The University of Texas at Tyler
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DNP Final Report: Translation of evidence-based practice: Developing Nurses\u27 ability to recognize and respond to clinical deterioration
Get PDFClinical deterioration is a serious physiologic disturbance or a sudden worsening patient condition increasing the risk of morbidity and mortality (Jones et al., 2013). Clinical deterioration compromises hemodynamic stability and produces marked physiological decompensation (Padilla & Mayo, 2017). Patients often exhibit physiological signs several hours or more before decompensation is readily apparent (Andersen et al., 2016; Khanna et al., 2019). The need for early recognition of clinical deterioration has been well-identified and documented (Ashbeck et al., 2021). Increasing time duration from the onset of clinical deterioration to intervention is associated with increased resuscitation and critical care requirements, the presence of end-organ dysfunction, and high mortality (Jones et al., 2013; Padilla & Mayo, 2018; Whebell et al., 2020). Successful recognition and rapid intervention of clinical deterioration require synergistic parity between nurse competence, clinical judgment, and a confident response to improve patient outcomes (Clayton, 2019).
An on-demand asynchronous course of didactic instruction coupled with distance simulation was devised to offer bedside nurse providers readily applicable knowledge and skills to rapidly recognize and appropriately intervene during episodes of patient clinical deterioration. A resource-sparing, low-cost, convenient, low-fidelity virtual case study simulation was designed to provide budget and staff-constrained education departments with an alternative platform of didactic instruction and application of skills direct to the clinical site for in-service training or as a part of a formal education curriculum. A video-streamed 2-hour block of instruction viewed conveniently by learners was envisioned and herein offered to develop deep knowledge, exercise skills, and practice critical thinking responses to patient clinical deterioration
A Real-World Comparison of Apixaban and Rivaroxaban in Obese and Morbidly Obese Patients With Nonvalvular Atrial Fibrillation
Get PDFBackground: Contemporary guidelines for managing nonvalvular atrial fibrillation (NVAF) include apixaban and rivaroxaban as first-line anticoagulation treatment options. Minimal guidance is available regarding selecting anticoagulants for patients with class I-III obesity. Objective: This study aims to evaluate the comparative effectiveness and safety of apixaban and rivaroxaban in both obese and morbidly obese patients with NVAF. Methods: A retrospective cohort study was conducted at an outpatient cardiovascular clinic after Institutional Review Board approval. Patients were eligible if they were ≥18 years of age, had a BMI ≥30 kg/m2, and took apixaban or rivaroxaban for NVAF for ≥3 months. The primary endpoint was the composite rate of stroke, transient ischemic attack (TIA), myocardial infarction (MI), or presence of atrial thrombosis. Bleeding events were evaluated as the primary safety endpoint. Results: Combined, the cohorts consisted of 303 obese or morbidly obese patients. The primary composite endpoint occurred in 3.8% of patients taking apixaban and 1.7% of patients taking rivaroxaban (P = .28). Both clinically relevant, non-major and major bleeding occurred more often in the apixaban arm, but this difference was not statistically significant; however, bleeding risk may have been skewed due to differences in baseline characteristics. Conclusion and Relevance: For obese and morbidly obese patients prescribed either apixaban or rivaroxaban for NVAF, rates of stroke, TIA, MI, and atrial thrombosis did not differ. The preferred DOAC for patients with class I-III obesity remains elusive, but current data points to a patient-centered approach for anticoagulant selection
LEADERSHIP BEHAVIORS, PRACTICES, AND SYTLES IN MERGERS AND ACQUISITIONS IN THE U.S. TECHNOLOGY-BASED ORGANIZATIONS: A QUALITATIVE STUDY
Get PDFLeaders guide and shape the success of mergers and acquisitions (M&A) to meet an organization’s goals and objectives. In this study, I explored the role of leadership during M&A and the effect of different leadership behaviors, practices, and styles (BPS) on different organizational cultures during M&A. This study explored the contribution of leadership BPS on M&A outcomes within an organization with a robust and innovative culture. I focused on the human capital investment strategies of M&A integration concerning different leadership BPS utilized to improve the success rate of M&A goals and objectives. I concentrated on technology-based organizations because they are inherently rich in innovative culture in the US to develop a more profound understanding of how leaders can improve performance objectives during M&A integration. This study showed the importance of a company\u27s goals, executive leadership, department leadership, and employees working simultaneously toward executing an optimal M&A leadership strategy. The conceptual model was presented represents M&A leadership opportunities that may contribute to successful M&A outcomes or to a high risk of failure. The interview findings support that leaders are critical in guiding employees\u27 knowledge, skills, and abilities during organizational change. The analysis and interpretation of this study showed the importance of understanding leadership BPS during M&A, contributing to an organization’s performance objectives through the creation of a M&A leadership BPS model. The alignment of ODC activities was presented with an M&A leadership BPS model including strategies and techniques utilized for the purpose of improving both organizational and individual performance
