Welcome To OpenBU
OpenBU is Boston University’s digital institutional repository for scholarly articles, theses and dissertations, preprints, and grey literature. This repository enables BU researchers to share, disseminate, and preserve their scholarship, and makes their research more accessible
If you are looking for information on BU's opt-out open access policy, please visit the BU Open Access Policy page.
Communities in OpenBU
Select a community to browse its collections.
Recent Submissions
Implementing evidence-based practice in clinical settings: a collaborative and educational program for occupational therapy practitioners
(2024) Brosnan, Caitlin; Marnell, Lisa; Jacobs, Karen
Occupational therapy practitioners (OTPs) understand the importance of implementing evidence-based practice (EBP) in clinical settings. However, they often have difficulty implementing it within practice (Saunders et al., 2019). The problem is that without EBP, clients may not receive quality care because OTPs may not be up to date with research (Christiansen, et al., 2015). OTPs report that current barriers include time constraints, lack of access to articles, and not having the support or the skills to interpret research (Nott et al., 2020). Subscriptions to journals and online literature are the most common forms of evidence to review (Rodriguez et al., 2006). However, medical journals require paid subscription for access which OTPs do not have the financial resources to subscribe.
Developing an approach to address the identified problem required a comprehensive literature search which was completed by the program author. Results obtained supported several important or key ingredients to be included in the program. For example, several resources were identified to support clinicians in implementing EBP within a clinical setting. One example is the KT Toolkit which assists clinicians with promoting EBP within their practice setting (Juckett et al., 2022b). Also, mentorship is a crucial strategy to embrace as it can increase participants confidence with engagement in EBP (Eames et al., 2018). When implementing a new program, it is important to consider buy-in from management which can be accomplished through clear communication and fostering a team environment (Bleser et al., 2014). In addition, commitment from staff members participating in the new program is required which can be established through clear communication (Engle et al., 2017). Providing data and clear expectations of the program will assist with buy-in through explaining the purpose of the program to participants (French‐Bravo et al., 2020).
To assist OTPs with incorporating EBP into treatment plans the proposed program, Implementing Evidence-Based Practice in Clinical Settings, will be implemented in an inpatient rehabilitation setting. Although the proposed program is designed to be implemented in an inpatient rehabilitation setting, it can be generalized to other practice areas as well. Initially, the program will be provided as a pilot project to senior OTPs who will provide feedback on the program and serve as mentors to other therapists. The program will be delivered in person to a small group starting with informational sessions then transitioning to a journal club format to allow participants to actively engage in EBP. Through a group format, participants are encouraged to collaborate with one another during the initial meetings and afterward to promote engagement in EBP within their practice setting. As the program is still in its early stages, data will be gathered before and after the pilot program using a non-experimental research design (Giancola, 2020).
The primary audience for this program is OTPs, and the secondary audience is management within occupational therapy. A plan for evaluating the effectiveness of this dissemination plan is described through written information, person-to-person contact and electronic media.
Second rib cut, donor IBXFT
(2024) Kelly, Ashlin; Wisco, Jonathan J.
This illustration provides a view of the second rib cut procedure using bone shears. The image demonstrates the technique for cutting through the second rib while ensuring the preservation of the surrounding anatomical structures. This step follows the cutting of lower ribs and precedes the first rib cut.
Heart dissection, donor IBXFT
(2024) Kelly, Ashlin; Wisco, Jonathan J.
This illustration depicts the anterior heart dissection.
On the left, the image shows the exterior of the heart with dashed lines indicating the planned incision sites for the dissection. These lines outline the areas to be cut to provide access to internal structures.
On the right, the image reveals the heart after the incisions have been made and the outer layers have been cut. The internal structures, including the muscular walls of the ventricles and the myocardial fibers, are visible.
Patellofemoral joint dissection, donor IBXFT
(2024) Kelly, Ashlin; Wisco, Jonathan J.
This three-part illustration provides anterior views of the patellofemoral joint dissection.
The first image shows the knee in an extended position, providing a clear view of the patella, femur, and tibia with the patella in its natural resting position within the femoral groove.
The second image elevates the patella to reveal the underlying structures, including the articular surface of the femur and the patellar tendon attachment, showing the contact area between the patella and femur.
The third image depicts the knee in a flexed position, showing changes in patellar alignment and its relationship with the femur and tibia during knee movement.
First rib cut, donor IBXFT
(2024) Kelly, Ashlin; Wisco, Jonathan J.
