Quality Improvement Initiative in Transplant Diabetes Care: Needs Assessment and Protocol Development

Over 30,000 people receive a solid organ transplant each year, with 5-30% developing post-transplant diabetes mellitus (PTDM) (United Networking for Organ Sharing, 2015). At a Midwestern transplantation center, over 22% of patients with a history of diabetes were not consulted to endocrinology after kidney and liver transplantation. With poor glycemic control, there is an increased risk of developing PTDM leading to poor outcomes. Utilizing the Donabedian model and the Six Sigma’s Define, Measure, Analyze, Improve, and Control (DMAIC) as guides for implementation, the purpose of this project was to address the process measures of increasing appropriate consultations for evaluation and treatment of PTDM patients that would lead to an important quality measure of improved glycemic control for this population. The project involved the implementation of a clinical pathway to address this quality measure. Even though there was not a statistically significant change in number of consultations, there was a clinical meaningful difference because the patients who were consulted after pathway implementation received the benefit of management by endocrinology specialists to improve glycemic control post transplantation. Limitations of the project leading to the reported results include that the sample size was less than 30 and the period of evaluation was only one month. The recommendation is for transplant and endocrinology teams to continue to work together to develop clinical pathways to appropriately consult endocrinology teams that is consistent with the standardized care of other organ transplants. Though this is a small piece to a larger problem, the use of standardized pathways will potentially improve care leading to improved glycemic control in the kidney and liver transplant population. Early consultation immediately after surgery will potentially improve the transitions of care from inpatient to outpatient setting for this patient population

An Analysis of Salary Difference for Left-Handed Pitchers

This thesis examines whether there is a difference in salary for left-handed pitchers in Major League Baseball. I review prior research regarding the valuation of MLB pitchers, salary discrimination in baseball, and left-handed pitchers to shape my methodology. Using Sean Lahman’s Baseball Database, I utilize various regression models to analyze effects on salary. Variables are transformed into cumulative, per 9- inning values and left-handed interaction variables are created to observe any difference in salary experienced only by left-handers. The models show that for variables with a statistically significant effect on salary, left-handers experience a statistically significant effect on salary above and beyond the effect on all pitchers, providing evidence that there is a difference in salary for left-handed pitchers in the MLB

The voice behind the microphone : media systems and United Nations peacekeeping in Hait and Cote d'Ivoire

Title from PDF of title page (University of Missouri--Columbia, viewed on September 12, 2012).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Thesis advisor: Dr. Larry BrownIncludes bibliographical references.M.A. University of Missouri--Columbia 2012."May 2012"Since 1948, and the authorization of the deployment of military observers to the Middle East by the Security Council, peacekeeping has played a significant role in the United Nationsmission. The relationship between the news media and its audience via the now of information requires a critical examination, for the impact of the media on peacekeeping missions presents far-reaching ramifications. Perpetuated by the news media, globalized political discourses have become a mechanism that both constrains and directs peacekeeping. Certainly, radio and television broadcasts, as well as newspaper stories, have created a collection or voices that have shaped public views; however, despite the debate that has occurred concerning the media as a manipulator of public perceptions, much remains to be explored. Contemporary scholarship (e.g., the manufacturing consent model; the political consent model) focuses primarily on the interactions between government, media, and the public over the control and now or information between those bodies. The goal of my research is neither to prove nor disprove these arguments, but rather to examine the ideologies and potential patterns of discourse among news sources. This paper intends to identify meaningful grounded theories by comparing different levels or media and their portrayals, perceptions, and discourses of current United Nations peacekeeping operations and peacekeepers in two former French colonies: Haiti and Cote d'Ivoire

The "lived-in" moment: the aesthetic potential of nonfiction literature in a third grade classroom

Despite the fact that "emphasis on nonfiction literature in the development of literacy understandings, content knowledge, and literacy abilities is not new" (Möller, 2013, p. 59) at the university level, having been advocated by literacy scholars across all decades since the 1970s, research has documented across two decades that elementary students have received and continue to receive only minimal exposure to nonfiction texts in classrooms and schools (Duke, 2000; Jeong, Gaffney, & Choi, 2002; Ness, 2011; Pappas, 1991). Given the requirements in the Common Core State Standards (CCSS), which call for 50 percent of classroom reading to be nonfiction by fourth grade, there is a need to investigate how students respond to different formats of nonfiction literature. The dissertation investigates the selection and use of nonfiction literature in a third grade class as well as students' responses to different formats of nonfiction. This project explores the nonfiction literature selections of the teacher, the responses of the students, and the link between the two. In a four-month qualitative study of a third-grade teacher and five focal students I highlight the complex web that links the teacher's instruction with the evocation of an aesthetic response by the students. The main research questions that guided this study are: How and why do teachers select nonfiction literature for classroom use? In what ways are teachers including nonfiction literature in their classroom instruction? What do students notice and discuss about different formats of nonfiction literature? How do specific types/formats of nonfiction literature invite students to take and develop personally meaningful stances (aesthetic, efferent, mixed or shifting stances) when reading? Data sources for this study come from the perspective of a third-grade teacher through interviews and classroom literacy observations. In addition, this study presents the "lived-through" response of five focal students as I observed their response to reading nonfiction literature and engagement in literature discussion groups. Analysis of the data unravels a complex web of classroom practice, social reading context, and personal preference that shaped the responses that students evoked when reading nonfiction literature. In sum, this study demonstrates the potential for third grade students to evoke an aesthetic response when reading different formats of nonfiction literature