CONCEPTUALIZING FIRST-YEAR WRITING AGENCY: THE TRANSFER-RHETORICAL GENRE-VOICE TRIAD AS AN ENACTMENT OF RHETORICAL AGENCY
Get PDFIn First-Year Composition, Teaching for Transfer is an evidence-based pedagogy that teaches students to write across contexts, a goal specified in the WPA Outcomes Statements for First-Year Composition (3.0). However, the implicit relationships shared between Teaching for Transfer, expressivism, and Rhetorical Genre Studies pedagogies are an underexplored area in the teaching of first-year composition. Given the presence of an implicit relationship between transfer, proficiency in rhetorical genres, and student voice in the WPA Outcomes, this thesis defines a dynamic interrelationship between pedagogies of transfer, expressivism, and Rhetorical Genre Studies. In an effort to foreground a comprehensive first-year composition pedagogy that teaches students to transfer writing knowledge across contexts and in the disciplines, this thesis develops the terminology of rhetorical agency to position students as agents of their own learning. As expressed by the transfer-rhetorical genre-voice triad, a pedagogy based in rhetorical agency redefines the expressivist notion of voice to teach students to position their writerly identities amid various rhetorical genres and contexts of writing, a socially situated and evolving communicative practice. Moreover, this thesis uses classroom research from an online first-year composition course to explore whether students can reimagine their voices outside of a purely personal and expressivist context
INOCULANT TO INFLUENCE: CULTIVATING CRITICAL CITIZENSHIP BY FOREGROUNDING ONTOLOGY THROUGH KENNETH BURKE AND WALTER FISHER’S RHETORICAL FRAMEWORKS
Get PDFScholars interested in exploring the potency of the writing modality of critical pedagogy for molding students into proactive citizens will find the integration of Kenneth Burke’s Dramatism and Walter Fisher’s Narrative Paradigm instrumental, offering tools essential for cultivating a rhetorical awareness adept at navigating narratives in the 21st century. Synthesizing Burke’s rhetorical dialectic between the nature of reality and our understanding of it with Fisher’s concept that the human condition is a narrative condition yields insights into the critical writing process. This integration fosters a rhetorical awareness, serving as an inoculant to influence, countering the prevailing persuasive elements within today’s public discourse that empower students to engage with narrative more critically. Furthermore, this thesis situates the roles of writing instructors within a balanced methodology to support cultivating informed student decision-making while avoiding ideological imposition. This thesis reassesses writing instruction as a crucible for critical reflection and engagement in varied professional, public, and private discourse. I posit an alternative view of critical pedagogy as not just a channel for social change through writing but a nuanced engagement at the intersection of personal and social identities with narrative. This thesis promotes rhetorical preparedness over rhetorical assertiveness, presenting a framework for critical citizenship emphasizing rhetorical awareness aligned with Burke’s terministic trivium that language is a reflection, selection, and deflection of reality. Thereby showing that cultivating critical citizenship through these rhetorical frameworks aligns with Kant’s call for enlightenment, underscoring the interplay of rhetoric, narrative, and critical reflection at the intersection of ontology and narrative
Vaginal Preparation in Cesarean Delivery to Decrease Surgical Site Infections: A Benchmark Study
Get PDFThis benchmark project intends to decrease the rate of surgical site infections related to cesarean procedures with vaginal preparation through an evidence-based approach. Vaginal preparation is a simple technique that cleanses the vaginal walls by removing microorganisms. The goal of the benchmark project is to promote the implementation of a vaginal preparation policy across any healthcare facility that performs cesarean procedures. Vaginal preparation is intended for scheduled cases, add-on cases, and urgent cases. The benchmark study does not include emergent cesarean deliveries, as vaginal preparation is at the discretion of the physician in those cases.
