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Reviewing Efficacy of a New Central Line Bundle
No full textIntroduction: Reviewing efficacy of a new central line bundle in reducing central line associated bloodstream infection (CLABSI) as compared to the old central line bundle. Using evidence-based research to develop a new bundle to include curos caps, povidone-iodine nasal swabs, and daily CHG wipes on all patients with central lines. Design: Retrospective chart review Methods: A microsystem assessment was conducted on a 32-bed transitional medical unit. Collaborated with the CLABSI value improvement team and the infection prevention team to review the data on CLABSI for 3 separate months in fiscal year 18 and fiscal year 19. A CLABSI safety analysis tool was used to screen infections to ensure they met the inclusion criteria for CLABSI. It was determined that the new bundle reduced CLABSI occurrence. Results: All the charts that indicated possible CLABSI were analyzed thoroughly using the CLABSI safety analysis tool. It was determined that there were two CLABSIs for the FY18 and zero for FY19 when compared month to month. The new bundle was estimated to increase cost by 2,865 per month. At a cost of 36,158 for the two cases. The unit spent about 27,563. Conclusion: The new bundle adds to the operating expense of the unit but significantly reduces the overall cost. It also improved patient outcome by implementing evidence-based practice that reduced CLABSI occurrence. Keywords: new central line bundle, CLABSI, patient outcome, infection prevention, central lineM.S.N., Clinical Nurse Leader -- Drexel University, 201
Implementation of an Oncology Specific Fall Risk Assessment Tool
No full textAbstract Falls are a concern for all patients, but oncology patients are at increased risk from falls due to treatment including transplantation and aggressive chemotherapies. As part of a quality improvement project, Penn State Cancer Institute piloted a new fall prevention tool on a 39-bed oncology unit to reduce falls. The Cleveland Clinic-Capone Albert (CC-CA) fall risk assessment for cancer patients, developed by Capone, (2012) was chosen. The pilot study design had three phases; a retrospective chart review of falls in 2018, a direct comparison random trial, and a 29-day trial implementation of the CC-CA. The CC-CA and the Hendrich II were compared for their ability to identify at risk patients. Implementation was supported by PDSA rapid cycle improvements by the interdisciplinary care team. The retrospective study results showed that the CC-CA was 2.43 times more predictive then the Hendrich II and had a sensitivity of 74.12 and specificity of 47.82. The two falls that occurred during the trial were both identified by the CC-CA and only one was identified by Hendrich II. The Hendrich II identified an average of 6.1 patients daily at risk for falls where the CC-CA identified 12.96. In the retrospective study 9 patients a day were put on fall precautions based on nursing judgment and after implementation of the CC-CA the average was 2.62. The pilot confirmed the CC-CA predicts and identifies more patients at risk for falling in the cancer population then the Hendrich II and provided nurses greater awareness of previously unidentified risk factors. Keywords: Falls assessment tool, Oncology, Bone Marrow Transplant, CC-CA assessment, Falls, Injuries, Nursing, Quality Improvement, Chemotherapies, Hendrich IIM.S.N., Clinical Nurse Leader -- Drexel University, [20
Cartilage Molecular Engineering Using Biomimetic Proteoglycans
No full textOsteoarthritis is among the leading causes of disability, affecting more than 30.8 million people in the United States, and is associated with a high economic burden that will continue to increase with the aging population. Osteoarthritis is a progressive disease characterized by the degeneration of collagen and the loss of proteoglycans such as aggrecan. The loss of proteoglycans cause a decrease in hydration, load bearing support, and lubrication of the articular cartilage. The goal of this thesis was to evaluate the use of a novel family of biomimetic proteoglycans as a treatment during the early stages of osteoarthritis and to examine the molecular engineering of the cartilage matrix by biomimetic proteoglycans. Biomimetic proteoglycans synthesized by our lab have similar composition, structure, and hydrating capabilities as natural proteoglycans that are lost during osteoarthritis, but resist enzymatic degradation from the hostile environment caused by osteoarthritis. Here, we investigated the effects of biomimetic proteoglycans injected into the intra-articular space in an in vivo osteoarthritic rabbit knee model and evaluated the histological response, joint friction, and the distribution and retention of biomimetic proteoglycans. Our findings showed that biomimetic proteoglycans were well tolerated by the cartilage for the mild osteoarthritic state that was generated and that the molecules were able to diffuse into the cartilage and remain there for at least five days. We also examined the diffusion characteristics of biomimetic proteoglycans through cartilage with the use of an in vitro cartilage diffusion model in both normal bovine and human osteoarthritic cartilage explants. The molecular diffusion was shown to be size and concentration dependent. Steady state diffusion coefficients for biomimetic proteoglycans were found to be comparable to other large molecule diffusion in cartilage despite the difference in charge. In both bovine and osteoarthritic human cartilage, biomimetic proteoglycans were found localized around the chondrocytes in the pericellular matrix, the region around a chondrocyte which modulates mechanical and chemical signals. This is a first look into the use of biomimetic proteoglycans to molecularly engineer articular cartilage as a way to restore the proteoglycans lost during osteoarthritis.Ph.D., Materials Science and Engineering -- Drexel University, 201