Data for "a physics-informed impact model refined by multi-fidelity transfer learning"
Snapp, Kelsey L.; Silverman, Samuel; Pang, Richard; Tiano, Thomas M.; Lawton, Timothy J.; Whiting, Emily; Brown, Keith A.
This folder contains the experimental data for the research paper "A physics-informed impact model refined by multi-fidelity transfer learning" which is scheduled to be published in Extreme Mechanics Letters.
The designs are broken up into several categories:
TPU 1-6: Figures 1-3
TPU 7-8: Figure 4
TPU Foaming 1-14: Figure 5
Both STL and Gcode files are available for each design. Note that spiral/vase mode is used when slicing, so the part will be hollow when sliced. The proper extrusion multiplier must be used to reach the mass target for each design. The slicer settings are included in the Gcode at the end of the file.
The raw data for physical experiments performed in both constant velocity tests in a universal testing machine (UTM) and impact tests using a drop tower are also included. They use the following naming structure:
UTM tests: _V_.csv
Note that velocity is in mm/min and trial is either a, b, or c. Only 2 mm/min velocity tests contain b and c trials.
Impact tests: _V.csv
Note that velocity is in m/s and goes to two decimal places.
Costs and cost-effectiveness of interventions to improve HIV treatment adherence in Cape Town, South Africa
(2024) West, Rebecca Lynn; Sabin, Lora L.
BACKGROUND: Improving adherence to antiretroviral therapy (ART) is crucial for achieving HIV epidemic control in South Africa. The SUSTAIN trial aims to identify the most cost-effective package of evidence-based strategies for adherence monitoring (pharmacy refill monitoring (PRM), electronic adherence monitoring (EAM), viral load (VL) monitoring) and support (check-in texts (SMS), enhanced adherence counselling (EC)) for patients newly initiating ART. Participants were randomized to receive one of sixteen combinations of interventions using a multi-phase optimization strategy design.
METHODS: First, a cost analysis of implementing SUSTAIN interventions for the first cohort (n=260) of participants was conducted from a health system perspective, using a micro-costing approach that employed three data collection methods: self-reported time and cost worksheets, independent staff observation, and discussions with staff during site visits. Second, a cost-effectiveness analysis was conducted using costing and adherence data from SUSTAIN participants to explore costs for achieving >80%, >90%, and >95% adherence for each intervention component. Third, a forward-looking costing model estimated costs for scaling up the interventions in a real-world setting (City of Cape Town) over a 10-year time horizon. All cost analyses were adjusted for inflation and discounted using an annual rate of 3%.
RESULTS: The costs for one person-year of participation in SUSTAIN were $12 for PRM, $25 for VL monitoring, $162 for EAM, $16 for EC and $42 for SMS. Cost-effectiveness analyses showed PRM was cost-saving versus EAM and VL monitoring for achieving all categories of adherence. For support interventions, EC was cost-saving compared to SMS for achieving all categories of adherence. Estimated per annum future costs per patient ranged from $11–$25 for general program costs, $12–$20 for VL monitoring, $69–$122 for EAM, $3–$5 for PRM, $12–$14 for SMS, and $16–$31 for EC. A cost-effectiveness analysis of future costs found SMS would be more cost-saving than EC; the monitoring interventions remained the same.
CONCLUSION: EAM was costliest due to high technology costs; however, these will decrease with mass production if scaled up. Pending final cost-effectiveness results from the main SUSTAIN trial, a differentiated approach based on cost and sensitivity of monitoring interventions could be considered for those restarting versus initiating ART. Support options require further investigation.
The application of machine learning and causal inference to improve suicide outcomes among U.S. veterans: a focus on clinic characteristics
(2024) Tenso, Kertu; Strombotne, Kiersten
Suicide is the tenth leading cause of death among the general U.S. population and the second leading cause of death among those under the age of 45. Veterans are at a particularly high risk, representing 13.7% of the suicides among adult Americans in 2019, despite accounting for only 7% of the total population. The high rates have led the Veterans Health Administration (VHA) and others to develop predictive tools to help identify at-risk patients and facilitate targeting for suicide prevention.
Suicide prediction is a notoriously complex challenge. Current theories suggest that suicidal behavior is a result of complex interactions between psychological, clinical, biological, social, and environmental factors. Despite decades of effort in suicide research, predictive abilities for suicide have remained at near-chance levels for the past 50 years. As a result, many organizations, including the VHA, have shifted to advanced statistical methods, such as machine learning, based predictive models. These models have improved suicide prevention efforts by leveraging individual-level electronic health records to detect patterns and identify individuals at highest risk of suicide, thereby enabling the delivery of additional mental health resources to those flagged by the model. Although researchers have made important advances in recent years, we have limited knowledge about how facility-level factors, such as variables related to access and capacity, may affect suicide-related events and aid suicide prediction and prevention. Understanding these factors is important because research demonstrates that clinic operations factors can have direct effects on suicide outcomes and are more easily changed by policymakers and facility managers relative to biological or social factors.
