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Pro Bono Artium: Understanding the Challenges of Volunteer Lawyers for the Arts
No full textThis thesis discusses the Volunteer Lawyers for the Arts ("VLA") network and seeks to determine the challenges the network is facing in serving their communities with sufficient pro bono legal assistance. This thesis first asks the broader question of what differentiates one VLA organization from another as well as what is similar between them. It further asks whether the current presidential administration has had any effect on the network and also questions whether a specific regional location is a contributing factor to a VLA's success. From there, it also addresses whether a particular funding structure or marketing strategy works best and also discusses other factors that were not anticipated before research was conducted. Interviews were conducted with the staffs of the three case study organizations and data was collected from their Forms 990, social media, and websites to address all of these questions. This thesis determines that the three case study organizations are facing much of the same challenges and finds that neither a particular regional location nor the current political climate has had too drastic of an influence on their operations. Finally, it provides recommendations as to how they might better serve their communities as well as suggestions for future research.M.S., Arts Administration -- Drexel University, 201
A Meta-Analysis Comparing Weight Loss Outcomes Between Overweight Participants with and without Binge Eating Disorder in Behavioral Weight Loss Treatment Programs
No full textObjective. Binge eating disorder (BED) is highly comorbid with obesity, making weight loss an important goal. Yet, findings from behavioral weight loss (BWL) interventions including participants with and without BED are mixed. The present meta-analysis compared weight loss outcomes of individuals with and without BED in BWL interventions, while controlling for variables that could influence weight loss outcomes. Weight regain and dropout rates between groups were also examined, as well as the effect of BED diagnostic category on outcomes. Methods. Electronic search engines were searched for relevant manuscripts published up to May 2017 using terms related to weight loss treatment and binge eating disorder. Twenty-eight manuscripts (full-threshold BED N = 1,333; non-BED N = 6,336; sub-threshold BED N = 251) were deemed eligible for inclusion. Results. A meta-regression found that individuals with full-threshold BED achieved lower weight loss (by approximately 2.3 kg) when key covariates were controlled for. A random effects model showed that a full-threshold BED diagnosis increased the odds of treatment dropout by 50%. Meta-regression models found no effect of full-threshold BED condition on weight regain, or BED diagnostic category on weight loss. Conclusions. Overall, individuals with full-threshold BED, compared to those without BED, lost less weight in BWL interventions and their odds of dropping out of treatment were increased by 50%. Future research should consider examining BED diagnosis as a moderator of treatment outcome in BWL interventions, and aim to close the gap in weight loss outcomes and retention rates between those with and without full-threshold BED.M.S., Psychology -- Drexel University, 201
Voices in Closure: The Role of the Voice and Music Therapy in Addressing Closure with Drop-In Oncology Support Groups
No full textSupport groups can be an important resource and place of strength and safety for many cancer patients whereby peers can share their experiences to receive and share support. It is within the cancer support group setting where cancer patients can express their unique experiences while not being stigmatized or distressing their loved ones. This capstone investigates the use of various singing interventions as a form of closure for oncology support groups. Pertinent literature was examined to inform the use of music therapy interventions with closure of a drop-in support group. Support groups within the oncology population provide essential peer support from individuals who are also cancer survivors. Through the addition of group singing interventions, themes and content that emerged throughout the discussion within the support group are settled through the closure ritual. Four case vignettes are identified and proposed as methods to address closure after oncology support groups. Within the cases, various music therapy interventions are explored as potential interventions to integrate the themes discussed within the support group while closing the group. Therapist/intern integrated chant into music assisted relaxation interventions, used song, and created a containment environment through the use of sustained pitches. The writer provides recommendations on future considerations using group singing interventions as closure in addition to reflections of her unique experience of facilitating the closure intervention.M.A., Music Therapy and Counseling -- Drexel University, 201
Impact of the STOP-Bang Questionnaire on the Assessment of Sleep Apnea in Hospitalized Adults with Acute Decompensated Heart Failure (ADHF)
