ponar grab was used for collection of benthic sediments and samples were sieved according to sediment size. Complimentary samples were analyzed for heavy metal abundance by the Everett Environmental Laboratory. These data collected from previous ORCA students were analyzed for spatial trends in mercury and lead abundance with sediment size at the three different locations from 2013 to 2015. Lead and mercury are neurotoxins that when found in high abundance can cause harmful effects to marine organisms.
 

 The majority of Americans do not engage in regular physical activity. Fitness Zones, a program sponsored by The Trust for Public Land, aims to increase physical activity by providing free outdoor fitness equipment in public parks. This program has gained popularity across the United States; however, few evaluations exist on the effectiveness of the program. Additionally, the majority of previous Fitness Zones were installed in warm locations. The purpose of this study is to examine physical activity patterns of park users in two Seattle parks where Fitness Zones will be installed, as well as to evaluate the effect of weather on park attendance and Fitness Zone utilization in these participating parks. Data collection will be performed in two Seattle parks prior to installation of Fitness Zone equipment with follow up at one of the parks after installation using a combination of observation and survey/interviews of park users. Observations are performed using System of Observing Play and Recreation in Communities (SOPARC). Park attendance will be assessed using a Park User Log and weather condition data will be obtained through Underground Weather. Qualitative content analysis of park user responses and comparison of park user turnout during tolerable versus poor weather differentiated by temperature, wind speed, and precipitation will be used for analysis. In addition, we will use linear regressions to determine correlational strength between park user attendance and various weather conditions. The results will contribute to the understanding of park use, and how to improve physical activity levels of all people in Seattle parks. Results will also describe relationships between Seattle weather conditions, park user attendance, and Fitness Zone utilization. Ultimately, this study will add to the knowledge base about whether Fitness Zone installation in public parks is an effective method to increase physical activity in the Seattle area.

Short-term inflammation processes are commonplace following traumatic brain injuries (TBI), as they are a normal defense mechanism the body elicits to heal itself. However, when prolonged or chronic, inflammation can become detrimental. One inflammatory cytokine, Interleukin-6, has been shown to be increased in cerebrospinal fluid and blood post-TBI. In other non-TBI related clinical studies, Interleukin-6 has been associated with pain, fatigue, sleep disturbance, and depression. In this study, we examined whether plasma levels of interleukin-6 were associated with a higher symptom levels of four symptoms (headache, fatigue, sleep disturbance and depression) in the post-acute phase in patients with mild TBIs. To answer this question, secondary data analysis from a study that is currently underway was used. In the parent study, interested participants were enrolled from the Harborview Medical Center ED if they were 21-54 years of age, had sustained a mild TBI within the last 24 hours, and met other inclusion/exclusion criteria which would have impacted the immune response. Endorsement of symptoms and total symptom burden at 3 and 6 months was measured using the Rivermead Post-Concussion Questionnaire. Interleukin-6 levels at 3 and 6 months post-injury were obtained from banked plasma samples using a multiplex assay (Millipore, Minneapolis, MN). The sample (N=84) had a mean age of 34.7 years (SD 9.4). At 3 months post-injury the percent of patients endorsing symptoms as a problem were, 35.9% for headaches, 44.9% for sleep disturbance, 50% for fatigue and 32% for feelings of depression. At 6 months, the percentage reporting the symptom was higher for headaches (38.2%). Data analysis is currently underway using chi-squared tests and regression analysis to assess for the association between Interleukin-6 levels. If such an association is shown, this understanding of disease progression in mild TBIs could bring new treatment modalities to the medical realm concerning chronic inflammation.

Despite the importance of social support for patients with diverse cancers, there has been no study to date that examines the differences and similarities between partner caregivers' report of communication support given to the patient and the patients’ perception and appraisal of that support. The purpose of this paper is to analyze partner caregiver communication support to wives’ diagnosed with Stage IV ovarian cancer and compare it to the wives’ view of the support they receive from their partner caregiver. One of the most important measures of social support in the research literature is the form and type of communication the partner caregiver offers the wife regarding her feelings and emotions with the cancer. This paper will be a secondary analysis using data drawn from an ongoing clinical trial of women initially diagnosed with Stage IV ovarian cancer and their partner caregivers [both genders]. Analyses will include patient-reported appraisal of received supportive communication using a standardized quantitative measure “What He/She Does for Me”, and the comparable measure of partner caregivers report on a standardized measure, "What I Do for Her." Data will be compared to assess the concordance or discordance between the enacted versus the perceived support. Results will have implications for nurses’ teaching partner caregivers types of communication that in the data are commonly misperceived by the diagnosed patient, including methods spouses can more effectively use to offer support that will be interpreted as support.

