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The Impact of a Nurse-Driven Multi-pronged Approach for Medication Education on Patient Satisfaction
No full textD.N.P.Patient education is at the core of nursing responsibilities, yet research demonstrates that many patients retain less than 50% of what is explained to them, often related to low health literacy. This knowledge gap underscores the critical need for thorough discharge teaching, specifically emphasizing medication education in a meaningful and memorable manner. This quality improvement (QI) project explored the impact of a nurse-driven, multi-pronged approach to medication education on patient satisfaction scores over a three-month period, as measured by top box scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®) domain of “Communication about medicines.” The prongs included: 1) utilization of the teach-back method; 2) placing stickers on water pitchers for "new" medications; 3) highlighting "NEW" medications on discharge instructions; 4) placing a magnet with pharmacy contact information on patient whiteboards; and 5) identifying an Evidence-based Practice (EBP) Change Champion (CC) on the unit. The secondary aim of this project was to measure nurse conviction and confidence in using the teach-back method in practice. The number of HCAHPS® surveys returned pre- to post-practice change was identical (N = 19); however, the survey response rates declined (25.33% to 22.00%) and were slightly lower than the national response average (-0.67% and -4%, respectively). The top box scores for the medication domain declined by 11.81% despite the multi-pronged approach being developed by a multidisciplinary team with intentionality and details rooted in literature. Seventy percent (N = 14) of the nurse participants completed all three conviction and confidence surveys. All participants reported high conviction (M = 8.9-9.1; SD = 0.7-2.5; p = .280) and confidence (M = 8.9-9.1; SD = 0.7-2.4; p = .131) in using teach-back, although not significant, Mann Whitney U = 27.5. All elements of the teach-back method either stayed the same or increased. Six of the elements increased significantly (
The Relationship Between the Paris Agreement and the Profits of Petroleum Companies in the United States
No full textM.P.P.This research explored the peculiarities of the relationship between the Paris Agreement and the financial performance of U.S. oil companies, focusing on the effects of U.S. exit and re-enter into the agreement. The analysis based on a strong fixed-effects regression model of high-frequency data from 2015 to 2021 has revealed the financial dynamics in the stability of major changes on the agenda of government policies on climate change and carbon emissions. Instead of the expected post-policy bump based on the assumption that savings on compliance with the mandatory rules would bring short-term economic relief, the findings illustrate a significant drop in revenues after the U.S. retreat in 2020. This result suggests that the market could punish companies not aligned with global sustainability trends, which also raises concerns over long-term investor reluctance, market-driven consumer preferences, and outlook over the policy climate in the future. The research on the pressured environment-to-earnings equilibrium contributes to the hugely debated strategic impact of international climate accord compliance on firm profit and sustainability. The outcomes provide takeaways for regulators, investors, and industry players, highlighting that U.S. oil companies need to change their behaviors and mature under new international environmental trends and competitive market conditions
Causality, Modality and Contextual Argument Interpretation: Lessons from Teochew
No full textPh.D.This dissertation investigates the syntactic, semantic and pragmatic properties of Teochew periphrastic causatives, and specifically the means by which the so-called causee interpretation of the intermediate external argument is derived.I show despite the same embedded predicate, causees in these causatives demonstrate different patterns when diagnosed by many linguistics tests targeting the argument interpretations. Comprehensive syntactic analysis shows that these causatives are very similar in their syntactic argument structures, e.g., recursive VoiceP and vP. I argue that the listing approach, treating argument interpretations as syntactic primitives and listing them with specific verbs or syntactic layers, cannot account for the different causee interpretations. The alternative contextual approach, contextualizing argument interpretations as post-syntactic derivatives through syntactically-oriented event structures, is more favorable.All the previous contextual studies on external argument interpretations exclusively focus on the eventuality of the syntactic complement of the argument-introducing head. However, causees are traditionally viewed as shared arguments between the embedding causative verbs and the embedded predicates. Based on Teochew data collected in fieldwork research and insights from philosophy, I develop a formal modal semantics analysis of each causative verb to account for the encoded multidimensional causal relations that cannot be captured by the monolithic CAUSE operator.For complex causer interpretations, I demonstrate a fine-grained implementation of the complement-oriented approach not discussed before. I also develop a novel formalization of the relationship between different modules of the grammar that constrains the possible causee interpretations in a two-step way. More specifically, I show that the causee interpretation depends on the structure of event in which the argument occurs, first the eventuality of the embedded predicate and then that of the embedding causative verb with modal properties. I further explore the nature of many so-called agentive diagnostics widely adopted in recent literature, showing a fine distinction between intuitive AGENT and grammatical AGENT is required to be drawn. Building on the different properties of each type of AGENT, I showed how the final causee interpretations map to their compatibilities with different linguistics diagnostics, which solves the causee interpretation puzzle.In its focus on causee, this dissertation sheds light on the linking between syntax and semantics in argument interpretation with a focus on external arguments. It also provides implications for complex causal event structure, research on argument structure (e.g., the introduction of arguments and argument licensing), and the phasehood or domain sensitivity at LF
