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Facilitators and Barriers to Center for Patient and Professional Advocacy’s Co-Worker Observational Reporting System Program at Vanderbilt University Medical Center
No full textSchool of Nursing Doctor of Nursing Practice Program ProjectPurpose:
The purpose of this quality improvement project was to identify from Co-Worker Observation Reporting System (CORS) peer messengers possible causes for unknown delivery status of messaging reports. CORS is a tool and a process used across three academic medical centers to address disrespectful behavior. CORS trains staff nurses to serve as messengers and provide feedback to their peers. In a recent study by CORS, 15% of peer messages had an unknown status of delivery.
Methods:
A REDCap survey was distributed to 91 current Vanderbilt University Medical Center CORS peer messengers that have delivered a peer message in the past three years. A thirteen-question survey was utilized to gather quantitative data. Multiple choice and Likert scale questions were presented. Once survey was distributed via email, participants had a two-week time frame to complete. Data was assessed for barriers and facilitators to completing the peer message.
Results:
Thirty (32.9%) peer messengers at Vanderbilt University Medical Center completed a REDCap survey. Data revealed that peer messengers (n = 23) felt prepared to discuss the report with a peer. Twelve participants reported that they were unable to deliver a peer message due to a lack of communication from receiving peers (n = 12, 86%). Peer messengers indicated that a tips and tricks sheet was adequate in preparing them to discuss reports with peers. The majority of participants (n = 15, 53.6%) felt extremely comfortable with opening a conversation with a peer and felt extremely comfortable (n = 15, 55.6%) with how to deliver a message. Some (n = 9, 33%) experienced difficulty connecting with a peer.
Implications for practice:
The “Tips and Tricks” information sheet should continue to be given to each peer messenger. Incentivizing peer messengers and emailing reminders could increase completion of surveys
Weak Exactness and Amalgamated Free Product of von Neumann Algebras
No full textWeakly exact von Neumann algebras were introduced by Kirchberg in 1995 in parallel with exact C-algebras and have since become an effective tool for allowing the use of C-algebraic techniques in the theory von Neumann algebras. It is known that for von Neumann algebras with separable predual, weak exactness is preserved under taking subalgebras with conditional expectations, tensor products, crossed products with exact groups, and increasing unions.
We show that the amalgamated free product of weakly exact von Neumann algebras is weakly exact. This is done by using a universal property of Toeplitz-Pimsner algebras and a locally convex topology on bimodules of von Neumann algebras, which is used to characterize weakly exact von Neumann algebras. As a corollary, we deduce that weak exactness is preserved under HNN extensions and graph products. We also introduce a generalized notion of exactness on C-bimodules which extends both exactness of C-algebras and weak exactness of von Neumann algebras
The Listening Leader: A Program Review
No full textLeadership and Learning in Organizations capstone projectThis capstone project evaluates the effectiveness of a new leadership development program at Helping Hands Family Autism Services (HHF). Launched in January 2025, the program aims to enhance the competencies of Board Certified Behavior Analysts (BCBAs) in active listening and trust-building to improve their relationships with Registered Behavior Technicians (RBTs). The study utilizes the Leader-Member Exchange (LMX) framework to assess the impact of the training on listening quality, supervisory satisfaction, job satisfaction, and retention rates among RBTs.
The evaluation employs a mixed-methods approach, combining quantitative surveys and qualitative interviews across four clinics—two serving as intervention sites and two as control sites. Key findings indicate that improved listening skills among BCBAs lead to higher satisfaction with supervisors and reduced turnover in the intervention clinic. However, job satisfaction is influenced more by factors such as compensation and peer relationships than by supervisory behavior alone. The study underscores the importance of consistent implementation and the role of peer support in enhancing job satisfaction and retention.
Based on these findings, the project recommends reconfiguring the learning framework to be competency-based, institutionalizing peer communities of practice, ensuring full implementation of leadership programs, expanding key leadership behaviors organization-wide, redesigning workload systems to align with motivational drivers, and institutionalizing listening as a core competency across clinical operations
Metabolic Engineering of Phaeodactylum tricornutum for Triacylglycerol Production
No full textCulturing microalgae for biodiesel production is one of the few viable methods to completely replace our reliance on petroleum for transportation vehicles. Phaeodactylum tricornutum (Pt) produces lipids called triacylglycerol (TAG) that can be easily converted into biodiesel. Despite the recent advancements in TAG production, a clear understanding of how environmental conditions and genomic engineering enhance TAG production. In this work, 13C isotopic nonstationary metabolic flux analysis (INST-MFA) was utilized to investigate how light intensity and malic enzyme overexpression increase TAG production. First, wild type Pt cells were cultured under two different light conditions, 60 μE and 250 μE. Increased light intensity was found to increase growth and TAG production. As light intensity increases, the excess fixed carbon was directed towards TAG synthesis instead of biomass. Next, a malic enzyme (ME) overexpressing strain was developed through electroporation. The mutation increased TAG production while maintaining equivalent growth rate to wild type. Using INST-MFA, the primary mechanism of ME was shown to direct the citrate and pyruvate pool towards TAG synthesis and decrease TCA cycle flux. Finally, a systematic analysis of the effect of pool size measurements on flux estimates was conducted. Pool size measurements increase sensitivity to errors in the model. Therefore, inclusion of pool size measurements results in the accurate flux estimates even when there are certain model errors. Overall, these studies show the utility of INST-MFA to elucidate the underlying mechanisms for TAG synthesis. Furthermore, this work highlights the potential of INST-MFA to develop gene targets and optimize cell culture conditions to increase TAG production
The linearized Israel-Stewart Equations with a Physical Vacuum Boundary
No full textThe Israel-Stewart theory describes relativistic viscous fluids and provides a robust model for simulating important physical phenomena in astrophysics, high-energy physics, and cosmology. However, it has been studied far less extensively than relativistic ideal fluids governed by the relativistic Euler equations. In this dissertation, we investigate an equation of the Israel-Stewart type with bulk viscosity in the presence of a vacuum.
