Environmental and Occupational Health Sciences Institute
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Would a simulation-based education program for perioperative staff increase performance and comfortability during intraoperative cardiac arrest for non-cardiac surgery?
No full textPurpose of Project: The purpose of this project was to assess the effects of simulation-based education surrounding the event of an intraoperative cardiac arrest. The Association of Perioperative Registered Nurses (AORN)’s intraoperative cardiac arrest crisis checklist was modified and utilized to compare the initial simulations to subsequent simulations with the operating room (OR) staff. Our goal was to have more checklist criteria met and quicker response times to interventions on the final day of simulations as compared to the initial day.
Methods: We conducted a quality improvement project utilizing 3 groups per day over 2 simulation-based training days that were 6 weeks apart with the perioperative staff at a large teaching hospital in an urban setting in the Northeast of the United States between January and February of 2024. A total of 47 staff members were present on Simulation Day 1 and 51 were present on Day 2. An analysis of the data comparing times to interventions on the crisis checklist was performed between both simulation days. In total, six cardiac arrest simulations were conducted. A debrief and feedback session was conducted at the end of each simulation day, as well as one final debrief after the results were calculated.
Results: Averages were drawn from all groups on both simulation days, and then were compared. Results are as follows when comparing Day 1 with Day 2. Checklist criteria met: 10 of 13 v. 9.7 of 13. Averaged times to announce crisis: 16s v. 10.7s, call for help and emergency cart: 29s v. 16.3s, float personnel to enter room: 43s v. 47.3s, emergency cart in the room: 55.7s v. 40.3s, first chest compression delivered: 43s v. 16s, defibrillator pads applied: 102s v. 112.7s, first shock delivered: 201.7s v. 167.7s, jet syringe assembled: 153.7s v. 157.7s. Overall times to treatment decreased by 9.42s. Self-reported IOCA comfortability from pre- to post-simulation implementation increased from a 2.8/5 to 4.3/5 on the Likert scale survey assessment.
Implications: Research suggests clinician education and simulation training play a key role in improving outcomes during an in-hospital cardiac arrest. By achieving better outcomes during the final simulation day, the hospital could include emergency simulation scenarios as part of an annual competency to help improve overall performance and comfort during a future, real-life event.
Keywords: “simulation-based education”, “intraoperative cardiac arrest”, “mock code”D.N.P.Includes bibliographical reference
Low flow anesthesia with sevoflurane project evaluation: final paper
No full textPurpose of Project: The advantages of low-flow anesthesia are well established and includedecreased anesthetic waste, costs, and greenhouse gas effects. Villegas and Zarsadias’s (2022) quality improvement project demonstrated the efficacy of provider education, visual reminders, and continuous reinforcement on changing flow rate practices. While their original results demonstrated a significant reduction in FGF rates and hospital cost, the sustainability of their project has not been examined. By performing a program evaluation on the previous quality improvement project, we will be able to strengthen Villegas and Zarsadias’s project, identify what strategies have worked, if any additional training or education is needed, and make plans to continue the improvement project in the future.
Methodology: Using a retrospective study design, fresh gas flow rates were observed between October and November 2023. Fresh gas flow rates were assessed ten minutes after induction in 200 cases that met study inclusion criteria.
Results: A total of 200 cases were observed. The 2023 average FGF with sevoflurane was 2.3 L/min, compared with 1.7 L/min in 2022. Results from a Mann-Whitney U test revealed a statistically significant difference between 2022 and 2023 FGF rates, p=<.001.
Implications for Practice: Opportunity for reduced FGFs exists, but consistent education and reinforcement is recommended to improve adherence to and sustainability of low flow anesthesia.