The overarching aim of this dissertation was to improve risk prediction and suicide outcomes in the Veteran population by investigating the impact of clinic operations characteristics on suicide outcomes through the use of two methodologies: machine learning and causal inference. Its three specific aims were the following: (1) to investigate the performance of risk-prediction models after adding facility-level predictors of suicide-risk to commonly used machine learning algorithms, (2) and to explore the potential bias in machine learning based suicide risk prediction by stratifying the models by age, sex, race, and ethnicity. The third aim (3) used an instrumental variables approach to explore the causal relationship between virtual care utilization and individual-level suicide related events.
Findings from Aim 1 were mixed and showed that adding facility attributes to suicide risk prediction models, specifically logistic regression and elastic net models, could accurately identify a larger number of individuals at greatest risk of suicide, depending on the specification of the model. The analysis from Aim 2 uncovered notable differences in the sensitivity of these models within various subgroups, with enhanced benefits observed for Black, Non-Hispanic, male, and younger populations. Aim 3 results highlighted that a rise in the proportion of virtual mental health visits compared to all visits significantly reduces suicide-related incidents, suggesting that the implementation of virtual mental health services could lower the incidence of suicide outcomes.
The findings of this dissertation underscore the value of integrating clinic characteristics into suicide prevention efforts, offering a nuanced approach to improving predictive accuracy and mitigating biases in machine-learning models through the incorporation of facility-level factors. Furthermore, the application of causal inference methods provides critical policy-relevant insights, helping to answer fundamental 'why' questions that underpin suicide-related outcomes. Overall, these findings advocate for a broadening of perspectives from individual-level factors to include facility-level predictors, thereby enhancing the scope and effectiveness of suicide prevention efforts.
Self-efficacy as an outcome of an integrated reading/anxiety intervention
(2024) Newman, Kathryn; Grills, Amie E.
This three-part mixed methods study uses a parallel-databases convergent design to explore self-efficacy as an outcome of an integrated reading and anxiety intervention. Study 1 presents a qualitative analysis of teacher perspectives on effective components of the intervention, with particular attention to teacher and student self-efficacy. Study 2 is a psychometric evaluation of a brief instrument measuring the sources of reading self-efficacy in children. Study 3 employs the revised reading self-efficacy scale to collect data before and after students complete one year of the integrated intervention. Qualitative and quantitative data were analyzed together for a more complete understanding of intervention effects on reading self-efficacy. Results contribute to discussion on the self-efficacy of struggling readers.
Occupational therapy in palliative and hospice care: a certificate program
(2024) Alcorn-Borodach, Kara Lynn; Stone Kelly, Lauren
As the population ages and individuals with serious illnesses continue to live longer, they are experiencing disruptions in habits and routines, roles, and rituals that provide meaning to their lives. Many individuals receiving palliative or hospice care and their family members are unable to maintain their quality of life (QOL) and well-being due to the negative impact of the serious illness. Individuals and their family caregivers experience difficulty in participating and engaging in activities of daily living (ADLs) (i.e., dressing, bathing, eating) and instrumental activities of daily living (IADLs) (i.e., making meals, working, finances). Individuals are unable to maintain their independence, return home due to environmental barriers, and receive support from family members due to a lack of training. Family caregivers are thrust into the role of caring for their loved ones without training. Currently, there is an increased need for more health professionals to work in palliative and hospice care. Occupational therapy is one profession that can fill this gap; however, there is a lack of education for occupational therapy practitioners (OTPs) at both the entry and post-professional levels.
Occupational Therapy in Palliative and Hospice Care: A Certificate Program contains key components of related professional certification programs in palliative care. Program content aligns with palliative care principles and specific evidence-based occupational knowledge so OTPs will become integral interprofessional palliative care team members. It aims to demonstrate occupational therapy's value in this setting and prepare OTPs to work successfully. Modules provide the foundational information needed to facilitate the use of the principles of palliative care, understand the clients, collaborate with members of the interprofessional team, and provide meaningful occupational interventions during this transition. This program addresses the gap and need for occupational engagement, health promotion, and occupational justice for these individuals and their family members at the end-of-life (EOL).