Evolution of expertise among critical care nurses

According to the literature, development of expertise is directly correlated with three fundamental requirements: a) a tremendous amount of dedicated work, b) time, and c) relevant experience. Experts in most domains attain their highest level of performance after 10,000 hours of dedicated practice. This is equivalent to ten years of dedicated and relevant experience within the expert’s respective domain. Within the domain of critical care nursing the skill level of the bedside nurse has been directly correlated with quality patient outcomes, greater reimbursements, and decreased operational costs. The purpose of this grounded theory study was to explore the emic perspective of the critical care nurse as it relates to expertise, expert performance and the critical care nurses journey in the achievement of expert performance. Benner’s model of skill acquisition, Novice to Expert, provided the theoretical structure and framework. However, as expertise was considered within the dynamic critical care environment, Ericsson and Smith’s expert performance approach was used to strengthen Benner’s Novice to Expert Model providing valuable structure and insight into the concept of expertise. As themes were identified the expert performance approach provided valuable evaluative strategies to facilitate understanding of expert nuances and processes within critical care practice. Study findings supported three major themes: a) experience with sub-themes diversity and intensity; b) knowledge with the sub-theme critical reasoning; and c) self-actualization with sub-themes personal presence, and life-long learning. Furthermore, data findings supported the researcher’s assertion that “tacit” knowledge is a more appropriate term to represent the requisite knowledge base and diversity of experience demonstrated by nurses in actual clinical practice rather than the term “intuitive grasp” as found in current literature. Research findings of this study will help educators and nursing leadership better understand the transition from novice to expert critical care nurse within the context of clinical nursing practice. In so doing, nursing leadership will have the tools and the added insight to facilitate that transition in the most efficient manner possible thereby improving not only professional satisfaction but patient outcomes and cost as well. (Published By University of Alabama Libraries

Study of structure-property-performance relationships for organic thin-film transistors and polymeric solar cells

Organic electronics has great potential for fabricating low cost, flexible and large-area devices. Despite the rapid development, several main challenges of the field need to be addressed in both organic conjugated polymer and small molecules based devices, including organic thin-film transistors (OTFTs) and polymer solar cells (PSCs). This dissertation first explores two approaches to align small molecule crystals and improve surface coverage. The controlled evaporative self-assembly (CESA) method is combined with binary solvent system using small molecule SMDPPEH to control the crystal growth. By optimizing the two solvent ratios, well-aligned SMDPPEH crystals with significantly improved areal coverage were achieved. Also, polymer additives can be added into small molecule to control crystal alignment. As a result, mobilities are at least 10 times higher than that from spin-coated film. The SMDPPEH based OTFTs exhibit a mobility of 1.6×10-2 cm2/Vs, which is the highest mobility from SMDPPEH ever reported. The donor-acceptor vertical composition profile on the performance of the P3HT/PCBM based organic bulk heterojunction solar cells was studied. In this simulation study, variety of donor-acceptor vertical configurations was investigated for both regular and inverted PSC structures. The physical mechanisms behind the diversification of open circuit voltage, short circuit current, and fill factor, and thus power conversion efficiency from various vertical configurations are explained. The effect of vertical composition profile from the study could serve as guidance for experimental optimization of organic bulk heterojunction solar cells. Also, morphology variation of ZnO electron transport layer from atomic layer deposition and sol-gel methods on the performance of organic inverted solar cells were investigated. AFM and SEM were utilized to characterize the morphology of ZnO thin films and nanorods so as to explain the efficiency difference. The final part of the work demonstrates one-step multi-layer pattern transfer to make organic solar cells on rigid and flexible substrates. A multi-layer inking and stamping, a cost-efficient, purely additive pattern transfer technique, was developed to fabricate PSCs. GLYMO is added into PEDOT:PSS hole transport layer and its effect on PSC performance and pattern transfer yield was investigated to reach overall PSC efficiency and high yield pattern transfer. (Published By University of Alabama Libraries

