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Behavioral and Social Science (BSS) classes in higher education provide students with understandings of human behaviors, motivations, and actions that are crucial to confronting both social and personal problems. Moreover, most community college degrees require that students take at least one BSS class—anthropology, economics, political science, psychology, and/or sociology. While BSS classes are important—both from a philosophical as well as a degree-requirement standpoint—without effective student engagement, that importance may be lost. Oftentimes, BSS classes are still taught largely through didactic instruction. Yet, active and collaborative learning has proven to be a more effective instructional approach. Moreover, the need for active and collaborative learning may be even more crucial in community college BSS classes due to the unique demographics of these institutions. Building on findings that active and collaborative learning in BSS classes is more effective than didactic instruction, the purpose of this study is to better understand BSS instructors’ knowledge of active and collaborative learning and to identify the factors that foster this instructional approach and those that present hurdles. By determining these factors, recommendations can be made for replicating effective active and collaborative learning in BSS classrooms and/or working to minimize the roadblocks to this instructional approach.
Problem Statement: Obese adults having laparoscopic surgery are at increased risk for postoperative pulmonary complications (PPCs) due to the alteration in pulmonary physiology caused by their body habitus, the use of Trendelenburg position, and the abdominal insufflation required for this surgical approach. Current literature recommends utilizing lung-protective ventilation (LPV) strategies to reduce the incidence of PPCs, but anesthesia provider implementation of LPV strategies is inconsistent. The purpose of this quality improvement project was to explore anesthesia providers’ knowledge and utilization of lung-protective positive end-expiratory pressure (PEEP) strategies in obese patients undergoing laparoscopic surgery.
Methods: The descriptive design aimed to investigate anesthesia providers’ knowledge and use of LPV PEEP strategies in obese patients (BMI > 30kg/m²) undergoing laparoscopic surgery via an anonymous, quantitative electronic survey consisting of 24 Likert-scale questions. A convenience sampling of certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs) was used. The survey was disseminated via e-mail and available by QR code. Data was stratified by role/education, age and years of experience to evaluate for trends.
Results: Fifty-two providers completed the survey. There were significant differences in likelihood to incorporate LPV PEEP strategies across groups.
Conclusions: Anesthesia provider utilization of LPV PEEP strategies remains inconsistent. Education regarding utilization of evidence-based LPV PEEP strategies in obese patients undergoing laparoscopic surgery is warranted.
Keywords: postoperative pulmonary complications, lung-protective ventilation, positive end-expiratory pressure
Problem Statement: Obese adults having laparoscopic surgery are at increased risk for postoperative pulmonary complications (PPCs) due to the alteration in pulmonary physiology caused by their body habitus, the use of Trendelenburg position, and abdominal insufflation required for this surgical approach.
Background: Current literature recommends utilizing lung protective ventilation (LPV) strategies to reduce the incidence of PPCs, but anesthesia provider implementation of LPV strategies is inconsistent. The purpose of this quality improvement project is to explore anesthesia providers’ knowledge and utilization of lung protective alveolar recruitment maneuvers (ARMs) in obese patients undergoing laparoscopic surgery.
Clinical question: “In a large urban trauma center, what are anesthesia providers’ knowledge and utilization of lung-protective alveolar recruitment maneuvers (ARMs) in obese (BMI>30kg/m2) patients aged 18 and older undergoing laparoscopic surgeries?”
Methods: The descriptive design of this project aimed to investigate anesthesia providers’ knowledge and use of LPV alveolar recruitment maneuvers in obese patients (BMI>30kg/m2) undergoing laparoscopic surgery via an anonymous, quantitative electronic survey consisting of 24 Likert scale questions. A convenience sampling of certified registered nurse anesthetists (CRNAs) and physician anesthesiologists (MDAs) was used. The survey was disseminated via email and available by QR code. Data was evaluated and stratified by role/education, age, and years of experience to evaluate for trends.
Results: Fifty-two providers completed the survey. There were significant differences in likelihood to utilize lung protective ARMs.
Conclusions: Anesthesia provider utilization of LPV strategies remains inconsistent. Education regarding implementation of evidence-based lung protective ARMs in obese patients undergoing laparoscopic surgery is warranted.
