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Implementation of Team Based Care and Its Effects on Patient Comfort and Trust in Primary Care
No full textUB SON, DNP Research ProjectCurrent demands placed on primary care offices to manage complex patients create a burdened outpatient system. Team-based care (TBC) has potential to reconfigure the primary care team to be better equipped at meeting these demands. However, little was known on the patient perspective surrounding TBC. When there is interference in patient comfort and trust, the patient provider relationship (PPR) suffers. Any break in the PPR has potential to lead to poor patient outcomes. The primary objective was to identify and measure the effects that the delivery model of TBC has on patient comfort and trust in the patient-provider relationship. The secondary objective was to compare the patient perspective of comfort and trust between TBC and standard, usual care. Under the framework of the Relational Coordination Theory, a quasi-experimental study of TBC implementation was compared to usual care. Data collection was conducted through a one-time survey/questionnaire approach. Tools utilized in this project were the Health Care Relationship (HCR) Trust Scale and Patient-Doctor Relationship Questionnaire (PDRQ-9). The data collection occurred over a period of 4 weeks. Data was analyzed through an Independent Sample T-Test approach after consideration for influences of demographics on survey results. Due to the unfortunate small sample size, the results for this project were statistically insignificant. Even though results did not reveal a significant difference between the groups, comfort and trust was preserved under TBC. The findings from this project provided supportive data for TBC in primary care with preservation of patient comfort and trust
Health-Related Quality of Life Perceptions and Experiences Among Pediatric Hematopoietic Cell Transplant Recipients and Their Caregivers
No full textUB SON, DNP Research ProjectResearch indicates that pediatric HCT recipient and caregiver perception of health-related quality of life (HRQoL) is in fair to moderate agreement, indicating that caregivers may not accurately reflect their child’s HRQoL. The purpose of this qualitative descriptive study was to explore HRQoL perceptions and experiences among pediatric HCT recipients and their caregivers. One-on-one semi-structured interviews were conducted in person or via telephone with four pediatric HCT recipient-mother dyads. Thematic data analysis generated one overarching theme, We are in a very different world when you’re in oncology, and two main themes, 1) Some things just suck…some things did suck, they were horrifying and, 2) What am I supposed to do with someone…who went through all this? Findings revealed that pediatric HCT recipient - caregiver HRQoL perceptions and experiences were similar and that a major HRQoL barrier was the lack of assistance with transitioning pediatric HCT recipients back to school and resocialization
An Educational Intervention: Increasing Knowledge Regarding the Influenza Vaccine to Improve Nursing Vaccination Rates
No full textUB SON, DNP Research ProjectBackground and significance: Seasonal influenza threatens the health of individuals worldwide. One effective way to prevent this burden is to ensure healthcare personnel (HCP) comply with the annual influenza vaccines. One major factor that may influence influenza vaccine compliance amongst HCP is lack of certainty over the vaccine's efficacy and/or a lack of information (Carter, & Yentis, 2018).
Purpose and objectives: The purpose of this project, is to create an educational pamphlet that educates HCP regarding the influenza vaccine in hopes of improving the vaccination rate. The pamphlet includes the following information: myths and facts, background information on the influenza vaccine, statistics, barriers preventing nursing staff from getting the influenza vaccine, and details on how nursing personnel are susceptible to influenza and the consequences it may present to patients, family, friends, and colleagues.
Theoretical framework: The Health Belief Model (HBM) was utilized for this project. Methods and design: A literature review was conducted to determine common barriers and misconceptions that may prevent nursing staff from getting the influenza vaccine.
Conclusion: The pamphlet served as a convenient way to increase the nurse’s knowledge on influenza and the influenza vaccine.
