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Delirium Assessment of the Elderly in the Intensive Care Unit
No full textObjective: To improve delirium identification by nurses of elderly patients over the age of 65 in an intensive care unit through the implementation of the CAM-ICU. Design: Evidence-Based Practice (EBP) quality improvement project framed with in the Iowa model of EBP. Inter rater reliability was established in the use of the CHART-DEL tool in accordance with the guidance from the CHART-DEL manual. The CHART-DEL was then used as a monitor for concurrent validity for the CAM-ICU performed by the intensive care nurse. Finally, to ensure rigor in the findings a randomly selected sample of the CHART-DEL was re-validated by an expert rater. Participants: Intensive Care Unit (ICU) Registered Nurses. Intervention: Education and implementation of the CAM-ICU for delirium screening. Patients over the age of 65 admitted to the ICU will be screened for delirium using the instrument. Results: The result of implementation of this evidenced based practice will improve the identification of delirium by nurses and increase the adherence to delirium screening through the use of the CAM-ICU. All nurses receiving CAM-ICU education were found to use the tool with accuracy as validated by the CHART-DEL abstraction tool. Adherence to the use of the embedded CAM-ICU was 100 percent for intensive care nurses receiving education on the proper use of the tool.D.N.P., Nursing Practice -- Drexel University, 201
Environmental Music Performance, Music Medicine, and Environmental Music Therapy: Contributions to Aesthetics in the Hospital Environment
No full textNoise has negative effects on a person’s physical, mental and spiritual wellbeing, especially for patients in medical settings. Woodward’s (2004) survey of hospitalized patients indicated perceptions of a lack of beauty and aesthetics in the inpatient setting. The most common negative aspect that has been found is noise in hospitals (O'Neill & Moss, 2014). Evidence shows that music structured intentionally can promote psychological movement, activate brain reward systems and promote pleasant emotions (Nolan, 2013; Lumley et al., 2011). Using live music can meet safety concerns and best promote emotional and physical responses of patients (Loewy, 2009). Music also serves to move patients’ attention away from negative stimuli to something more joyful and comfortable (Thoma et al., 2015). This capstone review thesis focuses on music-related methods to improve beauty and aesthetics in inpatient settings, including Environmental Music Performance, Music Medicine, and Environmental Music Therapy (EMT) techniques. It also includes a program proposal for incorporating music and music therapy interventions to improve the aesthetic experience in the inpatient medical setting.M.A., Music Therapy and Counseling -- Drexel University, 201
Enhancing Engagement: Dance/Movement Therapy with a Mother and Child with ASD
No full textThis case conceptualization explores how dance/movement therapy can foster social interactions in an African American family with a child who is diagnosed with Autism Spectrum Disorder. Autism Spectrum Disorder is a pervasive developmental disorder that can cause persistent impairments in social communication and social interactions across multiple contexts with restricted, repetitive patterns of behavior. Deficits in social communication and social interaction are often the early indicators of ASD. It makes it difficult for those who are diagnosed with ASD to relate to others and typically becomes the main focus in intervention planning. The Creative Arts Therapies can encompass many developmental goals for children with ASD. Dance/movement therapy, a modality within the field of the creative arts therapies addresses this deficit through relational intervention attending to non-verbal, as well as verbal behaviors, creating play scenarios and supporting shared focus of attention. This case conceptualization takes an in-depth look into six dance/movement therapy sessions with mother and son dyad to further explore the impact that DMT has on social interactions.M.A., Dance/Movement Therapy and Counseling -- Drexel University, 201
Machine Learning Techniques for Forensic Camera Model Identification and Anti-forensic Attacks
No full textThe goal of camera model identification is to determine the manufacturer and model of an image's source camera. Camera model identification is an important task in multimedia forensics because it helps verify the origin of an image and uncover possible image forgeries. Forensic camera model identification is generally performed by searching an image for model-specific traces left by a camera's internal image processing components. Many techniques, including recent data-driven deep learning algorithms, have been developed to perform camera model identification. In the meantime, forensic researchers have discovered that existing camera model identification algorithms can be maliciously attacked by altering images without leaving visually distinguishable artifacts. These anti-forensic attacks arouse concerns about the robustness of camera model identification techniques and urge the need for effective defense strategies. In this thesis, we propose new algorithms to perform forensic camera model identification, and new anti-forensic attacks. We first introduce a highly accurate and robust camera model identification framework developed by fully exploiting demosaicing traces left by cameras' internal demosaicing process. In light of the complexity of demosaicing traces, we build an ensemble of statistical models