Environmental and Occupational Health Sciences Institute
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Driver: poems
No full textDriver is a collection of mostly prose poems, which chart an unnamed speaker's impulsive roadtrips across the country.M.A
Multi-analytical approach for the characterization of art materials used in Ben Wilson's haiku
No full textSince prehistoric times, paints have been used for decorative and practical purposes. In the twentieth century, the paint industry altered manufacturing techniques to improve household, industrial, and artistic uses. These changes have led to a variety of new pigments, additives, and binding components. In addition, some of these pigments are synthetic and they make analysis of paints used in artwork even more challenging. These complex mixtures have the potential to deteriorate over time and the integrity of the artwork, both visual and physical, is jeopardized. The characterization of these materials is essential for art conservation and restoration. Ben Wilson (1913-2001) was a talented contemporary artist born in Philadelphia, Pennsylvania who is known for his vibrant, dynamic abstract paintings. A painting entitled Haiku from Ben Wilson’s Haiku series resides in the Rutgers Camden Collection of Art (RCCA) on Rutgers University’s Camden campus. Haiku was analyzed using micro-invasive and non-invasive techniques including Raman, external reflection Fourier transform infrared (ER-FTIR) spectroscopy, and X-ray fluorescence (XRF). This multi-analytical approach allowed for a detailed analysis of the composition of Haiku by Ben Wilson. The detection of art materials including calcite, vermillion, and ultramarine were supported by results across methods. In addition, FTIR analysis provided spectra indicative of poly(vinyl acetate) (PVA), a common binder for interior house paints.M.S.Includes bibliographical reference
Power to thrive: exploring the effects of personal agency on well-being and community engagement
No full textPersonal agency, one’s capacity to enact control over one’s life through the self-determination and pursuit of goals, is a fundamental mechanism through which the social world is constructed and navigated and is a phenomenon of particular importance for the study of subjective well-being and the Capabilities Approach to development. However, despite its importance for the social sciences, personal agency is often under-operationalized in scholarship, limiting our ability to understand how the concept interacts with other individual and social characteristics and outcomes. This study takes several steps to build on existing research to clarify and refine the concept of personal agency and probe its relationships with other material and psychosocial phenomena. First, relevant scholarship is reviewed to identify the essential characteristics of personal agency and situate it within the broader concept of human agency. Next, a multifactor General Personal Agency Scale (GPAS) is developed and validated using waves II and III of the Midlife in the United States (MIDUS) dataset. The GPAS is then used to test the relationships between personal agency and its subfactors, well-being indicators, social attitudes and behaviors, and potential predictors of personal agency. Findings indicate that the GPAS is a reliable construct for measuring personal agency, and that, with some exceptions, personal agency and its subfactors predict a variety of outcomes related to well-being and social participation. Analyses also demonstrate that personal agency variables are predicted by personality and goal-oriented traits like one’s sense of purpose, personal mastery, commitment to personal growth, optimism, and lower stress reactivity. The implications of findings for the study of well-being, the practice of community development, and other fields interested in empowerment and human flourishing are discussed, as are limitations to the present study, and recommendations regarding future directions for research on personal and human agency are provided.Ph.D.Includes bibliographical reference
Correlates of pre-exposure prophylaxis (PrEP) use among Black women
No full textBackground: Black women have disproportionate rates of HIV infection and low rates of PrEP uptake. Using the situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM) model, this study examined factors predicting PrEP willingness among Black women (i.e., knowledge, attitudes towards PrEP and perceived HIV risk).
Hypotheses: The hypotheses tested included: 1) There is a positive correlation between PrEP knowledge, attitude towards PrEP, perception of HIV risk, demographic factors, and willingness to use PrEP among Black women; 2) High perception of HIV risk is significantly associated with willingness to use PrEP; 3) PrEP knowledge, PrEP attitudes, HIV risk perception, and demographic factors are independent predictors of willingness to use PrEP.
Methods: Using a cross-sectional Qualtrics survey, the study collected data from 193 PrEP-eligible Black women seen in an urban primary care practice. The IMB Model for PrEP Use Scale was used to measure PrEP knowledge, PrEP attitudes, and PrEP intentions. The Perception Risk Scale was used to measure perception of HIV risk. The demographic questionnaire was used to collect the participant characteristics.