Key Words: low flow anesthesia, low flow anesthesia sevoflurane, renal, sevoflurane, fresh, gas, flow, anesthesia, education, environment, Compound A, review, retrospective, CIPP framework.D.N.P.Includes bibliographical reference
Antibiotic stewardship in the surgical patient: implementing an evidence-based algorithm to decrease administration of broad-spectrum antibiotics in patients with a documented beta-lactam allergy - a program evaluation
No full textPurpose of Project:
In 2022 an antibiotic stewardship initiative was implemented at a tertiary care medical center in New Jersey to promote the utilization of the validated PEN-FAST tool as a means to evaluate the risk of administering a cephalosporin to a patient reporting a Penicillin allergy. This quality improvement project demonstrated a significant increase in cephalosporin administration over broad spectrum antibiotics after implementation. Upon request of key stakeholders and in congruence with recommendations from the CDC, a program evaluation was performed to assess the long-term impact and sustainability of the initial antibiotic stewardship initiative. Methods:The process evaluation was performed as a retrospective chart review beginning after the completion of the original quality improvement projects data collection and continuing through the following seven months. Data was collected from electronic health records, synthesized, and analyzed to determine the PEN-FAST tool’s long-term use and any areas for improvement. Results:Upon completion of the data analysis, it was determined that utilization of the PEN-FAST tool had gone from near 100% administration to 0% administration after the medical center transitioned to a new electronic health record. Due to the lack of application of the PEN-FAST tool with the new EHR no further data was able to be collected regarding the PEN-FAST tool’s use. Implications:While the initial quality improvement project demonstrated a high compliance with the PEN-FAST tool administration and subsequent administration of cephalosporins to patients with a low risk for cross-sensitivity reaction with their reported Penicillin allergy, the facility was unable to sustain the program following the conversion to a new electronic health record. Unfortunately, with the complete cessation of administering the PEN-FAST tool this process evaluation was unable to determine other areas of possible improvement or delinquency in the initial antibiotic stewardship program. These findings were presented to the key stakeholders at the medical center along with recommendations on ways to reinstitute, improve and sustain an antibiotic stewardship initiative. Key words: PEN-FAST, Antibiotic stewardship, program evaluation, process evaluation, penicillin allergy, beta-lactam allergyD.N.P.Includes bibliographical reference
Program evaluation of an out-of-hospital checklist for rapid sequence intubation
No full textPurpose of the Project: Rapid Sequence Intubation (RSI) is a procedure often performed in the prehospital setting for critically ill patients requiring immediate advanced airway management. An intubation checklist was implemented for prehospital providers to decrease incidences of hypotension, hypoxia, cardiac arrest, and multiple intubation attempts to improve patient outcomes.Methodology: This project is a program evaluation of a quality project that included a retrospective and prospective chart review of all patients intubated using RSI in the prehospital setting over a 6-month period. Data was manually extracted from the electronic health record to determine if the incidence of peri-intubation adverse events decreased following the implementation of an intubation checklist.
Results: This project included data analysis of 30 patient records for the preimplementation period and 30 postimplementation. Post checklist implementation demonstrated a slight increase in rates of hypotension, severe hypoxic events, episodes of cardiac arrest, and failed airway attempts. The changes pre to post were not statistically significant, and the groups were not equal on BMI, with the postchecklist group demonstrating a higher BMI, a factor known to influence successful intubation.
Implications for Practice: While this project did not produce statistically significant results, the data obtained can be used for future evaluation and education. Provider feedback and checklist modification may improve checklist use effectiveness.
