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The Impact of a New Surgical Advanced Practice Provider Role at Night on Patient and Nurse Satisfaction
No full textD.N.P.The growing Advanced Practice Provider (APP) workforce can be instrumental inaddressing provider shortages and improving staff satisfaction, which has never been more pertinent than during this period of high burnout and turnover in healthcare. Research demonstrates the positive impact APPs have on patient outcomes in the acute care setting. This quality improvement project aimed to evaluate the impact of a new nocturnal APP role on patient satisfaction, length of stay (LOS), and nursing satisfaction over four months at a large academic hospital. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and LOS data were collected via the hospitals database retrospectively. Data four months before and four months after the addition of the nocturnal APP were compared using two proportion z tests. Nursing satisfaction was evaluated with a pre and posttest design and analyzed using a one sample t test. There was no statistically significant change or improvement in either patient satisfaction or length of stay when comparing before and after the APP role implementation. There was a statistically significant improvement in nursing satisfaction four months after the nocturnal APP role was implemented. Nursing staff reported improved teamwork and cooperation with providers and more nurses felt they had adequate time to discuss and provide direct patient care. Additional research, including multicentered randomized studies, are needed to address the clinical significance of adding a nocturnal APP role for patient and staff satisfaction and patient outcomes
Characterization and Phase Transformation of Biogenic and Synthetic Uric Acid Forms
No full textPh.D.Though the major nitrogen waste form in humans is urea, any uric acid that is produced from purine metabolism cannot be further oxidized due to the silencing of the uricase enzyme. Uric acid crystallization is associated with medical conditions like gout and kidney stones due to its low solubility in physiologic solutions. Here, we explored synthetic and biogenic means of manipulating the crystallization and properties of uric acid. The addition of heterocycles with multidentate binding motifs were added to the growth solution to disrupt the usual uric acid binding motifs. Some compounds delayed the onset of crystallization and yielded new uric acid cocrystal phases. Unusual behavior in the growth and transformation of uric acid dihydrate in the presence of one heterocycle, 2,4-diaminopyrimidine, was further examined.Uricotelic species, those that primarily eliminate excess nitrogen as solid uric acid, colloquially referred to as "urates," also have lost uricase enzyme activity. Examination of urates from a range of snake species led to the identification of two general compositions: uric acid (protonated) from "ancient" snake species and ammonium urate from "modern" snake species. These variations suggested an adaptable nitrogenous waste management mechanism that could be insightful in handling large amounts of uric acid.
The composition and properties of uric acid in ball python urate microspheres was determined to be nanocrystalline with a structure close to uric acid monohydrate featuring turbostratically disordered layering. This phase had a significantly higher solubility than common pathogenic deposits in humans (anhydrous uric acid, uric acid dihydrate, and monosodium urate), and its stability was assessed under varied conditions. The phase readily converted to the more stable (and less soluble) anhydrous uric acid and uric acid dihydrate forms in water and when heated. In the presence of ammonia, this uric acid hydrate phase underwent a conversion to ammonium urate hydrate, which suggested a common precursor across reptile species and a clever way to detoxify hazardous ammonia.