to capture diverse demosaicing information in the form of content-dependent color value correlations. Diversity among these statistical models is critical for each model to capture a unique set of color correlations introduced by the demosaicing process. We obtain a diverse set of linear and non-linear demosaicing residuals and extract both intra-channel and inter-channel color correlations following a variety of geometric structures. The ensemble of collect diverse color correlations forms a comprehensive representation of the sophisticated demosaicing process inside a camera. This proposed framework not only achieves high camera model identification accuracy, but more importantly, it is robust to image post-processing operations and anti-forensic camera model attacks. Given recent popularity of deep learning algorithms, forensic researchers have started to build deep neural networks, especially convolutional neural networks, to perform camera model identification. In this thesis, we investigate the robustness of deep learning based camera model identification algorithms by developing anti-forensic camera model attacks to expose vulnerability of these algorithms. We propose a generative adversarial attack to perform targeted camera model falsification. Given full access to the camera model identification networks, this attack has been proven to be able to falsify camera models of images from arbitrary sources. Under black-box scenarios where no information about the camera model identification networks is available, we train a substitute network which mimics the camera model identification networks and provides gradient information to craft adversarial images.Ph.D., Electrical Engineering -- Drexel University, 201
The Art of Being Unseen: A Phenomenological Study Exploring Alienation as Told Through the Lived Experiences of LGBTQ U.S. Military Service Members Who Served Before and During the DADT Repeal
No full textFor many years, mastering the art of being unseen been a practice for countless LGBTQ military personnel in order to avoid harassment, violence, and expulsion from the U.S. Armed Forces. Prior research on LGBTQ military personnel who served both before and after the repeal of DADT has documented their multifaceted experiences (Alford & Lee, 2016; Allsep, 2013; Gatson, 2015; Goldbach & Castro, 2016; Mondragon, 2013; Parco, Levy, & Spears, 2014; Quam, 2015; Spinks, 2015; Vaughn, 2014). While several studies identified the participants' experiences of alienation, these studies were largely exploratory and did not investigate or interrogate alienation with any depth or rigor. Drawing on Seeman's (1975) six variants of alienation, this dissertation explores the phenomenon of alienation as experienced by LGBTQ military personnel. Understanding their experiences of alienation may help to inform and improve military policies and procedures intended to ensure their full integration into the U.S. Armed Forces. This research study utilized a phenomenological approach to explore alienation as lived and experienced by five LGBTQ military personnel during both the enactment and repeal of DADT. Participants were recruited from private and closed military and veteran LGBTQ partnering support groups and organizations located online. Of the five participants, three identified as lesbian, one identified as gay and/or homosexual and the fifth participant identified as queer. Analysis of the data resulted in three themes: 1) experiences with coming out; 2) a climate of oppression; and 3) alienation. This research study includes four major findings: 1) three of the five participants identified themselves as being in the identity acceptance stage the first time that they disclosed their sexual orientation; 2) participants described military culture as oppressive to LGBTQ military personnel both before and after the repeal of DADT; 3) of Seeman's six variants of alienation, cultural estrangement was the most prominent variant described by the participants; and 4) in addition to Seeman's six variants of alienation, participants exhibited a resilient variant of alienation in the form of self-preservation. Findings from this study inform both practice and future research. In addition, the study identifies the need for further exploration of the lived experiences of transgender military persons.Ed.D., Educational Leadership and Management -- Drexel University, 201
Clarifying the Role of Values in Weight Control: A Pilot Study of a Values-Based Intervention to Promote Weight Loss
No full textMore than 160 million American adults are overweight or obese. Existing weight loss interventions from self-help to gold standard behavioral treatments, while often effective, do not sufficiently maintain motivation to adhere to dietary goals in the face of powerful biological and environmental influences to consume highly palatable foods. Clarification and awareness of values, a staple of acceptance-based treatments drawn from Acceptance and Commitment Therapy, are thought to enhance autonomous motivation to engage in behaviors consistent with one’s personal life values (e.g., health) in the presence of countervailing forces (e.g., hunger, deprivation). However, the independent efficacy of values clarification and awareness in facilitating weight control has never been tested. This pilot study sought to investigate whether a series of analog weight loss workshops (based off the gold standard), infused with techniques to enhance clarity and momentary awareness of values, could produce meaningful improvements in values-based mechanistic processes (i.e., target engagement). Nineteen participants attended three