Keywords: prehospital, transport, out of hospital, intubation, rapid sequence intubation, peri-intubation, advanced airway management, checklist, bundle, protocol, adverse effects, hypoxia, hypotension, cardiac arrest, first pass success ratesD.N.P.Includes bibliographical reference
Understanding the experiences of women with multiple roles in online social work education programs
No full textWomen’s access and representation in higher education has dramatically increased over the past 50 years, with recent data indicating that women make up 59.5% of all college students, surpassing men in both new applications and recent program completion rates (Belkin, 2021). The number of women studying online has continued to grow over the past few years, with 50% of undergraduate online students and 52% of graduate online students identifying as women (Duffin, 2020). Within the field of social work, graduate social work degree programs report 83.4% of students who identify as women and more than half of accredited programs offer online/hybrid options (Council on Social Work Education, 2023). Many women students who are pursuing education report that they combine student roles with full or part-time employment, and with parenting or other caretaking responsibilities (Cragg et al., 2005; Furst-Bowe, 2002; Home, 1997; Rockinson-Szapkiw et al., 2017; Stone & O’Shea, 2019). This qualitative study aims to understand the lived experiences of women who hold multiple roles (i.e., caretaking, employment, and student) and were enrolled in online graduate level social work education. This study used semi-structured in-depth individual interviews to explore the experiences of women in fully online MSW programs. Forty-eight interviews were completed with participants across nine schools of social work. Thematic analysis was used to analyze the data from the interviews and themes were identified to tell the participants stories, starting with how online education created opportunity for the participants to pursue their degree – that otherwise may not have been possible because of their different roles. Within this discussion themes related to gender were explored, particularly how participants saw their own experiences impacted by gender roles and their identity as women. The study also examined themes connected to how programs support these students, the challenges programs/curriculum created, and how a sense of community is perceived. The findings have important implications for higher education program administrators, including how to better support students in online classrooms, how programmatic supports are provided and made available, how programs consider curriculum and format, and support and training for those teaching online.Ph.D.Includes bibliographical reference
Adsorption of carvacrol from package headspace onto food surface and its impact on antimicrobial activity
No full textThe efficacy of an antimicrobial agent in controlled release packaging (CRP) is influenced by both the headspace concentration of the antimicrobial and its adsorption onto the food surface. However, the mechanistic relationships between antimicrobial efficacy and headspace concentration or adsorption were never fully understood, thereby hindering the optimization of CRP. The overall objective of this study is to elucidate how the efficacy of carvacrol, a prominent antimicrobial agent, in CRP is influenced by its headspace concentration, the concentration on food surface, and the adsorption rate. This information could guide the design and optimization of CRP in future studies. To achieve this goal, the study was conducted in three parts. In the first part of the study, a mechanistic mathematical model was developed to predict the temporal profiles of headspace concentration, surface concentration, and adsorption rate for carvacrol, using the physical principles that govern the movement of carvacrol molecules in a CRP system. The model and its estimated parameter values were validated using three different sets of gas chromatography measurements—this rigorous process confirms the accuracy and reliability of the model. Advancing beyond existing models, our model enhances the understanding of the dynamics between the concentration profile and its interacting processes including evaporation, adsorption, and gas transmission. It provides packaging developers with a superior alternative to the trial-and-error approach to tailor concentration profiles for optimizing antimicrobial efficacy, leading to more efficient and better design of CRP.
In the second part of the study, relationships were investigated between carvacrol’s efficacy against E. coli O157:H7 Sakai on tryptic soy agar and variables predicted by the model, including the headspace concentration of carvacrol, its surface concentration, and the adsorption rate. Through different regression analyses and a dimensional analysis using Buckingham π theorem, a strong positive correlation between the surface concentration of carvacrol and its antimicrobial efficacy was revealed, with a potential decline in efficacy after the surface for adsorption becomes saturated with the antimicrobial. Different from surface concentration, carvacrol’s headspace concentration showed no positive correlation with the antimicrobial efficacy, but it may still indirectly contribute to the antimicrobial activity through modifying the surface concentration.
In the third part of the study, carvacrol’s efficacy against E. coli O157:H7 Sakai on different foods was studied. The selected foods accounted for different surface properties such as hydrophobicity, porosity, and moisture content. The result not only confirmed the positive correlation between carvacrol’s efficacy and surface concentration, but also associated the various efficacy on different surfaces to carvacrol’s mobility after being adsorbed, expressed by freedom level (δ), drawing inspirations from water activity. Reflected by higher δ, free carvacrol on agar and freeze-dried honeydew had more frequent interaction with microorganisms and showed stronger efficacy. Conversely, with lower δ, carvacrol adsorbed onto blueberries was bound to the food matrix and showed weaker efficacy.
