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Music Therapy with an Individual with Autism Spectrum Disorder and a Co-Occurring Behavioral Health Diagnosis: A Contextualized Case Study
No full textThis capstone thesis will provide a brief outline of the literature regarding the following subjects: autism spectrum disorder (ASD), including emotion regulation and co-regulation; co-occurring mood and behavior disorders, including anxiety, depression and bipolar disorder, and the use of music therapy with ASD and co-occurring behavioral health diagnoses. Then, the case study sessions will be described in order examine music therapy with an individual with ASD and a co- occurring behavioral health diagnosis. Finally, the author will provide discussion pertaining to the literature, reflections on the case study experiences, and recommendations for future practice with this population.M.A., Music Therapy and Counseling -- Drexel University, 201
End of Life Simulation Training for Registered Nurses
No full textBackground: Nurses are not adequately trained in evidence-based end-of-life (EOL) care. The lack of knowledge can negatively impact the patients, families, and nursing staff. During EOL, the symptom burden is high, and the emotions of families and staff caring for these patients maybe stressful and challenging. For hospitals, determining what the most effective and efficientmethod to educate nurses on end-of-life care can be challenging. Purpose: The purpose of this evidence-based practice project is to improve EOL knowledge and care of the patients and families in clinical nurses by viewing a simulation training video. Methods: Prior to implementation of the project an EOL simulation video using live actors was developed based on the CARES tool. CARES is a pneumonic for comfort, airway, restlessness,emotional and spiritual support and self-care. The CARES tool is designed to help nurses stay focused and provide a method to account for the necessary tasks to address during the last fewdays to hours of a patient’s life. All clinical nurses were asked to participate in this voluntary project. The clinical nurses had the ability to view the video as a group or as individuals. The project consisted of Lazenby’s End of Life Professional Caregiver Survey. A 28-item Likert scale tool was used to measure outcomes in this pre and post-test design. The survey was administered before and immediately following viewing the video. A total of 70 nurses participated in the project. Analysis: Median of each item was analyzed pre and post survey noted improvement in 24 outof 28 survey questions. Overall median improvement was 2.55-2.90 respectively. Results: This EOL simulation video overall increased the knowledge of EOL for clinical nurses to improve care and confidence when caring for patients and families during this life-changing event.D.N.P., Nursing Practice -- Drexel University, 201
The Impact of Safety Huddles on Staff Perception of Safety
No full textDespite an organizational commitment to patient safety, the medical-surgical registered nursing staff at an urban community hospital had a less positive perception of its hospital’s safety culture than Mid-Atlantic colleagues working in medical-surgical units at different hospitals within the geographic region. A quality improvement project was implemented utilizing unit-based safety huddles to address this gap. The huddles were implemented to improve staff perception in five selected composites of the Agency for Healthcare Quality and Research’s Hospital Survey on Patient Safety Culture.The composites included: feedback/communication about errors, communication openness, non-punitive response to error, management support for patient safety, and supervisor/manager expectations and actions promoting patient safety. The survey’s five composites were used as a baseline measure of the medical-surgical registered nurses’ perception of safety. Safety huddles were then implemented at the start of each twelve-hour shift for a three-week period and staff completed a post-survey using the same five composites. Unit-based safety huddles resulted in increased percentages of positive perception in every composite and the corresponding composite items. Statistical analysis demonstrated a statistically significant (p<0.05) improvement in the composites of communication openness, non-punitive response to error and supervisor/manager expectations and actions promoting patient safety, and six composite items. Safety huddles improved the medical-surgical staff nurses’ perception of key attributes of hospital safety culture in this project.D.N.P., Nursing Practice -- Drexel University, 201
Dance/Movement Therapy, Creative Arts Therapy, and How Dance and Performing Arts Managers Can Assist Program Participants and Employees in Times of Need