Ethical Decision-making: Exploring How Teachers Define and Respond to Professional Dilemmas
No full textThroughout the course of their careers, teachers will encounter a variety of professional dilemmas that will demand their attention; how they choose to address these dilemmas can have a lasting impact on their students, their careers and their communities. In order for teachers to effectively address these ethical dilemmas, they need to enter the teaching profession with the appropriate skills and training. By using a social constructivist approach based in grounded theory, this study explored the experiences that teachers have had with ethical decision-making and how they have navigated the process of addressing such dilemmas. Findings from this study addressed six key themes (1) Demographic Information, (2) Disposition, Values, and Ethics, (3) Ethics Training, (4) Identifying Ethical Dilemmas, (5) Addressing Ethical Dilemmas, and (6) Training Need Areas. Analysis of these themes and the existing literature identified a significant link between the participants' professional dispositions and key philosophical approaches to ethics, the importance of cultural diversity awareness when making ethical decisions, common types of professional ethical dilemmas encountered by teachers and the existence of ethics training opportunities. The recommendations generated from this study are designed to help those who develop teacher preparation curricula to construct programs that provide teacher candidates with effective and comprehensive ethics training opportunitiesEd.D., Educational Leadership and Management -- Drexel University, 201
Response to Intervention and the Perceived Academic Self-Efficacy of Urban Elementary Students
No full textResponse to Intervention (RtI) is a multi-tiered system of support that provides varying levels of intervention to address academic achievement. This data-driven framework allows educators to categorize students into tiers and identify specific areas of strength and weakness. Yet, the problem the study seeks to address is that educators have a limited understanding of the self-reported academic self-efficacy of students in the varying levels of an RtI model. This mixed methods study investigated the perceptions of elementary-aged students and general education teachers. Through the administration of itemized rating scale survey, student academic self-efficacy perceptions were reported. The researcher also conducted five one-on-one interviews with general education teachers to garner their viewpoints regarding differences, if any, between academics, behaviors, and motivations between students in different RtI tiers. Archival records of RtI student movement data and change scores were also reviewed. An analysis of the survey data revealed that students in Tier III of an RtI framework, have statistically lower levels of academic self-efficacy than their Tier I or Tier II peers. The reports of general education teachers revealed that on average, teachers had lower academic expectations for Tier III students than their Tier I or Tier II peers. A final analysis of the archival records review indicated that mean test change scores for Tier III students were statistically lower than the mean test change scores for Tier I or Tier II students. This research allows elementary educators to gain stronger understanding of the academic self-efficacy perceptions of Tier I, Tier II, and Tier III students within a RtI system. The results of this study suggest that educational leaders must continue to reflect upon current practices and seek innovative ways to target and improve the academic self-efficacy levels of elementary students.Ed.D., Educational Leadership and Management -- Drexel University, 201
The Potential Impact of Raw Milk on the Small Intestine Microbiome: An in vitro project
No full textHomogenization and pasteurization are common processing techniques used in the dairy industry on bovine milk to produce a uniform fluid that does not separate while stored and is virtually free from harmful bacteria. Many raw milk proponents however argue that these processes damage the nutritional value and in turn could be harmful to the gut microbiota. Many articles have been published, studying the relationship of milk processing and its subjection to in vitro digestion, however little information is available about the effects of milk on the small intestine microbiome. This project aims to compare and add to the current work on milk and the microbiome with the use of bioreactors, and to provide future experimentation procedures and suggestions for use of the data.M.S., Food Science -- Drexel University, 201
An Investigation of the Distorted Geometries of Copper(II), Nickel(II), and Cobalt(II) Complexes Induced by 1,3-Bis(pyridylimino)isoindoline Derivatives
