Environmental and Occupational Health Sciences Institute
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Shakespeare and the value of theatrical character
No full textShakespearean character is regularly valued by its affinity with other words, with nouns like “interiority,” “individuality,” and “autonomy,” and with adjectives like “realistic,” “authentic,” and “self-same.” This dissertation interrogates the social and economic basis of the scholarly and popular attachment to Shakespearean character, locating its origins in a period of literary history where theatrical inventions were always also commercial productions. By combining the commercial lineage of Shakespearean character with materialist and feminist analysis, I contend that the qualities of personhood that are typically associated with Shakespeare’s characters are the effects of an institutional process that transforms theatrical characterization into a repository of symbolic and economic value. Character has remained a dominant category of popular and scholarly inquiry into Shakespeare, I argue, not because he had some special purchase on demonstrating human continuity—though that is often the story that gets told—but because character is value circulating in a material infrastructure: the playhouse, the publishing industry, the joint stock company, and the institutions that preside over the economies of leisure and entertainment. “Shakespeare and the Value of Theatrical Character” argues that the economic origins of playing in the sixteenth and seventeenth centuries in England gave rise to character’s formal articulations and appearances. Each of the three plays covered, Romeo and Juliet, Hamlet, and Troilus and Cressida, trace a period in Shakespeare’s theatrical career typically linked to a stylistic shift away from his contemporaries. This period also happens to track with the inception of the Lord Chamberlain’s Men, the company for which Shakespeare began writing specific characters for specific actors, notably Richard Burbage, who is credited to having played Hamlet, Romeo, Macbeth, Brutus, Lear, and others. Rather than suggesting that these developments in characterization arise independently of their material and historical contexts—the product of Burbage’s histrionic excellence, say, or Shakespeare’s authorial ingenuity—this dissertation shows how Shakespearean characterization emerged within a theatrical industry that had to contend with already existing literary traditions, aesthetic standards, and styles of playing that commanded the dramatic possibilities of Shakespeare’s plays. Unsatisfied by criticism that marvels at Shakespeare’s ability to create fictional characters that act and behave like real persons, “Shakespeare and the Value of Theatrical Character” intervenes in these discussions to uncover an ethics and politics of characterization that is indisputably governed by the accumulative demands of exchange value. Focusing on the division of labor between male and female characters, boy actors and adult players, and onstage and off-stage action, allows us to see that what is produced by Shakespearean characterization is not a person, but the fetishistic illusion of one. The result is a dissertation that tells a story of theatrical labor and the commodification of identity critical to character’s institutional authorization.Ph.D.Includes bibliographical reference
Attachment style, political attitudes, and behavior
No full textAttachment Theory is a broadly studied subject in both research and clinical psychology as it predicts behaviors ranging from interpersonal conflict to school performance to speed of pulling a fire alarm. However, it is a neglected topic within political science. This dissertation discusses the development of attachment theory and its measurement, makes recommendations for the best instrument for use in political science, connects attachment style to important dependent variables in political science research, explores attachment style’s role in the interplay of emotions and learning, and overall demonstrates that attachment theory is a distinct construct worthy of future study by political scientists.Ph.D.Includes bibliographical reference
Intraoperative in-situ cardiac arrest to improve technical and non-technical skills in operating room staff
No full textPurpose of Project: This quality improvement project was designed to improve technical and non-technical skills of operating room staff in the management of intraoperative cardiac arrests at a large academic medical center in New jersey. Methodology: The initial simulation took place on October 25th, 2023. Participants (40) were divided into two rooms with identical equipment to take part in an intraoperative cardiac arrest simulation. Key action items were timed and noted to measure technical skills. Teamwork performance was assessed and rated. A 15 minute debriefing and education session was held post-simulations. On December 13th, 2023, a subsequent simulation day occurred. Data comparing the results from Day 1 and Day 2 were compared and analyzed. Results: A time decrease was found in 5 out of 6 key action items, from Day 1 to Day 2 of the simulations. The p-value (<0.001) was statistically significant and proved that the simulation was most likely the case of the time decrease. The key action item that resulted in the greatest time improvement was “first defibrillation shock,” with a decrease of 123 seconds. The assessment of teamwork performance between Day 1 and Day 2 did not produce consistent results. Implications for Practice: The time improvement of key action items, from Day 1 to Day 2 of the simulations, demonstrated better performance of the participants in the management of cardiac arrests. The time to “first defibrillation shock” decreased by approximately two minutes, equating to better neuronal tissue preservation and patient outcomes in a real-life scenario.D.N.P.Includes bibliographical reference
Central Line Associated Blood Stream Infection Prevention in A Skilled Nursing Facility: Implementing a Central Line Maintenance Checklist
No full textAbstractPurpose of Project: Individuals in skilled nursing facilities are highly susceptible to central line associated bloodstream infections (CLABSIs) because these patients are more likely to have a percutaneously inserted central catheters (PICCs) for continued treatment therapies. Strict central line insertion and infection prevention protocols must be followed to prevent the occurrence of CLABSIs (Center for Disease Control, 2011). This quality improvement project was aimed towards implementing a tool to facilitate the reduction of CLABSI rates in an identified skilled nursing facility.