Future implications and recommendations: Future research should focus on validating whether the educational pamphlet helped increase flu vaccine rates in nursing. Future research should also focus on barriers and misconceptions found in other disciplines
Exploring the Factors that Influence Faculty Connectedness to their Online Graduate Programs: Multidimensional Instrument Development and Results
No full textPh.D.The full text PDF of this dissertation is embargoed at author's request until 2022-02-19.After more than two decades of close attention by both researchers and academic institutions alike, the supports required to properly guide faculty across the many facets of the distance educator role remain an ill-defined and moving target. Further, existing research on distance education focuses largely on the undergraduate and community college settings, with some question as to the generalizability of those findings to online graduate programs that focus as advanced career preparation. With these issues in mind, this research investigates: 1) the relationship between an instructor’s perceptions of their own connection to the institution for which they teach; and 2) explores the relationship between that connectedness and their learning, development and performance as online instructors. Informed by the findings of a recently published pilot study entitled Faculty Development for Online Learning Using a Cognitive Apprenticeship Model (Wiss, DeLoia, Posey, Waight & Friedman, 2018), this multi-institution (N = 4) and multi-program (N = 10) study examines the psychological factors that influence faculty perceptions (N = 187) of their own connectedness to the programs for which they teach. Through an extensive review of the literature, a multidimensional instrument was constructed to measure the dimensions of instructor connectedness and was disseminated to participants via web based questionnaire. Key findings from this research include: 1) significantly positive levels of affective commitment, extrinsic and intrinsic motivation experienced by contingent faculty, at higher levels than their full-time counterparts; 2) role ambiguity as the single most important predictor of ongoing learning and professional development as described by cognitive apprenticeship, and; 3) overall levels of instructor connectedness increased with experience teaching online over time.A discussion of these findings in context of the online graduate program model utilized by participating programs is conducted, with focus on the influence of: team teaching models, small class size, synchronous program components, and the professional identity of contingent graduate program instructors. This research enhances the existing body of literature relating to faculty development by focusing attention on the interplay of complex workplace and psychological factors that contribute to ongoing instructor development and performance in the online graduate program setting.**To request an accessible version of the file(s) associated with this item, contact [email protected]. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.*
Defining the Functions of TRPM4 and PLCβ3 in Taste Cell Signaling
No full textPh.D.The taste system evolved as a way to detect nutrients and toxins in the external environment. This system is critical for survival because without the taste system, an organism could not detect beneficial compounds or avoid harmful compounds. To detect environmental chemicals, taste receptor cells use a variety of signaling pathways. Some of these signaling pathways are well-established, whereas some are not. The goal of my dissertation is to identify new proteins and pathways that are involved in the transduction of taste stimuli. My first study identified a previously unknown role for TRPM4 in the transduction of bitter, sweet, and umami stimuli. TRPM4 belongs to the transient receptor potential (TRP) family of non-selective cation channels and regulates membrane potential in other systems. Loss of TRPM4 in taste cells severely impairs both cellular and behavioral responses to these stimuli (Chapter II). In my second study, I characterized a new taste cell population that uses a PLCβ3/IP3R1 signaling pathway to detect bitter, sweet, and umami stimuli. These cells respond to multiple taste stimuli across taste modalities, and are called broadly responsive (BR) cells. My data found that loss of BR taste cells abolished central taste activity and taste-driven behaviors, demonstrating that these cells are important for taste transduction (Chapter III). I also found that TRPM4 works downstream of the PLCβ3 signaling pathway in BR taste cells. In these cells, TRPM4 modulates the membrane potential to regulate the L-type VGCC activity and links the PLCβ3 signaling pathway with the events that cause neurotransmitter release (Chapter IV). Taken together my studies demonstrate that taste signaling is much complex than previously thought.**To request an accessible version of the file(s) associated with this item, contact [email protected]. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.*
"The Coming Parent Revolution:" Mothers, Children, and Alcohol in Reagan's America
