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Improving The Human Papillomavirus Vaccination Rate in Adolescents in a Rural Pediatric Primary Care Clinic: A Quality Improvement Project
No full textImproving The Human Papillomavirus Vaccination Rate in Adolescents in a Rural Pediatric Primary Care Clinic: A Quality Improvement Project
BACKGROUND: Human papillomavirus (HPV) is a known infection that causes cancers and other health issues years after the initial exposure. Adolescents can receive a vaccine to help prevent these serious health problems. However, the percentage of adolescents receiving the vaccine remains low.
LOCAL PROBLEM: In a busy rural pediatric primary care clinic in East Tennessee, observations revealed a significant knowledge gap among the clinical staff regarding HPV and the HPV vaccine. The observation also showed that the clinic conducts numerous recall programs for several common medical concerns. The purpose of this project was to improve staff knowledge and increase vaccination completion rates.
METHODS: The Model for Improvement will help the project team implement this project. It helped keep the project focused during the implementation of the two interventions.
INTERVENTIONS: The interventions included an educational in-service for clinical staff, during which they completed a pre- and post-questionnaire, as well as a reminder program for patients at the clinic who were due for a second dose of the vaccine.
RESULTS: The project successfully achieved its main goals of increasing clinical staff members\u27 knowledge about HPV and the vaccine, as well as boosting HPV vaccination rates in the clinic. A statistically significant difference was observed between the pre- and post-questionnaire scores (p \u3c 0.001). The data showed a 6.8% increase in the HPV vaccination completion rate.
CONCLUSIONS: This project successfully implemented clinical staff education and a reminder program for the HPV vaccine in a pediatric primary care clinic. Future initiatives should include regular chart audits to identify the percentage of patients needing an HPV vaccine dose, ongoing educational sessions for staff, and a sustained reminder program. Continuing this evidence-based approach could increase the overall HPV vaccination rate in the clinic, which is essential for the health of the adolescents serve
ECOHYDRAULIC MODELING: DEVELOPING A PHABSIM MODULE FOR HEC-RAS 2D
Get PDFUrban streams are susceptible to declining water quality and rapid geomorphic changes degrading physical habitat. Stream restoration goals are to rehabilitate stream health closer to natural conditions though common restoration practices generally lack consideration of biological integrity. An increasingly popular solution to this issue is the use of ecohydraulic modeling. This process typically involves 2D hydraulic modeling integrating Habitat Suitability Criteria (HSC) for target aquatic species among different flow stages to assess habitat suitability for existing and proposed restoration conditions. Habitat suitability is quantified by applying a PHABSIM modeling approach, based on species preferences for stream velocity, water depth, and bed substrate where model output is a composite Weighted Usable Area (WUA). Currently available freeware, River2D, performs 2D hydraulic modeling and computation of WUA. However, the engineering standard for 2D hydraulic modeling is the HEC-RAS model which lacks PHABSIM capabilities. The objective of this research project was to develop a modeling routine for HEC-RAS 2D that incorporates the PHABSIM capability. To accomplish this objective, a reach of Beaver Creek near Knoxville, Tennessee at low flow and bankfull conditions was modeled using HEC-RAS 2D to obtain velocity and depth outputs per mesh cell. Additionally, substrate data was included by importing a substrate raster into HEC-RAS, and HSC data for three fish species with different habitat preferences was utilized. To calculate WUA, RASter Calculator was used to create a function that multiplies the surface area of each mesh cell by its corresponding composite suitability value, producing a WUA per cell output raster. Outputs were summed to a total WUA for the entire reach. Results were then compared to composite suitability and WUA results from a River2D model developed for the same channel segment by Schwartz et al. (2015). The composite suitability maps for HEC-RAS corresponded well to fish habitat preferences during both high and low flow. Composite suitability differed slightly between HEC-RAS 2D and River2D, which may be attributed to different velocity patterns across the channel segment between model outputs as well as a difference in substrate classification during model development. Overall, a PHABSIM module can be feasibly implemented into HEC-RAS 2D
The Dynamics of Goal-Directed Visual-Manual Coordination to Multiple Feature Objects: An Embodiment Perspective
No full textEmbodied cognition posits that cognitive processes are deeply intertwined with bodily experiences and interactions with the environment. It is not known how visual-manual coordination (visual: Initial Attention/Sustained Attention and Manual: action planning/selection/execution) changes dynamically across planning and executing goal-directed behaviors to objects with multiple features. Therefore, this study attempts to answer questions regarding how visual attention responds to objects with multiple features, how manual reaching influences the visual selection of object properties, and what changes occur in visual-manual coordination before and during reaching. An embodiment perspective is used to explain the role of goal-directed actions on the perception of multiple feature objects resulting in visual-manual coordination. From an embodiment perspective, I suggest that pre-selection of the hand facilitates more efficient goal-directed coordination than visual attention or object-feature-saliency alone. I further suggest that the role of object features is to facilitate more efficient and sophisticated visual-manual coordination, but only when the object features are aligned spatially with the intended motor command. Moreover, from an embodiment perspective, I suggest that shifts in visual attention from action planning to execution are spatially and temporally contingent on the sensorimotor/proprioceptive aspects that are relevant to the goal of the task.