No full textBackground: Over half the patients diagnosed heart failure have co-existing sleep apnea. New guidelines in the treatment of heart failure recommend early recognition and assessment of sleep apnea. Evidence shows that adequate treatment of sleep apnea decreases morbidity and mortality in high-risk patients with heart failure. Using a valid and reliable assessment tool like the STOP-Bang(c) Sleep Apnea Questionnaire can help identify patients in need of further assessment. Current practice at the bedside does not use a systematic approach to screen patients with heart failure for sleep apnea. Methods: An evidence-based project was piloted consisting of educational sessions on the use of the STOP-Bang(c) Sleep Apnea Questionnaire followed by the implementation of the tool on two cardiac telemetry units. A retrospective chart review was conducted to determine the impact of the questionnaire on referrals to the sleep center when compared to current standard practice. Evaluation: The DNP student compared the number of referrals to the sleep center pre and post implementation of the STOP-Bang(c) Sleep Apnea Questionnaire over a three-week pilot. Conclusion: Early assessment of sleep apnea with a validated questionnaire allows for an increase number of referrals for polysomnograms leading to early identification and differentiation of sleep disorders. Based on risk, health care providers can formulate appropriate referrals for better outcomes. Further research to evaluate outcomes such as mortality and readmissions based on sleep apnea treatment is needed. Keywords: sleep apnea, heart failure, STOP-Bang(c) questionnaire, obstructive sleep apnea, central sleep apnea.D.N.P., Nursing Practice -- Drexel University, 201
Studies of the Full-length Histidine Kinase VanSA in Detergent: From Sensing Vancomycin to Regulating its Response Regulator, VanRA
No full textVanSA is a sensor histidine kinase responsible for detecting vancomycin and activating expression of vancomycin-resistance genes in vancomycin-resistant bacteria. When VanSA senses vancomycin it autophosphorylates and then transfers that phosphate to the transcription factor VanRA. Phospho-VanRA then activates transcription of the enzymes that remodel the cell wall to avert vancomycin’s effects. In the absence of vancomycin VanSA has a third enzymatic activity, phosphatase activity, which it uses to maintain VanRA in an inactivated state. This is required because VanRA can be non-specifically phosphorylated by small molecule phospho-donors and, potentially, other histidine kinases (referred to as cross-talk). To study this VanRSA signaling system we purified the individual components including the full-length VanSA protein solubilized in detergent. An ongoing question in the field is whether VanSA detects vancomycin directly or detects a downstream effect of vancomycin. We found that vancomycin does not affect the activity of purified full-length VanSA in detergent. We also found that a non-partner histidine kinase, PhoR, phosphorylates VanRA much more slowly than its cognate partner VanSA does. PhoR binds VanRA with an affinity comparable to that of VanSA, indicating that the binding affinity alone does not confer partner-like signaling.Ph.D., Biochemistry -- Drexel University, 201
Reinforcing Personal and Cultural Identity for Older Adults with Dementia through Treasured Songs
No full textOlder adults with dementia may experience changes to their sense of identity that ultimately cause loss of identity as well as loss of memory, which are common symptoms of dementia. Identity is important for individuals as it represents who they were and who they are. As identity and self-esteem are related, loss of identity may impact one’s self-esteem and low self-esteem may lead to other conditions such as depression ultimately affecting one’s health. The purpose of this capstone thesis was to develop a method using treasured songs to reinforce personal and cultural identity for older adults with dementia at a residential nursing home and rehab setting. The relevant literature was reviewed in order to help developing the method. The reviewed literature demonstrates that music and music therapy can reinforce individuals’ personal and cultural identity in some circumstances including those who have dementia. Case vignettes are provided to illustrate how treasured songs are used in music therapy sessions with older adults with dementia to help reinforce their identity. Based on the literature and clinical vignettes, it is suggested that use of treasured songs in music therapy sessions may help reinforce personal and cultural identity in older adults with dementia.M.A., Music Therapy and Counseling -- Drexel University, 201
Nature Prescriptions, Community Health Workers, and Evaluation at the Intersection: A Research Paper for NaturePHL Considering Evaluation of the Role of the Nature
No full textNaturePHL, with the unique component of a Community Health Worker acting as a navigator for families once they receive the prescription throughout the length of their program. This novel component of the program has the potential to provide added value and improved health outcomes. To show the added value and improved health outcomes from this component effective means of evaluating that role is necessary and the main reason for producing this research paper.M.P.H., Community Health and Prevention -- Drexel University, 201
Predicting future climate and land use conditions for water resources in the Schuylkill River Watershed
No full textThe Schuylkill River watershed located in southeastern Pennsylvania drains approximately 2,000 square miles and provides services to nearly 1.5 million residents. The water resources provide many benefits and services to the environment, economy and society in the region. The impact of changing climate and land use conditions on these resources has the potential of majorly affecting the day-to-day functioning of the watershed. Water management policies are designed to ensure the availability of water resources to meet the water demand in a region based on historical data. As these policies are based on historical information, it is important to assess the effects of changing climate on water resources in the future, especially with the intensification of climate change. This, coupled with changing land use conditions, could alter the quantity and quality of water resources significantly.