No full textPh.D.When Candy Lightner founded Mothers Against Drunk Drivers (MADD) in 1980 following the death of her daughter, there was little reason to think the group would succeed in its mission. To stigmatize such a common drinking practice would threaten to upset a model of acceptable social alcohol use that had held since the defeat of Prohibition, and the group's maternalist identity and strategy threatened to paint it as a neo-prohibitionist organization. Despite those obstacles, MADD was an immediate success, transforming drunk driving from a minor folk crime into one of the most prominent social issues of the day and forcing Ronald Reagan to sign legislation raising the minimum legal drinking age to twenty-one. MADD was successful because its rhetoric of endangered children resonated with growing numbers of white, middle class parents who responded to the economic and social disruptions of the 1970s by asserting greater control over their children and investing more and more emotional labor in preparing their children for success in (and protecting them from the threats posed by) what seemed to be an increasingly hostile world. In so doing, MADD joined with other parent power organizations in redefining the family as the center of American political life, amplifying and reinforcing many of the messages of the emerging conservative right through the seemingly apolitical language of a grieving mother.**To request an accessible version of the file(s) associated with this item, contact [email protected]. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.*
Testing Physical Properties and In vitro Cytocompatibility of Chitosan-Based Hydrogel and Hydrogel with Mustard Powder for Joint Lubrication
No full textM.S.Osteoarthritis (OA) is one of the leading factors influencing the quality of life, most common in older age groups but not uncommon in younger groups. OA can affect any joint in the body. Mainly affected joints are “stress bearing” (e.g. knee, hip, hands, feet). It can also affect “non stress bearing joints” (e.g. shoulder, wrist, ankle). Various treatments of OA currently include pharmacological methods (NSAIDS, GABA receptor blockers, intra-articular injections) and non-pharmacological methods (surgical intervention, acupuncture and rehabilitation).This thesis research was primarily based on a concept of intra-articular injection of a chitosan/glycerol-phosphate (C/Gp) hydrogel in comparison with two formulations containing mustard powder (M) as a potential antioxidant. C/Gp/M hydrogels were prepared by subjecting the chitosan solution and glycerol phosphate solutions to -17oC separately, before mixing to form the hydrogel. Cytotoxicity on Human Calvarial Osteoblasts (HCO) cells (in-vitro) was determined by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay after a 48-hour culture period. Gel deformation by compression at room temperature and coefficient of friction were evaluated. Based on the MTT data, results showed that C/Gp and C/Gp/M (0.002gm/10ml of gel) produced greater mitochondrial activity when compared to an agar control (p=0.001, p=0.001 respectively). There was no statistically significant difference between agar and C/Gp/M (0.02gm/10ml) (p=0.82). After medium was conditioned with hydrogels (with and without mustard) for 48 hours, there was no statistically significant difference between the no-gel control and conditioned medium (p=0.23). It was observed that as cell culture well surface area was increased, the mitochondrial activity in the group with gels was similar to the no-gel control. Compression tests indicated that the hydrogels with pre-exposure temperature of -17C can take up more load before deformation (p=0.0001). Tissue-on-tissue coefficient of friction indicated the hydrogels can reduce friction from approximately 0.45 to approximately 0.15 (n=1 per condition).Based on the MTT data, results showed that C/Gp and two formulations of C/Gp/M (0.02gm/10ml and 0.002gm/10ml) were not cytotoxic. Microscopic spreading of gel in culture wells decreased mitochondrial activity in smaller wells, relative to no-gel control wells. Gels can reduce friction, supporting use as a joint lubricant. Further analysis is required for the formulated hydrogel including increasing sample size for different analyses, testing if material could reduce inflammatory markers (reactive oxygen species) in a cell culture or animal model, confirming mustard particle dissolution and equal distribution in hydrogel, and determining extent of release of particles from the hydrogel.**To request an accessible version of the file(s) associated with this item, contact [email protected]. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.*
Modeling Framework for Collision Avoidance Learning in Multirotor Unmanned Aerial Variables
No full textM.Eng.This work focuses on the idea of generating the learning framework for cooperative collision avoidance between two quadcopters. Two strategies for reciprocal online collision-avoiding actions (i.e., coherent maneuvers without requiring any real-time consensus) are proposed. In the first strategy, UAVs change their speed, while in the second strategy, they change their heading to avoid a collision. The avoidance actions are parameterized in terms of the time difference between detecting the collision and starting the maneuver and the amount of speed/heading change. These action parameters are used to generate intermediate way-points, subsequently translated into a minimum snap trajectory, to be executed by a PD controller. This work presents a learning-based approach to train such reciprocal maneuvers. A Neuroevolution approach, which uses evolutionary algorithms to optimize the topology and weights of neural networks simultaneously, is used as the learning method--which operates over a set of sample approach scenarios to evaluate the fitness of each neural network candidate. Unlike most existing work (that minimize travel distance), the training process here has the capability of minimizing the required detection range and detection time. The specialized design of experiments and line search is used to identify the minimum detection range for each sample scenarios. This training process can also handle substantial