Ovarian cancer is the 2nd most frequent female cancer in the U.S. Among couples in which women have been diagnosed with stage III or IV ovarian cancer, the partner is often the caregiver, and his or her social support can greatly impact the diagnosed woman’s disease process. Despite advances in the study of the partner-caregiver’s role, there have been few nursing interventions specifically created to provide emotional healing and recovery for him or her during the disease process. Our study involves a 5-session nurse-delivered counseling intervention designed to address the partner-caregiver’s emotional care. The purpose of my research is to examine the data from before and after the intervention to determine the effect it had on the partner-caregiver’s depressed mood. Each participating partner-caregiver completed a CES-D (Center for Epidemiologic Studies – Depression) scale before and after the intervention. The target sample was 10 partners of women diagnosed with stage III and IV ovarian cancer who were enrolled in the Taking Care of Her Program. The data analysis entailed comparing the partner-caregiver’s CES-D scale results before and after the intervention to evaluate the intervention’s impact on the respondent’s wellbeing. Due to the swift and terminal effects of ovarian cancer, and the time period needed to complete the sessions, only five partner-caregivers’ results have been collected to date. Of the five, four scored lower on the CES-D when their baseline scores were compared to their post-intervention scores. Although we are optimistic over these early results, caution is also in order, given the single group design (pre-posttest). There could be plausible other causes of these results. This early suggestive evidence argues the potential importance of this intervention but future research is needed within a more rigorous experimental design with a larger sample.

In 2015, the American Heart Association (AHA) stated that sudden cardiac arrest is still a primary cause of death in the United States. During cardiac arrest, lack of intervention to maintain the perfusion of tissues with oxygenated blood leads to irreparable damage to the brain and vital organs within minutes. In 2010, the A-B-C (airway, breathing, circulation) of CPR changed to C-A-B (circulation, airway, breathing) due to strong evidence that supports the idea that high-quality CPR chest compressions help sustain life until the underlying causes of cardiac arrest are addressed. The purpose of this study was to use technology to measure and review chest compression data collected during cardiac resuscitations, and evaluate specific compression parameters, in relation to AHA standards, for overall quality improvement. The CODE-STAT™ technology used in this study measured changes in thoracic pressure during a cardiac resuscitation, and then generated a report stating rate of chest compressions per minute, and total time spent on chest compressions. The data was then given to the hospital resuscitation teams so that they could visualize and discuss the quality of their performance in comparison to AHA and hospital standards. Thus far, results of the study have shown that in-hospital resuscitation teams have compression rates that are too fast and there are too many pauses, or times without chest compressions. A compression rate above 120 beats per minute can decrease sufficient blood return to the heart from the rest of the body, making subsequent compressions less effective at dispersing blood. Too many pauses in chest compressions can negatively impact the pressure gradients in the thoracic cavity that are required to maintain adequate cerebral and coronary blood flow. Hospitals must continue to implement technologies that measure CPR performance so that cardiac arrest patients receive the best possible outcomes for survival.

Among middle school age youth, recent research estimates that approximately 1.3% of students identify as transgender (a gender identity that differs from the sex assigned at birth). Transgender youth are at considerable risk for depression, anxiety, and suicide associated with bullying at school or difficulties at home. School nurses are well positioned to identify these youth, intervene, and provide support. Public health study of cultural competence in caring for sexual minorities has begun to emerge, yet little of this research addresses the disparities of care experienced by transgender patients. Previous research has shown that school-based health professionals lack adequate skills and knowledge to care for transgender youth. This study focuses on the state of care within the school setting for transgender youth in Washington State. A survey of knowledge of transgender issues and experiences with transgender youth was conducted among Washington State school nurses serving youth grades 6-12. The UW Catalyst hosted questionnaire was distributed to members of the SNOW (School Nurses Organization of Washington) email list-serv. A snowball sampling approach enabled recipients to forward the survey link to additional respondents. Questions included demographic information (educational attainment, type of work settings, institution size, etc), confidence in ability to provide care to transgender youth, presence and enforcement of the school anti-bullying policy, willingness/interest in receiving additional education, knowledge of community resources, and awareness of/contact with transgender students in the school population. Data from this study provides a picture of the educational needs of Washington’s school nurses in order to care for this sensitive population successfully.