Results: Willingness to use PrEP was high (93%) despite limited PrEP knowledge and low perceptions of HIV risk. In multivariate models, marital status was the only significant predictor of willingness to use PrEP, with widowed women most willing (M = 10.53, range: 3-12) and separated women least willing (M = 7.89).
Conclusion: This study addressed the knowledge gap regarding PrEP use among Black women. Findings suggest high interest in PrEP; however, the study was limited to women living in an area with high HIV prevalence. Future research should test the sIMB-CIM model in other settings and populations of Black women. Qualitative research should examine the reasons for the study’s findings to develop more effective outreach campaigns targeting women (i.e., to improve understanding of HIV risk factors and PrEP) and clinicians (i.e., to increase PrEP prescriptions). Longitudinal designs are also necessary to evaluate whether willingness leads to actual PrEP uptake.Ph.D.Includes bibliographical reference
The effects of a pilot virtual simulation intervention on critical thinking and clinical judgment abilities in Associate-degree nursing students
No full textNursing educators are challenged to find strategies that will develop critical thinking and clinical judgment abilities in students. As technology has advanced, the use of virtual simulation platforms has increased in use in nursing courses. This study examined the effect of a pilot virtual simulation intervention on critical thinking and clinical judgment abilities in Associate Degree Nursing students. A convenience sample of thirteen students from a community college in Northern New Jersey participated in this pre-test, post-test study. The increase in critical thinking and clinical judgment test scores were not statistically significant, yet there was a noted increase in group mean and several individual scores. No noted correlation was observed in the critical thinking and clinical judgment test scores post virtual simulation cases. Age, gender, ethnicity, and prior experience in healthcare were not significant predictors of critical thinking and clinical judgment abilities post virtual simulation cases. The increase in mean and individual test scores showed promise for feasibility for testing this intervention on a larger scale. As virtual simulation is being used more in nursing education, additional research is warranted to examine the impact of this teaching strategy on critical thinking and clinical judgment abilities.Ph.D.Includes bibliographical reference
Centering the voices of graduates to shape self-advocacy in special education transition programs: a qualitative study
No full textAdults with disabilities are more likely than their non-disabled peers to struggle with self-advocacy after graduating from school, as they are less likely to have the skills or knowledge necessary to communicate their needs, access services, or exercise their rights in communities and workplaces. Special Education transition programs are accountable for delivering quality transition services, including self-advocacy instruction, but current research and practice are very narrow, privilege the perspectives of professionals, and have no measure of the effects of interventions over time, leaving self-advocacy outcomes in adulthood under-researched and under-theorized. Specifically, a dearth of literature that centers the voices of graduates as a critical resource to understand what self-advocacy skills and knowledge are most relevant for graduates after they leave high school exists.In the current study, I used a qualitative phenomenological approach to answer the following research questions: (1) What are the self-advocacy challenges graduates experience after leaving school, and do they report being prepared to meet those challenges? (2) What self-advocacy skills or information did graduates report needing during self-advocacy challenges? (3) How did graduates report they learned the skills or information needed during these challenges? (4) What self-advocacy skills or information did graduates believe is most important to learn?
Results revealed themes and subthemes related to the self-advocacy challenges of participants in adulthood. The challenges highlighted the Realities of Living with a Disability (Theme 1) and the Emotional Burden (Theme 2) experienced during self-advocacy. Participants shared they felt Unprepared to Advocate (Theme 3) when they graduated from high school.
Participants reported how they addressed self-advocacy challenges by demonstrating Strong Self-Awareness (Theme 4), communicating in ways that Make Others Take Me Seriously (Theme 5), and Building a Strong Support System (Theme 6). Further, participants shared that becoming better self-advocates required Many Modes of Learning (Theme 7) and Stepping Into Leadership Roles (Theme 8), both being formative ways participants learned how to advocate for themselves and others. Space to Fail, Try, and Grow (Theme 9) were also common attributions needed to evolve as a self-advocate.