We explore the dynamic interplay between perception and action by having 18 right-handed adults (9 Females, 9 Males) participate in a series of 36 looking and reaching trials involving objects with various features, including shape, asymmetry, details (stickers), and spatial incongruence. Visual fixations were collected using remote eye-tracking.
This study\u27s relevance lies in its contribution to the growing body of research on embodied cognition, providing valuable insights into how the human mind and body collaboratively adapt to the complexities of the surrounding environment. Understanding the mechanisms underlying visual-manual coordination has implications for various fields, including neuroscience, psychology, human-computer interaction, and rehabilitation sciences. By unraveling the intricacies of embodied cognitive processes, this research enhances our knowledge of human agency, paving the way for applications in fields where precise coordination suggests efficient goal-directed behaviors
Material Recovery and Evaluation of Recycled Disassembled Automotive Plastic Components: Enabling the Automotive Circular Economy
No full textAs the automotive industry increasingly relies on plastic components to meet fuel efficiency and emissions targets, the challenge of managing end-of-life vehicle (ELV) plastics continues to grow. Currently, more than 80% of ELV plastics in the U.S. are landfilled due to limited economic incentives and technical barriers to recycling. This study examines a mechanical recycling pathway for thermoplastic components disassembled from End-of-Life Vehicles (ELVs) and assesses their usability for reintegration into new vehicle parts. Four representative materials were chosen based on material labels embedded in recovered parts and aligned with their virgin industrial equivalents: polypropylene (PP), 10% talc-filled PP (PP-T10), 20% talc-filled PP (PP-T20), and a 20% glass/mineral-filled polyamide (PA6+GF7+MF13). The materials underwent shredding, drying, and injection molding before being characterized by particle size analysis, density measurement, thermal analysis (TGA, DSC), mechanical testing, and heat deflection temperature (HDT) evaluation. Results indicate that while minor changes in density and crystallinity occurred, mechanical properties such as Young’s Modulus and ultimate tensile strength (UTS) remained largely within functional ranges for automotive applications, particularly for filled PP and PA6 samples. These findings suggest that mechanically recycled, disassembled ELV plastics can retain sufficient structural performance to support circularity efforts in the automotive sector
Surface Modification of Carbonaceous Materials Toward Direct Air Capture of Carbon Dioxide
No full textDirect air capture (DAC) of CO2 [carbon dioxide] is a promising solution for reducing the carbon footprint through negative emission technology. However, the low CO2 concentration and the dynamic nature of DAC processes present challenges in designing effective sorbent systems. Recent advancements in material design and structural engineering have led to the development of high-performance solid sorbents, offering a more stable, safe, and energy-efficient alternative to traditional liquid CO2 capture methods. This thesis covers design principles, synthesis methodologies, and their impact on CO2 chemisorption, comparing the advantages and limitations of each approach. Characterization techniques, especially operando methods and computational tools to understand sorbent behavior during CO2 integration and release. The reaction pathways and interaction mechanisms of these sorbents with CO2 are analyzed to guide future design. Additionally, the CO2 chemisorption behaviors, including capacity, sorption kinetics, recyclability, and durability in the presence of gaseous impurities and under humid conditions will be evaluated and compared. The superbase ionic liquids (ILs)-modified carbon substrates were developed towards DAC of CO2 by harnessing the strong CO2 binding capability of IL and the ordered porous channels provided by the carbon supports. Detailed porosity analysis revealed that the IL with aromatic cation and oxygenate anion preferred to fill the micropores, and a thin layer was created on the surface of the mesopores. Strong π-π interaction between the IL layer and the carbon surface was disclosed by wide-angle X-ray scattering (WAXS) analysis, leading to enhanced thermal stability of the IL phase. With the same lL coating amount, the DAC of CO2 evaluation revealed that larger mesopore size and pore volume in the carbon/IL composite materials led to higher CO2 uptake capacity by exposing more active sites to integrate CO2 from diluted sources. The thermodynamic analysis confirmed the critical role of IL coating in providing strong chemisorption sites and significantly improved selectivity to enrich the diluted CO2 from the air atmosphere
Initiating Early Palliative Care in the ICU: Integrating Critical and Supportive Care for a Unified Approach
No full textBackground: Adults are at the highest risk for chronic and serious illnesses that often result in intensive care unit (ICU) admissions. These individuals typically live with these conditions for the remainder of their lives. While curative treatments may not exist, palliative care offers a viable option to improve quality of life and potentially increase longevity. Early palliative care involvement—within 24 hours of ICU admission and during daily rounds—may enhance patient outcomes. The need for these services continues to rise with the aging population and increasing prevalence of non-communicable diseases.
