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Evaluation of environmental and nutritional changes in a home food environment intervention for weight loss
No full textThere is a pressing need to improve standard behavioral weight loss (BWL) programs to improve both short-term and long-term weight loss outcomes. One limitation of current BWL programs is that they rely heavily on participants’ own self-control to make and sustain major changes to their diet and overall energy intake. However, the reliability of willpower alone to maintain weight loss has been called into question; over time, when weight loss slows and motivation drops, adherence to the implementation of core BWL skills and principles may drop and lead to weight regain. Increased structure and targeted skills designed to shift the burden away from self-control could help improve dietary intake and weight loss outcomes in BWL. The current study aimed to investigate changes in the home food environment and dietary intake across three weight loss conditions: standard behavior therapy, behavior therapy plus meal replacement provisions, and behavior therapy supplemented with nutritional and food environment counseling (Nutritrol). Across all three conditions, results showed that participants were able to make positive quantitative (i.e., reductions in overall energy intake) and qualitative (e.g., decrease in percentage of energy intake coming from fat) changes over the course of the intervention, although the sustainability of these changes in the follow-up period was mixed. Over time, Nutritrol showed a meaningful advantage over the other conditions regarding the percentage of intake that came from carbohydrates and fats, and the overall amount of fiber that was consumed. Contrary to our hypotheses, no other differences were detected in dietary quality, quantity of energy intake, or obesogenic nature of the home food environment between conditions. Possible explanations for these lack of significant findings, including measurement tool limitations or insufficient treatment doses, are discussed.M.S., Psychology -- Drexel University, 201
Use of the Medication Fall Risk Score in Post-Surgical Patients to Identify High Risk Patients
No full textThe purpose of this quality improvement project was to determine if surgical patients evaluated with a Medication Fall Risk Score (MFRS) used in conjunction with the Morse Fall Scale (MFS) would be noted as higher fall risks compared to those evaluated with only the MFS, thus eliciting a change in fall risk precautions. A retrospective chart review was performed on twenty of thirty-two patients that fell during the time frame of January 2018 to December 2018. The documented MFS of the patient assessed prior to the patient’s fall was noted. The MFRS was then calculated from data extracted from the patient’s electronic medical record to determine if the patient would have been found to be at a higher fall risk using this tool that specifically takes into account medications. After the data was collected and analyzed, it was found that half of the patients that fell were found to be higher falls risk using the MFRS tool, as compared to the MFS. This is significant, since any reduction in patient falls will be cost effective for this institution. The results of this project support the use of the MFRS to better identify surgical patients at high risk of falls. However, due to the limitations of a retrospective chart review, it can be concluded to perform a Plan, Do, Study, Act (PDSA) on a larger sample of patients admitted to the surgical unit with appropriate follow up for implementation. Keywords: fall risk score, surgical patients, fall risk, patient falls, medicationsM.S.N., Clinical Nurse Leader -- Drexel University, 201
Therapist Fidelity in Two Family-Based Treatments: Association with Client Outcomes, Therapeutic Alliance and the Role of Therapist Factors in Treatment
No full textIntroduction. Efforts to determine effective psychotherapy interventions are confounded by a variation in treatment delivery by therapists. For high-risk populations impacted by depression and suicidal behavior, therapist interventions are important to consider. Methods & Aims. Using outcomes data from a large randomized controlled trial (RCT), this study evaluated therapist fidelity to 16 weeks of interventions in Attachment Based Family Therapy (ABFT) and Family-Enhanced non-directive supportive therapy (FE-NST), for their impact on client outcomes for 129 adolescents. The researcher coded fidelity data from recorded therapy tapes and utilized existing outcomes data. This dissertation explores three research questions. First, does therapist overall fidelity to the treatment manual predict improved client outcomes? (Reduced suicidal thoughts and behaviors, reduced depression symptoms, increased family functioning and client satisfaction) Second, does therapists' use of relational interventions unique to ABFT, contribute to outcomes? Third, do peripheral factors such as therapeutic alliance and therapist demographics moderate this adherence-outcome association? 17 therapists participated in the study and independent coders rated 280 therapy sessions on a fidelity measure that comprised interventions from both treatments. Analysis & Results. The tool was psychometrically validated through a factor analysis using the principal component analysis method. Inter-rater reliability was established between coders and between coders and trainers at [alpha]=0.90. Multi-level analysis using pre-post change scores in the Hierarchical Linear Regression (HLM) method, accounted for nesting by treatment and therapist. Findings revealed that overall therapist fidelity was associated with reduced suicidal ideation and increased client satisfaction in the presence of a positive therapeutic alliance. Utilization of relational interventions in family therapy promoted youth-reported family cohesion. Mediation analysis revealed that therapist fidelity to ABFT mechanisms in early and middle stages of treatment increased family functioning, which in turn improved depression outcomes. Discussion. The above findings are presented in the context of existing fidelity research. The opportunities and challenges associated with training therapists in manualized treatments are discussed. Research and clinical implications for different therapy models and future therapist training are also noted.Ph.D., Couple and Family Therapy -- Drexel University, 201