Background
Sugammadex is an effective and safe drug to reverse surgery induced neuromuscular blockade. However, the interaction of Sugammadex and hormonal contraceptives may lead to unintended effects in surgical patients who are using hormonal birth control. There is insufficient evidence regarding the effectiveness of online education among post-anesthesia care unit (PACU) nurses, who are responsible for delivering discharge education.
Purpose
The purpose of the project is to examine the effect of a web-based education on PACU nurses’ awareness and knowledge about the interaction between Sugammadex and hormonal contraceptives.
Methods
We conducted a quasi-experimental study with pre-/post-test design. The study was conducted in a surgical center located in the southeastern region of the United States. A digital survey was given both prior to and following the online educational session. The effects of web-based education was examined by comparing the differences of the pre and post-educational survey knowledge scores.
Results
Among 19 PACU nurses, their years of experience ranged from 0 to 33 years (M = 5.67, SD = 8.81, Mdn = 3). There was a significantly increased number of corrections between pre- and post-test from 4.37 ± 0.90 to 4.81 ± 0.40 (t = 2.52, p = .023).
Conclusion
The online education proves to be both feasible and effective in enhancing the knowledge of drug interactions among PACU nurses. This finding could contribute to the development of a standardized educational framework for ongoing drug education in nurses.
Background
Sugammadex is a useful reversal agent of neuromuscular blockade during surgery. However, its interaction with hormonal contraceptives could lead to undesirable outcomes in surgical patients using birth control pills. The feasibility and effectiveness of web-based education targeting post-anesthesia care unit (PACU) nurses are limited. PACU nurses are responsible for patient education related to the interaction between Sugammadex and hormonal contraceptives.
Purpose
The purpose of the project is to examine the effect of a web-based education on PACU nurses’ awareness and knowledge about the interaction between Sugammadex and hormonal contraceptives.
Methods
A quantitative, quasi-experimental, pre-/post-test design study was conducted among PACU nurses who work at a healthcare facility located in the southeast region of the United States. An online survey was used to investigate the effect of web-based education on PACU nurses’ knowledge about the interaction between Sugammadex and hormonal contraceptives.
Results
Among 27 PACU nurses, their years of experience ranged from 0 to 26 years (4.43 ± 6.65). There was a significant pretest-posttest difference on Question 1 (the mechanism of action of Sugammadex) (χ 2 (1) = 6.22, p = .013). The average number of correct answers increased from 4.00 ± 0.87 to 4.70 ± 0.54 (t = 3.99, p < .001).
Conclusion
The web-based education was effective in improving PACU nurses’ knowledge of drug interactions. This finding may contribute to the development of a standardized online education program for anesthesia providers, enhancing their skills and competence in providing patient education on anesthetic agents.
Background
Sugammadex is one of the most used agents to reverse surgery induced neuromuscular blockade. It also reduces hormonal contraceptive effectiveness. There is limited evidence about developing effective education of the interaction between Sugammadex and birth control pills in post anesthesia care unit (PACU) nurses who are responsible to provide discharge education to patients taking hormonal contraceptives.
Purpose
The purpose of the project is to examine the effect of a web-based education on PACU nurses’ awareness and knowledge about the interaction between Sugammadex and hormonal contraceptives.
Methodology
A quasi-experimental study with pretest posttest design was conducted in a southeast healthcare facility. An animated educational video was designed to enhance the knowledge about the interaction between Sugammadex and hormonal contraceptives. An online survey was performed to assess the change of pre and post education knowledge score.
Results
The study included 27 PACU nurses. Age was associated with pretest score (b = 0.04, p = .010). Older participants were likely to have higher pre-intervention score. There was a significant pretest -posttest difference on Question 1 (the mechanism of action of Sugammadex) (χ2 = 7.72, p = .005) and total score (3.93± 1.00 vs. 4.55 ± 0.67, t = 2.81, p = .011).
Conclusion
The web-based education is effective to improve PACU nurses’ knowledge of the drug interaction between Sugammadex and hormonal contraceptives. The finding may help the development of discharge teaching in surgical patients taking hormonal contraceptives.
