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Right Patient, Right Prescription, Every Time: A Quality Improvement Project for Two-Person Time-Out in Dialysis
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Background: Patients diagnosed with end-stage renal disease (ESRD) receiving in-center hemodialysis (ICHD) three times a week are at risk for unintentional harm from human error when programming dialysis machines. Accurate dialysis is vital for patient safety, improved health outcomes, decreased adverse events and hospitalizations, and lowered healthcare costs. Evidence supports the use of standardized time-out procedures to mitigate medical errors, ensuring the accuracy of the patient and procedure, and this practice is commonly performed before invasive procedures in other clinical settings.
Local Problem: Current policy within a dialysis company states that the licensed nurse will verify the dialysis prescription within the first hour of treatment initiation. A one-hour window poses a risk of 25% or more of a patient’s dialysis being delivered with the wrong prescription. The purpose of this project was to standardize a two-person timeout procedure before each dialysis treatment with the aim of reducing dialysis prescription entry errors by 50%.
Methods: The Model for Improvement (MFI) was the guiding framework for this project. A pre-hemodialysis timeout checklist was implemented utilizing PDSA (plan-do-study-act) cycles and a process map. Error rates were measured pre- and post-implementation; the checklist use rate was measured post-implementation.
Intervention: A two-person timeout procedure was completed before the start of every dialysis treatment, guided by a pre-hemodialysis checklist and process map.
Results: The implementation of the checklist reduced machine set-up errors by 53% across 543 total treatments. Increased checklist compliance resulted in decreased errors.
Conclusion: Implementing a two-person timeout, using a pre-hemodialysis checklist, before initiating dialysis treatments in the ICHD setting resulted in a 53% reduction in machine setup errors, exceeding the project\u27s aim. The integration of a timeout checklist into the electronic medical record (EMR) is recommended to enhance usability and sustainability, thereby improving patient safety and the delivery of adequate dialysis
Low-Cost Optical Surface Measurements for Wire-Arc Additive Manufacturing
Get PDFWith recent expansion and popularity of the Additive Manufacturing (AM) industry, Wire-Arc Additive Manufacturing (WAAM) processes utilize tried and tested welding equipment in conjunction with robotics to create metal parts for a variety of customers and applications. As with many other AM processes, process monitoring and product quality are among the areas with the most sought-after improvements as the manufacturing technology is being deployed. In particular, for WAAM, this can be a difficult task, as the process area, commonly referred to as a weld cell, can be uninhabitable for sensitive and expensive monitoring technology due to the high heat, spatter, and debris that occur during welding. Because of this, it is difficult to detect defects during the manufacturing of parts. Due to the high input energy process of welding, many heating and cooling cycles between layers of material can result in heat-induced stress within the part. This can cause morphological warping that results in a nonconforming part, which costs manufacturing partners time and money. The ability to detect these defects within a weld cell with equipment that is economically suitable for the hazardous environment can speed up manufacturing and result in fewer defect parts. The research described in this work seeks to develop and demonstrate a cost-effective solution to obtain morphological data from within a weld cell using a commercially available stereo depth camera integrated with code to capture and process the data. One key feature of the process described in this work is that it leverages the robotics already used for the WAAM process to produce higher quality results faster than other common methods
From Coal to Cops: Examining the Transformation of Union Solidarity into Policing in Appalachian Communities