group-based, values-infused workshops over three weeks. Results indicate that the values-based intervention was feasible, acceptable, and capable of producing potentially meaningful improvements in values clarity and values awareness. There was mixed evidence of improvement in constructs highly related to values targets. The intervention was modestly effective in facilitating weight loss, and mixed associations were observed between changes in values targets and related constructs over time. Taken together, results demonstrate preliminary proof of concept that an isolated, values-based treatment can act on some, but not all, theorized mechanisms of action. Further research with larger samples and more intensive interventions are needed to establish longer-term mechanistic effects, as well as the additive efficacy of the values component in producing weight loss.M.S., Psychology -- Drexel University, 201
Cell-Free Identification of S. cerevisiae Strains by Analysis of Extracellular Matrices using Liquid Chromatography - Mass Spectrometry
No full textCurrent literature shows a gap for the identification of yeast strains in samples where there are no viable cells remaining. The studies contained in this thesis describe the development of a cell-free technique to identify strains of S. cerevisiae using Liquid Chromatography-Mass Spectrometry (LC-MS) by analysis of the yeast supernatant and beer. Solid phase extraction (SPE) was used to concentrate analytes while removing sugars, salts, and polar small molecule metabolites, thus improving peptide detection and reducing potential ion suppression. SPE also served to remove highly hydrophobic cellular components, such as lipids, reducing interference with peptides and system contamination. Non-targeted analysis was performed and the data were simplified into "pseudo-spectra" for classification using spectral pattern matching (k-nearest neighbors), and biomarker matching. MS/MS fragmentation was also acquired using data-dependent acquisition (DDA) to identify specific peptides and proteins. This provided additional information about the sample composition and stability, without the need for additional sample preparation or additional instrument time. Yeast grown in various media, and in various stages of growth, were tested to examine the robustness of the technique. Similarly, beers at various ages, and from separate batches, were evaluated. 100% of pure yeast supernatant samples were successfully classified according to strain by specific biomarker identification/detection, and by MS pattern recognition. The ability to classify the samples was not affected by incubation time (2 – 7 days) or by the carbon source used in the growth media (glucose, maltose, or fructose). However, longer incubation times, plus the addition of nutrients (nitrogen, trace metals, vitamins, and salts), did increase the amount of proteins and peptides identified, enabling the generation of more detectable biomarkers. 80% of beer samples were also successfully classified according to the yeast strain (4 of 5), when compared against different batches of beer using the same yeast strains. In this case, biomarkers were more useful than pattern recognition. This may be due to the large number of analytes in the patterns that are attributable to partially digested barley. An additional complication was uncovered during the analysis of beer. The composition of the beer peptides change over time, as the samples age from 0 to 5 months; the number of detectable peptides and proteins decrease, and the average peptide size decreases. This indicates that active proteases/peptidases remain in the beer, as the degradation rate is far higher than what is observed in typical aqueous environments. Additional batch-to-batch, and bottle-to-bottle differences in the beer manufacturing process were evident. Finally, it was attempted to classify beer samples using biomarkers identified in pure yeast supernatant samples. This was not successful. There is potential that this could be re-visited in the future, if improvements to the biomarker identification strategy occur. Improved sample cleanup of non-peptide compounds, and the inclusion of chromatographic retention time in the identification of biomarkers, would increase the likelihood of success. This technique could potentially be used for quality control of various fermented foods or beverages, as well as for the analysis of environmental samples where yeast strain identification would be valuable. It could likely be expanded for strain identification of other types of microbial samples, such as bacteria.Ph.D., Chemistry -- Drexel University, 201
Generation, Computational Biofluid Mechanics, and Visualization of Complex Blood Flow Dynamics
No full textThe advent of new non-invasive imaging modalities (i.e. 4D MRI, 3D Echocardiography) in recent years have facilitated the study and growing recognition that some of the blood flow in the cardiovascular system is naturally spiral and three-dimensional. The helical organization of the myocardial fibers, the heart's torsional contraction dynamics, aortic valve structure, the out-of-plane geometry of the aorta and tortuosity of vessels all contribute to the generation of spiral patterns of blood flow. In nature, many forms of fluid transport (e.g. whirlpool, cyclones) demonstrate high efficiency, flow entrainment, and stability due to their spirality. Flow in the cardiovascular system may also benefit from similar self-stabilizing impulsion dynamics. Although spiral blood flow structures have been observed in the aorta and other large arteries, many questions remain unanswered regarding its influence on normative