Environmental and Occupational Health Sciences Institute
Rutgers University Community RepositoryNot a member yet
58345 research outputs found
Sort by
Improving antibiotic stewardship at jcmc 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. Key stakeholders within the anesthesia 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. MethodologyAn education in-service 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. ResultsBaseline 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 for PracticeDespite 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 healthcare system.D.N.P.Includes bibliographical reference
Increasing enrollment in a pediatric weight management program in the primary care setting
No full textPurpose of Project: Lack of engagement and attrition of referred pediatric patients to weight management programs have been identified as key barriers to the successful treatment of childhood obesity. This quality improvement project utilized a multi-dimensional recruitment strategy to increase enrollment in a pediatric weight management program in the primary care setting. In addition to increasing enrollment, the project aimed to identify barriers to enrollment for referred patients who declined program participation. Methodology: The multi-dimensional recruitment strategy consisted of recurrent outreach to patients and families through various modalities including informative pamphlets, an emailed newsletter, and a follow-up phone call. In addition, a Qualtrics survey was distributed with the intention of identifying patient-specific barriers to enrollment at the project site. The sample included all children between ages 3-18 years old that were referred to the weight management program over an 8-week period. Results: Of the total sample size (n=10), 1 participant enrolled in the weight management program. This resulted in a 10% post-intervention enrollment rate. Of the 10 eligible participants, zero voluntary surveys were completed. Implications for Practice: Clinical practice recommendations continue to focus largely on methods that increase the utilization of the obesity program. It is suggested that a reevaluation of the enrollment strategy may be necessary by utilizing different communication techniques and protocols that are centered around instituting behavioral change. Integrating change focused on therapeutic and motivational dialogue can facilitate patients to enroll in the program and remain engaged throughout the 12-week duration. By addressing barriers and increasing utilization of the weight management program, the project site can create a strong impact on effectively treating childhood obesity in this vulnerable population.
Keywords: pediatric weight management, barriers to enrollment, enrollment, recruitment strategies, reminder phone calls, pamphlets, and attritionD.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.D.N.P.Includes bibliographical reference
Using emojis to improve nurse’s toxicities documentation and communication with providers.
No full textPurpose of the project: Patient symptom reports are essential to the safe treatment of oncology patients. Standardized depictions of symptoms understood between patient and nurse serve to align subjective and objective assessments and mitigate miscommunication. Emojis and other visualizations as a method for reporting subjective symptoms related to treatment toxicity are effective mechanisms for symptom endorsement and transcend barriers related to health literacy and nursing practice.
Methodology: A quality improvement project was developed to improve nurse toxicities documentation and communication between providers in an outpatient infusion center. Over 4 weeks the emoji-based toxicity cards were offered to all patients receiving chemotherapy treatment in a large suburban infusion center. Aggregate report on patient characteristics and toxicities documentation for four weeks before and four weeks after the implementation was obtained. The co-PI monitored nurse-provider communication for four weeks pre and post-implementation. The anonymous pre-post Likert type nurse survey consisted of 8 and 9 questions respectively and was offered to all nurses working in the infusion. Results: There was a statistically significant change in toxicities documentation (Mann-Whitney 1-tailed test with z-score of 1.92685 is significant at p < .05) and provider communication (Mann -Whitney two-tailed test with z-score -4.11629 significant at p < .05). The use of Emojis improved the thoroughness of toxicities assessments and documentation and was significantly associated with nursing self-reports of improvement in education about side effects X2=(1, N=24) = 7.1, p=.007).
Implications for Practice: Emoji-based chemotherapy cards improve patient education and are an effective tool to improve symptom reporting, toxicities documentation and communication between providers.