Exploring the Influence of an Arts-Based Mindfulness Program on Student Behavior and Classroom Conduct in Selected Urban Middle School Classrooms
No full textThis qualitative case study, with a focus on the use of arts-based mindfulness practices, was designed to explore the influence of an implemented 4-week pilot program in an urban middle school setting. Through classroom observations, teacher interviews and review of archival data, the following research questions guided the study and led to an understanding of how student behavior and classroom conduct were affected: (1) How does the implementation of an arts-based mindfulness program in a traditional urban school affect student conduct and behavioral outcomes? (2) In what ways do the skills and strategies taught through arts-based mindfulness practices support students with self-regulating their own behavior in a traditional urban school? (3) In what ways have students in a traditional urban school with a previous record of behavior offenses responded to the arts-based mindfulness practices? Framing the study were three streams of literature that provided mindfulness models and practices; methods for reducing student behavioral incidents; and developing home and school engagement. Each stream was rooted in brain-based and arts-based learning theories. Collected data from observing teachers instruct in arts-based mindfulness practices, and interviews with two of those teachers about their perceptions of student behavior 'pre' and 'post' the 4-week program, revealed whether any changes occurred in students and classroom culture. The researcher found the piloted arts-based mindfulness program was an innovative solution to addressing the needs of students and reducing incidents that negatively impact school and classroom culture. The findings of this study increased the exposure level of arts-based mindfulness practices outside of a clinical setting and strengthened the recommendation for further research and implementation in urban schools throughout the United States.Ed.D., Educational Leadership and Management -- Drexel University, 201
Speaking Up for Safety: The Impact of Team Training on Effective Communication
No full textBackground: Ineffective teamwork dynamics and communication among team members is a common factor in adverse event root cause analysis. Communication failures directly or indirectly account for approximately 75% of preventable patient harm events in a community hospital. Current safety behaviors and tools have not demonstrated sustainable results after an initial decline in adverse patient safety events. Purpose: The purpose of this project was to improve the perception of teamwork and communication in the surgical services environment. Methods: This quality improvement project included the development of a team training program. The program was developed using the TeamSTEPPS® competencies and outcomes. All members of the surgical services team participated in training sessions. Implementation Plan/Procedure: The TeamSTEPPS® framework was used for the implementation of this project. The surgical services staff received a pre-teamwork perceptions questionnaire, participated in a team training session and then received a post- teamwork perceptions questionnaire. Implications/Conclusions: Although the team training sessions were appreciated by staff there was no statistical significance identified between the pre- and post-survey results. Staff has incorporated the safety behaviors and tools in their daily work. The effect of team training has been identified through decreased patient safety events.D.N.P., Nursing Practice -- Drexel University, 201
Implementation of a Nurse-Driven Progressive Mobilization Plan among Hospitalized Older Adults
No full textExtended time spent in bed is prevalent among hospitalized older adults thus leading to mobility decline. The published literature documents deleterious effects of immobilization during hospitalization. These effects include nosocomial infection, injurious falls, pressure ulcers, institutionalization, increased healthcare costs, and extended length of stay. Current evidence supports early mobilization to reduce functional deterioration, falls, prolonged length of stay, and readmission. This project implemented a nurse-driven progressive mobilization plan and evaluated the effect of progressive mobilization plan on the percentage of older adults ambulates within 48-72 hours of hospitalization and the length of hospital stay. Retrospective chart reviews were conducted three weeks before and three weeks after implementation of the progressive mobilization plan. Descriptive statistics analyzed the demographic data and the percentage of older adults ambulated in the unit. Inferential statistics examined the significance of the length of stay. Three weeks after implementation of the progressive mobilization plan, the percentage of older adults ambulated in the unit improved from 18% (9 of 50) to 68% (34 of 50) within 72 hours of hospitalization. However, the mean length of stay of older adults was not significantly different between the pre and post implementation groups (t (97) = -0.59, p = .560). Nurse-driven mobilization plan had an impact on early ambulation of the older adults in the unit and decreased the time spent lying in bed. Early progressive mobilization should be a standard of care in all inpatient units to prevent mobility decline during hospitalization.D.N.P., Nursing Practice -- Drexel University, 201
A Mixed Methods Case Study: Exploring the effectiveness of a community college's Business Writing Across the Core program for improving business writing