cardiovascular physiology and pathophysiology. The research work herein aims to study spiral flow dynamics and to understand its specific characteristics, especially those in athero-susceptible regions. Computational fluid dynamics (CFD) was used to study the modulation of spiral flow and its impact in idealized vascular phantoms (Aim 1) and realistic vascular geometries, namely the aortic arch with an anastomosed cannula, representative of the outflow graft of a mechanical circulatory support device (Aim 2). Aim 1 served as a test platform for studying spiral flow characteristics. Aim 2 provided an example of the translational applicability of spiral flow. Benchtop flow circuits were used to validate key aspects of the in-silico simulations. This research work brought together computational fluid dynamics with 3D vascular printing and benchtop mock circulatory flow loop visualization and analysis methodologies. The ability of spiral flow to clear and reduce the size of recirculation zones in a set of idealized vascular phantoms was demonstrated in Aim 1. The phantoms tested were angled conduits with 45°, 90°, and 135° turns and idealized asymmetric and axisymmetric stenosis models. A spiral flow inducer was utilized to enable in-silico to in-vitro comparisons, while standalone phantoms were used to test the impact of spiral flow modulation. In the vascular phantoms coupled to spiral flow inducer models, the recirculation zones at the corners of the angled conduits and the flow separation post-coarctation in stenosis models demonstrated a marked decrease in size of regions of low velocities ( 80 dyn/cm2) for the highest helical content compared to straight flow. The highest WSS at the fluid impact site in the inner curvature of the aorta belonged to the test case with the highest helical content, reaching 150 dyn/cm2. Cannula angle variation dictated the impact site of the outflow jet. In all cases, counter-clockwise spiral flow decreased regions of low velocity (up to 1.2-fold reduction) and resultant areas of low WSS (up to 1.1-fold decrease). The cannula angled down case provided the best decrease in low WSS areas, however, it had the largest area of high WSS. With clockwise and counter-clockwise spiral flow, the areas of high WSS in the cannula angled down case decreased by 10.5% and 29.8% respectively. Spiral flow has been shown to improve washout of hard-to-reach recirculation zones, reducing regions of low velocity and decreasing areas of low WSS. In particular, the clinical translation may prove to be impactful in blood recirculating devices, helping improve near-wall transport and flow dynamics, diminishing jetting and fluid collisions, mitigating device-related adverse events, and encouraging athero-protective conditions. The findings of this research are expected to inform the next generation engineering designs of vascular/endovascular prosthesis, stents, cardiac valves, and mechanical circulatory support devices.Ph.D., Biomedical Engineering -- Drexel University, 201
Disaster Preparedness and Recovery: How Arts Organizations Can Re-Engage the Community Through Arts-Driven Initiatives After a Natural or Human-Made Disaster
No full textThis thesis explores the impact of large-scale natural and human-made disasters primarily on communities across the United States, and how arts organizations can use arts-driven initiatives as a tool for disaster relief. Included in this analysis, is the look at some current relationship between arts leaders and administrators within nonprofit arts organizations and their communities, strategies for resilience, interviews with arts leaders who responded to disasters within their community by using the arts, and survey results with arts leaders and emergency personnel across the United States. These sources provide evidence to show that arts organizations and those living in the surrounding area(s), often experience multiple layers of loss because of large-scale natural and human-made disasters, including emotional loss. The research shows that arts organizations, through collaborative relationships across different sectors, can provide additional help by leveraging the power of the arts through comprehensive creative placemaking and proactive emergency disaster planning. This thesis discusses areas where arts-driven initiatives can be used as a relief tool to aid in the recovery of impacted communities. I have detailed key takeaways from arts leaders, nonprofits, and emergency relief personnel who have experienced and responded to disaster.M.S., Arts Administration -- Drexel University, 201
When a Child is Sick: Helping Young Patients Cope in a Hospital Setting
No full textThe purpose of this project was to develop a method to build coping skills and lessen anxiety for school-aged children suffering from a medical illness requiring an extended hospital stay. Relevant literature was reviewed in order to support creation of the method. The literature review included articles and research including anxiety in general and in a pediatric medical setting, coping in general and in pediatric medical settings, various aspects relating to a hospital stay, other creative and alternative therapies, and dance/movement therapy. The method was intended to use three phases (breath work, choice and control, and ritual ending) to expand coping abilities for a more expansive coping repertoire and work on the expansion of an emotion understanding. I additionally used the research and literature to reflect on the creation of the method, the implications of the method, and the results of the method.M.A., Dance/Movement Therapy and Counseling -- Drexel University, 201