Key Words: side effects reporting, toxicities documentation, nurse-provider communication, patient-nurse communication.D.N.P.Includes bibliographical reference
Implementing a targeted algorithm for antimicrobial stewardship: optimizing antibiotic use in surgical patients with beta-lactam allergies
No full textAbstract Purpose 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
False-green kyllinga (kyllinga gracillima miq.) ecology and integrated managemnt strategies in cool-season turfgrass
No full textFalse-green kyllinga (FGK; Kyllinga gracillima) is a common weed in cool-season turfgrass. Infestations can span across large areas and cause substantial turfgrass loss. Turfgrass practitioners will apply postemergence herbicides for FGK control, but efforts usually require sequential herbicide and overseeding applications. Although FGK infestations are especially prominent throughout the northeastern United States, there are few integrated management strategies that have been researched. Additionally, there is little known about the seedling competitiveness and the seedling response to preemergence herbicides used in cool-season turfgrass. The objectives of this research were to evaluate the establishment of FGK from seed in Kentucky bluegrass (Poa pratensis), evaluate the efficacy of preemergence herbicides used in cool-season turfgrass against FGK emergence from seed in soil, and to evaluate the impact of soil-applied nitrogen on effectiveness of single postemergence herbicide applications. The first experiment was conducted over a two-year period at one location in adjacent sites in New Jersey. This study evaluated the effects of two turfgrass density programs (high and moderate) and three weed seeding programs (FGK 5 and 500 kg ha-1 and smooth crabgrass (Digitaria ischaemum) at 500 kg ha-1) on FGK establishment. Seeding rates were designed to simulate a small infestation (5 kg ha-1) or a severe infestation (500 kg ha-1). Smooth crabgrass was included for comparison. The high turfgrass density program was designed to create a very dense stand of turf produced by high and moderate input programs, whereas the low density program was designed to produce a turf typical of a low low program. FGK establishment from seed was influenced more by turfgrass density than smooth crabgrass. Additionally, FGK re-established from rhizomes the after overwintering. Interestingly FGK cover was less affected by turfgrass density in the growing season after overwintering in one of two experimental runs. Most importantly, FGK established from seed in both high and low density turfgrass, reinforcing the need for further research in preemergence herbicides. A preliminary experiment was conducted over a two-year period at two locations in greenhouses in New Jersey and Indiana to evaluate the effects of 12 herbicides, two rates (100 and 10% of typical use rates for cool-season turfgrass) and two species (FGK and smooth crabgrass). Herbicides and 100% use rates included bensulide (11,200 g ha-1), corn gluten meal (880,000 g ha-1), dimethenamid (1,680 g ha-1), dithiopyr (560 g ha-1), isoxaben (1,120 g ha-1), mesotrione (280 g ha-1), methiozolin (516 g ha-1), oxadiazon (4,500 g ha-1), pendimethalin (3,360 g ha-1), prodiamine (840 g ha-1), siduron (13,500 g ha-1), and sulfentrazone (280 g ha-1). Dithiopyr, pendimethalin, and prodiamine were less effective against FGK than smooth crabgrass. Bensulide, dimethenamid, and oxadiazon were the most efficacious herbicides against both species at both locations. Further investigation conducted in a greenhouse in New Jersey involved seven herbicides (bensulide, dimethenamid, dithiopyr, isoxaben, oxadiazon, prodiamine, and sulfentrazone), six rates (100, 50, 25, 12.5, 6.3, 3.2% of typical use rate in cool-season turfgrass) and two species (smooth crabgrass and FGK). Bensulide, dimethenamid, and oxadiazon were the most effective herbicides (GR80 < 4% of registered use rate) against FGK establishment from seed in both runs. Prodiamine and dithiopyr provided more smooth crabgrass control than FGK. To evaluate postemergence control with herbicides, a final experiment was conducted over a two-year period at two locations in New Jersey to evaluate a complete factorial of four nitrogen programs (0, 13, 25, 50 kg N ha-1), and three herbicide programs (sulfentrazone + carfentrazone at 280 + 30 g ha-1, halosulfuron at 70 g ha-1, and pyrimisulfan at 53 g ha-1) on herbicide effectiveness. At 52 weeks after treatment (WAT), halosulfuron application without nitrogen resulted in 70% FGK cover, whereas when 50 kg N ha-1 was added, cover decreased to 4%. Nitrogen did not affect FGK control from sulfentrazone + carfentrazone in either experiment. The effect of N on pyrimisulfan is unclear. In run 1 there was a non-significant tendency for pyrimisulfan efficacy to increase with N rate. In run 2, N applied at ≥13 kg decreased pyrimisulfan efficacy 12 WAT. Inconsistencies amongst treatments across years warrant a third experimental run planned for 2024. Results of the experiments suggest that practitioners should implement integrated management strategies that focus on maintaining a dense turfgrass stand and furthermore, it may be beneficial to use preemergence products such as bensulide, dimethenamid, and oxadiazon when controlling false-green kyllinga from seed in soil.M.S.Includes bibliographical reference
Non-Invasive sleep apnea detection using microphone technology