No full textThis paper explores social solidarity and brotherhood modification in rural Appalachian communities, outlining its shift from coal mining unions to modern policing structures. Historically, coal mining has been paramount to Appalachian identity as an industry and a source of regional pride among miners and residents. Through unionization, particularly in the mid-20th century, coal miners were able to collectively struggle and provide mutual support through their shared labor under exploitative mining corporations and hazardous working conditions. The decline of coal extraction in the Appalachian region during the late 20th century through the 21st century has resulted in both economic hardship and a general lack of union presence. Amid this economic and social restructuring, the author investigates how the concept of coal-centric brotherhood has transitioned into local policing. Building on insights from critical carceral scholars and critical policing scholars, the paper historically and visually dissects how the brotherhood ethos has been recontextualized within Appalachian police forces. This analysis illuminates the shifting identity of the Appalachian working class and offers insight into how regional cultures reshape and redeploy core values in response to economic and social transformations
Narratives of Fear and Resistance: LGBTQ+ Visibility and Media Power in Contemporary America
No full textThis thesis explores the relationship between fear, media narratives, and the representation of LGBTQ+ communities in American society. Utilizing theory and qualitative content analysis, the study examines how mainstream media outlets, specifically Fox News’s The Five and CNN’s The Lead with Jake Tapper, frame LGBTQ+ issues during two significant periods: the aftermath of the 2015 Obergefell v. Hodges decision and the lead-up to the 2024 U.S. presidential election. The research identifies distinct framing strategies employed by these outlets, highlighting how fear-based discourses are constructed, transmitted, and contested. Fox News\u27s coverage often presents LGBTQ+ advancements as cultural threats or political manipulations, whereas CNN’s reporting tends to frame these issues within civil rights and normalization narratives. The thesis also investigates the role of fear in shaping public perceptions and social hierarchies, discussing the broader implications of media framing on policy debates and societal attitudes. By analyzing language and emotional appeals, the study contributes to understanding the mechanisms through which fear influences political discourse and marginalized communities\u27 representation. The findings offer insights into media’s role in both reinforcing and challenging social inequalities, providing a foundation for further research and critical engagement with media narratives surrounding LGBTQ+ issues
INVESTIGATION AND OPTIMIZATION OF INTERPLANATARY TRAJECTORIES TO TRANS-NEPTUNIAN OBJECTS
No full textThe outer reaches of the Solar System have great potential for scientific discovery. Unfortunately, visiting celestial bodies beyond Neptune, or trans-Neptunian objects, require lengthy mission durations with limited payload capacity. These missions are also costly due to the large infrastructure, manpower, and time required to plan and execute them. This thesis summarizes, analyzes, and discusses 14 years of research on interplanetary trajectories to trans-Neptunian objects completed by The University of Tennessee to discover methods of decreasing transit time and increasing payload mass. Additional research was then completed to investigate and expand upon these discoveries and optimize various aspects of the trajectories. There is a gap in the research done by The University of Tennessee pertaining to delta-VEGA maneuvers for orbiters and other complex inner planet trajectories to increase mass on target which were not investigated in this thesis but are important topics. The summary revealed areas which could be optimized including powered/unpowered Jupiter gravity assists, two-stage capture burns, and dual-target missions. The pass distance for Jupiter flybys was found to have a substantial impact on transit times. Lower Jupiter periapsis flyby distances decrease transit times, and/or the required delta-v for powered flybys, but increase the amount of radiation experienced by the spacecraft. The propellant mass for each stage of a two-stage burn is dependent on the size of the burn and initial mass before the burn. A technique to optimize a two-stage burn is proposed which would increase the arrival mass for lander and orbiter missions. A dual-target mission architecture with a single launch vehicle is devised and optimized which couples two trajectories by their powered Jupiter flyby delta-v to find the minimum sum transit time to both targets. A mass calculation method deemed “mission mass fraction” was also proposed allowing missions to be evaluated for a range of potential launch vehicles quickly
Untangling the Mystery of the Barrens: Long-Term Fire Records from Tennessee and Missouri, U.S.A.