We went on to characterize a novel ammonium urate hydrate structure grown in vitro from anhydrous uric acid as an analogous structure to the phase synthesized from ball python microspheres. This is the first known report of the ammonium urate hydrate form. Using the synthetic ammonium urate hydrate, we demonstrated that biogenic urate forms found in human and other animal uroliths are often a mix of anhydrous and hydrated ammonium urate forms, previously complicated without this novel form. This research sheds light on the crucial control of uric acid crystallization in vitro and in vivo, characterized complex crystallographic biogenic "urates" in snakes, and identified novel crystalline forms
Effects of CDK4/6 Inhibitor-Induced Stromal Senescence on the Metastatic Niche and Metastasis of Breast Cancer
No full textPh.D.CDK4/6 inhibitors (CDKI) have improved disease control in hormone receptor-positive, HER2-negative metastatic breast cancer, but most patients still develop progressive disease. It is unclear to what extent host responses to CDKI, such as CDKI-induced cellular senescence, contribute to this impediment. We hypothesized that host stromal senescence after CDK4/6 inhibition promotes metastatic seeding and growth of mammary cancer cells based on evidence from our lab that stromal cells treated with CDKI can enter a cellular senescence-like phenotype and evidence from the literature that stromal cells driven into senescence by other systemic anticancer therapies have been shown to promote tissue degeneration and development of metastases. To investigate this, we assessed the contribution and consequences of palbociclib-induced cellular senescence to lung seeding of breast cancer cells using the p16-INK-ATTAC mouse model of inducible depletion of senescent host cells. Palbociclib pretreatment of naïve mice increased lung seeding of CDKI-resistant syngeneic mammary cancer cells, and this effect was reversed by depletion of host senescent cells. RNA sequencing analyses of lungs from non-tumor-bearing p16-INK-ATTAC mice identified that palbociclib downregulated immune-related gene sets and gene expression related to leukocyte migration. RNA sequencing from other non-tumor-bearing organs treated with palbociclib, such as the murine liver, reveal that palbociclib-induced decreases in immune-related gene sets are consistent across the lung and liver. CIBERSORTx analysis revealed that palbociclib altered intra-lung macrophage populations. A portion of these effects were reversed by concomitant senolysis, including pathway-level enrichment of TGF-β-related signaling that presented as a delayed-onset effect of palbociclib treatment. Notably, lung metastases from palbociclib-pretreated mice revealed senescent endothelial cells. Palbociclib-treated endothelial cells exhibited hallmark senescent features in vitro, upregulated genes involved with the senescence-associated secretory phenotype, leukocyte migration, and TGF-β-mediated paracrine senescence, and induced macrophage invasion in co-culture. These studies shed light on how stromal senescence induced by palbociclib affects lung metastasis, and they describe palbociclib-induced gene expression changes in the normal lung and endothelial cell models that correlate with changes in the tumor microenvironment in the lung metastatic niche
Reducing Diesel School Bus Emissions: An Empirical Analysis of the Effects of the California Lower Emission School Bus Program on Student Health
No full textM.P.P.In 2006, the state of California implemented the Lower-Emission School Bus Program to improve the safety and cleanliness of its bus fleet for school children and the surrounding community. This school bus program funded the replacement or retrofit of the highest polluting diesel engines in California’s public school buses. Diesel pollution is linked to a wide range of adverse respiratory health outcomes in children. In this thesis, I analyze the effects of the school bus program on childhood asthma and aerobic capacity using a difference-in-differences model. I restrict my model to the counties in the Bay Area to reduce socioeconomic and geographic variability. I contribute to the existing literature by shedding light on the relationship between bus retrofit funding, emission rates, and childhood health. My analysis finds that the school bus program effectively reduced diesel emissions and significantly decreased childhood asthma rates in counties that received funding. The results highlight the harmful effects of diesel on children's respiratory health and emphasize the importance of clean school bus programs
Exhibit J: Querying Procedures Used by the Central Intelligence Agency in Connection with Acquisitions of Foreign Intelligence Information Pursuant to Section 702 of the Foreign Intelligence Surveillance Act of 1978, as Amended, [REDACTED], No. [REDACTED] (FISA Ct. Mar. 13, 2023).