No full textDespite advancements in device and machine learning programs for diagnosing obstructive sleep apnea (OSA), widespread adoption is hindered by key implementation barriers, including the need for more accurate and non-invasive diagnostic tools. Various methods, such as ECG, EEG, SpO2, and respiratory signals, are used for detection, but limitations in accuracy persist. This thesis focuses on developing a machine learning algorithm using Subspace KNN classification of respiratory signals to detect different breathing patterns in individuals with and without OSA. The research also explores optimization strategies for hardware components, using Arduino and PCB boards, to enhance data collection over multiple nights. By exploring respiratory-based approaches for OSA detection, this thesis aims to provide a more targeted and specific method to detect apnea events, enhance accuracy and efficiency in detection, and contribute to the advancement of a more user-friendly and accessible solutionM.S.Includes bibliographical reference
Experimental measurement of the influence of off-axis laser discharge on a projectile’s flow field
No full textTrajectory control and maneuverability of aircraft at high speeds present significant challenges, primarily due to the need for substantial control authority. As the Mach number increases, conventional flight control methods become less effective because of the inherent inertia in mechanical actuators. During the time it takes for mechanical actuators to adjust the flight path, the vehicle can travel several times its own length at supersonic speeds. Plasma-based methods on the other hand can offer a solution for high-speed flow control, owing to their ability to rapidly induce changes in local fluid temperature and manipulate shock structures through energy deposition. This dissertation investigates the capability and effectiveness of the plasma-based flow control method, specifically Laser Energy Deposition (LED), for trajectory control in high-speed flows. The goal of this work is to quantify the ability of LED to achieve appreciable alteration of the aerodynamic loading about an ogive-cylinder. Experiments were performed within Rutgers University’s supersonic wind tunnel to measure the influenceof off-axis laser energy deposition on the flow field about an ogive cylinder at a freestream Mach number of 2.8. Perturbation of the flow field was accomplished using an infrared laser source, focused to a point ahead of the ogive cylinder. Stereoscopic particle image velocimetry (SPIV) measurements were performed to quantify the effects of energy deposition on the velocity field at discrete time delays following the generation of the spark. The primary effect of the discharge was toincrease the local temperature by creating a heated region, thereby altering the local Mach number. A lensing effect was observed as this region with a reduced local Mach number moved through the shock structure. Furthermore, the continued evolution of the heated area led to the formation of a vortex system and an induced jet. Moreover, SPIV measurements were conducted across a variety of LED test cases to quantify the impact of changes in energy deposition parameters on the perturbed flow field. These parameters included laser input energy, the laser’s operational mode (single or double-pulsed), and the location of the energy discharge. Results showed that the magnitude of the velocity changes was directly proportional to the laser input energy. Using a double-pulsed LED enabled stronger and more sustained changes in the velocity field. Altering the initial streamwise location of the discharge did not significantly impact the induced changes in the
velocity field. Surface pressure measurements were taken using a fast-responding, pressure-sensitive paint. These measurements enabled the observation of temporal changes in the surface pressure following the laser energy discharge. From these data, the induced side force was calculated to determine the strength and effectiveness of the laser dischargefor the trajectory control of such a projectile. Interactions between the heated region and the shock structure resulted in localized pressure reductions around the projectile’s nose. The energy discharge’s initial location had a direct effect on the magnitude of these pressure reductions. Results indicated that discharging energy closer to the ogive’s axis led to more pronounced changes in the pressure field, thereby generating a stronger side force. Moreover, using a double-pulsed LED resulted in a more substantial side force and more prolonged alterations in the pressure field over time.Ph.D.Includes bibliographical reference
Welcome to the conversation garden! cultivating learning communities, critical práxis, and asset-based thinking
No full textWhile universities’ interest in community engagement has grown over time in the United States, the public pedagogies set forth by them do not always reflect a commitment to sustaining community-engaged learning. Additionally, commitments sometimes demonstrate mindsets and the language of “helping” the community or “fixing” a problem – deficit-based approaches, as opposed to the mindset that university stakeholders are there to learn with and from community members and organizations. This dissertation analyzes the experiences of 15 undergraduate students from primarily immigrant backgrounds in a community-engaged language learning partnership program grounded in asset-based and power-cognizant práxis. It also examines what their community-engaged instructor, the author, learned with and from them. The students and instructor collaborated over the year to facilitate an English-focused program grounded on conversation, social interaction, and community building. The Conversation Garden has been a successful community-engaged program for more than a decade, sustaining old partnerships and building new ones over time, despite a lack of sustained institutional support. The program facilitates opportunities for immigrant adults to practice English through conversation with university students, who in turn learn with and from those adults and their rich cultural and linguistic repertoires. Particularly, this dissertation centers on the longstanding partnership with a worker