Good communication is crucial to a patient's healthcare experience and an integral part of a nurse's role in providing care. Patients with communication disorders are susceptible to poorer health outcomes and decreased satisfaction with services due to breakdowns in communication with nurses. Literature suggests that nurses should receive training on how to effectively communicate with these patients, but it is unclear whether this training is currently included in nursing school curriculum. What are nursing students at universities across Washington State being taught about how communication disorders impact medical interactions, or how to better communicate with patients who struggle? Are these students lacking the necessary education and training to provide quality care for patients with communication disorders? In an attempt to answer these questions, survey data will be collected from junior and senior nursing students at the University of Washington, as well as from faculty responsible for developing nursing student curriculum at UW and other in-state universities regarding the current communication skills curriculum being taught in this area. Based on preliminary findings we hypothesize that a gap exists in nursing student curriculum related to how to communicate effectively with this patient population, and that the survey data collected will show that nursing students in Washington State are not currently being taught about communicating with patients with communication disorders. The key implication of this study will either suggest a need for nursing school curriculum to implement communication skills training targeted toward patients with communication disorders or show that students are in fact receiving this training. The addition of education and training in this area can help nurses improve the quality of care for this patient population. 

The purpose of this quality improvement study is to determine if hospital protocols regarding central line disinfection techniques are being followed. A central line is an intravenous access with a catheter leading directly to the heart, and is more permanent than a standard peripheral intravenous line. Central line-associated bloodstream infections (CLABSIs) are a serious concern within patient care settings. Improper central line maintenance techniques contribute to CLABSI incidence, which leads to significantly increased patient health burden, length of hospital stay, medical costs, and mortality risk. Observations will be performed in four intensive care units at a metropolitan level one trauma hospital in the greater Seattle area. Patients with central lines will be identified on observation days. The number of opportunities for central line lumen caps to be covered by an alcohol-impregnated cap versus the number of caps that are actually covered will be counted. Number of opportunities are identified as being: unused lumen of central line, any unused or used peripheral IV, and side ports of tubing connected to central line or peripheral IV, per institution policy. Moreover, if a RN accesses a line during observation, disinfection techniques will be observed and compared to institution policy. We anticipate our results to show a 50% compliance rate with the protocol we are observing. We also anticipate that a lack of knowledge on the protocol will play a role in this, as evidenced by nurses asking questions during our observations. It is the hope of this study to identify if disinfection practices are in compliance with central line maintenance care protocols. If not, then further interventions can be developed and put into place to increase compliance and aid further in the reduction of CLABSI.

Mall walking has the potential to increase physical activity and improve overall health of older adults but there is insufficient research about how older adults initiate and maintain participation. Older adults are a growing demographic and over half do not meet the daily recommendations for being physically active. Malls provide a safe, convenient, free, flat surface, and accessible venue for older adults to walk. Additionally, benches, water fountains, close parking, and bathrooms make it an ideal walking environment. The purpose of this quality improvement project was to better understand mall walkers’ reasons for initiating and maintaining walking in a local mall walking program. We partnered with a Seattle Parks and Recreation program called Sound Step Strollers that offered weekly mall walking in Seattle. We used a cross-sectional design and included one-on-one interviews and written surveys. Interviews were conducted in person over 6 weeks during mall walking hours and consisted of questions about motivators and barriers to walking. Attendees who listened to a presentation about walking at a local retirement community were invited to complete a written survey that consisted of questions about incentives to walking. Interviews of 9 mall walkers from Sound Step Strollers were conducted as well as 15 surveys from a local retirement facility after the walking presentation. Findings revealed that the primary motivator to participate in a mall walking program was to manage and improve physical symptoms from chronic illness (e.g. arthritis). Additional factors that impact participation in mall walking include the influence of social peers, proximity of walking programs, and that information about the program had been provided at community centers and senior buildings. These findings suggest that coordination between clinicians and mall walking programs could provide a safe and accessible transition of care as well as an opportunity for continued health maintenance for older adults.

Despite glaring disparities in obesity trends by race in the United States, little is known about the most effective processes used to engage underrepresented communities in obesity prevention research. As recognized by the U.S. federal government, these underrepresented populations include African Americans, American Indian/Alaska Natives, Hawaiian/Pacific Islanders, and Hispanic/Latinos. As African Americans and Latinos hold the highest age-adjusted obesity rates in the U.S., the purpose of this study is to identify best practices for engaging these local underrepresented communities in academic partnerships for obesity prevention research. Data for this study will be collected through key informant interviews among three published community-based obesity prevention researchers from the disciplines of medicine, nursing, and public health at the University of Washington, a designated research intensive institution. Content analysis will then be performed to describe the approach and process used by researchers to engage underrepresented communities as well as barriers and facilitators to community engagement. Study findings will be used to identify key transdisciplinary strategies for engaging underrepresented populations in obesity prevention research which may also be applicable to other fields of study.