No full textFirst page of documen
A CASE STUDY: ASSESSING THE EFFECTIVENESS OF CHANGES IN URBAN FLASH FLOODING POLICY IN MOROCCO
No full textUrban flash flooding is a growing risk across the world. This is particularly true in the country of Morocco, characteristic of the North Africa and Middle East region, beset by an arid climate, an urbanization trend, and climate change. This paper uses Morocco as a case study to examine policy changes over the last few decades and assess their effectiveness in addressing the issue of urban flash flooding. By researching policy changes and assessments from independent third parties such as the World Bank and the United Nations, this paper maps Morocco’s changing approach to flash floods and identifies the existing weaknesses in the system. These weaknesses are that while policy changes can be seen, there is a lack of data indicating that these changes have had any impact. Morocco’s policies cannot be assessed without a national data collection mechanism created. Further studies are needed to address this dearth of data
The Mortara Center for International Studies, Walsh School of Foreign Service, Georgetown University Annual Report 2021-2023
No full textAnnual report describing the activities, initiatives, and events undertaken by the Mortara Center throughout the academic year
Screens and Faces: Using Social Cohesion and Online Communication as Proxies for Loneliness Effects on Happiness
No full textM.P.P.The progressive increase in connectivity, while allowing for higher resilience to loneliness, has not decreased the effect that loneliness has on overall wellness. In addition, the lower quality of online based interactions and relationships may exacerbate unhappiness despite an increase in social activity. The paper explores the mediated relationship between loneliness and happiness, assuming that social cohesion and engagement will act as a buffer for loneliness’s negative effects. To do so, data is pulled from the General Social Survey and the American National Elections Study to analyze changes in online interaction rates between 2018 and 2020, and verifying if these were met with corresponding changes in loneliness and happiness self-evaluations. The Fixed Effects Multinomial Logit model revealed that social cohesion and political participation are effective predictors of wellness among unhappy people in situations of high loneliness. Furthermore, online communication is still significantly correlated with improvements in wellness among already happy people, though these results may be compromised by the confounding quality of online based relationships. A dual system utilizing frequent digital interactions for loneliness prevention and community engagement for wellness treatment is proposed, and European programs dedicated to fighting loneliness are listed as a base for policy construction and implementation
Design, Development and Synthesis of π-conjugated Nanoporous Ladder Polymers
No full textPh.D.Organic π-conjugated nanoporous ladder polymers are highly sought after because of their single atom thickness, ability to control pore size, shape, and chemical functionality. An array of nanopores can make these ladder polymers useful for applications such as high-throughput transport detection, DNA sequencing, voltage-gated ion transport, and gas separation. However, due to the limitations of current top-down approaches and the lack of amenable synthetic strategies, there have been very few reports of bottom-up strategies to synthesize fully conjugated ladder polymers to date. Recognizing this challenge, our research group developed design strategies to generate soluble conjugated porous ladder polymers. A series of non-slanted H-shaped small molecules were synthesized using non-traditional cycloalkyl straps to investigate the effect of straps in hindering intermolecular π-π stacking interactions and improving solubility. This work showed that a twist between the strands and rungs affects the extension of π-conjugation and could hinder the intramolecular zipping required to generate the final nanoladder. A planar H-shaped molecule with an electron-deficient fused backbone was designed using pyrazinacenes to combat this issue. Linear pyrazinacene-based polymers were synthesized through organometallic polymerization conditions using mercuric chloride. Their photophysical and redox properties were investigated and showed extended conjugation along the polymer backbone and lowering the LUMO energy level, making these polymers useful for organic electronics, electrochemical transistors, and sensors. To generate error-free nanoladders, a tetrafunctional pyrazinacene H-shaped monomer having a completely fused backbone was synthesized. This allows for a more rigid structure and helps form error-free nanoladders through a two-step polymerization strategy. A more electron-deficient backbone allows for anion recognition through anion-π interactions, which is useful for potential application in medicine and environmental research.
In addition to the synthesis of ladder polymers, cycloalkyl-strapped linear polymers having non-strapped repeat units were also synthesized to investigate the impact of straps on polymer-small molecule interactions. Compared to fully strapped homopolymers, the copolymers with 20% non-strapped aryl units exhibited enhanced polymer-small molecule interactions. These copolymers could be useful in organic electronics and energy applications
The Effectiveness of Sanctions as a Foreign Policy Tool: The Influence of Sanction Objectives and Types on Sanction Success in African Nations
No full textM.P.P.Are sanctions effective as a foreign policy tool? In this study, we analyze the effectiveness of sanctions as a foreign policy tool through the influence of sanction objectives and types on sanction success in African nations. The emergence of new data to explore the effectiveness of sanctions on African nations allows us to estimate the effect that sanction objectives, sanction types, and the number of sanctions have on sanction success. Additionally, we estimate the effect that financial sanctions have on key economic indicators of GDP and exchange rates. There appears to be an association between the objectives promoting democracy, stopping terrorism, and destabilizing a regime; the sanction types financial and travel, and the number of sanctions on sanction success. It also appears that when imposing multiple sanctions on an African state with the goal of promoting democracy, it should not also be tied to the other objectives of stopping a terrorist organization or destabilizing the regime of a state when implementing sanctions. Further, there appears to be an effect of financial sanctions on GDP and exchange rates. The effect of financial sanctions on exchange rates shows a decrease to the exchange rates, appreciating the local currency relative to the U.S. dollar