Methods: Nurses at this facility were educated on central line care and given a central line maintenance checklist to aid in the prevention and monitoring of CLABSIs. CLABSI occurrences were evaluated over three months pre- and over three months post- implementation of the central line maintenance checklist. Descriptive statistics were used to analyze the data.
Results: 16 patients at pre-implementation and 14 patients at post-implementation were reviewed. There were 149 incidents at pre-implementation and 127 incidences at post-implementation where a CLABSI could have occurred. It was observed that there were zero CLABSI occurrence pre implementation and zero CLABSI occurrence. During the post implementation phase there was 92.9% checklist compliance.
Implications: Although this particular project showed no significant change in CLABSI occurrence after the implementation of an identified checklist, it is important to consider the value of such checklists in other integral fields such as aviation, surgery, etc. The use of a central line maintenance checklist has proven to be beneficial in healthcare settings. This study has the potential to add to the ongoing work to evaluate practicality and safety of central lines in a skilled nursing setting.D.N.P.Includes bibliographical referencesIncludes vit
Multimodal imaging and closed-loop brain stimulation of human theta oscillations during spatial navigation
No full textThe phase of the theta rhythm created by cells in the parahippocampal cortex (PHC) and its reset are linked to the encoding of spatial memories in rodents. This theta coding mechanism has been studied extensively in animals and intracranial recordings in humans. However, less is known about the relationship of theta oscillations recorded in EEG and spatial memory encoding during spatial navigation. My thesis has two overarching goals: 1) map the neural circuitry and investigate the properties of right posterior theta (RPT) oscillations in human EEG during spatial navigation, and 2) test whether there is a causal link between PHC phase and memory by using a novel real-time closed-loop (RT-CL) system for EEG-TMS. Closed-loop stimulation is a novel approach for tailoring neurostimulation protocols to individual brain rhythms, which allows for more direct causal testing of the relationship between memory and the properties of neuronal oscillations. Across three aims I present evidence for an EEG signature of PHC theta phase resets in response to encountering motivational spatial information, demonstrate its relationship with spatial memory performance, outline the development of the RT-CL capable of instantly delivering phase-locked TMS pulses at a higher precision than state-of-the-art systems, and finally combine these lines of research by targeting different phases of RPT with the RT-CL. This allowed me to investigate the causal role of RPT in spatial memory encoding. These findings about RPT as a potential scalp-level marker of PHC phase resetting and memory encoding in conjunction with the RT-CL could be used as a versatile tool for non-invasive research and therapeutic interventions in clinical populations suffering from memory-related disorders.Ph.D.Includes bibliographical reference
A novel glutamatergic pathway from the pedunculopontine nucleus to the spinal cord before and after spinal cord injury
No full textInitiation of movement involves the coordination of multiple brain regions sending signals to the spinal cord, where local circuits coordinate motor programs, and motor neurons relay signals to muscles to perform actions. The mesencephalic locomotor region (MLR), situated in the midbrain, is often described as an interface between higher motor structures (e.g., motor cortex and basal ganglia) and lower motor structures (e.g., gigantocellular nuclei). Previous studies demonstrated that glutamatergic MLR neurons modulate aspects of movement such as speed and gait. Previous work from the Mena Lab showed that glutamatergic axons originating in the largest region of the MLR, the pedunculopontine nucleus (PPN), traverse the entire length of the spinal cord. This direct connectivity suggests the PPN has a direct role in the modulation of movement. Therefore, I aimed to characterize the anatomical structure of the PPN-spinal