Overall, this study used carvacrol to demonstrate that the efficacy of an antimicrobial agent in CRP is regulated by the concentration of the antimicrobial on food surface and its mobility after being adsorbed. Meanwhile, factors like headspace concentration does not directly influence the efficacy but may contribute to the antimicrobial activity through modifying the surface concentration. To design and optimize CRP in future studies, achieving an effective concentration of the antimicrobial on food surface should be the primary focus to ensure effectiveness, and other system parameters can be adjusted accordingly based on the mechanistic model.Ph.D.Includes bibliographical reference
Which groups are the automorphism groups of graphs without choice?
No full textFrucht’s theorem says that “every group is the automorphism group of a graph”.This was proved in ZFC independently in (deGroot 1959) and (Sabidussi 1960). In Chapter 2, we show that an existing proof of Frucht’s theorem can adapted towork in ZF set theory without choice. However, without choice, the argument makes
explicit reference to elements of elements of groups. This is strange, but possible
because of how groups are represented inside ZF set theory. In Chapter 3, we show that this strangeness is necessary by looking at Frucht’stheorem in ZFA set theory; which allows for atoms with no elements. We will give
several models of ZFA set theory where Frucht’s theorem fails. We will also give
several models where Frucht’s theorem holds for non-obvious reasons. We do not have
a complete classification yet, but our techniques seem to decide Frucht’s theorem in
many common permutation models. In Chapter 4, we look at what these ZFA results can tell us about ZF set theory.While Frucht’s theorem cannot fail in ZF, we show that a stronger version can fail.
We also tried, unsuccessfully, to establish some Borel combinatorics results related to
Frucht’s theorem, which we described in Chapter 6. Chapter 5 is essentially independent, and shows that the class of Hopfian countablegroups is a complete co-analytic subset of the standard Borel space of countable
groups.Ph.D.Includes bibliographical reference
Migrant Futures: Waiting, Hope, and Fieldwork in the San Joaquin Valley
No full textCitizenship, bestowed with a mythical quality, does not necessarily transform everyday lives of undocumented migrants. Yet the promise of citizenship often seems worth waiting for and it remains an aspiration where dreams and hopes of the future are projected. Among my undocumented interlocutors, day-to-day desires such as housing, working with dignity, and raising children sustain their hopes despite the struggles of life without papers. This dissertation explores how waiting for citizenship and immigration reform challenges dominant narratives of hope and future-making in everyday life for undocumented migrants across different generations: youth in college without DACA, working DACAmented young adults, and undocumented parents, fieldworkers, and community organizers. The life chances of without DACA, who I refer to as the “Post-DACA generation” is constrained compared young adults who received DACA during the Obama era. The dissertation explores the betrayal experienced by the post-DACA generation, especially those who attended university, the so called American “great equalizer.” In addition, I explore experiences of undocumented mothers and grandmothers, who must balance their domestic life and familial responsibilities with their desire for community activism, as well as the aspirations they impart onto the future generation. Their understanding of life, citizenship and the future in the United States is different than the broader migrant youth population. Based on 18 months of ethnographic fieldwork, I demonstrate the complexity of undocumented life and delineate how to ascribe value to undocumented life without solely reifying trauma, victimhood, and deservingness vis-à-vis resilience. Undocumented migrants aspire, refute, and strategically use the language of moral and legal legibility to further claims their claims for US citizenship. The dissertation considers their “ordinary” aspirations about the future. Building on Berlant’s (2011) Cruel Optimism, I argue that citizenship suspends and catalyzes people’s social actions and self-fashioning. Through ethnographic interviews, participant-observation, and life histories, I analyze the temporal orientations undocumented migrants feel and experience (such as the wait for citizenship, feeling stuck, and ideals of futures) as they live years without papers. The future—whatever that may be for my interlocutors and waiting are primary themes for framing the lived experience, self-embodiment, and narratives of undocumented migrants. I ethnographically demonstrate how undocumented people live as they encounter the realities of waiting and living a life without papers. Hope was often used to describe their aspirations, dreams, and their desires for a good life, despite the fraught tensions and consideration that citizenship may not be the panacea to the structural condition that haunts undocumented life such as detainment, deportation, and uncertainty. My dissertation contributes to the growing body of scholarship on migration and temporality; the different experiences and life chances of undocumented migrants across various generations from youth without DACA, young adults with DACA, and the older parent-grandparent generation; the importance of field work in the Central Valley for sustaining people’s everyday realities, yet not enough to symbolize the “better life” they migrated for. Finally, the dissertation argues against the public perception of migrants as lacking agency or only seen between the divisive poles of criminality and innocence.Ph.D.Includes bibliographical referencesIncludes vit