Three essays in agency related issues

This dissertation explores three types of agency related issues. The first essay is related to the CEO-shareholder relation. We examine how the legal background of affects the corporate policy and shareholder wealth. We empirically analyze whether law CEOs manage their firm differently. We find that law CEOs take less risk and perform better in the short-run. Law CEOs are especially valuable to firms involved in litigation. Specifically, when firms experience litigation, those with law CEOs experience less volatile market returns, maintain better operating performance and face lower litigation settlement costs. However, our evidence also suggests law CEOs tend to be more myopic. Firms with law CEOs invest less in R&D and have lower R&D growth rates. The second essay examine the relationship between acquirers and M&A advisors. Using a sample of serial takeover sequences, we examine the cost-benefit tradeoffs associated with an acquirer’s willingness of selecting suitable advisors for each deal during a sequence of acquisitions. We find that acquirers are willing to do so experience more favorable announcement reactions from shareholders, pay lower acquisition premiums and advisory fees, and complete transactions faster. We also use propensity score matching to address possible endogeneity concerns and find our results are robust. These findings suggest that acquirers benefit from selecting the right advisor for each acquisition rather than staying with one advisor throughout the sequence of acquisitions. The third essay focus on buyer-agent relationship. This essay studies the role of buyer brokers in the home-buying process under different market conditions by examining the effects of brokerage representation on home prices and search duration. Using data from 2006 and 2012 NAR annual surveys, we find that buyer brokers have no effect on prices in a seller’s market while they do have a statistically significant positive effect in a buyer’s market. We find that buyer brokers do not affect search duration in either a buyer’s or seller’s market. To address the endogeneity problem, we use the propensity score matching methodology, which find our results are robust. We also find that Internet search frequency has a significant effect on purchases prices and search duration. (Published By University of Alabama Libraries

Evaluation of HRV as a predictor of response to a modified physical training program in ROTC cadets

Continually enhancing military personnel training is essential in order to prepare soldiers to perform optimally. The soldier’s ability to perform may be closely associated with baseline autonomic nervous system activity, indicated by heart rate variability (HRV). Variability in heart rate may be related to results on the Army Physical Fitness Test (APFT). PURPOSE: The purpose of this study was to determine if ROTC cadets’ APFT scores would improve following a novel 8-week training program, if performance on the APFT was related to baseline HRV, and if training adaptations in APFT performance were related to changes in HRV. METHODS: Twenty ROTC cadets (age 20 ± 1 yr) were evaluated on APFT at baseline, 4 and 8-weeks. A subset of 13 cadets completed HRV recordings using a validated smartphone application immediately upon awakening. The initial 3-days of HRV recordings served as baseline HRV. A subset of 8 cadets recorded HRV after the 4th week APFT through the end of the 8th week. An average of 3 readings at the beginning and end determined ΔHRV, and week 4 and 8 scores were subtracted to get ΔAPFT. RESULTS: APFT scores significantly improved in all fitness measures over the 8-week training program. Baseline HRV was moderately correlated with performance in each event, except for push-ups. Change in HRV and change in APFT scores from week 4 to week 8 was not significantly correlated. CONCLUSION: A periodized, progressive overload program significantly improved APFT scores. A trend towards moderate to strong correlations were found between performance tests and HRV, though they were not all significant in this sample size. (Published By University of Alabama Libraries

Effectiveness of case management intervention to improve treatment outcomes: a study using secondary data analysis to compare outcomes for juvenile sex offenders

This study compared two consecutively offered treatment programs to compare “treatment only” to treatment with the addition of case management services in a community-based treatment program for juvenile sex offenders. The two programs were operated using the same model of cognitive behavioral therapy and provided services for youth in both diversion and post-residential circumstances. A secondary data analysis utilizing a pre- and-post-test quasi-experimental design without random assignment was used. The sample included data for 144 clients from the comparison group (treatment only) and 171 clients from the case management group. Only clients who were terminated by 2/1/2012 were considered in order to allow for observations from the four year follow-up period. Analyses were conducted using primarily multiple logistic regression to test hypotheses. Case management was a statistically significant (p = 0.011) predictor of non-sexual re-offense for diversion youth. Program completion was a statistically significant predictor of non-sexual re-offense for both diversion (p = 0.003) and post-residential (p = 0.032) youth, as well as, sexual re-offense for diversion (p = 0.043) youth. While case management was not a statistically significant predictor of program completion, the case management group had a higher rate of program completion which may be clinically significant for the program evaluation. The case management group experienced a 14.3% non-sexual re-offense rate which was decreased from 28.6% in the comparison group. Both the case management and the comparison groups had a very small rate of sexual re-offense and the change between the two groups was not statistically significant. However, the change may have clinical significance as the case management group had a 2.9% sexual re-offense rate as opposed to the comparison group rate of 7.6% (Published By University of Alabama Libraries

Metabolic engineering and process development in butanol production with clostridium tyrobutyricum