The postpartum period can be a challenging experience for many women as they adjust to the physical and social changes of new motherhood. Breastfeeding is one of the postpartum tasks that may be more difficult than expected. Additionally, many women may feel that their postpartum body fails to meet an idealized image, leading to body dissatisfaction. Mindfulness-based interventions have been developed for stress reduction in a variety of health contexts, including pregnancy. Mindfulness-based interventions may provide strategies for new mothers to handle the challenges of breastfeeding the infant and to improve their body image. The purpose of this study is to explore whether participants in a mindfulness based childbirth and parenting class (MBCP) during pregnancy found mindfulness skills beneficial to their breastfeeding experiences and postpartum body image. Women who participated in a ten week MBCP course during pregnancy were interviewed within the first year postpartum to discuss their experiences. The semi-structured interview guide included questions on how participants may have used mindfulness to approach a variety of positive and negative experiences. Findings demonstrate that women used mindfulness to appreciate the positive aspects of their postpartum experiences as well as handle the challenges they faced. During breastfeeding sessions participants deliberately focused on mindful attention on their infants. Women also used mindfulness to appreciate their postpartum bodies for the achievement of giving birth and to show self-compassion for the physical challenges of recovery. Findings have implications for future research on the postpartum experience and intervention design.

Obstructive sleep apnea (OSA) is a major public health concern associated with poor health outcomes (health-related quality of life (HRQOL), cognitive deficits). An estimated 1-4% of typically developing children have OSA. Less is known about the prevalence of OSA and co-morbid effects of OSA in children with chronic health conditions such as juvenile idiopathic arthritis (JIA). JIA is an autoimmune disorder associated with joint inflammation, pain, fatigue, and disturbed sleep. A recent study reported a high prevalence of OSA in JIA, however the associations between OSA and health outcomes were not reported. The aims of this study were to: 1) compare the prevalence of OSA, HRQOL, and fatigue in JIA and control children; and 2) compare HRQOL and fatigue in JIA and controls with OSA to those without OSA. Participants included children 6-11 years, with JIA (n=68) and without JIA (n=75). Children underwent overnight polysomnography (PSG). Children and parents also completed the Pediatric Generic Core scale (HRQOL), Multidimensional Fatigue Scale; and parents completed the Pediatric Sleep Questionnaire (PSQ). The analysis for aim 1 examined group differences in demographic and clinical characteristics, PSG OSA indices, parent-reported OSA symptoms, HRQOL, and fatigue. For aim 2, we categorized JIA and control children who met the clinical criteria for OSA by PSG and by PSQ. Mean scores for HRQOL and fatigue were examined in children with OSA confirmed by PSG and PSQ, to children without OSA confirmed by PSG or PSQ. We found that children with JIA have increased OSA by PSG and parent report, lower HRQOL, and increased fatigue severity compared to controls. Results of this study will inform clinical practice by highlighting the need to routinely screen children with JIA for OSA, and the impact of OSA on important patient-reported health outcomes in JIA.

Nationally, twenty-two percent of discharged heart failure patients are readmitted within 30 days. Readmission places the patient at increased risk for complications and has financial repercussions for the hospital due to Medicare penalties under the Affordable Care Act. Previous studies indicate a multi-level approach to the discharge process—including discharge protocols, patient education, and supported transition to home or care facility—reduces readmission rates. Teach-Back is one approach to patient education that includes an assessment of patient learning about self-care, allowing them to demonstrate their knowledge and understanding to their nurse or other healthcare professional. The purpose of this study was to understand the nurses’ perceptions of the benefits and barriers to using Teach-Back during discharge. A Quality Improvement survey was distributed to approximately 1100 nurses at University of Washington Medical Center with a 28% response rate. Nurses indicated that primary barriers to using Teach-Back were increased time requirements (58%), burden of documentation requirements (52%) and lack of knowledge on how to perform Teach-Back (36%). Preliminary content analysis of two open ended questions related to Teach-Back integration and implementation identified four themes: efficiency, support, checklists and training. We interpreted these results to suggest that increasing demands on nurses’ time requires efficiencies in other areas to rebalance the workload. Recommendations include a more efficient system of prompts and documentation of Teach-Back. In-service training should be carried out first on units with the lowest rates of Teach-Back. Additionally, we recommend streamlining discharge documentation in the electronic medical records with the aim of time reduction by way of fewer screens and fewer clicks. One limitation of this study is non-respondent bias; since we do not know why 72% of nurses did not respond, we cannot rule out the possibility that the shortage may have been due to lack of confidence with Teach-Back.

