bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Structure and Surface Chemistry of Porous Carbon Electrodes on Supercapacitor Performance
Authors:   , Dyatkin Boris , Gogotsi Yury
Published: July 2021

Electrochemical double layer capacitors, which rely on electrosorption of ions in nanostructured carbon electrodes, can supplement or even replace traditional batteries in energy harvesting and storage applications. While supercapacitors offer > 10 kW/kg power densities, their ~5 Wh/kg energy densities are insufficient for many automotive and grid storage applications. Most prior efforts have focused on novel high-performing ionic liquid electrolytes and porous carbons with tunable pore diameters and high specific surface areas. However, existing research lacks fundamental understanding of the influence of surface heterogeneity and disorder, such as graphitic defects and functional groups, on key electrosorption properties at electrode-electrolyte interfaces. These interactions significantly impact charge accumulation densities, ion transport mechanisms, and electrolyte breakdown processes. Subsequently, they must be investigated to optimize ion screening, charge mobilities, and operating voltage windows of the devices. The research in this dissertation examined the influence of surface functional groups and structural ordering on capacitance, electrosorption dynamics, and electrochemical stability of external and internal surface of carbon electrodes. High-temperature vacuum annealing, air oxidation, hydrogenation, and amination were used to tune pore surface compositions and decouple key structural and chemical properties of carbide-derived carbons. The approach combined materials characterization by a variety of techniques, neutron scattering studies of ion dynamics, electrochemical testing, and MD simulations to investigate the fundamental intermolecular interactions and dynamics of ions electrosorption in different pore architectures and on planar graphene surfaces. Contrary to expected results and existing theories, defect removal via defunctionalization and graphitization decreased capacitance. Hydrogenated surfaces benefitted electrosorption, while oxygen-containing groups, which increased the wettability and ionophilicity of electrodes, positively impacted capacitance by decreasing ion densities in confined pores and improving electrolyte diffusion. The influence of surface defects strongly depended on ion properties, carbon particle size and internal-to-external surface ratio, porosity, and ion confinement. These fundamental concepts were applied to several energy storage systems, including high-performance coarse-grained and core-shell carbide derived carbon electrodes, a novel in situ spectroelectrochemical analysis method, and design of an environmentally benign "green" supercapacitor.
Structure-Property-Processing Correlations in Freeze-Cast Hybrid Scaffolds
Authors:   , Hunger Philipp Malte , Wegst Ulrike G. K.
Published: July 2021

Porous materials are highly sought after for applications ranging from catalyst carriers to tissue scaffolds. Most applications require clearly defined structural features and a specific mechanical performance. Therefore, it is essential to establish systematic structure-property-processing correlations to be able to tailor both structure and mechanical properties for a particular application. Because the introduction of porosity is detrimental to the mechanical performance of highly porous structures, it is necessary to generate a structure that allows for the mechanical properties to be maximized. One example for such a structure are honeycombs. In addition to the porosity and pore morphology, the scaffold's performance depends on the properties inherent to the material from which it is made. Polymeric foams possess high toughness but low stiffness, whereas ceramic foams possess high stiffness but low toughness. Natural composites like bone, antler and nacre have both high stiffness and high toughness. This unusual set of mechanical properties is thought to be intricately linked to the multi-level hierarchical composite structure present in these materials. Great potential for the fabrication of stiff, strong and tough porous scaffolds is thus seen in nacre-like composite materials with a hierarchical, honeycomb-like structure. Freeze casting is a method with which such hybrid materials can be made, adding the third dimension to nacre by forming a highly porous, hierarchical bulk material, with dense, nacre-like cell walls. The nacre-like cell walls self-assemble during the directional freezing of a water-based ceramic-polymer slurry. Reported here are structure-property-processing correlations observed in these materials. They are unusual, because they are, like nacre, solely glued by a polymeric phase and not processed further by sintering. The results illustrate several pathways to control both structure and mechanical properties in freeze-cast composites and highlight the considerable gain in stiffness, strength and toughness that can be achieved when the cell walls have a nacrelike structure. As an example for their application, the great promise of freeze-cast hybrid scaffolds for bone tissue engineering is illustrated.
Compressive Sensing Applied to MIMO Radar and Sparse Disjoint Scenes
Authors:   , Minner Michael Francis , Foucart Simon , Woerdeman Hugo J.
Published: July 2021