Illiberalism In The North Atlantic Treaty Organization (NATO): A Challenge To Liberal Democracy
No full textD.L.S.An enduring belief shared by the United States and its allies within the North Atlantic Treaty Organization (NATO) is that a set of mutually shared principles underpins the alliance, espousing the view that member nations adhering to these principles will ensure peace and security within the transatlantic area. Under this belief, security is accomplished through a shared commitment to democracy, individual liberty and the rule of law. Taken a step further, the belief holds that a values-based philosophy prevents democratic nations from going to war against one another. This assumption is actually codified within NATO’s founding charter and has been consistently repeated over the last seventy years within the strategic documents and public pronouncements made by various NATO leaders. For the alliance, these democratic principles are upheld to be universal, so certain standards of behavior are assumed to be expected from each member nation. In this context, NATO, which is widely considered to be the world’s most powerful political-military alliance, views itself not only as a security organization but a community of shared values, a claim that is often heard within the alliance. In recent years, however, NATO has witnessed the rise of illiberalism, or movement away from those very democratic principles and towards authoritarianism, nationalism, and populism. This is seen among several member nations, including the United States. In this context, the democratic principles that uphold NATO appear to be under attack, and this could threaten the alliance’s cohesion as well as its credibility. Russia figures prominently in this phenomenon. The Kremlin views not only NATO’s military power but its democratic principles as posing threats to Russia’s own security and way of life. Interestingly, the autocratic leadership exhibited by Russian president Vladimir Putin has found a certain appeal among various NATO leaders. Among them, Hungary’s Viktor Orbán has unapologetically embraced illiberalism, claiming that there is no one-size-fits-all approach to democracy, which he insists that Hungary still is. Using the lens of postmodernism, this thesis examines the phenomenon of rising illiberalism within the NATO alliance. Can democracy, individual liberty, and rule of law flourish under autocratic leaders? Does illiberalism put NATO’s credibility at risk? Can illiberalism coexist with liberal democracies? This thesis explores these questions and seeks to uncover why illiberalism is happening
Colloidal Preparation of Rare Earth Telluride Nanomaterials
No full textPh.D.The lanthanide telluride phases, LnTex (Ln = La-Lu; x = 1-3) host a wide variety of electronic, magnetic, and coupled magneto-electric properties. However, study of these properties as a function of material size have been limited by their challenging synthesis and air sensitivity. We sought a general colloidal approach to access these materials on the nanoscale, to allow for sufficient quantities of materials to screen for optical, electronic and magnetic changes observed on the nanoscale. Due to the lack of a generalized colloidal synthetic scheme for the lanthanide tellurides, we began by designing a synthesis that yielded high quality single crystalline NdTe3. By small variations of reagents, two different thicknesses of this highly anisotropic material were grown. These nanosheets exhibited enhanced charge density wave ordering temperatures, and diminished antiferromagnetic character on the nanoscale.
We then studied how this synthesis could be adapted to access other lanthanide telluride phases. By decreasing the concentration of tellurium, dissolved as trioctylphosphine telluride, we found phase control between LnTe3 and LnTe2 (Ln = La-Nd, except Pm), and LnTe3 and Ln2Te3 (Ln = Sm-Tb, except Eu). This allowed for access to CeTe3 nanosheets, which exhibited a significant change from antiferromagnetism in the bulk, to ferro/ferri-magnetism on the nanoscale.
In an effort to achieve additional control over the thickness of the nanosheets, GdTe3 was investigated, where synthetic variables such as ligand identity, halide source and reaction time were studied. We found that the largest aspect ratio nanosheets were formed from GdI3, however, thickness control remains elusive.
Lastly, the divalent lanthanide tellurides, LnTe (Ln = Eu, Yb) and EuTe2, were formed on the nanoscale and their optical/magnetic properties were studied as a function of their particle size. A minor blue shift of the band gap with decreasing particle size was observed for EuTe nanoparticles, and EuTe2 showed a decreased critical field for its spin flop transition. This work is the first colloidal approach to multiple phases of the lanthanide telluride family of materials, allowing the study of properties that appear to be highly sensitive to particle size changes
Binding Site Portability and Adaptability in an Intrinsically Disordered Protein-Small Molecule Interaction
No full textPh.D.Intrinsically disordered proteins (IDPs), characterized by their lack of stable three-dimensional structures, have traditionally been considered difficult targets for drug discovery. However, their critical roles in biological processes and involvement in various diseases make them attractive targets. This dissertation explores the interactions between IDPs and small molecules, aiming to understand better the fundamental principles that govern their binding mechanisms and selectivity.In Chapter II, we demonstrate the successful transfer of a disordered binding site from one IDP to another while retaining ligand affinity. This finding highlights the portable and adaptable nature of an IDP binding site. In Chapter III, we investigate sequence specificity in IDP-small molecule binding, revealing crucial residues in the IDP binding site. Mutational analysis also demonstrates strict sequence requirements at certain positions in the binding sequence. The observed dependence of binding on precise amino acid sequences reveals a highly specific molecular recognition event between the small molecule and IDP. This sequence-determined specificity was further pronounced in more complex sequence rearrangements, highlighting the importance of a specific residue composition for successful interaction.