Integrate learning and reasoning for large language model and recommender systems
No full textIn the current era, recommendation systems has become increasingly integral to our daily lives. Despite the significant advancements in recommendation systems, many models still lack robust reasoning capabilities, which limits their effectiveness and reliability. This research aims to address this gap by enhanciIng the reasoning abilities of recommendation systems to improve their overall performance. Our initial focus was on integrating counterfactual reasoning and logical reasoning abilities into recommendation models. By applying these reasoning techniques, we observed a marked improvement in the performance of recommendation systems, demonstrating the potential of reasoning-enhanced models in practical applications. Building on these findings, we extended our approach to large language models (LLMs). Our experiments showed that incorporating logical reasoning into LLMs significantly enhanced their performance across various benchmarks. Given their extensive use in natural language processing tasks, enhancing the reasoning capabilities of LLMs is particularly crucial. We aimed to improve their text reasoning abilities, ensuring that these models could not only understand but also logically process and respond to complex textual information. However, the rapid development of large language models also brings forth ethical challenges. It is imperative that we do not solely focus on optimizing model performance without addressing potential moral and ethical concerns. Recognizing this, we developed a benchmark to evaluate the moral integrity of LLMs. This benchmark assesses the ethical implications of the models' outputs, ensuring that they align with societal values and norms.Ph.D.Includes bibliographical reference
An empirical comparison of different methods of defining “bicultural” and its relevance to the bicultural identity integration scale
No full textBicultural identity integration (BII) is the degree to which an individual's two cultural identities are harmonized and blended vs. conflicted and compartmentalized and is measured via the Bicultural Identity Integration Scale (BIIS1 or 2). BII is rooted in John W. Berry's bidimensional model of acculturation which describes 4 acculturation strategies/profiles (biculturalism/integration, assimilation, separation, marginalization). Within this research, participants are subdivided into the four strategies based on their responses to self-report measures (e.g., Language use). However, samples recruited to create the BIIS1/2 were drawn from individuals who simply self-identified as bicultural. In this study, I aimed to test whether individuals who self-identify as bicultural are the same as individuals who "score" as bicultural to verify that the BIIS1/2 capture the experience of biculturals identified in earlier acculturation research.I recruited 363 first- and second-generation immigrant individuals of color who completed a set of self-report surveys, one of which asked the participants to self-select into an acculturation strategy/profile. The other surveys captured traditional acculturation domains such as language use. I performed a k-means cluster analysis (k = 4) of this data to quantitatively sort individuals into the 4 acculturation profiles. Analyzing the responses to the scale meant to capture how individuals saw themselves in terms of the profiles yielded mixed results. The scale used for this purpose was of my own design (The Global Assessment of Acculturation Profile, GAAP) and did not work completely as expected. I ended up comparing three different methods. The first relied on responses to a single item in the GAAP that simply asked the participants to pick which profile best fit them. The second method relied on my interpretation of the responses to the rest of the GAAP items and the third method was the cluster analysis of self-report scales just discussed.
The three methods yielded similar results with most of the sample labelled as "bicultural" regardless of method. Furthermore, individuals placed into each profile seemed to represent the correct profile no matter the method used. However, the category labels themselves were not particularly predictive of important outcomes (e.g., depression, anxiety, and BII). Thus, while this study demonstrates the overall validity of the BIIS1/2 as the samples recruited to create these measures likely did represent "biculturals", this study provides less support for the validity of the acculturation profiles themselves contrary to previous research.Ph.D.Includes bibliographical reference