Local Problem: Standardized palliative care screening within 24 hours of ICU admission is not routine practice. As a result, ICU patients and their caregivers often experience unmet and unrecognized needs during hospitalization.
Methods: The Model for Improvement (MFI) guided this Doctor of Nursing Practice (DNP) project. The Supportive and Palliative Care Indicators Tool (SPICT) was implemented using Plan-Do-Study-Act (PDSA) cycles to identify palliative needs within 24 hours of ICU admission. Pre- and post-implementation palliative care referral rates were compared, and Registered Nurse (RN) compliance with screening was measured.
Interventions: All ICU patients were screened for palliative needs within 24 hours of admission by the admitting RN. Patients who screened positive received an automatic referral to palliative care, eliminating provider discretion. Negative screenings prompted continued daily screenings until ICU discharge.
Results: Palliative Care referrals increased by 200%, from 20% to 60%, following implementation of the SPICT screening tool. RN screening adherence reached 90%, contributing to the rise in referrals.
Conclusion: Eliminating provider discretion and implementing a standardized screening tool led to a 200% increase in palliative care referrals, exceeding the project’s goal. This highlights the clinical impact of a structured palliative screening in the ICU. Integrating the SPICT tool into the electronic medical record (EMR) is recommended to enhance usability and ensure long-term sustainability in critical care settings
Transforming Care: A Gender-Affirming Care Simulation Study
No full textTransgender and gender non-conforming (TGNC) individuals experience significant health disparities, often stemming from bias, stigma, and a lack of provider education regarding gender-affirming care. Despite growing societal awareness, nursing curricula continue to under-prepare students to provide culturally congruent, gender-affirming care. This dissertation, presented in manuscript format, explores a pilot study integrating simulation-based education including TGNC standardized patients to improve nursing student attitudes and beliefs toward TGNC individuals.
Chapter 1 introduces the problem, highlighting the specific gap in nursing education, which is the lack of TGNC-focused content, and the urgent need to address disparities in care for TGNC individuals. Chapter 2 presents an integrative review of the literature, revealing both the lack of TGNC-focused content in baccalaureate nursing programs and the effectiveness of simulation as an educational intervention. Chapter 3 provides an analysis of Rivera’s Gender-Affirming Nursing Care (GANC) model, a prescriptive middle-range theory grounded in cultural humility, therapeutic relationships, and inclusive engagement. This framework guided the development and implementation of the simulation.
Chapter 4 describes the findings of a mixed-methods study involving thirteen nursing students who participated in a gender-affirming simulation. Quantitative data were collected using the Transgender Attitudes and Beliefs Scale (TABS) before and after the simulation. Results indicated statistically significant improvements in interpersonal comfort and sex/gender beliefs. Qualitative analysis of focus group debriefings revealed four key themes: increased comfort and confidence, power of authentic representation, enhanced empathy through lived experience, and commitment to inclusive and respectful practice. Students consistently emphasized how working with TGNC-standardized patients enhanced realism, empathy, and their commitment to inclusive care.
Chapter 5 concludes by synthesizing the study’s contributions to nursing education, theory, and practice. The findings support including TGNC standardized patients in simulation to promote affirming care, deepen students’ reflections, and prepare future nurses to meet the needs of diverse populations. This work advances equitable, patient-centered nursing education and calls for broader implementation of inclusive simulation experiences grounded in relational and reflective frameworks