No full textBiomimetic properties of copper, nickel, and cobalt coordination compounds have been studied extensively as these metals are found in the active sites of numerous proteins. Coordinating ligands with nitrogen donor atoms are especially of interest because nitrogen is also extremely common at these active sites. By changing the structure of the ligand, the complexes can be modified to mimic a wide array of enzymes. Studying these complexes has led researchers to propose mechanisms for many enzymes. In this work, tridentate ligands with nitrogen donor atoms were complexed with Cu(II), Ni(II), and Co(II) to form tetracoordinate and pentacoordinate systems. Syntheses and characterizations will be presented including X-ray crystallographic data, electron spin resonance, and electronic absorption data. [phi]t, [omega], and [tau] parameters will be given to describe the distorted geometries of the metal-ligand complexes.M.S., Chemistry -- Drexel University, 201
Revisiting Capital Accumulation: Implications for Business Cycles and Productivity Growth
No full textThis thesis consists of three chapters that look at the business cycle and productivity implications of relaxing certain assumptions regarding capital accumulation. In the first chapter, I introduce capital search frictions into an otherwise standard Real Business Cycle model. New and used capital markets are separate and used capital reallocation is subject to search frictions. The model produces the desired property of procyclical reallocation of used capital in equilibrium in line with business cycle data facts. The second chapter relaxes the assumption that capital depreciation is exogenous, to study the implications of such an assumption on productivity growth. In a Dynamic Stochastic General Equilibrium model where capital depreciation varies with the rate of technological innovation, the model finds that failure to account for depreciation's endogenous response to technological changes, only biases productivity measures when the economy is switching regimes. Along the Balanced Growth Path, when the rate of technological innovation is fixed, the econometrician who computes Total Factor Productivity from standard growth accounting, using capital stock with constant depreciation, will exactly pin down true productivity. The model is then used to study two main episodes of productivity slowdown in the US, the slowdown of the early 1970s and that of the mid 2000s. As the economy switches from a higher to a lower growth rate of technology in the early 1970s, failure to account for endogenous capital depreciation overestimates the slowdown by approximately 15%, while the opposite is true in the mid 2000s. As the economy switches from a higher to a lower growth rate of technology, the true slowdown is underestimated by approximately 5% when capital depreciation is kept constant. The third chapter proposes two approximations of the non-recursive, infinite horizon model of endogenous depreciation used in the second chapter, otherwise known as the Putty-Clay model, in order to implement and solve the model in Dynare. The first approximation is based on the assumption that it takes a capital vintage a certain number of periods to fully depreciate. This assumption takes care of the infinite horizon problem and the contribution of the paper is to show how to automatize and solve this non-recursive model in Dynare using its first-order perturbation methods. The second method proposes approximating the non-recursive equilibrium equations through a time-series process of lag one that preserves the dynamics of the putty-clay model. While the first method automatizes the non-recursive model in Dynare for any general number of periods, it is computationally expensive, which matters for estimation. The recursive approximation method can resolve this issue by reducing the state-space of the model.Ph.D., Economics -- Drexel University, 201
A look at arts funding in Europe: Sustainable revenue models in a time of dwindling public funding
No full textThis study looks at arts funding in Europe in 2019 to understand what role European governments play in arts funding, how that role has changed in recent decades, and how arts organizations in Europe can support themselves as government funding declines. It does not present a wholistic view of arts funding on the Continent because the Continent is vast and public funding scenarios vary from country to country and even between organizations within the same country. Through a literature review and interviews with fundraising professionals in the United Kingdom, France, and Austria, the study presents the challenges and opportunities that face the specific organizations represented in the interviews and additional arts funding trends around the Continent. These challenges include declining government funding, largely tied to the recession of 2008, and the need to replace it with new revenue channels such as membership, individual giving, and corporate sponsorship. The study finds that private fundraising is on the rise in Europe with some organizations already seeing significant and growing revenue. Private, contributed revenue might never completely replace government subsidies, but it is an attractive complement to state financing that could diversify funding sources and enable arts organizations to survive any further decreases in government support. The study concludes that to build these channels, arts organizations in Europe must learn to communicate their needs and get to know their philanthropic audience, what they want to support, why and how. They must also seek out fundraising best practices and develop a culture of asking for money. These will inform how to build a culture of philanthropy that can support their organization long-term.M.S., Arts Administration -- Drexel University, 201
Secondary organic aerosol formation indoors: Experimental and modeling investigations of impacts of surface reactions and equilibrium partitioning processes