The effects of climate and land use change on the water resources were quantified by estimating the runoff produced and the baseflow available in the region under simulated future conditions. The runoff was calculated using the Curve Number method by incorporating the effects of land use and hydrologic soil conditions present in the region. The baseflow was deduced by integrating the effects of the precipitation, potential evapotranspiration and soil moisture in the region. The land use change conditions were projected based on historical change in impervious conditions and future demand projections. The projected land use conditions were used to calculate the Curve Number for the period of 2020-2040. The climate change conditions and hydrologic parameters used for the calculations were derived from the Localized Constructed Analog (LOCA) data and the Bias-Correction Spatial Disaggregation (BCSD) data respectively.M.S., Environmental Engineering -- Drexel University, 201
Phylogenomics of New World Toucans and Barbets: A Model for Understanding Biogeographic History of the Neotropics
No full textThis study focuses on the phylogenomic relationships of a monophyletic clade of birds including the toucans (Aves: Ramphastidae) and their relatives, the New World barbets (Aves: Capitonidae) and toucan-barbets (Aves: Semnornithidae). Toucans and their relatives have been models for reconstructing the biogeographic history of the Neotropics. Multiple genera of toucans and their relatives co-occur across the Neotropics and thus these taxa can serve as replicates for testing biogeographic hypotheses. I used both UCE and mitochondrial genome sequences to reconstruct phylogenetic trees and chronograms and then used BioGeoBEARS to map highland/lowland and cis/trans-Andean and Atlantic Forest areas onto these trees. I confirmed previous studies indicating that (1) lowland Selenidera toucanets may be paraphyletic with respect to Andigena mountain-toucans and (2) the toucan barbets (Semnornithidae) are sister to the toucans (Ramphastidae). This ancestral state reconstruction confirmed that the Andes were important in the diversification of both lowland and highland taxa in this group and that lowland taxa dispersed into the Andes seven times. For lowland taxa, there were 8 transitions from the cis-Andean or highland regions to trans-Andean regions and Amazonian taxa likely colonized the Atlantic Forest relatively recently during Pleistocene climatic oscillations. Overall, a combination of data on timing and reconstruction of ancestral areas suggests that although Andean uplift may have been a factor in diversification, the primary driver for both highland and lowland toucan and barbet taxa was dispersal into the Andes from the lowlands, dispersal from the cis-Andean to the Trans-Andean region, and dispersal into the Atlantic Forest from Amazonia.M.S., Environmental Science -- Drexel University, 201
Development Towards a Clinically Relevant Gemcitabine Loaded Ultrasound Contrast Agent
No full textInjectable ultrasound contrast agents (UCAs) are being researched as a vehicle for ultrasound sensitive targeted drug delivery. Chemotherapeutic drugs such as gemcitabine (GEM) can be loaded into the poly(lactic acid) (PLA) shell of an echogenic microbubble (MB) limiting side effects from undesired interactions with GEM and healthy tissue. Upon insonation, GEM-loaded MBs (GEM-MBs) shatter into drug-loaded nanoshards (Nsh) which can pass through the leaky vasculature of the tumor. Pancreatic cancer is known for displaying a dense fibrous stroma surrounding the tumor inhibiting perfusion of chemotherapeutic treatment. Increasing GEM concentration through GEM-MBs may overcome this limitation. Acoustic properties of GEM-MBs were characterized by maximum enhancement and stability under ultrasound (0.45MPa). GEM-MBs reached a maximum enhancement of 18.40±1.78 dB with a half-life of 9.89±3.76 minutes. This confirms that GEM-MBs can successfully reflect ultrasound and is stable enough to travel through the circulatory system. In vitro, cytotoxicity of GEM-MBs and GEM-loaded nanoshards (GEM-Nsh) was observed against MIA PaCa-2 human pancreatic cancer cells and compared to controls daily for 7 days. While unloaded MBs possess no effect on cell growth, GEM-MBs killed cells similar to free GEM at a GEM concentration of 750nM. After 7 days, cells treated with control media, free GEM and GEM-MBs exhibited dsDNA concentrations of 419.63±204.98 ng/mL, 9.92±3.73 ng/mL and 17.89±11.82 ng/mL confirming cytotoxic effects of GEM-MBs in vitro; however, literature suggests that in vitro success does not predict in vivo cytotoxicity. To increase GEM loading, incorporating GEM-bound gold nanoparticles (AuNPs) (GEM-AuNPs) into the MBs was explored. Four methods of synthesizing GEM-AuNPs were compared for size and aggregation. GEM-loading for the final AuNP protocol was found to be 155.77±89.95 µgGEM/mgAuNP on average. These GEM-AuNPs were loaded into polymer MBs at a concentration of 1mg per 0.1g PLA to create GEM-loaded GEM-AuNP-loaded MBs (GEM-AuNP MBs). These MBs were characterized acoustically for maximum enhancement (17.33±2 dB) and half-life (>15 minutes) under constant insonation at 0.42MPa. Compared to GEM-MBs, GEM-AuNPs display similar enhancement with increased stability. GEM-AuNP MBs were found to load significantly more GEM per mg MB than GEM-MBs with 5.51±1.38 µgGEM/mgMB compared to 4.29±0.33 µgGEM/mgMB (p=0.03). Increasing GEM concentration may allow treatment to better penetrate pancreatic stroma and induce a stronger cytotoxic response.M.S., Biomedical Engineering -- Drexel University, 201