The purpose of remote sensing is to acquire information about an object through the propagation of electromagnetic waves, specifically radio waves for radar systems. However, these systems are constrained by the costly Nyquist sampling rate required to guarantee efficient recovery of the signal. The recent advancements of compressive sensing offer a means of efficiently recovering such signals with fewer measurements. This thesis investigates the feasibility of employing techniques from compressive sensing in on-grid MIMO radar in order to identify targets and estimate their locations and velocities. We develop a mathematical framework to model this problem then devise numerical simulations to assess how various parameters, such as the choice of recovery algorithm, antenna positioning, signal to noise ratio, etc., impact performance. The experimental formulation of this project leads to further theoretical questions concerning the benefits of incorporating an underlying signal structure within the compressive sensing framework. We pursue these concerns for the case of sparse and disjoint vectors. Our computational and analytical treatments illustrate that knowledge of the simultaneity of these structures within a signal provides no benefit in reducing the minimal number of measurements needed to robustly recover such vectors from noninflating measurements, regardless of the reconstruction algorithm.
The Effect of Morphological Variations at the Human Ankle and Hip Joints on their Biomechanical Function
Authors:   , Namani Ramya , Siegler Sorin
Published: July 2021

The morphology of the articular surfaces of bones and the insertion sites of ligaments crossing anatomical human joints were reported to vary greatly amongst individuals. These morphological variations could be the main cause for the observed large variations in the joint mechanical function. The goal of this study is to explore the causal relationship between the joint morphology and mechanics in two specific joints- ankle and hip joint. To achieve this goal, six experimentally validated numerical models of the ankle joint complex, were developed from morphological data, obtained from magnetic resonance images of six cadaveric lower limbs and six numerical models of hip joints were developed from morphological data obtained from computer tomographic scans of six healthy hip joints. The morphology of the bone is systematically varied and the resulting mechanical function such as range of motion of the joint, flexibility of the joint and forces in the ligaments are compared with the change in morphology. Since all models used identical material properties and were subjected to identical loads and boundary conditions, it was concluded that the observed variations in mechanical behavior of the joint were due to variations in morphology. The results suggested that the morphological variations could be the main cause for the large variations observed in joint mechanics and could influence the mechanical consequences of ligament injuries and surgical procedures such as joint fusion and joint replacement.
The Effect of Substrate Stiffness on Endothelial Cell Stiffness and Monolayer Permeability in Response to Inflammation
Authors:   , Urbano Rebecca Lownes , Clyne Alisa Morss
Published: July 2021

Cardiovascular diseases represent a major risk to global health, contributing to approximately one-third of all deaths worldwide. Inflammation and arterial stiffening are key in the pathogenesis of many cardiovascular diseases, including hypertension and atherosclerosis. However, little is known about their combined impact on vascular endothelial dysfunction. The central objective of this thesis is to investigate the contribution of arterial stiffness to endothelial cell stiffening and barrier loss in response to inflammation through actinomyosin contractility and reactive oxygen species. A novel dielectrophoretic (DEP) device for assessing deformability of micropatterned single attached cells was simulated, fabricated, and tested. The device was validated by showing that endothelial cells with cytoskeletal disruption and epithelial cells with induced tumorigenicity were softer by atomic force microscopy (AFM) and more deformable in response to directed DEP pushing force. Next, the effect of sub-endothelial stiffness on endothelial monolayer permeability in response to inflammation was explored ex vivo and in vitro. Elastin haploinsufficient (ELN+/-) mice exhibited stiffer sub-endothelium by AFM and increased vinculin at aortic endothelial cell-cell junctions. In vitro, porcine aortic endothelial cells (PAEC) on collagen-coated polyacrylamide gels of varying stiffness (6-50 kPa) showed increased vinculin localization to cell-cell junctions and junction loss in response to tumor necrosis factor alpha (TNF-[alpha]) and thrombin. These effects were abolished when cell contraction was inhibited. Substrate stiffness also enhanced functional barrier loss in response to thrombin, but not TNF-[alpha]; however, cells exhibited substrate-dependent stiffening following TNF-[alpha] exposure. Lastly, substrate stiffness enhanced endothelial reactive oxygen species (ROS) production in response to phorbol 12-myristate 13-acetate (PMA). On stiff substrates PMA-induced ROS elicited greater actin fiber formation and cell-cell junction loss, which was independent of cell contractility but prevented by ROS scavenging. Ex vivo, peripheral actin fiber formation was greater in the ELN+/- mouse abdominal aorta following exposure to PMA. These results demonstrate that sub-endothelial stiffness affects endothelial cell contractile and non-contractile (ROS-mediated) mechanisms of endothelial barrier dysfunction. This research supports studying the integrated effects of arterials stiffness and inflammation to develop new therapies to prevent endothelial dysfunction.
Correlated Electron Phenomena in 2D Materials
Authors:   , Lambert Joseph G. , Karapetrov Goran , Ramos Roberto C.
Published: July 2021