In typically developing children, obstructive sleep apnea (OSA) is associated with neurobehavioral performance deficits including impaired behavioral regulation and working memory. Less is known about the effects of OSA on neurobehavioral performance in children living with a chronic health condition, such as Juvenile Idiopathic Arthritis (JIA). Our recent study showed a high prevalence of OSA in children with JIA that was associated with slower reaction times and increased impulsivity. The purpose of this study is to compare the frequency of OSA, and the associations between OSA and neurobehavioral performance (behavior regulation [emotional control, inhibition], metacognition [working memory, organization]) in 150 school-age children with and without JIA. We hypothesized that OSA will be increased in children with JIA, and OSA will be negatively associated with emotional control, inhibition, working memory, and organization in comparison to an age, sex match group of control children. Children and their parents underwent an overnight polysomnography (PSG) in a sleep research laboratory. Parents completed neurobehavioral performance measures including Behavioral Rating Inventory of Executive Function (BRIEF) and Child Behavioral Check List (CBCL). OSA frequency between JIA and control children was examined with Chi-square analysis. Group differences (JIA vs. control) in neurobehavioral performance measures were examined with analysis of variance (ANOVA). Bivariate correlations were done to examine the associations between OSA and neurobehavioral performance tests. Findings from this study will provide new knowledge about the effects of obstructive sleep apnea on neurobehavioral performance in children living with a chronic health condition.

 Approximately 500,000 Americans undergo surgery for lower back problems each year. Despite dramatic improvements over the last decade in perioperative care, the outcome of spine surgery is associated with prolonged hospitalization and poor pain management. In April 2014, Harborview Medical Center introduced an enhanced recovery protocol, called the Perioperative Enhanced Recovery from Major Spine Surgery (PERMSS), which aims to reduce significant physiological stress and shorten hospitalization by implementing pre-operative nutrition supplement, standardized analgesic administration, and early mobilization. The purpose of this study is to investigate the efficacy of PERMSS on post-operative pain relief. This project takes a quantitative approach and follows the descriptive correlational design. From June 2015 to Feb 2016, fifty PERMSS and fifty non-PERMSS patients were recruited and interviewed in their hospital rooms on their first postoperative day. The validated International Pain Outcome survey was used to capture comprehensive data including patient demographics, comorbidity, surgical procedure, analgesic regimen, and patient-reported outcomes. In April 2016, data analysis will be conducted through Stata MP V13.1. to compare the difference between PERMSS and non-PERMSS patient outcomes. We expect a significant improvement in pain management, reflected by less time spent in severe pain, decreased interference in recovery activities, and improved patient satisfaction. The result of this study leads to two potential benefits: first, to introduce enhanced recovery protocol to other similar complex surgeries; and secondly, to reduce reliance on opioids especially in spinal patients who have a 15-30% likelihood to develop failed back surgery syndrome (FBSS) and become frequent victims of opioid use disorders. In contrast to traditional practice that relies heavily on opioids, PERMSS may help address this problem with its emphasis on multi-modal analgesic, which is a combination of opioid and non-opioid prescription.

Mild traumatic brain injuries (MTBI) affect millions every year. Symptoms are typically transient in nature but recovery time can span weeks to months. The neurobehavioral disturbances resulting from MTBI are associated with lower functional outcomes. Research suggests that well-developed social support networks contributes to improved health outcomes. However, less is understood regarding the existence of a relationship between social support networks and MTBI outcomes specifically. The objective of this study is to establish whether or not there is a relationship between social support availability and perceived symptom burden after MTBI. This study is a secondary analysis of data captured by the AIm:TBI study, which tests whether poorer outcomes from TBI in older adult survivors are associated with an altered post-traumatic immune response. In the parent study, participants were enrolled from the ED if they were 21-54 years of age and had sustained a MTBI within the last 24 hours (N=78). Social support was measured by the MOS-Social Support Scale (range 19-95; higher scores mean more social support). Endorsement of symptoms and total symptom burden at 3 and 6 months was measured using the Rivermead Post-Concussion Questionnaire (range 0-64; higher scores mean more burden). At baseline, the average social support score was 79.7 (SD 14.9). At 3 and 6 months post-injury the mean total symptom burden was 16.2 (SD 14.4) and 15.5 (SD 15.0) respectively. Analysis of the relationship between the two includes the assessment of relative influence of the type of social support received on symptoms. If the results of this study suggest that there is an inverse relationship between the severity of an individual’s symptoms after MTBI and the quality of their social support network, it may justify the development of interventions to increase social support in specific areas in order to facilitate better outcomes for MTBI patients.