Improving the Safety of Admitted Patients with Alcohol Use Disorder and Withdrawal

The aim of this chapter is to review the pathophysiology of alcohol withdrawal syndrome (AWS), discuss diagnostic strategies, identify clinical manifestations, outline appropriate management options, and address key patient safety considerations specifically as it applies to the hospitalized patient. Ethanol use causes substantial morbidity and mortality and is among the most widely abused substances in the world. Up to 40% of all hospitalized patients are at risk for suffering from alcohol withdrawal syndrome (AWS). AWS is a hyperdynamic syndrome with symptoms that can include anxiety, insomnia, tachycardia, hypertension, tremor, nausea, vomiting, seizures, coma, disability, and death. Several screening tools can help identify patients with alcohol use disorder and those at risk for AWS. Symptom based scoring systems, such as the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) or Severity of Ethanol Withdrawal Score (SEWS) score, are also available for guiding treatment. Treatment options should primarily consist of Gamma-Aminobutyric Acid (GABA) agonists, including benzodiazepines and barbiturate (mainly phenobarbital) medications, however other adjunctive therapies are also available. The most important patient safety principles for the hospitalized patient with AWS include early assessment, identification, and intervention, treatment of associated medical and psychiatric complications, as well as a comprehensive multi-disciplinary approach

Trouble with the edTPA: Sliding from Teaching to Preparing for the Test

This paper was written by a group of instructors responsible for preparing 100 elementary/middle school licensure students for the edTPA portfolio assessment. It is an analysis of our experiences doing so in the pilot year. The edTPA is a performance assessment required for teacher licensure. We considered this assessment to have significant advantages over a multiple choice test and we debated for a year how best to implement it. Our plan was to integrate what they needed to know into our courses rather than to prepare them directly for the test. We approached this with a positive attitude but emerged with a skeptical one. We gradually slid from preparing students to be teachers, to preparing them for the test. Using a narrative self-study, we chronicle and analyze this unexpected trajectory

Ungrading General Education: Preliminary Results from a Pilot Study

A group of faculty members representing more than 20 courses listed in the Eastern Kentucky University General Education curriculum participated in a pilot program to test and measure the effectiveness of “ungraded” pedagogy. “Ungrading,” as defined by the group, can be any conscious effort to move student emphasis away from grades and onto learning. Given this definition, ungrading took many forms in the pilot: gradeless classrooms, grading contracts, and greater choice of assignments by students, to name a few. At the end of the semester, quantitative and qualitative data was gathered from student course evaluations; DFW and retention rates were considered; and focus groups comprised of students in ungraded classes were convened. This piece provides preliminary results from the pilot and in an effort to begin a larger conversation about the widespread adoption of ungraded pedagogies

Ungrading Across the Disciplines: Reflections of a Professional Learning Community

A group of interdisciplinary scholars formed a Professional Learning Community (PLC) in the spring 2020 semester. Their topic of consideration was “ungrading,” defined by the group as any pedagogical practice that moves a student’s focus away from grades and toward learning and growth. This essay provides an account of each instructor’s experience as a member of the PLC, highlighting both practical and theoretical considerations for instructors interested in incorporating ungrading in their courses. It also provides perspectives of students who experienced ungraded approaches first-hand

Ultrasonic processing of butter oil (Ghee) into oil‐in‐water emulsions

Butter oil (ghee) derived from cow or buffalo milk is in semi-solid form at room temperature and contains >99% of lipids. Apparent high viscosity and water immiscibility – owing to the hydrophobic nature of lipid components hinder the applicability of butter oil for formulations. Here, we have employed ultrasonic processing technique to create oil-in-water emulsions of butter oil. We show that the butter oil is capable of self-stabilizing an emulsion at low concentration while higher concentrations could be kinetically stabilized using pluronic stabilizer. We were able to modulate water contents of emulsions in the range of 80%–95% and maintain the particle size in submicron range. Reported butter oil emulsions retain hydrophobic properties of the original butter oil within cores of dispersed particles, overcome a problem of butter oil-water immissibility, display fluid consistency, and are stable for several months. These properties are highly suitable for developing food, pharmaceutical, and cosmetic formulations. Practical applications Ultrasonic processing of butter oil improves its miscibility with water and increases its fluidity thereby enhancing its capability to be used as or to derive formulations for various applications. Further advantage of the reported butter oil emulsions is that they can be loaded with ‘polar’ in addition to ‘non-polar’ active molecules, which was hardly possible with formulations merely based on butter oil. This is because an aqueous phase of the butter oil emulsion contains 80%–95% water where polar molecules can easily be solvated. These emulsions, prepared from quite an abundant and economical source, can potentially act as alternatives to the emulsions that usually involve highly expensive lipid components whose extraction or synthesis are rather tough tasks. The ultrasonic processing of butter oil, presented here, could be easily scaled-up using continuous processing modes