In this thesis, I present experimental results on coherent electron phenomena in layered two-dimensional materials: single layer graphene and van der Waals coupled 2D TiSe₂. Graphene is a two-dimensional single-atom thick sheet of carbon atoms first derived from bulk graphite by the mechanical exfolia- tion technique in 2004. Low-energy charge carriers in graphene behave like massless Dirac fermions, and their density can be easily tuned between electron-rich and hole-rich quasiparticles with electrostatic gating techniques. The sharp interfaces between regions of different carrier densities form barriers with selective transmission, making them behave as partially reflecting mirrors. When two of these interfaces are set at a separation distance within the phase coherence length of the carriers, they form an electronic version of a Fabry-Perot cavity. I present measurements and analysis of multiple Fabry-Perot modes in graphene with parallel electrodes spaced a few hundred nanometers apart. Transition metal dichalcogenide (TMD) TiSe₂ is part of the family of materials that coined the term "materials beyond graphene". It contains van der Waals coupled trilayer stacks of Se-Ti-Se. Many TMD materials exhibit a host of interesting correlated electronic phases. In particular, TiSe₂ exhibits chiral charge density waves (CDW) below TCDW ~ 200 K. Upon doping with copper, the CDW state gets suppressed with Cu concentration, and CuxTiSe₂ becomes superconducting with critical temperature of Tc = 4.15 K. There is still much debate over the mechanisms governing the coexistence of the two correlated electronic phases - CDW and superconductivity. I will present some of the first conductance spectroscopy measurements of proximity coupled superconductor- CDW systems. Measurements reveal a proximity-induced critical current at the Nb-TiSe₂ interfaces, suggesting pair correlations in the pure TiSe₂. The results indicate that superconducting order is present concurrently with CDW in pure TiSe₂, contradicting the notion of a competition between two correlated electron states.
Attachment, Problem Solving, and Their Role in Relationship Conflicts for Female Perpetrators
Authors:   , Bennett Patrick , Nezu Arthur M.
Published: July 2021

Intimate partner violence (IPV) has been associated with both physical and psychological trauma in both men and women. Women appear particularly vulnerable to these negative effects, whether they are the victims of IPV or the assailants. However, existing interventions to reduce IPV have been tested primarily in men, and appear to be less effective for women perpetrators. Two potential intervention targets for IPV that may be particularly salient for women are problem solving strategies and relationship attachment. Ineffective social problem solving and insecure attachment have been found to be significantly correlated with each other, and have each been associated with an increased likelihood of IPV. The present study examines the relationships among social problem solving, attachment style, and IPV perpetration in a sample of female undergraduate students. It is hypothesized that social problem solving will mediate the relationship between a person's attachment style and severity of IPV in a romantic relationship. 126 female Drexel undergraduate student volunteers age 18-25 were administered three questionnaires measuring social problem solving (the Social Problem Solving Inventory-Revised), IPV (the Conflict Tactics Scale 2), and attachment (the Experiences in Close Relationships-Revised). The questionnaires were completed on Drexel's SONA system. A bootstrap confidence interval from SPSS's PROCESS regression analysis, showed that social problem solving partially mediated the relationship between attachment anxiety and IPV but not attachment avoidance.
Design and evaluation of collapsible pitch-adjusting impeller for use in mechanical cavopulmonary assist device of fontan patients
Authors:   , Patel Jay P. , Throckmorton Amy
Published: July 2021

Thousands of children are born each year with multiple malformations of their heart chambers and are categorized to have a single ventricle physiology. Surgical palliation is required for these patients to survive, and these staged-surgeries produce a unique anatomic configuration where the single ventricle functions as the systemic ventricle and the vessel connections in the pulmonary circulation facilitate passive blood flow to the lungs. Thus, one ventricle performs the workload of both the systemic and pulmonary circulations. The cardiovascular stresses imposed by the single ventricle Fontan physiology leads to premature dysfunction and heart failure. A heart transplant is a treatment option, but limited donor organs and matching constraints create substantial challenges. Blood pumps or mechanical assistive technology can provide temporary circulatory support until a donor organ is located, but current devices are over designed for mechanical assistance of the single ventricle physiology or cavopulmonary circuit. Hence, to address this unmet therapeutic need, we are developing an intravascular blood pump to provide mechanical cavopulmonary assistance to Fontan patients. In this thesis project, more than 10 rigid and 4 collapsible prototypes were designed, manufactured, and hydraulically tested in a flow loop using a blood analog solution. Flexibility, collapsibility, and blade twist were parameters of focus in the development of the prototypes and in consideration of maximal pump performance. Materials of construction included various polyurethanes, Nitinol wire, and watershed resin. All of the prototypes generated pressures and flows in the target range to support Fontan patients. This research serves as a solid foundation from where to begin the next phase of pump development toward designing a fully functioning and effective collapsible, pitch - adjusting blood pump. This new blood pump will advance the current state-of-the-art and operate as a bridge-to-transplant or bridge-to-recovery for children and adults with dysfunctional Fontan physiology.
Implementation of Video Processing Techniques on a Field Programmable Gate Array Development Platform
Authors:   , Amoruso Michael Thomas , Nagvajara Prawat
Published: July 2021

