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Impact of Opioid Overdose Education with Take Home Naloxone in the Emergency Department
No full textAbstract Background: The numbers of patients that misuse both prescription and illicit drugs resulting in dependency and overdose is causing an increase in utilization of emergency department (ED) services. It is estimated that in 2010 there were 135,971 ED visits for opioid overdose across the nation with an associated cost of 2.3 billion dollars (Yorkell, et al. 2014). Opioid misuse disorder patients that come to the emergency department for care present a unique opportunity for overdose prevention and naloxone take home education. This effort can contribute to saving lives with this patient population. Methods: The main objective of this quality improvement project using a PDCA project design was to show the impact of opioid overdose education and take-home naloxone in the emergency department using a pretest posttest method. Using the BOOKs questionnaire, participants received a pretest, opioid overdose education, risk reduction strategies and instruction on naloxone use. After ED discharge, a follow up was made and the post test administered. Results: Sixteen participants were recruited for this project. Follow up was made successfully to 6. There was a loss to follow up of 62.5% for various reasons. Data analysis of the pre and post test data using Fisher’s exact test did not provide statistically significant results. Conclusions: Pretest and posttest data was analyzed by individual question and knowledge domain. No statistical significance was realized from the data. The overall sample was small making it difficult for any type of conclusion about the education provided. Further projects with a larger group and longer period are needed to be able to have conclusive results.D.N.P., Nursing Practice -- Drexel University, 201
Urinary Catheter Usage and Care A Gap Analysis
No full textCAUTIs are one of the most common preventable causes of mortality in the United States. Urinary catheter-related infections increase the length of stay, antibiotic use, and healthcare cost. The daily risk of acquiring bacteriuria when an indwelling catheter in situ is 3-7%. This project aims to reduce CAUTI rates by reducing inappropriate urinary catheterization and duration of catheterization by 10 %. A gap analysis was performed to assess the system's current state of compliance with Catheter Usage and Care policy. Twenty-five charts total reviewed from October 2017 thru March 2018. The indications catheterization included: ten for neurogenic bladder, eleven for urinary retention, two post-operative surgical procedure, one for urinary obstruction and one for pelvic fracture. The ten for neurogenic bladder, one for urinary obstruction and one urology patient, did not meet the criteria of inclusion. A patient associated with a pelvic fracture had three days of unnecessary catheter days. Findings included the Catheter Usage and Care policy compliance rate of 86%. The cause of untimely removal is the failure to remove the urinary catheter when the indication is no longer valid, and no daily assessment of the urinary catheter indication. To improve patient outcomes, hospitals can use strategies to reduce CAUTI through the application of accepted evidence-based prevention practices. Documentation of the indication for the urinary catheter daily will assist in decreasing urinary catheter-related infections.M.S.N., Clinical Nurse Leader -- Drexel University, 201
Examining Teachers' Creativity-Fostering Behaviors in a STEAM Classroom: A Mixed Methods Case Study
No full textThis case study employs a convergent mixed methods design to examine the relationship between the creative ideologies and creativity-fostering behaviors of six teachers in a 5th grade STEAM class. Drawing on the theoretical concept of teaching for creativity and the purported student creativity development inherent in STEAM education, this study provides insights about teachers' perceptions and capacity to foster creativity in a stand-alone STEAM class. Both quantitative and qualitative data were collected and analyzed in order to triangulate and fully the examine the relationship between teacher's perceptions and teaching behaviors. The quantitative data includes teachers' self-assessed survey responses and measurement of the teachers' observed classroom behaviors. The qualitative data includes individual semi-structured interviews and field notes collected from 18 classroom observations
Design, production and evaluation of a Plasmodium falciparum merozoite surface protein 2-based vaccine for inclusion in a multivalent formulation targeting multiple parasite stages
No full textDevelopment of a highly efficacious vaccine will be necessary for malaria elimination. Studies in Plasmodium falciparum endemic areas indicate that naturally acquired antibody responses to MSP2 are associated with resistance to malaria, making PfMSP2 an attractive vaccine candidate. To overcome challenges encountered with subunit malaria vaccines, we established that the use of highly immunogenic rPfMSP8 as a carrier protein for vaccine candidates rPfMSP119 and rPfs25 facilitated production, minimized antigenic competition and enhanced induction of functional antibodies. Here, we exploited the benefits of our rPfMSP8 fusion partner to optimize a rPfMSP2-based subunit vaccine. A synthetic PfMSP2 (3D7) codon harmonized gene was used to produce unfused rPfMSP2 or chimeric rPfMSP2/8 in E. coli. Purified, rPfMSP2 formed amyloid-like fibrils in vitro, however rPfMSP2/8 did not. Immunization of rabbits and mice with both rPfMSP2 antigens elicited high titer anti-PfMSP2 antibodies that recognized the major allelic variants of native PfMSP2. Competition assays revealed differences in antibody specificities induced by the two rPfMSP2-based vaccines, with evidence of epitope masking by rPfMSP2-associated fibrils. Immunogenicity studies in mice demonstrated that formulation of rPfMSP2 vaccines with GLA-SE, a synthetic TLR4 agonist, elicited cytophilic IgG isotypes and production of Th1-associated cytokines. T cell responses were specific for epitopes within PfMSP2 and PfMSP8 domains. The rPfMSP2/8 + GLA-SE formulation induced significantly higher antibody titers with superior durability and capacity to opsonize P. falciparum merozoites for phagocytosis. Immunization with a trivalent vaccine including PfMSP2/8, PfMSP1/8 and Pfs25/8 induced high levels of antigen-specific antibody, with no evidence of antigenic competition. These results are highly encouraging for the addition of rPfMSP2/8 as a component of an efficacious, multivalent, multistage malaria vaccine.Ph.D., Microbiology and Immunology -- Drexel University, 201