By allowing for a vacuum, we introduces degeneracy in the governing equations near the boundary. It turns out that the decay rates of the fluid’s density and bulk viscosity play a crucial role in addressing this degeneracy. These decay rates also ensure that the boundary can have a finite, nonzero acceleration, allowing us to model some physical scenarios such as star rotation. Based on these decay rates, we define the physical vacuum boundary condition.
Our primary goal in the dissertation is to establish the local well-posedness of the linearized system with a physical vacuum boundary. Since the nonlinear system is degenerate near the boundary, the linearized equations are also degenerate near the free boundary. In this case, the local well-posedness of the linearized equations cannot be derived from the standard techniques. To handle these challenges, we incorporate a weight into our energy estimates, which naturally leads to a functional framework based on weighted Sobolev spaces.
The core strategy for proving local well-posedness relies on energy estimates in these weighted Sobolev spaces, combined with a duality argument. Within this process, weighted elliptic operators tied to the second-order evolution of the system play a crucial role. We show that these weighted elliptic operators satisfy some specific weighted elliptic estimates and connect the weighted Sobolev spaces at different regularities.
Finally, we discuss how the local wellposedness of the linearized equations contribute to constructing solutions for the fully nonlinear system, which will be presented in an upcoming work
The (Post)confessional Mode: Parodic Psychiatry in Feminist Literature and Performance
No full textThe (Post)confessional Mode: Parodic Psychiatry in Feminist Literature and Performance gathers a body of post-1945 feminist works that portray and aestheticize mental illness towards experimental forms of self-telling, a process that revises the first-person I as a fragmented, revisionary, and ultimately collective referent, often in response to exclusionary hierarchies in language and its attendant social and clinical effects. Reading across a lineage of postwar feminist literature and performance, I identify this strategy as part of a psycho-aesthetic phenomenon that reclaims portrayals of mental illness to achieve an ironic, parodic form of self-disclosure, which I call the “postconfessional” mode. Playful, irreverent, and evasive, the multimodal works by Sylvia Plath, Clarice Lispector, Kathy Acker, Claudia Rankine, Phoebe Waller-Bridge, Karen Finley, Taylor Tomlinson, and Cristela Alonzo demonstrate an increasing awareness of an external reader or viewer who participates in their self-fashioning, especially as artists increasingly move from texts to other media. Postconfessions decenter confessional literature as a dominant postwar genre, especially as a feminized practice that attempts to achieve authentic self-revelation. While revising long-established forms of psychiatric treatment and talk therapies, the formal strategies behind postconfessions increasingly implicate extra-clinical actors in newly therapeutic processes, leading to revisions of care that create catharsis through mutual recognition
Rural Environmental Justice: Structural Inequities and Care-Driven Resistance in Grundy County, Tennessee
No full textRural communities and populations have played a prominent role in the Environmental Justice Movement and have appeared within environmental justice scholarship. However, rurality, as a critical axis of difference—a socially constructed dimension of identity and place through which power, resources, and recognition are unevenly distributed—is an understudied dimension of environmental (in)justice. In response to this gap, a small but growing body of scholarship has begun to advance conceptual frameworks for understanding rural environmental (in)justice. These frameworks have identified unique mechanisms that contribute to and perpetuate rural communities’ vulnerability to environmental injustice. Contributing to this body of scholarship, this dissertation employs a case study approach, situated within the context of Grundy County, Tennessee—a rural county in South Central Appalachia—to examine the structural mechanisms (i.e., economic, political, and social) that contribute to the county’s vulnerability to environmental injustice. However, recognizing that rural communities are not passive recipients of environmental harm, it also explores how Grundy County residents mobilize collective action in response to environmental threats.
