CRNA Awareness of Evidence-Based Anesthetic Practices for Arteriovenous Fistula Procedures

Chronic kidney disease and the need for hemodialysis present frequent challenges for patients, providers, and the healthcare system. For dialysis to be successful, arteriovenous fistula maturation is of the utmost importance. However, variability in anesthetic practices has contributed to inconsistent outcomes. This doctoral project aimed to address that variability by enhancing anesthesia providers’ awareness of evidence-based anesthetic practices for arteriovenous fistula procedures. By designing and providing an educational seminar, this doctoral project demonstrated measurable improvements in anesthesia providers’ knowledge. The improvements were measured through a pre- and post- seminar questionnaire. The results showed statistically significant gains across five of the six questionnaire items, with positive trends on the sixth. These results confirm that a knowledge gap existed among anesthesia providers, and that an educational module was able to highlight and bridge the gap. The doctoral project was able to address a meaningful gap in anesthetic practice by successfully enhancing anesthesia provider awareness regarding evidence-based anesthetic approaches to AV fistula procedures. The educational seminar showed the value of education and how it can influence practice change. By providing anesthesia providers with current evidence, this doctoral project advances the goal of improving vascular access outcomes for patients requiring life-sustaining hemodialysis

An Objective Structured Clinical Examination (OSCE) for Epidural Blood Patch Administration

Certified Registered Nurse Anesthetists (CRNAs) commonly perform neuraxial anesthesia, specifically spinal and epidurals, for laboring mothers and cesarean sections. A frequent complication of these techniques is post-dural puncture headache (PDPH), resulting in the need for epidural blood patch (EpBP) administration. EpBPs are an effective procedure to alleviate these debilitating headaches. This doctoral project aims to address the clinical need for improved EpBP technique through the creation of an objective structured clinical examination (OSCE). The OSCE was formulated through research on current best practice guidelines to improve provider competency, confidence, and overall patient outcomes. The EpBP OSCE provides a clinical scenario in a simulated environment for CRNAs to assess and enhance EpBP technique. This doctoral project addressed the validity of the OSCE as an educational tool for providers in the clinical setting. To evaluate the OSCE, CRNAs were invited through email to participate in a review of the OSCE, followed by a survey to assess current provider competency in EpBP, as well as areas of improvement for this tool. The email included a link to the Qualtrics® survey, where providers agreed to informed consent, and were able to review the OSCE and answer survey questions. The questions included both a Likert Scale and one open-ended question regarding epidural blood patch administration, current provider competency, and areas for OSCE improvement. The results of the survey indicated that there were no needed improvements to the OSCE; however, there is a need for further education on the pathophysiology of PDPH and implications for epidural blood patch

Mental Health & Alcohol Outcomes for Student-Athletes: Exploring the Mediating Role of Drinking Motives

Hazardous drinking among college students has been a long-standing public health concern, with particular focus on student-athletes given their report of greater frequency and quantity of alcohol consumed. With the dual-role (i.e., student and athlete) of student-athletes, research has supported the comorbidity of mental health problems and alcohol outcomes, with drinking motives as an influential factor. Additionally, sport-related drinking motives may play a unique role, providing additional understanding of these relationships. No research to date has explicitly examined these variables despite the latest initiatives on student-athletes’ mental health and well-being. Thus, this study explored the mediating role of drinking motives, both general and sport-related, in the relationship between mental health and alcohol outcomes, to determine if these relationships differed by seasonal status. Athletic administration and support staff from 1,758 universities (e.g., National Collegiate Athletic Association (NCAA), National Association of Intercollegiate Athletics (NAIA), National Junior College Athletic Association (NJCAA)) across the United States were contacted to recruit student-athletes (N = 211; Mage = 20.53). Participants provided demographic information and completed measures of mental health symptoms, hazardous drinking, negative consequences, and drinking motives. Significant findings were evident when drinking motives were separated into two models. Conformity and coping drinking motives mediated the relationship between mental health symptoms and negative consequences, whereas social and coping drinking motives mediated the relationship between mental health symptoms and hazardous drinking. However, invariance testing was not supported across all models. Results suggested that exploring general drinking motives and sport-related drinking motives separately from one another may be the most advantageous way to understanding the drinking behaviors among student-athletes. Given the novelty of this study, further research is encouraged to better understand the relationships among these variables within this under-researched and high-risk population, particularly among more diverse samples

The Digital Incorporated Worker Narrative: A Mixed Methods Study of Digital Capital, Work Selection, and Outcomes in the Fourth Industrial Revolution