Latina Administrators and their Journey to Empowerment
No full textCalifornia continues to become increasingly diverse with 54% of the student population consisting of Latinos. Currently, about 20% of the teaching population is Latino while less than 2% of school administrators is Latina (California Department of Education, 2019). Understanding why there is a low representation of Latina principals and vice-principals in California public schools may provide insights for districts within California to increase the possibility of educators gaining access to administrative leadership roles through hiring practices, specifically vice-principalship and principalship. This narrative study explored the stories of Latina PK-12 principals to understand how their experiences allowed them to gain access and maintain leadership positions in PK-12 public schools. The study also sought to identify challenges faced and barriers experienced that may have limited their access to leadership roles. The theoretical framework and its three streams of theory and research that informed the current research included: (a) social identity, (b) psychological capital, and (c) confluence of intersectionality drawing on literature that pertained to administrative leadership and the access of Latinas to those leadership positions. The narrative methodology allowed the researcher to have discourse with eight Latina participants made up of four vice-principals and four principals in California public schools. The study's results identified four findings: (a) adult support and peer development had a significant effect on participants' professional identities; (b) the ability for these Latina administrators to attain leadership roles was based on both their early work experiences and administrative mentors; (c) Latina administrators focused on their goals to transform their Title I communities; and finally, (d) the ability to access leadership roles required the development of a strong sense of self as a Latina. The Latina administrators saw themselves as leaders of all students with a specific understanding and shared experiences of the Latino community struggles and challenges. Furthermore, the Latina administrators' path to the principalship and vice-principalship is crucial to supporting the Latino PK-12 student population in California.Ed.D., Educational Leadership and Management -- Drexel University, 201
Examination of Student Affairs Culture in Relation to Student Engagement and Success: An Explanatory Sequential Case Study
No full textHigher education models have continued to shift, with the primary focus of Student Affairs moving from the extra-curricular to the co-curricular, yet little data is available to assess the impact of this co-curricular focus on student engagement and success. It is vital for both faculty and student affairs staff to provide students with educationally purposeful activities, both in and out of the classroom. It is imperative for a deeper collaboration between Student Affairs and Academic Affairs in order to provide students with a holistic learning experience, which will prepare them for the "real-world", post-graduation. It is important for Student Affairs to implement a culture of assessment to ensure positive outcomes, in the programs and services that they are providing to students, to secure its position within the co-curricular. Limited research is available examining various cultures of assessment in Student Affairs on college campuses. Through a conceptual framework, this dissertation examined the existing literature, encompassing four streams of theory, research and practice: (a) framework of student affairs; (b) assessment and evaluation; (c) student affairs and academic affairs; and (d) student affairs and leadership. This research assessed how student affairs professionals recognize their own proficiency, knowledge, and skills to identify the strategies, skills, and leadership techniques, they used in their practice. This was an explanatory sequential, case study, which surveyed Student Affairs professionals from one large urban private institution. Key findings of this study examined how assessment is being used in Student Affairs, its impact toward enhancing student engagement and success, as well as clarifying experiences with Student Affairs staff surrounding assessment and leadership styles. Implications and recommendations for future creativity research are discussed.Ed.D., Educational Leadership and Management -- Drexel University, 201
Revisiting Play: Assisting Primary English Learners
No full textThe U. S. K-12 system today has been confronted with the challenge of educating its ever-increasing population of English Learners (ELs) on academic content while teaching a new language. While the challenge has always been to have all students reading at grade-level by the third grade, today, this challenge has been complicated by the large population of ELs needing to first acquire their second language (L2), in this case, the English language. While current research varies regarding the time required, it is evident that significant time would be necessary to do so. This research explored the impact of an early intervention program in a supportive environment, with opportunities for learning through play as well as the acknowledgement of and consideration for sociocultural influences that affect learning. The main research questions that were investigated were: 1) How does the environment of "play" influence behaviors, academic language and learning?, 2) What are the parents' and teachers' perceptions about child-centered instructional approaches and how they influence academic achievement for English Learners (ELs) in the primary grades?, and 3) What are the parents' and teachers' perspectives of the factors (parents, community, and school factors) affecting student learning in the environment of play? With an instrumental, single-case, case study design, the study used program documents, teacher and parent interviews, and focus groups to provide an intensive description of the bounded social phenomena found among students of a kindergarten program, and later, an analysis of the same.Ed.D., Educational Leadership and Management -- Drexel University, 201