No full textThe purpose of this study was to analyze dance/movement therapy’s role within the creative arts therapy landscape and the process of determining when dance/movement therapy would be recommended over other creative arts therapy modalities. The thesis provides information to help dance and performing arts managers to assist a program participant, or employee, potentially navigate the emotional, psychological, and potentially physical side of a situation they are facing. The final chapter includes resources and references for arts managers, offers of encouragement to use the resources, and a discussion on why being brave and vulnerable is more important than playing it safe.M.S., Arts Administration -- Drexel University, 201
Kidney Transplant Length of Stay: A Data Driven Quality Improvement Project
No full textKidney transplant has been deemed a cost-effective treatment for end-stage renal disease. Medicare is the primary payor for the kidney transplant diagnosis-related group and payment is based on a 5.5-day length of stay. Exceeding this designated length of stay leads to financial loss for organizations. The purpose of this quality improvement project is to provide a gap analysis between actual care provided and expected care during the discharge process of a kidney transplant recipient. The clinical nurse leader graduate student anticipated that identified gaps in expected care would drive evidence-based interventions that may reduce length of stay in this patient population. Since case management has a profound effect on the discharge process, the organizational case management policy Assessment and Discharge Planning for the Transplant Recipient was utilized as the foundational document for the gap analysis. Results of the gap analysis found that communication techniques may be a barrier to earlier discharge at this institution. An analysis of the data collected revealed that formal interprofessional discharge rounds are not being conducted and that communication to the outpatient transplant social worker is 30.7%. A literature review provided evidence that utilizing TeamSTEPPS to improve interprofessional communication during the discharge process could reduce kidney transplant hospitalization by 1-day. If the stakeholders at this academic hospital successfully improved communication during the discharge process via TeamSTEPPS, this change could potentially save the organization $60,000 annually.M.S.N., Clinical Nurse Leader -- Drexel University, 201
Characterizing the Induction of Senescence by Tau and Beta-amyloid in Rat Astrocytes
No full textAlzheimer's Disease characterized by cognitive deficits, memory loss and changes in behavior has no cure currently. Beta amyloid and tau are two main proteins that play a significant role in AD. A mutated Amyloid Precursor Protein abnormally cleaved by beta and gamma secretases causes the accumulation of beta amyloid that lead to the characteristic beta amyloid plaques found extracellularly in AD patients. Tau induces its own adverse effects by hyperphosphorylation and forming neurofibrillary tangles. Aging is the primary risk factor for Alzheimer's Disease (AD). Senescence is a hallmark of aging that can a contributing factors in pathology of AD. there are many overlapping consequences of senescence in AD such as oxidative stress, inflammation and DNA damage. Previous results from our lab have shown that there is an increase in the population of senescent astrocytes in AD patients and beta amyloid as the inducer of the program of senescence. Astrocytes have a vital role in regulating homeostasis at the blood brain barrier and hold a strategic position between the neurons and the capillaries. Astrocyte senescence is considered in this thesis as a contributing factor to AD. Tau, the other hallmark of AD may be also play a role in the induction of senescence in astrocytes. In this thesis, we analyzed the roles of tau and beta amyloid in the activation of senescence in rat by the expression SA-beta galactosidase and mitochondrial membrane potential. Our findings support that tau and beta amyloid have different targets that induce senescence in the astrocytes. The combination of beta amyloid and tau as well as beta amyloid by itself, were well characterized by the expression of SA-beta galactosidase and Tau is shown to be implicated in mitochondrial dysfunction.M.S., Biomedical Engineering -- Drexel University, 201
Thermoreversible Diels-Alder Healable Polymeric Systems for Corrosion Prevention