The thesis covers detailed description of a development platform for video processing system targeted for ON-camera applications. Platforms such as the Zynq and Xilinx Inc., integrate high-performance processing, programmable digital intellectual property (IP), core peripheral, and input-output video signal interfaces into a single FPGA chip. The advantages of using this method include size, weight, and power (SWAP) requirements in applications such as pilot helmet vision and binocular video processors. The contents include an overview of the processor system and IP cores on the FPGA architecture, video processing IP cores, Integrated Design Environment (IDE) tools, and case studies on grey scale conversion and canny edge detection. The results from the case studies display the effectiveness of the design and implementation methodology. Programmable IP core peripherals enable real-time processing, which is difficult to meet under SWAP constraints using software alone. The thesis presents studies on the design and implementation methodology and FPGA video processor platform.
Investigation of the Z-Binder Role in Progressive Damage of 3D Woven Composites
Authors:   , López Néstor A. Castaneda , Kontsos Antonios
Published: July 2021

The lack of strengthening or toughening mechanisms in the through-thickness or z-direction in two-dimensional (2D) laminated composite structures result in low mechanical performance for demanding aerospace and automotive applications, among others. To that effect, a 3D woven composite system consisting of z-binders for improved performance has been introduced to potentially provide additional means for enhanced damage tolerance and reduced mechanical property degradation. To investigate the benefits of these novel composite architectures, this work employs a multimodal nondestructive evaluation and characterization approach consisting of Digital Image Correlation (DIC) and Acoustic Emission (AE) to identify the failure behavior under tensile and fatigue loading conditions. Analyses of local strain patterns are shown to indicate increased transverse reinforcement through different length scales due to the presence of the z-binder in 3D woven composites, as opposed to its 2D counterpart. Complementary data acquired from X-ray micro computed tomography ([mu]CT), Scanning Electron Microscopy (SEM) and post-mortem fracture pattern analysis is used to determine specific damage mechanisms for potential applications as damage precursors.
Imidazolium-based Block Copolymers as Solid-State Separators for Alkaline Fuel Cells and Lithium Ion Batteries
Authors:   , Nykaza Jacob Richard , Elabd Yossef A. , Palmese Giuseppe R.
Published: July 2021

In this study, polymerized ionic liquid (PIL) diblock copolymers were explored as solid-state polymer separators as an anion exchange membrane (AEM) for alkaline fuel cells AFCs and as a solid polymer electrolyte (SPE) for lithium-ion batteries. Polymerized ionic liquid (PIL) block copolymers are a distinct set of block copolymers that combine the properties of both ionic liquids (e.g., high conductivity, high electrochemical stability) and block copolymers (e.g., self-assembly into various nanostructures), which provides the opportunity to design highly conductive robust solid-state electrolytes that can be tuned for various applications including AFCs and lithium-ion batteries via simple anion exchange. A series of bromide conducting PIL diblock copolymers with an undecyl alkyl side chain between the polymer backbone and the imidazolium moiety were first synthesized at various compositions comprising of a PIL component and a non-ionic component. Synthesis was acheived by post-functionalization from its non-ionic precursor PIL diblock copolymer, which was synthesized via the reverse addition fragmentation chain transfer (RAFT) technique. This PIL diblock copolymer with long alkyl side chains resulted in flexible, transparent films with high mechanical strength and high bromide ion conductivity. The conductivity of the PIL diblock copolymer was three times higher than its analogous PIL homopolymer and an order of magnitude higher than a similar PIL diblock copolymer with shorter alkyl side chain length, which was due to the microphase separated morphology, more specifically, water/ion clusters within the PIL microdomains in the hydrated state. Due to the high conductivity and mechanical robustness of this novel PIL block copolymer, its application as both the ionomer and AEM in an AFC was investigated via anion exchange to hydroxide (OH-), where a maximum power density of 29.3 mW cm-1 (60 °C with H2/O2 at 25 psig (172 kPa) backpressure) was achieved. Rotating disk electrode (RDE) experiments determined the interfacial resistance imposed during cell assembly between the AEM, catalyst, and ionomer was a factor in fuel cell performance. Further RDE studies investigated the electrochemical stability of the PIL block copolymer ionomer under applied potentials, where it was determined that potential cycling increased the degradation compared to constant voltage or open circuit voltage studies.
First Principles Design of Non-Centrosymmetric Metal Oxides
Authors:   , Young Joshua Aaron , Rondinelli James M.
Published: July 2021

