Factors associated with critical care nurses' communication with non-communicative patients in the ICU

Hospitalized individuals are isolated from their familiar environment at the onset of illness. Those individuals who are non-communicative are detached from the world and from life, as they previously knew it. Although nurses have long since recognized the importance of communication, patients still report the lack of iy. This study was done to identify factors influencing critical care nurses to communicate with their noncommunicative patients. The overall results of the study indicate that nurses are aware of the importance of verbal communication with patients who may be intubated, paralyzed, unconscious, comatose or neurologically impaired and are not deterred by them. Despite these results, some significant observations emerged identified. CCRN certified nurses and nurses with more years of experience were less likely to have verbal communication with noncommunicative patients. Nurses with children, spouses and those working full-time were more likely to communicate with non-communicative patients.

The knowledge and promotion of exercise to older adults with type 2 diabetes by dietitian diabetes educators

The extent to which Registered Dietitians (RD) promote exercise as part of diabetes self-management education to older diabetic adults has not been established. This study explored the exercise-related knowledge, design, and content of educational programs among RDs who were Certified Diabetes Educators (CDEs) and non-CDEs. The Exercise Teaching Questionnaire was completed by 94 CDEs and 73 non-CDEs in Florida, California, and Texas. ^ CDEs had significantly (p < 0.001) higher mean Knowledge, Design, and Content scores (11.8 ± 1.1, 33.5 ± 9.4, 26.9 ± 4.8, respectively) than non-CDEs (11.1 ± 1.6, 29.2 ± 11.1, 22.4 ± 7.4, respectively). However, Knowledge means for both CDEs and non-CDEs were above the 85 percentile. Design and content scale responses showed that while dietitians provided basic information about safety and benefits related to exercise, they frequently reported “never” or only “sometimes” making exercise recommendations. ^ Although these results suggest that RDs are knowledgeable about exercise for older adults with Type 2 diabetes, greater importance should be made on training RDs to promote exercise, perhaps with an emphasis on a comprehensive team approach. ^

A method for enhancing digital information displayed to computer users with visual refractive errors via spatial and spectral processing

This research pursued the conceptualization, implementation, and verification of a system that enhances digital information displayed on an LCD panel to users with visual refractive errors. The target user groups for this system are individuals who have moderate to severe visual aberrations for which conventional means of compensation, such as glasses or contact lenses, does not improve their vision. This research is based on a priori knowledge of the user's visual aberration, as measured by a wavefront analyzer. With this information it is possible to generate images that, when displayed to this user, will counteract his/her visual aberration. The method described in this dissertation advances the development of techniques for providing such compensation by integrating spatial information in the image as a means to eliminate some of the shortcomings inherent in using display devices such as monitors or LCD panels. Additionally, physiological considerations are discussed and integrated into the method for providing said compensation. In order to provide a realistic sense of the performance of the methods described, they were tested by mathematical simulation in software, as well as by using a single-lens high resolution CCD camera that models an aberrated eye, and finally with human subjects having various forms of visual aberrations. Experiments were conducted on these systems and the data collected from these experiments was evaluated using statistical analysis. The experimental results revealed that the pre-compensation method resulted in a statistically significant improvement in vision for all of the systems. Although significant, the improvement was not as large as expected for the human subject tests. Further analysis suggest that even under the controlled conditions employed for testing with human subjects, the characterization of the eye may be changing. This would require real-time monitoring of relevant variables (e.g. pupil diameter) and continuous adjustment in the pre-compensation process to yield maximum viewing enhancement.