No full textSelf-healing of thermosetting materials is desirable to repair damage that can occur through aging, wear resistance, and internal fractures. The focus of this work was to be able to apply a self-healing microcapsule system to a coating in order to improve the coating's durability to provide better corrosion protection to the underlying metal substrate. Furthermore, the design of encapsulation methods was studied to also encapsulate corrosion inhibitors. Embedding corrosion inhibitors into a coating would allow for more targeted delivery of the inhibitor to an area of damage and impede the corrosion of the underlying metal. A furan functionalized epoxy-amine thermoset with an embedded microcapsule healing system that utilizes reversible Diels-Alder healing chemistry was developed. A urea-formaldehyde (UF) encapsulation technique was used to create capsules with average diameters of 150 and 58 μm, filled with reactive solutions of phenyl acetate (PA) and multimaleimides. These capsules were incorporated into a polymer matrix and coating and upon fracture, break to release maleimide into the crack interface where it can react with pendant furan groups. These studies showed that the use of PA as a solvent and the concentration and structure of maleimide healing agent affects the degree of physical and chemical bonding across the crack surface. In addition, a method to encapsulate a zinc based corrosion inhibitor was developed. These capsules along with capsules containing reactive healing solution were then incorporated into a furan-functionalized epoxy coating and evaluated for corrosion prevention. It was found that healing of the coatings and direct delivery of inhibiting solution to an area of damage have an effect on corrosion resistance within short time scales.Ph.D., Chemical Engineering -- Drexel University, 201
Piezoelectric Plate Sensor for Isolation-free and Amplification-free Detection through an Innovative Combustion-Free Aqueous Materials Synthesis Route
No full textPiezoelectric plate sensor (PEPS) is a unique sensor platform developed in Shih and Shih laboratory capable of direct, in situ genetic detection with polymerase chain reaction (PCR) sensitivity and specificity but without the need of gene isolation or amplification. The heart of the PEPS technology is a highly piezoelectric lead magnesium niobate-lead titanate (Pb(Mg1/3Nb2/3)O3)0.65-(PbTiO3)0.35 (PMN-PT) freestanding film. The difficulty and complexity of the synthesis processes for the lead magnesium niobate (PMN) power rendered PEPSs not reproducible. The goal of this thesis is to investigate the aqueous synthesis processes of PMN powder to achieve reproducible PEPSs for isolation-free and amplification-free genetic and immune- detections. The most challenging part of the initial PMN powder synthesis was a combustion step as a result of using ethylene glycol as the medium. The combustion step made the PMN powder finer, essential for making the freestanding film from which PEPSs were made. However, combustion also made the process uncontrollable and difficult to obtain reproducible PEPSs. In this study, we have successfully circumvented the combustion process and achieved similarly fine PMN powder through (1) stringent control of the aqueous synthesis process, (2) mechanical particle size reduction, and (3) creative two-step heating process to crystallize the PMN powder at the same crystallization temperature. The repeatability of these steps and reproducibility of the PEPSs sensors are characterized by X-ray diffraction, particle size measurements, Scanning electron microscopy (SEM) examination sintering of the freestanding film, and the temperature stability and detection performances of the PEPSs. Results showed that the newly fabricated PEPSs made by the new aqueous synthesis routes detected anti-Tn antigen IgM in serum at a concentration 25,000 times lower than the comparing ELISA and detected DNA at 60 copies/ml as comparable to the PEPSs made from the combustion method. We further carried out hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA detection in simulated sera in 30 min without isolation and amplification to illustrate the reliable performance of these newly fabricated PEPSs.Ph.D., Biomedical Engineering -- Drexel University, 201
Exosome Mediated Neuro-immune Communication in Chronic Pain
No full textChronic pain, both inflammatory and neuropathic, is extremely difficult to treat. There is a need for investigating novel mechanisms underlying pain to identify new therapeutic targets. Growing evidence supports a role for immune signaling in chronic pain mechanisms. Pronociceptive and proinflammatory mediators secreted by resident immune cells, peripheral immune cells and sensory neurons contribute to the sensitization of neurons during chronic pain states. Cell secrete 30-150 nm extracellular vesicles or exosomes to communicate with both adjacent and distant cells. Exosomes transport regulatory biomolecules including proteins and RNAs and the contents vary depending on the source and the physiological states of cells releasing them. Disease states can alter exosome composition affecting the message conveyed and thus, uptake of exosomes can impact gene expression and function in recipient cells. The overall objective of this study was to assess the utility of exosomes as a therapeutic for chronic inflammatory pain and to characterize exosomes released during