No full textUnique barrens ecosystems with open canopies and diverse herbaceous plant species were once more widespread in certain areas of the eastern United States. Today these barrens require disturbances such as fire to maintain open habitat for the array of plant and animal life they support. But how long has fire played a role in shaping these systems? From study sites of Westall Swamp, in the historic Barrens area of middle Tennessee, and Cupola Pond, located near barrens in southeastern Missouri, long-term fire records were created to investigate the timescales over which fire has played a role in these landscapes. Macroscopic and microscopic charcoal records were created for Westall Swamp from a sediment core recovered in 2023, and a microscopic charcoal record was created for Cupola Pond using pollen slides originally prepared for a 1984 thesis on vegetation change by University of Tennessee student Everett Smith, Jr., based on a core recovered in 1983.
Records from both sites preserve evidence of fire in the earliest sediments analyzed, which dated to ca. 26,000 cal yr BP at Westall Swamp and 18,000 cal yr BP at Cupola Pond. Macroscopic charcoal concentrations and influx at Westall Swamp declined to very low values between ca. 20,000 cal yr BP and 8000 cal yr BP, except for a spike around 12,500 cal yr BP, before increasing dramatically after 3000 cal yr BP and again after ca. 1000 cal yr BP. Microscopic charcoal at Westall Swamp, examined at lower resolution, showed less variation, but concentration and influx values also peaked in the last ca. 1000 years. At Cupola Pond, microscopic charcoal influx and charcoal:pollen ratios both declined sharply at 15,000 cal yr BP, followed by small peaks in the record at 11,000 and ca. 7000 cal yr BP. Charcoal concentrations also peaked at ca. 7000 cal yr BP, in line with grass pollen percentages in the core as determined by Smith, suggesting that increased fire could be tied to a more open habitat with abundant grass
RESPONDING TO WAVES OF CHANGE : HOW HIGHER EDUCATION LEADERS ARE ADJUSTING THEIR COMMUNICATION AMIDST A SHIFTING SOCIAL, CULTURAL, AND POLITICAL LANDSCAPE IN THE SOUTH
No full textThe purpose of this study is to examine the ways in which individuals working in diversity, equity, and inclusion roles at higher education institutions communicate about their work within their current social, cultural, and political context. To explore how higher education-based diversity leaders communicate about their work, the study used a qualitative approach. In-depth semi-structured interviews were conducted with 13 diversity leaders at 4-year colleges and universities, in the Southern region of the United States. Leaders from this institutional type were selected due to the prevalence of diversity offices present and this region having a high concentration of state level policies and legislation centered on diversity. The findings from this study elevate awareness of the impact of external and internal factors that contribute to the ways that diversity leaders at universities communicate about issues. The study also examines contextual factors such as political dynamics, the positionality of the diversity leader, and variance among types of diversity roles and institutional types. Multiple Goals Approach and Co-Cultural Theory are models that help to provide insight on how diversity leaders navigate their roles and responsibilities in the current context. Standpoint Theory and Social Identity Theory are additional theories relevant to the study (Allen, 1998; Hogg et al., 2004; Lapinski & Orbe, 2007). These theories are examined and expanded upon. The study explores how diversity leaders frame their work, the communicative practices they engage in, and their goals, as they try to foster a culture of equity, diversity, and inclusion for their respective institutions. Six themes were produced from the data. More broadly, this study contributes to understanding the complexities of institutional leaders communicating about their work in the Southern region of the United States
MULTI-SCALE CHARACTERIZATION OF GLASS SURFACE MODIFICATION IN STRUCTURAL SHEET MOLDING COMPOUNDS
No full textThree commercially available glass fiber sizings for a given sheet molding compound (SMC) formulation using vinyl-ester and unsaturated polyester resin were compared mechanically and thermodynamically through multiple length-scales on the premise that the chemical sizing packages are different and the fiber it’s coated on is the same. Goals of this work include assessing the process-property relationship of SMC and the structural performance related to differences in processing resulting from the different chemical sizing treatments on fiber reinforcement throughout compounding and molding. Spiral flow compression molding indicated no noticeable differences in flow length resulting from sizing. One of the sizing treatments did show signs of incompatibility with the SMC formulation as 1/3rd of the panels contained blister defects. Quantitative comparison of