The effectiveness of explicit individualized phonemic awareness instruction by a speech -language pathologist to preschool children with phonological speech disorders

This study investigated the effects of an explicit individualized phonemic awareness intervention administered by a speech-language pathologist to 4 prekindergarten children with phonological speech sound disorders. Research has demonstrated that children with moderate-severe expressive phonological disorders are at-risk for poor literacy development because they often concurrently exhibit weaknesses in the development of phonological awareness skills (Rvachew, Ohberg, Grawburg, & Heyding, 2003).^ The research design chosen for this study was a single subject multiple probe design across subjects. After stable baseline measures, the participants received explicit instruction in each of the three phases separately and sequentially. Dependent measures included same-day tests for Phase I (Phoneme Identity), Phase II (Phoneme Blending), and Phase III (Phoneme Segmentation), and generalization and maintenance tests for all three phases.^ All 4 participants made substantial progress in all three phases. These skills were maintained during weekly and biweekly maintenance measures. Generalization measures indicated that the participants demonstrated some increases in their mean total number of correct responses in Phase II and Phase III baseline while the participants were in Phase I intervention, and more substantial increases in Phase III baseline while the participants were in Phase II intervention. Increased generalization from Phases II to III could likely be explained due to the response similarities in those two skills (Cooper, Heron, & Heward, 2007).^ Based upon the findings of this study, speech-language pathologists should evaluate phonological awareness in the children in their caseloads prior to kindergarten entry, and should allocate time during speech therapy to enhance phonological awareness and letter knowledge to support the development of both skills concurrently. Also, classroom teachers should collaborate with speech-language pathologists to identify at-risk students in their classrooms and successfully implement evidence-based phonemic awareness instruction. Future research should repeat this study including larger groups of children, children with combined speech and language delays, children of different ages, and ESOL students.^

The Effectiveness of Explicit Individualized Phonemic Awareness Instruction By a Speech-Language Pathologist to Preschool Children With Phonological Speech Disorders

This study investigated the effects of an explicit individualized phonemic awareness intervention administered by a speech-language pathologist to 4 prekindergarten children with phonological speech sound disorders. Research has demonstrated that children with moderate-severe expressive phonological disorders are at-risk for poor literacy development because they often concurrently exhibit weaknesses in the development of phonological awareness skills (Rvachew, Ohberg, Grawburg, & Heyding, 2003). The research design chosen for this study was a single subject multiple probe design across subjects. After stable baseline measures, the participants received explicit instruction in each of the three phases separately and sequentially. Dependent measures included same-day tests for Phase I (Phoneme Identity), Phase II (Phoneme Blending), and Phase III (Phoneme Segmentation), and generalization and maintenance tests for all three phases. All 4 participants made substantial progress in all three phases. These skills were maintained during weekly and biweekly maintenance measures. Generalization measures indicated that the participants demonstrated some increases in their mean total number of correct responses in Phase II and Phase III baseline while the participants were in Phase I intervention, and more substantial increases in Phase III baseline while the participants were in Phase II intervention. Increased generalization from Phases II to III could likely be explained due to the response similarities in those two skills (Cooper, Heron, & Heward, 2007). Based upon the findings of this study, speech-language pathologists should evaluate phonological awareness in the children in their caseloads prior to kindergarten entry, and should allocate time during speech therapy to enhance phonological awareness and letter knowledge to support the development of both skills concurrently. Also, classroom teachers should collaborate with speech-language pathologists to identify at-risk students in their classrooms and successfully implement evidence-based phonemic awareness instruction. Future research should repeat this study including larger groups of children, children with combined speech and language delays, children of different ages, and ESOL students

A method for enhancing digital information displayed to computer users with visual refractive errors via spatial and spectral processing