The lack of an inversion center in a material's crystal structure can result in many useful material properties, such as ferroelectricity, piezoelectricity and non-linear optical behavior. Recently, the desire for low power, high efficiency electronic devices has spurred increased interest in these phenomena, especially ferroelectricity, as well as their coupling to other material properties. By studying and understanding the fundamental structure-property relationships present in non-centrosymmetric materials, it is possible to purposefully engineer new compounds with the desired "acentric" qualities through crystal engineering. The families of ABO3 perovskite and ABO2.5 perovskite-derived brownmillerite oxides are ideal for such studies due to their wide range of possible chemistries, as well as ground states that are highly tunable owing to strong electron-lattice coupling. Furthermore, control over the B-O-B bond angles through epitaxial strain or chemical substitution allows for the rapid development of new emergent properties. In this dissertation, I formulate the crystal-chemistry criteria necessary to design functional non-centrosymmetric oxides using first-principles density functional theory calculations. Recently, chemically ordered (AA')B2O6 oxides have been shown to display a new form of rotation-induced ferroelectric polarizations. I now extend this property-design methodology to alternative compositions and crystal classes and show it is possible to induce a host of new phenomena. This dissertation will address: 1) the formulation of predictive models allowing for a priori design of polar oxides, 2) the optimization of properties exhibited by these materials through chemical substitution and cation ordering, and 3) the use of strain to control the stability of new phases. Completion of this work has led to a deeper understanding of how atomic structural features determine the physical properties of oxides, as well as the successful elucidation of new design principles to help guide experimental synthesis of novel materials.
The Development of an International Student Advisor
Authors:   , Sparaco Kathleen Keenan , Geller Kathy Dee , Bureau W. Edward
Published: July 2021

This qualitative study explored the professional experience of international student advisors. The statement of problem for this research was that the professional role of international student advisors has not been clearly defined or understood within U.S. higher education. The research questions asked (1) what encompassed the lived experience of international student advisors, (2) what emergent concerns might be important in the experiences of international student advisors, and (3) in what way have the personal constructs of professionalism and professional identity for international student advisors been developed? This studied utilized a grounded theory methodology, a systematic but flexible inductive approach to analyzing data to create theory specific to the studied phenomenon. Theory, in this study, was defined as a way of understanding or making sense of the world in order to have the practical insight needed to guide action. The research tool of interviews was used with international student advisors across the United States in a variety of institutions profiles. The findings were organized into three major thematic categories; the student first; not being invited to the table; and they don't get what we do. The first theme, the student first, reflected the connection of the participants to the student population they served. All the participants had had a transformative international experience prior to entering the field which was the catalyst in seeking a career grounded in commitment to international students. Not being invited to the table emerged as a way to understand the common experience of disenfranchisement across interviews. The final theme, they don't get what we do suggested that the overly regulatory, paper-focused, administrative side of working with international students is what many participants felt kept the advisor invisible and undervalued on campus. The findings indicated the participants demonstrated a clear commitment to the student population they served, but it is oftentimes when the advisor is off campus and interacting with other international student advisors that he or she experiences a true sense of community. The recommendations suggest international student advisors invest the time and money to participate in professional organizations.
Translating the Evidence of the Use of the Sepsis Screening Tool to Improve Sepsis Identification and Reduce Sepsis Mortality
Authors:   , Abella Nicolas , Rundio Al
Published: July 2021

Background: Sepsis is a life threatening syndrome that occurs rapidly when the body's response to blood infection injures its own tissues and organs. Sepsis is the most costly disease in the U.S. and the number one killer of patients admitted to acute care hospitals. On October 1, 2015, the Centers for Medicare and Medicaid Services (CMS) will start chart abstraction initiatives for Severe Sepsis and Septic Shock for the FY 2017 Payment Determination. In reviewing 2013 and 2014 data from the Community Hospital System (CHS), the majority of patients diagnosed with sepsis were not screened for sepsis in either the ED or the in-patient units, meaning that CHS as a whole has $20,000,000 at stake. for the CMS Value Based-Purchasing payment program. The main goal of this paper is to attempt to improve sepsis outcomes by closing the gap between compliance to the published sepsis treatment guidelines and daily clinical practice through the implementation of a Sepsis Screening tool. Methods: The planned course of work for this project is to use an existing data set that will be requested from the Executive Sponsor for all the Community Hospital System's Quality Collaborative (Sr. VP and CNO) of the system. This data will include the number of sepsis cases and the risk-adjusted mortality index in 2014, as well as current year to date data. Evaluation: Pre and post participation outcomes are to be compared using the T-test analysis. The outcome measures are the number of sepsis patients identified and the number of sepsis deaths within the 19 community hospitals participating in the Quality Collaborative. Significance and Implications: If the hypothesis is correct, the data will not only reveal an opportunity for growth but also lend a better understanding of how to increase sepsis identification and lower sepsis mortality for our community hospitals nationwide.
Nurse Leader Rounds
Authors:   , Babaev Angela , Giarelli Ellen
Published: July 2021