center that serves majorly Latin American immigrant workers, educating and advocating to amplify workers’ voices and fight for social justice across the state. This dissertation reports on a yearlong práxis developed with students, and in dialogue with community members and this community partner, drawing on a power-cognizant, multi-directional, asset-based approach to community-engaged learning. Through a methodology called dialogic (auto)ethnographic pedagogy, it explores how students made sense of their experiences and learning with and from local immigrant community members and organizations, and in collaborative dialogue with their peers and instructors. This study asks: How do students in a community-engaged, language-focused program make sense of their experiences and learning with and from local immigrant community members and organizations? This question is answered through an analysis that centers around 1) social interactions and relationships; 2) funds of knowledge and funds of identity; and 3) power-informed social critiques and agency, with an emphasis on students from immigrant backgrounds. Asset-based approaches orient this program, along with a critical Freirian pedagogy of ongoing reflection and practice, informed by theories and práxis, grounded within our own situated knowledges. In the program, students were welcomed into classroom learning communities in ways that acknowledged their whole selves and engaged with parts of their background and knowledge as key sources for theorizing. Through a critical, reflexive práxis, students learned to identify and leverage strengths in immigrant communities, and to situate community challenges within an understanding of social structures. At the same time, they were identifying and leveraging their own assets and challenges, striving to become better conversation facilitators, while also theorizing their experience and how it will impact their future societal roles. Hence, while this dissertation explores students learning about the strengths and challenges of immigrant communities, it dives into how this práxis facilitated learning about their own selves, backgrounds, identities, and agency. This work highlights reflexive dimensions of learning in community, as students and the author learned about themselves – their identities, orientations, and aspirations for social change – by engaging, reflecting, and theorizing with others. This work contributes to the literature on community-engaged learning partnerships, reinforcing the importance of co-producing place-based, power-cognizant, reflexive knowledge in our work with immigrant, or otherwise minoritized, communities within and beyond our campuses. It also contributes to the understanding of how students learn in community-engaged programs, highlighting relationships, community, and social interactions as pedagogical tools as well as outcomes.Ph.D.Includes bibliographical reference
Examining glia-vascular interactions in chronic diabetic retinopathy using microengineered systems
No full textChronic diabetic retinopathy (CDR) is one of the leading causes of blindness in working adults worldwide, projected to affect more than 160 million people by 2045. Unfortunately, current treatments such as anti-angiogenic drugs only slow down the progression of disease at early stage and remain refractory in chronic conditions. CDR results in aberrant neovascularization and the breakdown of the selective vascular network of the retina, known as the inner blood retinal barrier (iBRB). Despite profound knowledge of the etiology of CDR, the mechanisms on how cells of the iBRB respond to the disease in a chronic inflammatory state remain to be elucidated. By understanding the impact of diabetes on inducing changes at the cellular and molecular level in the iBRB, novel therapies can be developed to restore barrier integrity and halt progression of disease at the chronic stage. Here, we examined the synergistic relationship between endothelial cells (ECs) and Müller glia (MG), the two major regulators of the bidirectional transport of the iBRB in CDR. While the interaction of ECs and MG is known, it remains greatly understudied. Our findings demonstrate that these two cognate cells can regulate the expression of gap junction and tight junction protein, such as connexin 43 (CX-43) and zonula occludens 1 (ZO-1) via paracrine communication. By developing a diabetic in vitro model of the iBRB, we characterized the individual and collective contribution of ECs and MG to the integrity and permeability to this barrier. These results underscore the ability of MG to stabilize cell barrier integrity and maintain homeostasis in co-culture model with ECs. This project also demonstrated that anti-angiogenic therapeutics restore barrier integrity of cell barriers, but their effects are transient. In addition, our work includes the development of a novel microphysiological system that permits recording of cell barrier integrity under physiological flow conditions in real-time. This system is entirely transparent, which enables brightfield and fluorescence imaging in situ. Furthermore, this device was designed for rapid fabrication and assembling in a bench-top setting, requiring minimal training with low-cost manufacturing. Ultimately, we intend to use this new technology as a drug testing platform to identify the efficacy of therapies aimed to restore the integrity of the diabetic iBRB. Yet, this new system can be utilized for the study of other cell barriers, such as the blood brain barrier, kidney filter barrier, lung-air barrier, among others where only the cellular component and flow conditions change. Collectively, our results provide a groundwork to study the cellular interaction between ECs and MG in diabetic conditions using a novel microphysiological system.Ph.D.Includes bibliographical referencesIncludes vit