This research pursued the conceptualization, implementation, and verification of a system that enhances digital information displayed on an LCD panel to users with visual refractive errors. The target user groups for this system are individuals who have moderate to severe visual aberrations for which conventional means of compensation, such as glasses or contact lenses, does not improve their vision. This research is based on a priori knowledge of the user's visual aberration, as measured by a wavefront analyzer. With this information it is possible to generate images that, when displayed to this user, will counteract his/her visual aberration. The method described in this dissertation advances the development of techniques for providing such compensation by integrating spatial information in the image as a means to eliminate some of the shortcomings inherent in using display devices such as monitors or LCD panels. Additionally, physiological considerations are discussed and integrated into the method for providing said compensation. In order to provide a realistic sense of the performance of the methods described, they were tested by mathematical simulation in software, as well as by using a single-lens high resolution CCD camera that models an aberrated eye, and finally with human subjects having various forms of visual aberrations. Experiments were conducted on these systems and the data collected from these experiments was evaluated using statistical analysis. The experimental results revealed that the pre-compensation method resulted in a statistically significant improvement in vision for all of the systems. Although significant, the improvement was not as large as expected for the human subject tests. Further analysis suggest that even under the controlled conditions employed for testing with human subjects, the characterization of the eye may be changing. This would require real-time monitoring of relevant variables (e.g. pupil diameter) and continuous adjustment in the pre-compensation process to yield maximum viewing enhancement.

Organizational response to employment under the ADA of workers with psychiatric disabilities: Four case studies

Title 1 of the Americans with Disabilities Act (ADA) requires all employers, public and private, with more than fifteen employees to provide reasonable accommodation to qualified individuals with disabilities if the accommodation would, within limits, allow the individual to perform the essential functions of the job. Seven years after Congress enacted the law and five years after the initial provisions became effective, little information is available about the experience of organizations faced with requests for workplace accommodation.^ The question addressed in this study is: How are organizations responding to the ADA mandate to fit individuals with psychiatric disabilities in the workplace? The data sources are three organizations that allowed access to this sensitive information, and a fourth that had two disability discrimination charges filed against it.^ A brute-force case method approach applied to the four organizations yields the following information: Attorneys are hesitant to allow inquiry into company policy owing to fear of litigation; workers are not disclosing and requesting accommodation; tacit accommodation of long-standing employees appears to be a regular practice; knowledge of the intent of the ADA makes a difference in terms of equality of treatment; and insensitivity to employee privacy results in an adversarial situation.^ Implications are relevant to the need to improve lines of communication between human resource, EEO, supervisory, and legal staff; consequences of failure to address accommodations on an explicit level; need for better understanding of the availability and use of outside resources for achieving accommodation; and improvement of self-advocacy and disclosure by the employees with disabilities. ^

An approach for design and analysis of User-centric Communication Middleware

Today, the development of domain-specific communication applications is both time-consuming and error-prone because the low-level communication services provided by the existing systems and networks are primitive and often heterogeneous. Multimedia communication applications are typically built on top of low-level network abstractions such as TCP/UDP socket, SIP (Session Initiation Protocol) and RTP (Real-time Transport Protocol) APIs. The User-centric Communication Middleware (UCM) is proposed to encapsulate the networking complexity and heterogeneity of basic multimedia and multi-party communication for upper-layer communication applications. And UCM provides a unified user-centric communication service to diverse communication applications ranging from a simple phone call and video conferencing to specialized communication applications like disaster management and telemedicine. It makes it easier to the development of domain-specific communication applications. The UCM abstraction and API is proposed to achieve these goals. The dissertation also tries to integrate the formal method into UCM development process. The formal model is created for UCM using SAM methodology. Some design errors are found during model creation because the formal method forces to give the precise description of UCM. By using the SAM tool, formal UCM model is translated to Promela formula model. In the dissertation, some system properties are defined as temporal logic formulas. These temporal logic formulas are manually translated to promela formulas which are individually integrated with promela formula model of UCM and verified using SPIN tool. Formal analysis used here helps verify the system properties (for example multiparty multimedia protocol) and dig out the bugs of systems.