Abstract Background and Significance: The best possible inpatient experience is a priority for many hospitals in today's model of healthcare delivery. Achieving and sustaining measurable success is a key challenge. Nurse leader rounds (NLR) has been revealed to be an effective improvement strategy in some hospitals. The purpose of this DNP project was to analyze the impact of implementing daily NLR on patient satisfaction (PS) scores in two postsurgical units at Mount Sinai Beth Israel (MSBI) hospital in New York. Methods: This study used descriptive comparison to analyze existing survey data before and after NLR was implemented. The study took place in an academic, urban, tertiary care hospital in two postsurgical units. Data were collected using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey reflecting questions to measure patient's perceptions of care, specifically, assessing the nurse related communication to examine if there was a relationship between NLR and PS scores. Results: Patient perception data summarized in this study suggested that the implementation of NLR was associated with increased levels of patient satisfaction with communication (SC) with nurses following NLR in the inpatient setting on two post-surgical units. The results indicated significant difference between the pre and post scores of SC in nurse related questions referring to communication (Appendix A). Conclusion: Effective implementation of NLR can improve patient perception of care. Improvements in nurse communication impacted PS. Areas for improvement were to focus on patient self-management of care and medication education.
Perceptions, Attitudes, and Behaviors of Primary Care Providers Toward Obesity Management
Authors:   , Bornhoeft Kathleen , Giarelli Ellen
Published: July 2021

Background and Problem Statement: Obesity is a serious, costly, and prevalent chronic condition, which affects adults and children all over the world. There is evidence that clinicians fail to screen, diagnose, and treat obesity in accordance with national evidence-based clinical guidelines. The purpose of this DNP project was to explore perceptions, attitudes, and behaviors toward obesity management by providers in primary care. Methods: A descriptive qualitative design using semi-structured face-to-face interviews was used along with thematic content analysis to analyze data for development of themes. A purposive sample of 12 primary care providers (PCPs), from hospital owned suburban practices, was chosen for this study and included six nurse practitioners (NPs) and six physicians age 30-65 who care for patients with obesity. Results: Participants reported a lack of knowledge, communication, and support for managing obesity. Many different provider approaches to managing obesity were observed, which are based on perceptions, beliefs, and anecdotal medicine rather than on scientific evidence. Common barriers to obesity management were identified and three major themes emerged: Provider centered obstacles, organizational obstacles, and provider perception of patient obstacles. Conclusion and Clinical/Application: This study confirms the presence of a trend in the delivery of care in a traditional healthcare system that places emphasis and value on episodic visits for disease management rather than on prevention. Organizational healthcare policies, protocols and guidelines must adapt and change to form a multidisciplinary integrated approach for managing this chronic condition. Future clinically and community focused initiatives must be innovative and are needed to support primary care providers in their delivery of evidence-based, patient-centered care to improve outcomes and reduce healthcare cost.
IRB 15. 1874 Implementation of An Alcohol Detoxification Clinical Pathway
Authors:   , Fowler Maureen A. , Gonzalez Elizabeth W.
Published: July 2021

Approximately 1 in 5 medical patients have an underlying alcohol use disorder. Purpose: The purpose of this capstone project is to determine if standardization of the current clinical processes and assessment tools utilized for the alcohol withdrawal patient population contribute to improved patient outcomes as evidenced by a reduction in the overall cost to the organization in treating the substance abuse population on a non-psychiatric unit. Cost reduction will be measured by the number of transfers to a higher level of care and length of stay. Methods: The Symptom Management Theory Model was used as the framework for the project to facilitate timely patient assessment and interventions and to standardize the overall clinical management of the patient requiring alcohol detoxification. The symptom experience concept was the foundation for the development of a patient screening tool administered in the emergency department that requires the active participation of the patient and is utilized by providers to ensure timely interventions, prevent complications, and improve patient safety and care. Symptom experience includes vital signs, a history of alcohol withdrawal seizures or delirium tremens, and a history of required transfer to ICU in the past related to a complicated withdrawal. The symptom management concept was the foundation for the development of a standardized physician alcohol detoxification order set. Symptom management strategies include triage to the appropriate setting, early initial and ongoing patient assessment, and initiation of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) protocol and Moderate Detoxification Order Set. The symptom status outcomes concept was the foundation for evaluating the impact on transfers to a higher level of care, length of stay, development of alcohol withdrawal complications, restraint use, and patient aggression. Evaluation: To determine the effectiveness of the new program, a comparison of the patients treated with the new program for a six month period compared to those treated six months prior to program implementation will be conducted to evaluate the impact of implementing a new patient risk assessment, standardized Moderate Detox Order Set and a symptom-triggered (CIWA-Ar) approach on restraint usage, number of transfers to a higher level of care, and length of stay over a twelve month period. Recommendations: A standardized clinical process, assessment, and order set will improve the quality of care and decrease the associated cost of treating individuals requiring alcohol detoxification.
Needs Assessment among those Caring for Non-English Speaking Pregnant Migrant Women in Philadelphia
Authors:   , Ham Alycia , Bloch Joan R. , Gonzalez Elizabeth W.
Published: July 2021