A Unified Framework for Collecting, Annotating, Modeling and Prediction from Phenotypes in Multi-Institutional Pediatric Data Resources
No full textPredictive models on sequential observational clinical data have helped make headway utilizing large sets of this data collected from health systems from electronic medical record (EMR) and billing systems to predict outcomes, help physicians make decisions through clinical decision support (CDS) and possibly change the course of treatment of patients suffering from some of the most common diseases and illnesses. For diseases that affect a large portion of the population, standardized clinical data observations can be used to create new models that predict precise treatment options for individuals. This is referred to as precision medicine, and these treatments are derived from techniques in machine learning, artificial intelligence and other areas breaking to the surface by data scientists in healthcare. The question remains, is this data useful for those affected by rare diseases? Unlike diseases that common in the population like asthma or diabetes, rare diseases do not have characteristics well described or derived from the clinical records. Pediatric cancer, specifically brain tumors in children are severely lacking the sample size, consistent data capture and simple infrastructure to collect data. This hinders the speed at which scientists can discover breakthroughs in precision medicine as is seen in more common diseases. With the attention and buzz around the discipline under the umbrella of “artificial intelligence” in precision medicine especially in cancer, collaborations have been created to pool resources, data and biomaterials. In parallel, the government in the United States over the years has dedicated money and resources to large scale health data programs called Clinical Data Resource Networks (CDRNs) where standard observational clinical data is integrated across institutions to made large relevant sample sizes for observational research in one common data model. In this research, we investigate the intersection of both a specific rare disease repository, The Children’s Brain Tumor Tissue Consortium (CBTTC) and a CDRN, PEDSnet, with the goal of leveraging the CDRN to help ease the burden of human data entry in the CBTTC and make data available faster to more researchers over multiple disciplines. We use PEDSnet data from children diagnosed with malignant brain tumors to try to predict a highly malignant brain tumor, Primitive neuroectodermal tumors (PNETs), and reproduce a similar data set used in a physical laboratory project developed by researchers at the Children’s Hospital of Seattle (CHS), Children’s Hospital of Philadelphia (CHOP) and Toronto Hospital for Sick Children. We use a threefold pipeline of exploratory data analysis, multi-modal data transformation and predictive analytics to derive a data driven phenotype from a sample of over 1900 brain tumor cases from PEDSnet originating at CHOP and SCH. The hypothesis herein is that the CDRN could contain a set of data that can be derived through traditional machine learning techniques and used to supplement the current hand data entry and abstraction process to bring automation to data harmonization across institutions where longitudinal data is required for biomedical research. This research is supported by the iFellowship Program administered by the University of Pittsburgh as part of the iSchool Consortium and funded by the Andrew W. Mellon Foundation. This research reflects the goals of the Committee on Coherence at Scale for Higher Education in that this research aims to take information that is usually ‘siloed’ in a lab and make it available to more minds from different domains by using a national organization with large sets of patient data to drive an analogue, human data entry intensive project to scale.Ph.D., Information Studies -- Drexel University, 201
Processing - Structure - Performance Relationships: A Rheological Perspective
No full textOptimal performance of commercial battery electrodes is dependent on a homogeneous distribution of three components: 1) active material 2) conductive additive 3) polymer binder. In commercial batteries, the conductive additive and polymer binder are less than 10\% of the entire electrode, but homogeneous distributions of these components is non-trivial and greatly impacts electrode performance. Processing of battery electrodes is a multi-step process with a multitude of variables that could possibly impact homogeneity. Typically the study of processing parameters is associated with manufacturers. However, processing parameters are not universal or well transplanted from system to system and as a result academia has begun to investigate processing from a fundamental standpoint. Literature has demonstrated the complex relationship between processing and performance and how correlations can become convoluted if careful experimentation is not performed. During the first unit operation, an active material, conductive additive and polymer binder are dispersed in solvent creating a slurry. Battery slurries can create a wide variety of microstructures depending on the specific components, concentration, and component interactions. Rheological measurements have risen in prominence