challenges like uncertain UAV localization. For that, the relative pose of the other UAV, estimated by each UAV (at the point of detection), is considered to be uncertain. These capabilities have essential practical implications w.r.t. alleviating the dependency on sophisticated sensing and their reliability under various environments. Performing supervised learning based on optimization derived labels (as done in prior work) becomes computationally burdensome under these uncertainties. For an efficient training process, a classifier is used to discard actions (without simulating them) where the controller would fail. Also, a surrogate model is used to estimate the energy consumption and minimum distance between UAVs. The model obtained via neuroevolution is observed to generalize well to (i.e., successful collision avoidance over) unseen approach scenarios.**To request an accessible version of the file(s) associated with this item, contact [email protected]. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.*
Game Theoretic Studies in Decentralized Routing of UAVs
No full textPh.D.Unmanned Aerial Vehicles (UAVs) are widely used in intelligence, surveillance, and reconnaissance missions for defense and civilian applications. Centralized mission planning may not always be possible in the field, and a loss of information may occur due to decentralization. This loss of information is known as the price of anarchy. Game theory provides insight into decentralized routing and can determine the price of anarchy. In this research we present three approaches that populate a spectrum of anarchy. The first is a competitive game routing algorithm that finds the Nash equilibria of a game to route each UAV using a mixed strategy solution technique. The next is a leader-follower game routing algorithm that utilizes backwards induction in order to find the best possible solution for each UAV. The last procedure is a greedy algorithm in which a UAV collects information without regard for any other UAV. Over a design of experiments with different map types, we find that the leader-follower algorithm has clear advantages over the greedy, and is at least as good as the expected outcome of the competitive game algorithm for two player games. We extend the analysis to three player games and use an approximation algorithm for finding an ɛ-Nash equilibrium for the competitive game routing algorithm. The main difference here is that we are only finding one equilibrium compared to the two player game scenarios. There is an overall increase in the price of anarchy for three players, with the competitive game approach drastically increasing, and the leader-follower showing a major advantage. We also explore the effects of incomplete information on the price of anarchy, in situations in which UAVs may fall out of communications with each other for two players. We use a probabilistic random boolean generator to determine a communication condition at each time step of the multi-stage game. When players are out of communication, they employ the greedy algorithm. When in communication, the players employ both the competitive and leader-follower approaches. In some cases, this algorithm will outperform the traditional competitive and leader-follower approaches to find a better maximum gain. This is described as a sort of dithering effect.**To request an accessible version of the file(s) associated with this item, contact [email protected]. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.*
Beckett & the Impossibility of Mastery: An Analysis of Agency and Control in Samuel Beckett's Dramatic Works
No full textM.A.While Samuel Beckett did not explicitly comment on politics in his dramatic works, the personal essays he crafted during the beginning of his career, as well as his work as a translator, corroborate the assumption that he was a man with political interests, and found subtle ways to advocate justice where he felt it lacked (Morin 159). Though Beckett did not wish for an examination of his personal life to become synonymous with an interpretation of his art, his political and sociocultural exposures make the potential connotations of his dramatic works all the richer and more varied. Instead of using his background and political affiliations to limit interpretations of his dramatic works to his life alone, or to one ideology, one might perhaps explore the methods of subjugation that recur in his works and how they transcend ideology. His plays would never be about his background alone, but as he was witness to the formation of the Irish Free State, Nazi Germany and its effect on France, unrest during World War II, the Algerian War of Independence, and censorship—on many fronts—his experiences and intellectual correspondences certainly provided fodder for political commentary, however discreet (Morin 159). This thesis will avoid metaphysical interpretations to examine how Beckett’s dramatic works might comment on deception and exploitation in the real or actual, and thus will attempt to see Beckett’s stage as a metonym for the world. Of interest will be topics identity, responsibility, representation, and right to representation and/or expression. It will examine how Beckett's protagonists represent the individual under subjugation; how the condition of his audiences represents the responsibility and/or complicity of the general public in systems of inequality; how procedures and tactics of mastery deployed by his antagonists serve as allegory for domination in the world; and the means by which contemporary directors might reimagine Beckett, in light of the claim inherent in his works that artistic representation always fails to serve its intended signified in totality