neuropathic pain. Exosomes derived from antigen-presenting cells such as macrophages can induce therapeutically relevant adaptive immune responses, but the mechanistic basis of this protection is not well understood. Exosomes secreted by RAW 264.7 mouse macrophages after lipopolysaccharide (LPS) stimulation contain elevated levels of anti-inflammatory miRNAs. We observed efficient uptake of these exosomes by primary mouse cortical neurons, microglia and astrocytes and downregulation of miRNA target genes in recipient cells. Pre-treating recipient cells with these exosomes decreased pro-inflammatory cytokine expression upon LPS stimulation. A single intrathecal injection of 1µg exosomes derived from LPS stimulated RAW 264.7 cells attenuated mechanical hyperalgesia in the complete Freund’s adjuvant (CFA) mouse model of inflammatory pain. Importantly, exosomes did not alter the normal pain threshold in control mice. RNA sequencing of dorsal horn of the spinal cord showed exosome-induced modulation of ion channels and immune regulatory pathways. Interestingly, a single prophylactic intrathecal injection of 1[mu]g exosomes two weeks prior, attenuated pain hypersensitivity in CFA model without impacting the protective physiological inflammatory pain. Our findings provide strong basis for further investigating the use of exosomes from antigen presenting cells both as a pain therapeutic and as a prophylactic agent that can function as a vaccine against chronic pain. Recent studies indicate significant dysregulation of miRNAs and proteins in the dorsal root ganglion and spinal cord after nerve injury. However, there are no studies to date investigating alterations in exosome composition, function, and signaling mechanisms in a neuropathic pain state. We hypothesized exosome content would be altered following nerve injury and these alterations can provide insight into signaling mechanisms involved in neuropathic pain. To characterize exosome composition following nerve injury, exosomes were purified from mouse serum four weeks after spared nerve injury (SNI) or sham surgery. Our miRNA profiling showed a distinct exosomal miRNA signature in SNI model compared to sham control. Proteomics analysis using tandem mass spectrometry detected 274 gene products. Of these, 24 were unique to SNI model, 100 to sham surgery control and five to naïve control samples. In addition to commonly expressed exosome proteins, multiple members of serpin and complement family were detected in exosomes. Neuropathic pain can induce the activation of the complement cascade and our cytokine profiling using membrane-based antibody array showed significant upregulation of complement component 5a (C5a). Intercellular Adhesion Molecule 1 (ICAM-1), required for the leukocyte recruitment, adhesion and homing of exosomes was also upregulated in exosomes from SNI model compared to sham control. We observed a differential distribution of C5a and ICAM-1 within serum and exosomes between sham and SNI, indicating changes from local or paracrine to long distance signaling under neuropathic pain. Our studies suggest critical roles for cargo sorting of vesicular proteins in mediating neuropathic pain. Collectively, our studies show the therapeutic potential of exosomes derived from antigen presenting cells and shed light on novel mode of cellular communication mediated by exosomes after nerve injury.Ph.D., Pharmacology and Physiology -- Drexel University, 201
Using mindfulness and dance/movement therapy for emotion-focused coping with adolescents
No full textThe purpose of this capstone thesis was to create a method that incorporated mindfulness, body awareness, and movement to facilitate awareness and acceptance of emotions as they arise for adolescents in a school setting. Adolescents are at a complicated time in their development where their identities are beginning to form, they are often flooded with new and uncomfortable thoughts and emotions. Self-expression can be challenging for adolescents, for many reasons including lack of awareness of feelings and cultural stigma around the expression of emotions, especially those such as fear, hurt, anxiety, and sadness. The literature supported the use of dance/movement therapy as a beneficial intervention for adolescents to help with stress management, attending to the body, and emotional expression. Additionally, mindfulness was used as a tool to help the teenagers become more aware of thoughts and emotions as they relate to the felt experience of the body. Through an integration of dance/movement therapy and mindfulness the students who participated in this method became more aware of their thoughts and emotions and were able to pay attention to their bodily felt experience. Case vignettes were provided to illustrate the method in use within individual dance/movement and counseling therapy sessions.M.A., Dance/Movement Therapy and Counseling -- Drexel University, 201