No full textResearch has shown that colleges and universities are producing a generation of graduates with poor written communication skills. These deficiencies can negatively affect their job readiness. It has been noted that American firms may spend as much as $3.1 billion annually to remediate their employees' writing deficiencies. As American firms scan the educational landscape of recent college graduates for potential new employees, the lack of preparedness in current employees as previously noted calls into question the writing curriculum of higher education. Community college students' complete career-oriented programs and enter the workplace after two-three years of education; writing preparation of these students is an issue worth investigating. Community college students represent a diverse population of educational backgrounds and often first-generation college students who lack the reading and writing skills for college-level learning. Therefore, the writing across the curriculum (WAC) and writing in the discipline (WID) programming at community colleges are essential to prepare these students as they graduate and enter the workforce. The purpose of this mixed methods case study was to explore the impact the Writing Across the Business Core (BWAC) program has at the community college level and to explore the students' perceptions of their preparation to write in the workplace. The effectiveness of the BWAC program was explored by determining whether a significant improvement in students' writing skills, as determined by a pre- and post-production analysis of business documents in four business courses has occurred. This exploration was conducted in Business and Economic classes on a community college campus. The quantitative method asked participants to prepare specific business documents before and after BWAC writing instruction and compared their scores against a BWAC rubric. A comparison of the means using SPSS software provided the data for the quantitative analysis. The qualitative method ascertained the perception and experience of business writing through semi-structured individual interviews and a focus group from participants who were preparing to graduate from the Business Management program and enter into the workplace. In addition, an analysis of the common themes among the students' perceptions of their ability to prepare quality business documents was undertaken. The most significant findings from the quantitative method illustrated that participants had a significant improvement of 48% in the mechanics of writing from the pre- and post-writing assignment. The mechanics of writing includes, literacy - vocabulary, spelling, sentence construction, grammar, punctuation, and paragraph construction. The qualitative method produces three emerging themes, business writing, academic rigor, and program experiences. The participants commented how they desired more opportunities to write business documents and needed more detailed feedback on their writing submissions. A summarization of the study showed that the BWAC program had a positive effect on the participants' writing skill to prepare business documents. In addition, students welcomed the opportunity to write business documents and understood the development of effective writing skill is critical as they enter the workplace. Keywords: writing deficiencies, community college students, business writing, writing strategies, Business program, perceptions, Genre Theory, Writing Across the Curriculum (WAC), Writing in the Discipline (WID), Business Writing Across the Core (BWAC).Ed.D., Educational Leadership and Management -- Drexel University, 201
A Mixed-Methods Study Examining the Integration of iPads and Their Usage as an Instructional Tool for Special Education Teachers in Self-Contained Special Education Classrooms: Un estudio de métodos mixtos que examina la integración de iPads y su uso como herramienta de instrucción para maestros de educación especial en aulas de educación especial autónomas
No full textIn the 21st century, technology is constantly changing and evolving. Fortunately, students are motivated to use technology to support their unique instructional needs and gain information. The unfortunate nature is the inequitable deployment of these technologies across urban school districts. More concerning is the increased specific need for individualized technologies, such as the iPad, for self-contained special education classrooms. Not only are self-contained special education teachers responsible for addressing the academic needs of students in these classrooms, they are responsible for a wide range of global supports to attend to the delays and disabilities of the specific students assigned to these classrooms. This study found that iPads are an integral way of supporting the unique needs of students in self-contained special education classrooms. Additionally, this research found that teachers of self-contained special education classrooms struggle with the overall technology inventory needs to support their students given its unique benefits. Through use of a Technology Assessment Checklist (TAC) tool, the administrator was able to practice an evaluation of the technology integration practices in the self-contained special education classrooms. The administrator found the TAC tool to be a useful tool in guiding the oversight of teacher practices and honing in on the unique levels of classroom supports for the students at individual levels. Overall, this study revealed unique opportunities to support both teachers and administrators with technology integration into self-contained special education classrooms.
En el siglo XXI, la tecnología cambia y evoluciona constantemente. Afortunadamente, los estudiantes están motivados para usar la tecnología para apoyar sus necesidades instructivas únicas y obtener información. La desafortunada naturaleza es el despliegue desigual de estas tecnologías en los distritos escolares urbanos. Más preocupante es la creciente necesidad específica de tecnologías individualizadas, como el iPad, para aulas autónomas de educación especial. Los maestros de educación especial independientes no solo son responsables de abordar las necesidades académicas de los estudiantes en estas aulas, sino que son responsables de una amplia gama de apoyos globales para atender las demoras y discapacidades de los estudiantes específicos asignados a estas aulas. Este estudio encontró que los iPads son una forma integral de apoyar las necesidades únicas de los estudiantes en las aulas autónomas de educación especial.