Digital technology permeates society and industry, making digital-ready workers necessary for firms of all sizes as a firm seeks competitiveness in the market (Bergson-Shilcock et al., 2023; de Ruyter et al., 2018; Gorski et al., 2022; Karaboğa, 2023; Kim et al., 2017; Qureshi Zia, 2019). Firms seeking digital-ready workers face a complex digital divide that creates a worker shortage (Bergson-Shilcock et al., 2023; Karaboğa, 2023; Qureshi Zia, 2019). This study aims to describe workers\u27 work selection, work experience, and outcomes in a complex digital society. Most digital divide research focuses on the individuals excluded from owning, accessing, and having skills with information and communication technologies (Heeks, 2022), even though data reveals that the digital divide is not a simple dichotomy between the included and excluded (Ragnedda et al., 2020; Van Dijk & Hacker, 2003). Instead, the divide is a multifactor problem that can also cause stratification in the digital society (Ragnedda et al., 2020; van Deursen & van Dijk, 2015). This study uses the convergent mixed methods design to collect quantitative and qualitative data. The study data describes the stratification among workers in the digital society by exploring worker demographics, their accumulation of social, cultural, human, digital, and economic capital, and their work selection and outcomes. The study reveals (a) digital capital serves as a gateway to human capital and improved economic outcomes or economic capital, (b) the need for economic autonomy by those entering the workforce for the first time results in the selection of work that requires low-skill, and low to no digital capital. While this work is approachable and accessible, it offers low wages. (c) Workers\u27 cultural and social capital and accumulated work experiences shift from pursuing work solely for economic necessity to including purpose, ethics, and value alignment at work, requiring more digital capital to access jobs in this expanded scope. (4) increasing digital capital results in autonomy in pursuing outcomes supporting mental well-being, and (5) increasing digital capital results in feelings of disconnect from other humans

Behind the Screen: Content Moderation in the Shadows of Social Media

https://aquila.usm.edu/katrinagulfcoast_photos/1107/thumbnail.jp

Resistance to Evidence

https://aquila.usm.edu/katrinagulfcoast_photos/1116/thumbnail.jp

The Potential Future Impacts of Offshore Wind Energy Development and the Applicability of Size Limits for the Atlantic Surfclam, Spisula solidissima, Fishery in the U.S. Mid-Atlantic Continental Shelf

The Atlantic surfclam, Spisula solidissima, fishery is encountering combined pressures from climate change and offshore wind energy expansion along the North American continental shelf. Utilizing the Spatially Explicit Fishery Economics Simulator (SEFES), this study evaluates the potential future impacts of offshore wind energy development and the influence of warming temperatures on the applicability of size limits for the surfclam fleet. Simulations reveal declines in landings, effort, and fishing mortality when restrictions apply within wind farm areas. In addition to spatial constraints, long-term warming trends continue to reshape the surfclam population structure, particularly by reducing the maximum attainable size in the southern portion of its range, a pattern consistent with the temperature-size rule. SEFES simulations presented in this study incorporate size structured growth dynamics and suggest that although regulatory size limits are designed to protect reproductive capacity, the selective removal of large clams has a disproportionately high impact on lifetime fecundity. Results indicate minimal influence of the current size limit regulation on fishery performance and population dynamics, questioning the limit’s continued relevance under changing climate conditions. These findings highlight the crucial need for adaptive management approaches that integrate renewable energy spatial planning with ecological forecasts of species distribution and population structure in a changing environment

Investigating the Effect of Attentional Control on Source Monitoring and DRM Memory Performance

Theoretical frameworks such as Fuzzy Trace Theory (FTT), the Global-Matching Model (GMM), and Activation Monitoring Theory (AMT) have been proposed to explain the mechanisms underlying false memory formation in the DRM paradigm. Recent research has explored novel list types, such as mediated lists, to isolate spreading activation, and showed support for associative activation over gist-based processing. Studies examining source monitoring in DRM paradigms have highlighted the importance of attentional control (AC), with divided attention (DA) during encoding leading to impaired source detail recollection. This thesis examined how AC affected the accuracy of source monitoring and susceptibility to false memories based on list type. Experiment 1 investigated manipulations in attention at encoding by providing sets of directly related (DRM) and indirectly related (mediated) word lists for study and compared the source memory accuracy of full attention (FA) and DA conditions. Results did not display an effect of attention on recognition or source attribution rates. Experiment 2 utilized the same procedure, but instead of manipulating attention, participants’ inherent AC was measured using Stroop-, Simon-, and Flanker-squared tasks. AC was not related to recognition or source attribution rates for either list type. Discussion focuses on the role of attention in illusory recollection of source details for false memories and whether the distraction manipulation in Experiment 1 and squared tasks used in Experiment 2 were sufficient in capturing source processes