Pesticide use has reached alarming levels globally, causing potential risks to human health and the environment. With its high population densities and rapid development, California emerges as one of the country's leading users of pesticides in the country. Recognized point and non-point pathways for pesticides entering surface water include mixed indoor and outdoor applications and treated municipal wastewater effluent, indicating that conventional wastewater treatment plants (WWTPs) treatment processes are inefficient at removing pesticides from effluents. Recent studies have assessed the fate of pesticides in surface water with a limited understanding of watershed characteristics. This project aimed to quantify WWTP discharges, a lesser-known source of pesticide loads, and investigate the potential environmental benefits of their removal. To evaluate WWTP pesticide concentrations, we developed a geospatial model with municipal WWTP discharges, streamflow characteristics, and pesticide loading data to estimate pesticide concentrations within wastewater receiving streams. Next, we set a multimetric Pesticide Vulnerability Index (PVI) to identify the most vulnerable California watersheds to wastewater-derived pesticide loading. Finally, we investigated the environmental benefits of incorporating advanced WWTP processes for pesticide residue removal from treated effluent before surface water discharge using estimated WWTP life-cycle costs. This work presents an integrated assessment of pesticides in surface water to support source control and mitigation efforts. It highlighted the significance and effects of municipal WWTP pesticide loading in California’s urban waterways. In addition, completing this project provided insight into the environmental and economic costs associated with municipal wastewater-derived pesticide mitigation.
Personalized Learning Instruction (PLI) is the practice of personalizing instructional practices, scaffolding, and assessing the schoolwork of each individual student based on their specific learning needs and the standards of the curricular content. It involves student choice and interest within a flexible structure. Currently, most of the research that has been conducted on PLI has focused on math instruction, older secondary students (grades 9-12), and relatively small samples of students. Little research has been conducted to determine if and what impacts PLI may or may not have on English Language Arts achievement. Nor has much emphasis been placed on middle schoolers, where routines and patterns for future success in secondary school are established. The purpose of this study was to understand middle school principals’ perceptions of (1) Personalized Learning Instruction (PLI), (2) the effects of Personalized Learning Instruction on middle grades English Language Arts achievement, and (3) the impact of COVID-19 on the implementation of Personalized Learning Instruction in their schools. This qualitative case study involved in-depth interviews of four middle school principals who had experience with the implementation of PLI in their schools. Four themes emerged from these case studies and are expressed through thematic sentences; (1) Principals perceive a positive impact on student achievement through Personalized Learning Instruction, largely through increased engagement with reading in English Language Arts classes, (2) A misalignment exists between using PLI strategies and current instructional practices, (3) Staffing issues, inexperience, and vacancies have pushed instructional leaders away from Personalized Learning Instruction, and (4) Personalized Learning Instruction is not a priority post-COVID-19.
Group purchasing (GP) is a procurement strategy by which the retailers can negotiate better prices by increasing their negotiation power through collaboration with each other. GP problem can be modeled as a generalized newsvendor problem, although it is more realistic to model this problem with stochastic demand, current literature on GP is mostly focused on problems with deterministic demand. Comparing the single retailer newsvendor vs. a newsvendor problem with multiple retailers, there has been more attention paid to the newsvendor problem with single retailer. When there are multiple retailers, competition would be another important aspect to consider, which is lacking in parts of the literature and will be considered in this research. Different contracting scenarios such as revenue-sharing and buyback contracts are other aspects which can be considered in the GP problem which has not been studied so far. Given that; four research questions are defined to investigate in this study: 1) the first question investigates the newsvendor problem with quantity discount pricing from supplier by exploring an analytical approach to solve this problem building on existing solutions from the literature; next a second novel solution approach is proposed which solves the problem in fewer steps; answering this question makes the foundation for our subsequent research questions. 2) the second research question studies the GP problem with multiple symmetric retailers; this research question is an extension of the first research question which investigates the GP supply chain consisting of multiple symmetric retailers. 3) third research question explores the solution to GP with multiple asymmetric retailers and suppliers; since this problem is complex to solve, the GP problem is divided into two sub-problems, retailers’ problem, and suppliers’ problem which are solved separately and then brought together to provide an answer to the overall GP problem, and 4) finally, fourth research question introduces different supply chain contracts to the GP problem and investigates studying the effect of these contracts on the retailers’ profit. Mathematical results as well as managerial insights are provided for each model through sensitivity analysis and numerical experiments.