Objective: Language barriers and cultural sensitivity challenge healthcare providers in providing prenatal care to the diverse population of Non-English Speaking Pregnant Migrant Women in Philadelphia. This project seeks to find out from a multidisciplinary group, who serve this growing population, what they need to optimize their ability to provide care. Design: A qualitative needs assessment, utilizing focus group discussions and questions from two focus group sessions with the key stakeholders: physicians, nurse practitioners, registered nurses, certified nursing assistants, social workers, case managers, lead clinical assistants, secretaries, and community paraprofessionals. Setting: Einstein Medical Center Philadelphia, Pennsylvania and Nationalities Service Center Philadelphia, Pennsylvania. Participants: A total of 19 key stakeholders participated in two focus group sessions. Results: Key stakeholders identified barriers and facilitators for comprehensive, holisitic, and quality prenatal care to migrant non-English speaking pregnant migrant women. Conclusion The views of the key stakeholders about improving and promoting quality prenatal care and safe motherhood were identical when they were given an opportunity to discuss the issues. Hence, the key stakeholders' comments and recommendations provided have identified the key elements for the development of a future prenatal program.
Community Paramedicine Heart Failure Transition of Care Model Evaluation
Authors:   , Mumolie Gina Petrone , Rundio Al
Published: July 2021

Background and Purpose: More than 5 million adults live with the chronic progressive condition of heart failure (HF) in the United States. After age 40, there is a 20% risk of developing HF, where roughly 50% of the population diagnosed with HF dies within 5 years of their initial diagnosis. Transitional care presents a particularly unique opportunity to improve patient outcomes as evidenced in the literature. The aim of this project was to provide supporting evidence of effectiveness for an innovative community paramedicine model of care in reducing 30-day readmissions for patients with HF. Methods: An outcomes research study using a retrospective cohort design was the method used to evaluate the effectiveness of a model of care intervention, the paramedic home visit post hospital discharge, intended to meet the needs of HF patients at high risk for readmission and achieve the desired outcome of reduction in 30-day all cause readmissions. Results: Statistical testing did not support the hypothesis that: Patients with heart failure who have a paramedic home visit post discharge would have a lower rate of unplanned readmissions within 30-days of discharge than those without a paramedic home visit (p=.288). The reduction in 30-day heart failure readmission rates from 26.9% in 2012 to 19.2% in 2015 however was statistically significant (p=.006). Relative risk of readmission for heart failure in the post implementation period was less likely, RR 0.839, 95% CI [.733, .960] than that of readmission in the baseline line period. Gender was the only covariate that was significant as a predicator for readmissions. Clinical Implications and Recommendations: Community paramedicine is an emerging model of care that warrants further review. The results of this study begin to close the gaps in knowledge related to home visit effectiveness and the role of community paramedicine in transitions of care model designed to reduce 30-day readmissions.
Gentrification and the decline of African American arts and culture in Washington, D.C.
Authors:   , Jackson Kyle A. , Brody Jean
Published: July 2021

The purpose of this this thesis is to investigate and examine the effects of gentrification on the African American arts and culture scene in the city of Washington, D.C. This study seeks to prove that the effects of gentrification contributed heavily to the displacement of the city's Black population, while simultaneously contributing to the decline of African-American arts and culture in the city, and disturbing the lives and careers of the African-American artists who call Washington, D.C. home. The study discusses gentrification in the general sense, and moves on to discuss gentrification in the city of Washington, D.C. specifically. The thesis covers the various ways in which gentrification has contributed to the removal and attempted eradication of various examples of African American arts and culture in the city, primarily in its visual arts and music sectors, while questioning the authenticity of other attempts to preserve culture that, in many ways, seems appropriated. The thesis also discusses the notion that there are fewer available resources and funding opportunities for artists of color in Washington, D.C., while examining recent demographic changes in the city, primarily in areas that once held a Black majority that are now populated heavily by White residents. The thesis concludes with the idea that gentrification does, in many ways, contribute to the decline of African American culture in the city. A way to combat gentrification is to recognize and include the already established community as part of the revitalization process to ensure that the community does not feel deprived.
Music Therapy as a Treatment for Children with Autistic Spectrum Disorder
Authors:   , Lewis Danielle M. , Brody Jean , Zitcer Andrew
Published: July 2021