As a sustainable and environmentally friendly biofuel, biobutanol is a potential substitute for gasoline without any engine modification. The multiple Omics studies were applied to evaluate the change of the expression of host protein and intracellular metabolism in Clostridium tyrobutyricum in response to butanol production. The key enzymes related to carbon balance (i.e. acid and solvent end products and carbohydrates in central pathway), redox balance, energy balance, and cell growth has been studied. It was found that rebalancing both carbon and redox was critical to improve butanol production. These findings were used to achieve high production of biobutanol via integrated metabolic cell-process engineering (MCPE). In a comparative genomics study, the wild type C. tyrobutyricum, the metabolically engineered mutant with down-regulated acetate kinase and evolutionarily engineered strain showing fast cell growth were used to evaluated in butyrate fermentation at pH 6.0 and 37 oC. It was found that the cell growth rate was increased by 61-100% and butyrate productivity was improved by 44-102% by the evolutionarily engineered strain. To understand the mechanism of butyric acid production and cell growth regulation in engineered C. tyrobutyricum mutant, a comparative genomics study was performed. It was concluded that the genome mutations in transcription, translation, amino acid and phosphate transportation and cofactor binding might play important role in regulating cell growth and butyric acid production. Comparative proteomics, which covered 78.1% of open reading frames and 95% of core enzymes, was performed using wild type, mutant producing 37.30 g/L of butyrate and mutant producing 16.68 g/L of butanol. Carbon regulation enzymes in the central metabolic pathway that correlated with butanol production were identified, including thiolase (thl), acetyl-CoA acetyltransferase (ato), 3-hydroxybutyryl-CoA dehydrogenase (hbd) and crotonase (crt). The apparent imbalance of energy and redox was also observed due to the downregulation of acids production and the addition of butanol synthesis pathway. The understanding of the mechanism of carbon redistribution enabled the rational design of metabolic cell and process engineering strategies were revealed to achieve high butanol production in C. tyrobutyricum. With the fundamental understanding, the C. tyrobutyricum was metabolically engineered by rebalancing carbon and redox simultaneously. The overexpression of aldehyde/alcohol dehydrogenase (adhE2) and formate dehydrogenase (fdh) improved butanol titer by 2.15 fold in serum bottle and 2.72 fold in bioreactor. In addition, the proteomics study and metabolite analysis showed that more than 90% of the amino acid in the medium was consumed before the cell entered the stationary phase and some enzymes involved in amino acid metabolism had low expression in butanol producing mutant. Extra yeast extract or casamino acids was fed to the free-cell fermentation the mid-log phase, improving the butanol titer to more than 18 g/L compared to 14 g/L without extra nitrogen supplement. The rational metabolic cell-process engineering facilitated with systems biology understanding was demonstrated a powerful approach in butanol production. Finally, the C. tyrobutyricum was further rationally engineered by integrating multiple regualtors, including 1) heterologous NAD+-fdh that provides extra reducing power, 2) the thiolase (thl) that redirects metabolic flux from C2 to C4, and 3) AdhE2. Two novel mutatns, ACKKO-adhE2-fdh and ACKKO-thl-adhE2-fdh, were constructed and produced 18.37 g/L and 19.41 g/L, respectively. This study demonstrated that systems biology-based metabolic cell-process engineering of C. tyrobutyricum enabled a high production of butanol. (Published By University of Alabama Libraries

European integration and the nationalist parties

This dissertation presents a comprehensive analysis of the factors affecting nationalist parties’ support for the EU over time and across regions. Investigating how European integration and nationalist parties interconnect and looking for patterns among a large number of cases are important to understanding the nature of nationalism and the future of the EU. The approach of looking for patterns among a large number of cases contributes to overcoming limitations of existing studies that are based on a small number of cases and allows more valid generalizations about the nature of nationalist parties in the European context. This study combines a big-N method with case studies. The big-N method relies on aggregated data over a 30-year period from 1984 to 2014 in both Western and Eastern EU member countries to investigate the attitudes and behaviors of all kinds of contemporary nationalist parties toward European integration. A total of 105 nationalist parties across 26 EU member states are included. I build on Arnold, Sapir, and De Vries’s (2012) model for predicting Western European parties’ EU positions based on their electorate, parties, and party system characteristics. The differences are that (1) I focus strictly on nationalist parties, while Arnold, Sapir, and De Vries included all parties, (2) I broaden the scope to include both Western and Eastern European countries, and (3) I have added a variety of country-level variables. In particular, I emphasize party-level variables and party system characteristics, but other country-level variables are also included as controls because these might matter too. A variety of possible variables are classified into two categories: party-level (including ideology, party type (statewide versus minority nationalist), party size, and incumbency) and country-level (including party system fractionalization and polarization, as well as East versus West, state size, immigrant population, the length of EU membership, economic conditions, and public opinion). I look separately at statewide nationalist parties and minority nationalist parties, in addition to all nationalist parties combined, in order to investigate whether the independent variables have different effects for different types of nationalist parties. I found that extreme nationalist parties are more negative toward the EU, minority nationalist parties are more positive than statewide nationalist parties, larger nationalist parties are more positive, incumbent nationalist parties are more positive, political context matters differently for statewide nationalist parties and minority nationalist parties, and characteristics of the state matter more for minority nationalist parties than for statewide nationalist parties. Along with the big-N method, I conducted three case studies in order to investigate the actual changes in strategies and behaviors within real-life political contexts and to access similarities and differences between strategies of different parties in a comparative context. (Published By University of Alabama Libraries