Lastly, all of the participants shared what they would have wanted in school for themselves and made recommendations for Transition Programs that were directly informed by their lived experience. The results can inform future Special Education researchers, administrators, and teachers of Transition Programs that the lived experiences shared by adults with disabilities are the keystone to build around to create effective and relevant self-advocacy instruction in schools.Ed.D.Includes bibliographical reference
Ways of seeing: design-based research in a class on the social aspects of design
No full textThe purpose of this research is to investigate learning processes in a landscape architecture course designed to help students assess the environment we live in more critically --to realize that people use space in different ways and to become aware that different environments can either support or undermine how people use space (Anderson, 2015; Criado-Perez, 2020; Lynch, 1981; Mitchell & Breitbach, 2011; Sommer, 1969; Soja, 2009). A course called The Social and Cultural Aspects of Design was created to facilitate understanding of what makes a space inclusive. Because much research on social justice learning concerns overall student experience rather than focusing on how students learned, this study asked how students describe their social justice learning in this course, focusing on effective design principles. Five design principles linked educational theory to course design. These concern the impact of structured critical reflection upon development of self-awareness, use of rational discourse to support perspective sharing, use of a disruptive experience to dismantle normal ways of seeing and taking action to make space more inclusive.
Using design-based research (Sandoval, 2004, 2014), I systematically explored how these design principles were related to student learning. This study tracked how five students learned to “see” spatial exclusion in a campus space. Student learning is explained in their own words. Course artifacts and activities (including student focus groups) and post-semester student interviews were coded according to five social justice themes (self-awareness, appreciating difference, understanding power, sensitivity to belonging, and taking action) and analyzed using the constant comparative method. Results provided support for all five design principles.
The transfer of learning from theory to practice is often difficult (Day and Goldstone, 2012; Derry, 2016). Social justice learning transfer can mean confronting personal and implicit biases which can be unconscious thoughts (Dirkx & Espinosa, 2017; Mälkki, 2019). Subconscious thoughts must become conscious to be reflected upon critically. One of my most important findings is that to help students to “see” that space can be exclusive, the course design must assist students with confronting subconscious biases. This became the sixth (and most important) design principle.Ed.D.Includes bibliographical reference
In-situ pediatric code simulations effects on emergency department’s staff pediatric code management
No full textPurpose of Project: Pediatric codes account for 5% of all hospital resuscitations and the United States has shown poor survival rates. The current standard for healthcare pediatric resuscitation training is biannual Pediatric Advanced Life Support (PALS) certification. The growing evidence indicates that a few months after PALS certification, providers and nurses lose both their clinical skills and knowledge. Deviations in guideline adherence leads to poor pediatric resuscitation survival rates. Multiple studies recommend the use of back-to-back simulations as an adjunct to PALS education. Methodology: A quality improvement project was created to form a curriculum of back-to-back pediatric code simulations in the emergency department (ED). The simulation followed the PALS supraventricular tachycardia and intubation guidelines. There were 4 groups each consisting of a minimum of 1 provider and 1 nurse. Data collected included demographics, pre/post simulation self-confidence, and an open-ended questionnaire. PALS guidelines adherence was measured for each simulation.
Results: A Wilcoxen Signed Rank test was used to compare staff self-confidence pre/post-simulation; there was significance for positive change with p<.05 in self-confidence in personal ability to participate in pediatric codes. First and second simulation adherence scores were compared using descriptive analysis demonstrating a mean positive percentage change of 116% across all groups. Questionnaires were analyzed via content analysis which described participant endorsement on the value of the program.
Implications for Practice: Results of this project indicate that in-situ back-to-back simulations effectively increase confidence and skills in pediatric resuscitation and should be used to augment pediatric code training in ED staff. Keywords: Pediatric Advanced Life Support, PALS, Simulation, Emergency Department, Pediatric Emergency Department, American Heart Association (AHA), In-SituD.N.P.Includes bibliographical reference
Implementing a targeted algorithm for antimicrobial stewardship: optimizing antibiotic use in surgical patients with beta-lactam allergies
No full textPurpose of Project: To implement the (PEN-FAST) Penicillin Allergy Screening Tool to optimize antibiotic selection and reduce broad-spectrum antibiotic use in surgical patients. The tool efficiently identifies low-risk patients with inappropriate penicillin-related allergies and safely transitions them to beta-lactam antibiotics. With a strong negative predictive value of 96%, providers can confidently identify patients who would test negative in a formal penicillin allergy test. This streamlines antibiotic administration to improve patient care, reduce drug-resistant bacteria, and minimize surgical site infections.
Methods:
A retrospective chart review was conducted on surgical patients with a documented beta-lactam allergy to evaluate the impact of implementing an approved antimicrobial algorithm. The aim was to assess whether the implementation of this algorithm led to a decrease in the administration rates of broad-spectrum antibiotics in patients with a documented penicillin allergy who met the inclusion criteria. The primary outcome measured was the improvement in the appropriate selection of antibiotics, achieved through the preoperative PEN-FAST screening tool in patients classified as low risk.