Además, esta investigación encontró que los maestros de las aulas autónomas de educación especial luchan con las necesidades de inventario de tecnología en general para apoyar a sus estudiantes debido a sus beneficios únicos. Mediante el uso de una herramienta de Lista de verificación de evaluación de tecnología (TAC), el administrador pudo practicar una evaluación de las prácticas de integración de tecnología en las aulas autónomas de educación especial. El administrador descubrió que la herramienta TAC es una herramienta útil para guiar la supervisión de las prácticas docentes y perfeccionar los niveles únicos de apoyo en el aula para los estudiantes en los niveles individuales. En general, este estudio reveló oportunidades únicas para apoyar tanto a los maestros como a los administradores con la integración de la tecnología en las aulas independientes de educación especial.Ed.D., Educational Leadership and Management -- Drexel University, 201
Behavioral Malware Detection and Classification using Windows Prefetch Files
No full textThe advent of modern polymorphic and metamorphic malware, which encrypt or change their code when they replicate, rendered static signature detectors and classifiers less effective and gave rise to techniques that analyze the behavior of programs to detect and classify malware. Behavioral malware detectors and classifiers use run-time features to capture execution characteristics of running applications and are designed to overcome the shortcomings of static signature techniques. However, behavioral techniques introduce new challenges, for example, they need to be a) effective at attaining low false positive rates in a realistic setting, b) adaptive at maintaining their effectiveness as hosts change over time, and c) resilient against evasive malware that imitate the behavior of benign programs to avoid detection. This dissertation describes an adaptive and resilient malware detector and classifier based on behavioral data extracted from Microsoft Windows Prefetch files. The system detects and classifies malware with high accuracy, few false positives, and low overhead, but also adapts to changes in the monitored hosts, and is resilient against evasive malware. The malware detector uses an online algorithm to adapt to changes in the host Windows platforms over time. Moreover, the detector includes a defense mechanism against evasive mimicry malware. The malware classifier aims to improve on the state-of-art by classifying common and rare families with high classification accuracy and adapting to newly discovered malware samples and families. Extensive experiments are conducted to evaluate the effectiveness and performance of the detector and classifier, the efficiency of the online adaptation algorithm to learn new behavioral signatures, and the resilience of the techniques against mimicry malware. The novelty of the work lies in a) building a behavioral malware detector and classifier using dynamic features extracted from Microsoft Windows Prefetch files, b) creating a malware detector that is robust to mimicry attacks, and c) building an extensive experimental framework to evaluate the malware detector and classifier on a large collection of data.Ph.D., Computer Science -- Drexel University, 201
Neuroinflammation and circuitry changes in the dorsal raphe nucleus with depressive phenotype after spinal cord injury
No full textMajor Depressive Disorder (MDD) is attributed to an imbalance of the serotonin system that includes neurons of the dorsal raphe nucleus (DRN) involved in modulation of affective features such as attention, working memory and emotional control. In addition to motor, sensory, and autonomic dysfunction, patients with spinal cord injury (SCI) are at three-times the risk for MDD compared to the general population. Inflammation is implicated in MDD pathology as elevated levels of pro-inflammatory cytokines (TNF[alpha] and Il-6) frequently are detected in the serum of MDD patients and intracerebral adminstration of TNF[alpha] can elicit depressive-like behaviors in rodents. In a rat model of thoracic-contusion injury we correlated elevated DRN levels of TNF[alpha] with depressive phenotype at 5 weeks post-SCI. Chronic peripheral inhibition of soluble TNF[alpha] by administration of XPro1595 (a dominant-negative inhibitor) resulted in increase in the incidence of depression, yet central intracerebroventricular (i.c.v.) administration had no effect on incidence. These results suggest that modulation of additional components of neuroinflammation may be necessary to offset depressive phenotype after SCI. Whole cell patch clamp electrophysiology revealed an increase in excitability of DRN serotonergic neurons of post-SCI non-depressed vs. depressed mice, based on intrinsic membrane properties. No significant alterations in excitatory/inhibitory input to GABAergic or serotonergic neurons were found, though both cell types demonstrated an increase in action potential bursting after depolarizing current injection, suggesting a potential role for ion channel dysregulation in multiple neuronal types with post-SCI depression. Our findings suggest that intrinsic neuronal changes in excitability may contribute to decreased serotonergic output and the subsequent development of SCI-depression, providing beneficial insight in identifying future therapeutic targets.Ph.D., Neuroscience -- Drexel University, 201