To examine these topics, I draw on 24 months of fieldwork, guided by a methodological orientation rooted in critical inquiry. This approach employs a multimodal ethnographic methodology that includes participant observation, the collection of extant documents (i.e., historical, archival, social media, and news media), and in-depth interviews. I integrate these methods through a constructivist grounded theory approach, which recognizes knowledge as socially constructed and contextually situated. Informed by theoretical frameworks of spatial justice, environmental justice, and a feminist ethics of care, findings from this dissertation suggest that Grundy County’s vulnerability to environmental injustice is rooted in intersecting political, economic, and social processes that operate unevenly across space. Patterns of economic disinvestment, fragmented governance, and rural stigmatization have rendered the county politically marginalized and environmentally expendable. However, despite these structural conditions, residents do not passively accept harm; they engage in diverse forms of collective action rooted in an ethic of care and guided by situated practices of care that contest environmental injustices, defend a collective understanding of “home,” and enact place-based strategies of mutual responsibility, resilience, and pride of place
Autoeroticism, Solitude, and Christianity in Jane Eyre
No full textHiding, retreating, or fleeing from surveilling eyes and coercive religious discourse, Jane finds safety only within herself. Designating spaces for self-solace, rumination, and prayer, her absolute solitude is augmented by erotic and religious energies. These autoerotic and secluded moments, usually following some form of mistreatment, crippling confusion, or distress, help her to ultimately develop both self-possession and religious devotion. Mr. Brocklehurst, Helen Burns, St. John Rivers, and Edward Rochester offer various depictions of coercion and irreligion that reinforce Jane’s need for safe spaces and independence. This article partners with Eve Kosofsky Sedgwick’s “Jane Austen and the Masturbating Girl” to highlight the erotic and religious vitalities in spaces of complete inaccessibility: the alcove and corners of Jane’s childhood or the couches and bedchambers of her adulthood. She forces herself and her self to be utterly, rebelliously, out of reach—out of range of religious authority’s discipline and masculine control. In these common but private places, Jane’s Christian pilgrimage is punctuated by solitary gratification—her solitary communion—which unites religious-driven pleasure in attaining self-possession through a self-service akin to masturbation. Parson-less and self-motivated, Jane redefines the nineteenth-century Christian woman
Understanding the Context of Cramming: Student Cost Perceptions, Study Strategies, and Exam Performance
No full textAlthough many laboratory studies have shown that cramming is less effective than spacing, relatively few studies answer the question: Why do students cram for exams, and how is that related to their studying and exam performance? Building on the previous research, this study examined a set of contextual reasons: their perceived costs of studying, the busyness of their week, and the types of study strategies they employed. Across two
studies, 50 and 296 undergraduates enrolled in psychology courses responded to a survey in which they rated the extent they crammed for a specific exam, their perceived costs of studying, and how busy they were the week of their exam. They also described their study strategies, and exam scores were collected. In Study 1, students responded to this survey for three consecutive, non-cumulative exams, and in Study 2, students responded to the survey after their final exam. Study 1 revealed that students’ outside effort costs were positively related to cramming. Interestingly, there was no relationship between cramming and the types
of study strategies they used or how well they performed on the exam. The main findings from Study 1 were replicated in Study 2. In Study 2, the results show that students who cram do not spread out their study sessions, and there is no interaction effect between cramming and spacing on exam performance. Implications for future research are discussed
Structural investigation of ALA synthase reveals allosteric regulation governed by protein dynamics
No full textPyridoxal 5’-phosphate (PLP), a bioactive form of Vitamin B6, serves as a cofactor for over 140 distinct enzyme activities that are essential to biological survival. The reactivity of PLP places responsibility on the enzyme scaffold to mediate reaction type, therefore PLP-dependent enzymes (PDEs) can be categorized into fold types based on structural conservation. The differences lie in their distinct, allosteric mechanisms that help to regulate enzyme function. Since allostery relies on the interconversion of conformational states, understanding the protein dynamics within a system will provide an opportunity to target specific PDEs for therapeutic and industrial use.
In this dissertation, I have used an integrated approach involving structural, computational, biophysical, and biochemical techniques to explore the autoregulation of a member of the PDE Fold Type I superfamily. Aminolevulinic acid synthase (ALAS), a heme biosynthetic enzyme, contains a conserved, catalytic core, but eukaryotic homologs have evolved to include divergent, extended termini that differentially interact with the core. As a result, mutations spanning across conserved and divergent regions result in opposite functional phenotypes. My work demonstrates that the basis of these differences lies in the complexity and interconnectivity of eukaryotic ALAS protein dynamics. Unlike bacterial ALAS dynamics which rely solely on loop movement proximal to the active site, eukaryotic dynamics communicate across a wider region, encompassing both the core and divergent termini. This wide network of intra-molecular contacts further modulates inter-molecular interactions with ligands and other proteins, meaning that ALAS homologs have each adapted to function in their respective cellular contexts by fine-tuning protein dynamics. Structural and bioinformatic analysis of Fold Type I PDEs reveals similar conformational evolution, demonstrating that this case study of ALAS provides a foundation for the investigation of precise allosteric mechanisms for this family of enzymes