Evaluating the assessment and clinical application of the DSM-5 section III personality disorder model

The Diagnostic and Statistical Manual for Mental Disorders-5th Edition (DSM-5; American Psychiatric Association [APA], 2013) includes an alternate model for the assessment and diagnosis of personality disorders (PDs). This model is a hybrid dimensional-categorical model that includes functional impairment, maladaptive personality traits, and a set of categorical PD diagnoses. Previous research has begun to evaluate the different aspects of this model, particularly its trait model (see Krueger & Markon, 2014 for a review); however, additional research is needed that addresses the clinical utility of the model, the role of functional impairment in PD assessment, and validity of measure designed to assess the model (e.g., the Personality Inventory for DSM-5 [PID-5] and its alternate forms). The following studies aimed to fill those gaps in the literature. Study One evaluated clinical perspectives of Borderline (BPD) and Antisocial (ASPD) PDs using Section III dimensional traits and supported the use of these traits in operationalizing these two disorders in clinical practice. Study Two examined the functional impairment criteria of the model as they relate to specific PDs. This study suggested a lack of utility in measuring disorder-specific impairment due to overlap across PDs and instead suggested the use of more broad constructs of impairment. In addition, however, this study highlighted some of the overlap between functional impairment and maladaptive traits in this model, as described by other previous researchers (e.g., Zimmerman et al., 2015) and called for additional research regarding the utility of this criterion. Finally, Study Three evaluated a screening measure for the Section III trait domains, the PID-5-Brief Form (PID-5-BF; APA, 2013; Derringer et al., under review). This study found support for the factor structure of this measure as well as its construct validity as measured by its association with relevant external criterion variables. Although more research continues to be needed regarding the use of this alternative model, these studies have implications for its implementation and generally support the use of dimensional traits in the assessment and diagnosis of personality psychopathology. (Published By University of Alabama Libraries

Assessing the role of bikesharing in transit-oriented development: a case study of Birmingham

Transit-oriented development (TOD) is a community development strategy that has increasingly gained exposure in urban areas across the United States as a method for reducing sprawl and increasing community vitality. Specifically, bikesharing is seen to play a major role in the success of transit-oriented development across urban communities as it increases travel possibilities, encourages public transit connections, and provides opportunities for recreation. This research employed a case study of Zyp BikeShare, a point-to-point bike rental program that began in Birmingham, Alabama, in 2015. Here, we analyzed the bikesharing program in terms of implementation and development, user catchment, transit paths, and usage trends. In doing so, we were able to create a methodology for analyzing specific bikeshare programs. Similar methodology can be applied to other bikesharing programs as the transit-oriented development technique continues to grow and develop in American cities. (Published By University of Alabama Libraries

Numerical modeling of fluid flow and solidification phenomena during ultrasonic processing of metal-matrix-nanocomposites

In present study, 6061 and A356 based nano-composites are fabricated by using the ultrasonic stirring technology (UST) in a coreless induction furnace. SiC nanoparticles are used as the reinforcement. Nanoparticles are added into the molten metal and then dispersed by ultrasonic cavitation and acoustic streaming assisted by electromagnetic stirring. The applied UST parameters in the current experiments are used to validate a recently developed magneto-hydro-dynamics (MHD) model, which is capable to model the cavitation and nanoparticle dispersion during UST processing. The MHD model accounts for turbulent fluid flow, heat transfer and solidification, and electromagnetic field, as well as the complex interaction between the nanoparticles and both the molten and solidified alloys by using ANSYS Maxwell and ANSYS Fluent. Molecular dynamics (MD) simulations are conducted to analyze the complex interactions between the nanoparticle and the liquid/solid interface. The current modeling results demonstrate that a strong flow can disperse the nanoparticles relatively well during molten metal and solidification processes. Molecular dynamics simulation results prove that ultrafine particles (<< 1 µm) will be engulfed by the solidification front instead of being pushed, which is beneficial for nano-dispersion. Experimental results confirm that the nanoparticles are dispersed reasonably well in the metal matrix, but some insignificant agglomeration still occurs. Besides, SEM/EDS results show that C element tends to gather around the grain boundary area where the Si eutectic phase is located. (Published By University of Alabama Libraries