charge wetting and sheet density resulting from sizing treatment indicated blister defects to be the result of entrapped gas during compression molding. A range of mechanical characterizations were performed including single fiber tension, in-situ single fiber interfacial shear strength (IFSS) of the fiber-matrix interface via push-out, and complete quasi-static characterization of macro-mechanical bulk composite panels. Analysis of variance indicated significant differences at the micromechanical fiber-matrix interface, but no significant differences in strength or modulus of composite properties. Post-hoc testing indicated that sources of variances stemming from localized fiber volume and orientation in molded panels of each glass fiber type were much greater than variance induced by the 17 % – 20 % difference in IFSS between sizings. Surface free energy of sized multi-end rovings measured via inverse gas chromatography correlated with IFSS and the presence of blisters suggesting adhesion being important to processing and properties. Meso-scale tow tension tests were performed on unidirectional multi-end rovings infused with resin containing varied amounts of calcium carbonate to determine how thermodynamic adhesion changes for each sizing when varying the SMC formulation. Tensile strength and modulus of the tow samples prepared from each sizing showed difference and the improvement of properties with addition of calcium carbonate was observed and correlated with surface energy. Continuum mechanics and process model material cards were generalized and validated using Moldex3D and micromechanics modeling to describe this material system
Examining Barriers to Eating Disorder Care for Individuals with Binge Eating Disorder Symptoms and the Specific Role of Beliefs
No full textThis dissertation examines barriers to eating disorder (ED) treatment for individuals with binge eating disorder (BED) symptoms through three interrelated studies. Study #1, a systematic review of the literature, identifies factors related to not receiving ED treatment for individuals with BED symptoms at various socioecological/systemic levels. Study #2, an online quantitative survey, uses binary logistic regression and moderation analysis to examine the relationship between having BED symptoms and delaying mental healthcare due to a fear-based belief of experiencing weight discrimination, and the association that body size/shape, through body mass index (BMI), has on this relationship. Study #3, an online qualitative questionnaire, employs content analysis to understand the thoughts and beliefs individuals with BED symptoms have surrounding BED and care that influences accessing professional ED-related treatment. The studies in this dissertation highlight specific barriers experienced by individuals with BED symptoms, with specific attention to individual level cognitions, including beliefs as limiting accessing care
Large-Scale Interoperable Modeling and Simulation of Electric Power Systems
No full textThe increasing complexity of modern power systems, driven by emerging grid technologies and high renewable energy penetration, necessitates advanced computational methods for simulation, scheduling, and stability assessment. This dissertation develops a series of modeling frameworks and computational tools to enhance the interoperability, scalability, and efficiency of power system studies.
First, an upgraded Large-Scale Testbed (LTB) with an integrated market simulator is introduced to facilitate the interoperation between scheduling and transient stability assessment. Inspired by movable type printing, LTB adopts a modular, function-based design that enables a What You See Is What You Get modeling approach, reducing development effort while enhancing adaptability.
Second, a dynamics-incorporated scheduling framework is proposed to bridge the gap between steady-state generation scheduling and transient stability analysis. This framework enables extensible, scalable, and interoperable scheduling under high renewable penetration by integrating dynamics into optimization formulations.
Third, a charging-time-constrained control strategy for electric vehicle (EV) aggregation in secondary frequency regulation is developed using a state-space modeling approach. The proposed method ensures reliable frequency response while respecting EV charging constraints, balancing system stability with the preferences of EV owners.
Finally, a hosting capacity analysis of California’s power grid quantifies the limitations of renewable energy integration. The study highlights that hosting capacity is primarily constrained by grid infrastructure, demonstrates the potential of dynamic line rating in alleviating these constraints, and identifies significant disparities in hosting capacity between energy-disadvantaged communities (EDC) and non-EDC.
Collectively, this dissertation advances interoperability in power system modeling and simulation by providing open, extensible frameworks that support cross-domain, large-scale analysis