Results:
A total of 123 surgical patients were evaluated. For the pre-implementation phase, 40 patients were selected based on inclusion and exclusion criteria. Subsequently, an additional set of 40 patients were selected to determine if surgical patients with a documented non-IgE mediated beta-lactam allergy received the appropriate prophylactic surgical antibiotics. Pre-implementation data revealed 88% (n=35) of patients received a broad-spectrum antibiotic. Following the implementation of the screening tool, post-implementation data showed 80% (n=32) of patients with a penicillin allergy received a cephalosporin. The chi-square test was applied to determine the existence of a statistically significant difference in the proportion of patients receiving appropriate antibiotics before and after the implementation of the PEN-FAST tool.
Implications:
A PEN-FAST score of 2 or less is associated with a high negative predictive value and could be utilized by antimicrobial stewardships programs and policies to identify low-risk penicillin allergies.
Keywords: beta-lactam, antimicrobial stewardship, antibiotic resistance, PEN-FAST, screening tool, penicillinD.N.P.Includes bibliographical reference
Improving antibiotic stewardship through utilization of the PEN-FAST screening tool for surgical patients with documented penicillin allergy
No full textProject Purpose: This manuscript describes a quality improvement project aiming to improve antibiotic stewardship in surgical patients with documented penicillin allergy by reducing the rate of administration of second line antibiotics in the operating room. This project took place at a 348 bed tertiary care medical center over an 8 week period. Key stakeholders within theanesthesia department were educated on the PEN-FAST screening tool in effort to increase the administration rates of first line antibiotics, reduce surgical site infections, and reduce hospital costs. The informatics department was also heavily involved in facilitating integration of the PEN-FAST screening tool into the new electronic health record (EHR), EPIC, for easy access during the anesthesia preoperative patient evaluation.
Methodology: An education inservice was performed within the anesthesia department to educate anesthesia providers on the PEN-FAST screening tool and how to access it on the EHR. A retrospective chart review was conducted after 8 weeks of project implementation comparing rates of cefazolin administration to patients with a documented penicillin allergy to 8 weeks of baseline data. Investigators evaluated all patients within the total 16 week timeframe who self-reported a penicillin allergy. Inclusion criteria were CRNAs and physician anesthesiologists care for adult, non-obstetrical patients who reported a penicillin allergy and presented for surgery in the main operating rooms. Exclusion criteria were providers caring for patients with a documented IgE-mediated reaction to beta lactam antibiotics, or serious rash with systemic symptoms, blistering disorders such as Stevens-Johnson Syndrome or toxic epidermal necrolysis, and acute interstitial nephritis.
Results: Baseline data from prior to implementation identified 51 out of 90 patients with penicillin allergy who received cefazolin intraoperatively. Post-implementation data revealed 39 out of 85 patients with reported penicillin allergy received cefazolin intraoperatively. Additionally, of the 11 patients reported a penicillin allergy and that a provider completed a
PEN-FAST form for, 10 patients received an antibiotic. A pearson chi-squared test was performed on SPSS to determine if there is a statistically significant increase in first line antibiotics administered to surgical patients with a reported penicillin allergy and did not determine a significant increase or decrease. Compared to 56.7% of patients receiving a first line antibiotic at baseline, only 45.9% of penicillin allergic patients received a first line antibiotic after education to providers and
implementation of the PEN-FAST screening tool within the anesthesia department. Meaning, 54.1% of penicillin allergic patients still received an antibiotic preoperatively that was not cefazolin. Additionally, of the 85 penicillin allergic patients that were eligible to be screened using PEN-FAST, only 11 were actually screened by an anesthesia provider. Of those 11 patients, 10 received an antibiotic, while 1 patient did not receive any antibiotic as it was not surgically indicated. There was insufficient data to perform a correlational analysis to determine a significant relationship between utilization of the PEN-FAST screening form and the patient receiving an appropriate first line antibiotic.
Implications: Despite some limitations to this quality improvement project and statistically insignificant results, investigators believe this project still has clinical significance. By continuing to educate anesthesia providers on the PEN-FAST screening tool and encouraging the use of first line antibiotics in the operating room, patients will see improvements in quality of care through reduced secondary infections and surgical site infections. This quality improvement project was received positively by key stakeholders within the project site and has the potential to grow and expand throughout the sites within the RWJBarnabas system.D.N.P.Includes bibliographical reference