as tools to better understand the battery slurry's microstructure. The work presented here investigates the fundamentals of the mixing unit operation and its impact on the slurry microstructure and electrode performance. The first part of the work presented here investigates the particle-polymer interactions that develop in Lithium Nickel Manganese Cobalt Oxide (NMC), carbon black (CB) and polyvinyldiene diflouride (PVDF) cathode slurries and how they are impacted by component parameters and shear during mixing. The investigation determined that depletion interactions develop between the CB particles and PVDF, the sign of which determined whether CBs attraction to itself is increased or decreased. In the case of low molecular weight PVDF, the attraction between the CB particles increases due to the presence of PVDF. The increased attraction causing flocculation of the particles and at a critical volume fraction of particles a gravity withstanding network formed. Interestingly, the presence of NMC particles does not impact the gelation transition. Since the NMC particles do not participate in gelation the microstructure is directly related to the concentration of CB in the slurry. On the other hand, when high molecular weight PVDF is used gelation of CB is prevented by changing the sign of the interaction potential. Shear during mixing was shown to be sufficient enough to cause polymer scission of the PVDF chains decreasing molecular weight and causing gelation when high molecular weight PVDF was started with. Uncontrolled polymer scission was also shown as a potential reason for reproducibility issues during processing. Overall the first two chapters demonstrate how different slurry microstructures develop and its dependence on component size and mixing parameters. Once the basics of creating the initial slurry microstructure was determined, the role of other processing steps could be considered. The second half of the work presented here investigates how a processing step called "dry-mixing" impacts the electrode performance and techniques for investigating electrodes. Dry-mixing coats the conductive additive onto the surface of the active material prior to wet mixing with the polymer binder and solvent. By investigating dry-mixing at commercially relevant concentrations of CB, it was determined that dry-mixing improves performance by decreasing the resistance between active material particles. It is difficult to measure particle-particle resistances directly. Particle-particle resistances are incorporated into the Dualfoil(c) model for Li-ion batteries. Preliminary investigations into the use of this model are documented. Additionally this work discusses combining energy dispersive x-ray spectroscopy (SEM/EDS) and x-ray computational tomography (XCT) for mapping of the conductive additive and polymer binder in electrodes. Due to the elemental and density similarities of the conductive additive and polymer binder they are difficult to distinguish in both techniques. The use of a contrast agent was shown to improve both SEM/EDS and XCT results and allow for material specific connectivity to be calculated in XCT. The work presented here sets the frame work for fundamental investigations into the impact of processing on electrode performance. By using a consistent high performance electrode system conclusions about performance can be made in the absence of electrochemical limitations. The findings presented here demonstrate that complex interactions occur during mixing and that a variety of fluid phase microstructures can develop. In addition, the work presented here addresses the issue of reproducibility and demonstrates that short-range particle-particle resistances are the main limiting property in commercial battery electrodes. This work hopes to create a basis on which further understanding of the importance of processing can be based.Ph.D., Chemical Engineering -- Drexel University, 201
Assessing and Analyzing Stakeholder Perceptions of School Climate: Discovering Perceptual Congruence to Inform School Improvement
No full textAlthough research indicates the establishment and sustainability of a positive school climate contribute to school improvement, school leaders do not always assess and properly analyze the perceptions of its stakeholders. When school districts are void of proper assessment and data analysis methods, school leaders may inadvertently ignore conflicting stakeholder perceptions. If this gap in perceptual congruence among stakeholders is not addressed, districts can make uninformed educational decisions, which can lead to a poor school climate. In contrast, if these discrepancies are properly identified through a systematic method of data collection and analysis by which all stakeholders' perceptions are accounted for and valued, school leaders can move forward with a plan of action for school improvement. The purpose of this mixed-methods study was to identify and analyze the perceptual congruence that existed among stakeholder groups when assessing dimensions of school climate, so that it could inform district leaders of next-step school improvement efforts. The researcher identified perceptual discrepancies that exist between groups of students, staff, parents, and administrators when considering certain dimensions of school climate by analyzing survey data. Once discrepancies were discovered, focus groups comprised of the various stakeholder groups were asked to reflect on the survey data results and provide further insight on the findings. Data was collected after the administration of a school climate survey and through the facilitation of several stakeholder focus groups. The participants represented four buildings within a small, rural school district in Pennsylvania. Subjects included school staff, students, parents, and administrators. By discussing and questioning the gap in perceptual congruence among stakeholder groups, the school organization could begin to acknowledge the areas for improvement in their educational climate.Ed.D., Educational Leadership and Management -- Drexel University, 201