The topic of surgical site infections has been around for more than a decade. However, with the increasing number of cesarean deliveries, the rate of surgical site infections is also increasing. Many efforts have been made to decrease the incidence of surgical site infections in cesarean delivery; however, evidence shows that further work is still needed. Improved operating room ventilation, sterilization methods, barriers, surgical techniques, and antimicrobial prophylaxis are advances that have been made to promote infection control (ACOG, 2018). According to Berríos-Torres et al., (2017), approximately half of surgical site infections are deemed preventable using evidence-based strategies
The Effect of Naloxone Access Laws on Fatal Synthetic Opioid Overdose Fatality Rates
Get PDFBackground: Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level. Methods: A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid prescription rate, and capacity for medication for opioid use disorder (MOUD), utilizing a quadratic time trajectory. Data for the study was collected from the National Vital Statistics System using multiple cause-of-death mortality files linked to drug overdose deaths. Results: The presence of an NAL had a significant (univariate P-value = .013; multivariable p-value = .010) negative relationship to fentanyl overdose death rates. Other significant controlling variables were quadratic time (univariate and multivariable P-value \u3c .001), MOUD (univariate P-value \u3c .001; multivariable P-value = .009), and Good Samaritan Law (univariate P-value = .033; multivariable P-value = .018). Conclusion: Naloxone standing orders are strongly related to fatal synthetic opioid overdose reduction. The effect of NALs, MOUD treatment capacity, and Good Samaritan laws all significantly influenced the synthetic opioid overdose death rate. The use of naloxone should be a central part of any state strategy to reduce overdose death rate
APPLICATION OF ARTIFICIAL NEURAL NETWORK (ANN) IN DEVELOPMENT OF PREDICTION MODELS FOR PAVEMENT PERFORMANCE AND MATERIAL PROPERTIES
Get PDFThis dissertation presents the development and application of Artificial Neural Network (ANN)- based prediction models for Dynamic Modulus (E*), Dynamic Shear Modulus (|Gb*|, Phase Angle (b), Soil-Water Characteristics Curve (SWCC) parameters, and International Roughness Index (IRI). The IRI prediction model considering climatic and traffic conditions of Texas with data from the Long-Term Pavement Performance (LTPP) database with R 2 = 0.92 can be utilized by Local transportation agencies. An E* prediction model with three neurons, using 7400 data points obtained from 346 mixtures with R2=0.82 can bypass the need for laboratory tests. ANN-based |Gb*| and b prediction models were also developed with seven neurons and three neurons respectively. Both are independent of each other and perform better than the previous two models. ANN showed promising results in predicting SWCC parameters like af and cf. The models with equations are easier to use. Therefore, these models can be integrated into standard design procedures like MEPDG
Correlates of COVID-19 Vaccine Acceptance and Hesitancy in Rural Communities in Western Kenya
Get PDFVaccine hesitancy is a significant global public health concern. This study sought to determine the correlates of acceptance and hesitancy regarding COVID-19 vaccines in rural populations of selected counties in Western Kenya and assess the strategies that can be used to improve COVID-19 vaccine acceptance in Kenya. The study used a quantitative research strategy with a sample of 806 individuals in the Kisumu, Vihiga, and Kakamega counties. Descriptive statistics, correlations and regression analyses were used. Of the 806 study participants, 55% were males and 45% females. Vaccine acceptance was significantly associated with being a male (AOR: 1.46, 95% CI: 1.24–1.59, p \u3c 0.031), having no formal education (AOR: 2.25, 95% CI: 1.16–4.40, p \u3c 0.02), working in the private sector (AOR: 5.78, 95% CI: 3.28–10.88 p \u3c 0.02), and have low income (KES 0–999 (USD 0–9.16)), (AOR: 2.35, 95% CI: 1.13–3.47, p \u3c 0.02). Conclusions: The current study suggests that male gender, no formal education, working in the private sector, and low income KES 0–999 (USD 0–9.6) are significant factors influencing awareness of and possible acceptance of COVID-19 vaccination
Hibbs Institute Health Index: Examining Health Conditions in the Region (Updated 2023)
Get PDFThe Hibbs Institute for Business and Economic Research, a unit of the Soules College of Business at the University of Texas at Tyler, has developed the Hibbs Institute Health Index (HIHI). The HIHI is a tool that allows comparisons among regions, such as cities, counties, or Metropolitan Statistical Areas (MSAs) via the examination of local health conditions and their health status performance