No full textPeople in developed countries spend about 90% of their time indoors, so controlling in-door air quality (IAQ) is of primary importance for not harming public health. Airborne particu-late matter (PM) is one of the most problematic pollutants indoors, since exposure to particles with aerodynamic diameters smaller than 2.5 μm (i.e, PM2.5) is associated with respiratory dis-eases, as well as morbidity and mortality outcomes. Organic aerosol components, so called organic aerosol (OA), generally comprise the ma-jor portion of indoor PM, owing to its large indoor emission. One important component of OA indoors is secondary organic aerosol (SOA), which are condensed phase particles composed of semi- and low-volatility compounds. Most research has focused on SOA generated by terpene ozonolysis occurring in the gas phase. This work, however, explores a lesser researched for-mation mechanism, which is the possibility of airborne SOA generated by ozone surface reac-tions with sorbed squalene (C30H50), which is a nonvolatile constituent of skin oil. As such, thirteen steady state chamber experiments were performed to measure the SOA formation en-tirely initiated by ozone reactions with squalene sorbed to glass at two RH conditions of 21% and 51%, in the absence of seed particles. SOA was initiated from these surface reactions, and all experiments but one exhibited nucleation and mass formation. Mass formation increased with ozone concentration at RH = 51% while nucleation was more obvious at RH = 21%. Additionally, most indoor OA, either emitted or generated (i.e., not only SOA), is at composed of semivolatile compounds (SVOCs) in a state of dynamic equilibrium between gas and particle phases. Filters might have a reduced efficiency on removing these kinds of particles since they coexist in gas and condensed aerosol phases. The preferential filtration of particle phase material of the OA system could disrupt the equilibrium, and the removed aerosols might be enhanced by desorption from surfaces and repartitioning from gas phase. To explore this phenomenon, three types of particles, including non-volatile ammonium sulfate ((NH4)2SO4) aerosol, incense aerosol (which might be partly semi-volatile), and SOA derived from ozone + d-limonene reactions (the majority of which are SVOCs), were characterized and compared in terms of their effective removal by a portable air cleaner. For this comparison, the metric of the Clean Air Delivery Rate, CADR (m3/h), was used, which is the volumetric flow of pollutant-free air produced by an air cleaner. Results demonstrated that the lowest effective CADR was for SOA, followed by the incense, and then the ammonium sulfate particles, indicating a repar-titioning processes reduced the filter efficiency. Then a model based on the principles of desorp-tion and repartition process was developed, to quantify the reduced CADR as a function of par-ticle concentration and distribution, in terms of parameter ATSP, which is the ratio of particle surface area to mass. Finally, the influence of the above two parameters on amount of CADR reduction was discussed. Using some details gleaned from the above two experimental studies, a thermodynamic equilibrium model was developed using the volatile basis set (VBS), to predict indoor organic aerosol concentrations and behavior. The model outcomes are the total organic mass indoors (gas + condensed phase), and the fraction of it that partitions to the aerosol phase, including that existing as SOA formed by ozone + d-limonene reactions. With this model, the total OA concentration was simulated at key locations in an indoor environment, such as in the occupied space and different positions in a building mechanical system. The impacts of different condi-tions were compared, including commercial against residential buildings, surface against gas reactions, and winter against summer, within a Monte Carlo framework. Indoor OA concentra-tion indoors were higher when reactions were involved, and gas phase reactions had much more influence on SOA than surface reactions. Finally, the result dataset was used to evaluate the influence of key factors on the indoor OA concentrations, using multiple linear regression sen-sitivity methods. The most important factor that enhanced indoor particles was d-limonene emission rate with average SRC of 0.73, while the negative related factors were filtration effi-ciency with SRC of -0.33 for commercial and surface deposition rate with SRC of -0.22 for resi-dential buildings. Beyond the three SOA studies discussed above, humidifiers used indoors might be strong PM emitters. So, as a supplementary piece, this work also investigated the influence of three humidifier types (ultrasonic, evaporative, and steam humidifiers), and water type used (tap water, de-ionized (DI) water or distilled water), on indoor aerosol number/mass concentra-tions by performing 16 experiments. Particle size distribution during emission periods and size-resolved emission rates were explored to compare the emission ability of humidifiers. Two lung deposition models were also applied to simulate the deposition percentage of particles breathed in on three lung regions (HA, TB, and AL), and total percentage on varying age groups. Results showed that two year-old group was most vulnerable, with number deposition fractions of 0.36, compared with 0.25 for adults. Furthermore, roughly 70% of the total emitted particles pene-trates into the AL region of the lung.Ph.D., Environmental Engineering -- Drexel University, 201