Autism Spectrum Disorder (ASD) is an increasingly prevalent disorder affecting many children in the world today. The impact of autism on a child and their family is significant. This disorder is life changing and its early detection, diagnosis, and treatment is essential for the growth and development of a child affected by ASD. There are several traditional therapies associated with the treatment of ASD in children that include: speech, occupational, applied behavior analysis therapy. Music therapy is not included in the core list of therapies, but is a viable and effective tool to reinforce the concepts taught in the traditional therapy treatments. The purpose of these therapies, including music therapy, is to improve social behaviors, increase focus and attention, increases communication attempts (vocalizations, verbalizations, gestures, and vocabulary), reduce anxiety, and improve body awareness and coordination. Through my findings during this thesis process I have found that music therapy is a viable and effective treatment for autistic children.
An Examination of the Association between Sleep and Neurocognitive Performance in Relapsing-Remitting Multiple Sclerosis
Authors:   , Zamzow Jessica A. , Kloss Jacqueline D.
Published: July 2021

Individuals with MS experience a high rate of sleep disorder symptoms and a high frequency of cognitive deficits. Both sleep disturbance and cognitive impairment can have a profound impact on perceived quality of life and functional living. While it is well established that sufficient sleep quality and quantity are necessary for optimal cognitive performance in healthy adults, the relationship between sleep and cognitive function has been largely understudied in MS. The present study is an examination of the association between sleep and cognitive function for individuals with MS through the use of objective and subjective measures of sleep and neurocognitive function. Fifty participants with relapsing-remitting MS completed two weeks of standardized sleep diary and wore actigraphy for fourteen consecutive days. Participants then completed a two-hour testing session comprised of neurocognitive measures and questionnaires. Results indicated that sleep duration and sleep efficiency did not predict performance on tests of attention, vigilance, working memory, processing speed, inhibitory working memory, processing speed, or inhibitory control. Symptoms of all sleep disorders (i.e., insomnia, sleep apnea, and RLS/PLMD) were associated poorer cognitive function in individuals with MS.
Decision theory, motor planning, and visual memory
Authors:   , Lerch Rachel A. , Sims Christopher R.
Published: July 2021

Limitations in visual working memory (VWM) have been extensively studied in psychophysical tasks, but not well understood in terms of how these memory limits translate to performance in more natural domains. For example, in reaching to grasp an object based on a spatial memory representation, overshooting the intended target may be more costly than undershooting, such as when reaching for a cup of hot coffee. The current body of literature lacks a detailed account of how the costs or consequences of memory error influence what we encode in visual memory and how we act on the basis of remembered information. Here, we study how externally-imposed monetary costs influence behavior in a motor decision task that involves reach planning based on recalled information from VWM. We approach this from a decision theoretic perspective, viewing decisions of where to aim in relation to the utility of their outcomes given the uncertainty of memory representations. Our results indicate that subjects accounted for the uncertainty in their visual memory, showing a significant difference in their reach planning when monetary costs were imposed for memory errors. However, our findings indicate that subjects memory representations per se were not biased by the imposed costs, but rather subjects adopted a near-optimal post-mnemonic decision strategy in their motor planning.
Effects of Fat Gripz[TM] Training by Female University Students, Faculty and Staff Members on Hand Grip Strength and Maximal Deadlift
Authors:   , Rogers Harley C. , Volpe Stella L.
Published: July 2021

The deadlift is a full body exercise that is incorporated into weight training programs to maximize muscular strength. Research has shown that deadlift training programs, based on multiple sets of fewer repetitions with heavier weight loads, elicit greater strength adaptations than conventional body building programs. While the large muscle groups of the body are heavily taxed during the performance of the deadlift, the ability of the trainee to maintain grip strength is a limiting factor that leads to the employment of mechanical ergogenic aids (i.e., lifting straps) in an effort to compensate for this strength imbalance and complete the movement. Therefore, training the finger flexors, specifically the flexor digitorum superficialis, with the use of a Fat Gripz™ augmented Olympic barbell, might lead to increased grip strength, and a greater change in deadlift five-repetition-maximum (5-RM). In this study, female university students were matched for hand grip strength and then randomly assigned to complete an eight-week deadlift training program using only an Olympic barbell (control group) or an Olympic barbell with Fat Gripz™ (intervention group). The primary aims of this research were to: (1) evaluate hand grip strength, measured by a grip force transducer; (2) compare 5-RM improvement following training with and without Fat Gripz™; (3) quantify the flexor digitorum superficialis muscle's adaptation to deadlift training using electromyography (EMG) analysis; and, (4) analyze the interaction of protein and energy intake with improvements in hand grip and 5-RM strength.