These results challenge the notion of IDPs as undruggable targets and provide an outline for small molecule binding of IDP targets. By understanding the principles governing IDP-small molecule interactions, we can unlock the therapeutic potential of this underexplored region of the proteome, leading to the development of innovative drug discovery strategies for diseases associated with IDP dysfunction
The Relationship Between Public School Spending and Juvenile Delinquency
No full textM.P.P.Juvenile crime in the United States is extremely high compared to that of other nations. And while arrests of juveniles have been decreasing in recent years, addressing juvenile crime further has important implications for incarceration rates, public safety, and economic outcomes. Research has linked public school spending to a multitude of outcomes, including higher test scores, higher graduation rates, better economic opportunities, and decreased rates of crime in adults. This paper builds on previous literature by examining the relationship between public school spending and juvenile justice, specifically looking at the relationship between per-pupil spending and juvenile referrals to criminal court. I use data from the Annie E. Casey Foundation’s Kids Count Data Center to examine this relationship. Using fixed effects models, I find no relationship between per-pupil public school spending and juvenile court referrals. However, when looking at the later years of the dataset, I find a small, but statistically significant and negative relationship
The Environmental Security Dynamics of US-PRC Competition for Critical Mineral Resources
No full textAs the subject of thesis research, I examine the strength and novel contribution of
environmental security as a theoretical framework of analysis for the issue of Sino-American
competition over critical minerals. I will first provide an overview and set of working definitions
for current theoretical frameworks of analysis in international security studies. Through
comparative analysis, I will identify the strengths that other theoretical security frameworks
provide for the comprehensive analysis of competition between the United States (the “US”) and
the People’s Republic of China (“PRC”) over critical minerals. I will then outline the issue of
US-PRC competition over critical minerals and its strategic implications for security interests
across domains for both parties. Through an in-depth examination of the strategic value of
critical minerals and, in turn, the resulting conflict between the US and PRC, I will provide
evidence and ultimately argue for a unified framework of comprehensive analysis for this issue.
This will ultimately lead me to explain how environmental security accomplishes this and further
provides a novel contribution to such analysis
Assessing Health Without Use of Body Mass Index: Influence of an Educational Tool on Midwifery Care
No full textD.N.P.Weight bias, defined as negative attitudes toward people with higher body weights, is rooted in the false belief that weight is a marker of health. The reliance on the body mass index (BMI) in the U.S. healthcare system perpetuates weight bias because it categorizes a patient’s BMI into varying health categories solely based on height and weight. However, a myriad of biological, genetic, and environmental factors play a role in overall health, instead of BMI alone. Due to experiences of weight bias in the clinical setting, patients with higher BMIs (defined as BMI>30 mg/kg2) have delayed or avoided accessing the healthcare system, which can lead to poor health outcomes.The purpose of this quality improvement project was to measure the commitment to change practice among certified nurse-midwives/certified midwives (CNMs/CMs) after the completion of an education intervention about weight bias and its influence on health outcomes. The Commitment to Practice Change (CTC) framework, which reinforces learning with action statements aimed to support the application of knowledge into clinical practice, was used. Secondary project aims explored trends in CTC scores based on demographics and barriers/facilitators to implementing practice change. CNMs/CMs in the United States were invited to participate via flyers and email blasts distributed through professional midwifery state affiliate listservs. Thirty-seven participants completed the initial demographic survey and fourteen completed all surveys. Most participants identified as white and worked in the hospital and outpatient setting. Project findings revealed a high commitment to change practice based on mean (M) post-education scores (M=4.36 immediately post, M=4.46 two-months post) indicating that the intervention positively influenced a commitment to change practice. There was no statistical significance in CTC scores post-education when controlling for practice setting, years in practice, or racial identity. Strict organizational protocols were identified as the most common barrier to implementing practice change by the participants who attempted to forgo use of the BMI for health assessments. Midwifery advocacy for the implementation of organization-wide educational modules could lead to evidence-based weight inclusive clinical protocols which may improve health outcomes