cord pathway and its functional relevance in movement. I found that spinal cord-projecting glutamatergic PPN (PPNGLU) neurons are a distinct subpopulation producing no collaterals to basal ganglia structures. Furthermore, these neurons preferentially innervate interneurons in the intermediate zone of the upper cervical spinal cord. These interneurons are responsible for maintaining posture and neck and forelimb muscle tone suggesting a role in preparation for movement and transitions. Optogenetic inactivation supported this hypothesis, as it increased the braking phase and decreased the propulsion phase of the stride on the treadmill. In contrast, optogenetic activation increased the swing phase of strides. Damage to this pathway, such as that incurred in spinal cord injury (SCI), may result in loss of postural control and gait transitioning. Previous literature, however, has suggested that spared fibers and contralateral fibers reorganize to compensate for injury. Furthermore, it has been suggested that the activity of intermediate zone spinal interneurons influence the reorganization and recovery of spinal networks following SCI. After incomplete SCI, I found increased PPNGLU innervation below the injury site and axons associated with growth-associated protein-43. This study provides an explanation for conflicting literature on the role of PPNGLU neurons in movement and suggests this pathway may play a key role in the reorganization of spinal networks and recovery of movement following SCI.Ph.D.Includes bibliographical reference
Standardizing I-PASS use on a neurocritical care stepdown unit (NCCU)
No full textPurpose of Project: The chief aim of this quality improvement project was to increase I-PASScompliance and improve handoff quality among the nursing staff on the NCCU. Methodology: This project was implemented on a 24-bed NCCU at a level 1 trauma center in Northeastern New Jersey with a pre-post design. An 18-question anonymous electronic survey was disseminated to the NCCU nurses during every 7am and 7pm shift change to assess handoff quality. The survey included questions on the extent of inclusion of each component of the I- PASS in addition to the 16 identified key handoff elements. During each shift change, the oncoming nurses completed the survey based on the report they received. In Phase 1, the survey assessed baseline handoff quality and I-PASS compliance rates. In Phase 2, nurses received education on the components of I-PASS and the importance of its’ use during staff huddles and via informative emails for three weeks. Handoff quality and I-PASS compliance was then reassessed using the handoff quality survey during this 3-week period. Results: A total of 42 handoffs were analyzed in each phase. I-PASS use showed a statistically significant increase from 57.1% in Phase 1 to 88.1% in Phase 2 X2 (1, p = .007). Phase 1 had a 9.5% rate of high-quality handoff, while Phase 2 had a 26.2% rate. The handoff quality scores in Phase 1 and Phase 2 were then further compared using a Wilcoxon signed-rank test, which showed that the implementation of I-PASS education elicited a statistically significant increase in handoff quality scores (Z = - 4.682, p = <.001). Implications for Practice: Standardizing I-PASS use in the NCCU will improve handoff quality, which will thereby improve nurse-to-nurse communication and handoff satisfaction. Effective handoff will also decrease the risk of medical errors and adverse events.D.N.P.Includes bibliographical reference
Implementation of an ESI template tool at a federally qualified health center
No full textPurpose of the Project: Investigates an integrated Emergency Severity Index tool at Hometown Health Centers into the current EMR E-Clinical Works to increase verbal hand-off with providers and disposition accuracy for patients presenting with a chief complaint of chest pain.Procedures: Seventy-nine chest pain encounters were reviewed in this study at a Federally Qualified Health Center. Thirteen medical providers participated in this study (5 FNP, 8 MD, and 1 PA). Five triage staff members (3 RN’s, 1 MA, and 1 LPN) engaged in the research study. The dependent variables are overall provider congruence and verbal-hand off. While the independent variable consists of the ESI template tool.
Results: 86% of chest pain patient encounters had provider congruence with their dispositions. 54% of these patients’ encounters were deemed as an ESI level of 3. 29% of these patient encounters were deemed higher level acuity of levels 1 and 2. 57% of patients were given an EKG during their patient encounter. Verbal hand-off was given on average of 1.1 for ESI levels deemed 1 and 2.
Implications for Practice: There is high variability of the ESI tool due to usability, education, and background of the triage nurse. However, the research supports that the tool allows the triage nurse to expedite the triage of the patient. When verbal hand-offs are given, there is a higher likelihood that the provider can then dispense guidance and/or agreement or disagreement with the patient's disposition.
Keywords: Emergency Severity Index (ESI), auto-generated triage software tool, triage, chest pain, Federally Qualified Health Center (FQHC), EKG, verbal hand-off, provider congruenceD.N.P.Includes bibliographical reference
Training practitioners to conduct trial based functional analysis with adults with autism using pyramidal behavioral skills training
No full textAs the rates of Autism Spectrum Disorder (ASD) increase, so does the need to provide high-quality and empirically validated supports across the lifespan. Despite most of an individual’s life taking place in adulthood, it is well-documented that the supports and services for adults with ASD are severely lacking. This is evidenced by outcomes indicating that many adults on the spectrum are unemployed, underemployed, or do not have appropriate services. Challenging behavior is one of the most significant barriers to accessing community participation and employment. Individuals with ASD who present with challenging behavior require empirically validated methods that lead to function-based treatment. Trial-based functional analysis (TBFA) is a method of determining the function of behavior that is well-suited to community settings. However, adult services often lack the resources and qualified staff required to conduct specialized assessments, such as TBFAs. There is a need for empirically validated training methodologies (e.g., Behavioral Skills Training) coupled with strategies that reduce required resources (pyramidal training) to improve the outcomes for adults with ASD. The purpose of this study was to determine if a functional relation exists between: (a) pyramidal Behavioral Skills Training (BST) on the training of TBFA conducted by graduate students for center-employed job coaches and (b) the accuracy of implementation of TBFA conducted by job coaches. Specifically, I taught three graduate students to train job coaches to conduct a TBFA and measured the effects with a multiple probe single case design study.Ed.D.Includes bibliographical reference
The development of China’s community care services and its impact on older adults' health and subjective wellbeing: 1998 -2018
No full textAs China has experienced rapid population aging, the demand for elder care services has increased dramatically. The gap in service demand has become concerning because the traditional provision of eldercare heavily relies on informal care provided by the family. Social and demographic transformations have made the family-reliant care model unsustainable. Community care has become a reasonable and practical option to balance the care demand. Despite the crucial role of community care in elder care provision, the focus of many scholars has predominantly been on state, market, or family-provided care, with less attention given to community-based services.This dissertation examines the evolution and impact of community care services on the health and subjective well-being (SWB) of older adults in China. Utilizing data from four waves of the Chinese Longitudinal Healthy Longevity Study, the study employs person fixed-effect regression analysis to assess community care influence on the broader population of older adults, including subpopulations such as the childless and disabled.
Key findings indicate a significant disparity between the provision and needs of community care, with unmet needs having a notable negative impact on both health and SWB,especially pronounced in urban areas. The research reveals that while community care services significantly enhance SWB and health, the impact varies depending on the type of service, place of residency, disability status, and financial sufficiency. Specifically, cultural and social services were found to have a more significant effect on health outcomes, whereas medical care services notably influenced SWB. Importantly, the study also found that community care services might more directly influence older adults' subjective well-being than their objective health outcomes.
The dissertation highlights the critical need for policies that foster an integrated care model combining community and family care to effectively support aging in place. This approach not only leverages the strengths of both care systems but also addresses the unique needs of the aging population, thereby enhancing their quality of life and well-being. The study advocates for future research to incorporate more objective health measures and to examine the influence of degree of urbanicity on the effectiveness of community care services.Ph.D.Includes bibliographical reference