Theoretical investigations of intercellular communication in the microcirculation: Conducted responses, myoendothelial projections and endothelium derived hyperpolarizing factor

The contractile state of microcirculatory vessels is a major determinant of the blood pressure of the whole systemic circulation. Continuous bi-directional communication exists between the endothelial cells (ECs) and smooth muscle cells (SMCs) that regulates calcium (Ca2+) dynamics in these cells. This study presents theoretical approaches to understand some of the important and currently unresolved microcirculatory phenomena. ^ Agonist induced events at local sites have been shown to spread long distances in the microcirculation. We have developed a multicellular computational model by integrating detailed single EC and SMC models with gap junction and nitric oxide (NO) coupling to understand the mechanisms behind this effect. Simulations suggest that spreading vasodilation mainly occurs through Ca 2+ independent passive conduction of hyperpolarization in RMAs. Model predicts a superior role for intercellular diffusion of inositol (1,4,5)-trisphosphate (IP3) than Ca2+ in modulating the spreading response. ^ Endothelial derived signals are initiated even during vasoconstriction of stimulated SMCs by the movement of Ca2+ and/or IP3 into the EC which provide hyperpolarizing feedback to SMCs to counter the ongoing constriction. Myoendothelial projections (MPs) present in the ECs have been recently proposed to play a role in myoendothelial feedback. We have developed two models using compartmental and 2D finite element methods to examine the role of these MPs by adding a sub compartment in the EC to simulate MP with localization of intermediate conductance calcium activated potassium channels (IKCa) and IP3 receptors (IP 3R). Both models predicted IP3 mediated high Ca2+ gradients in the MP after SMC stimulation with limited global spread. This Ca 2+ transient generated a hyperpolarizing feedback of ∼ 2–3mV. ^ Endothelium derived hyperpolarizing factor (EDHF) is the dominant form of endothelial control of SMC constriction in the microcirculation. A number of factors have been proposed for the role of EDHF but no single pathway is agreed upon. We have examined the potential of myoendothelial gap junctions (MEGJs) and potassium (K+) accumulation as EDHF using two models (compartmental and 2D finite element). An extra compartment is added in SMC to simulate micro domains (MD) which have NaKα2 isoform sodium potassium pumps. Simulations predict that MEGJ coupling is much stronger in producing EDHF than alone K+ accumulation. On the contrary, K+ accumulation can alter other important parameters (EC V m, IKCa current) and inhibit its own release as well as EDHF conduction via MEGJs. The models developed in this study are essential building blocks for future models and provide important insights to the current understanding of myoendothelial feedback and EDHF.^

Evaluating the Effectiveness of Discrete Trial Procedures for Teaching Receptive Discrimination to Children with Autism Spectrum Disorders

Research has found that children with autism spectrum disorders (ASD) show significant deficits in receptive language skills (Wiesmer, Lord, & Esler, 2010). One of the primary goals of applied behavior analytic intervention is to improve the communication skills of children with autism by teaching receptive discriminations. Both receptive discriminations and receptive language entail matching spoken words with corresponding objects, symbols (e.g., pictures or words), actions, people, and so on (Green, 2001). In order to develop receptive language skills, children with autism often undergo discrimination training within the context of discrete trial training. This training entails teaching the learner how to respond differentially to different stimuli (Green, 2001). It is through discrimination training that individuals with autism learn and develop language (Lovaas, 2003). The present study compares three procedures for teaching receptive discriminations: (1) simple/conditional (Procedure A), (2) conditional only (Procedure B), and (3) conditional discrimination of two target cards (Procedure C). Six children, ranging in age from 2-years-old to 5-years-old, with an autism diagnosis were taught how to receptively discriminate nine sets of stimuli. Results suggest that the extra training steps included in the simple/conditional and conditional only procedures may not be necessary to teach children with autism how to receptively discriminate. For all participants, Procedure C appeared to be the most efficient and effective procedure for teaching young children with autism receptive discriminations. Response maintenance and generalization probes conducted one-month following the end of training indicate that even though Procedure C resulted in less training sessions overall, no one procedure resulted in better maintenance and generalization than the others. In other words, more training sessions, as evident with the simple/conditional and conditional only procedures, did not facilitate participants’ ability to accurately respond or generalize one-month following training. The present study contributes to the literature on what is the most efficient and effective way to teach receptive discrimination during discrete trial training to children with ASD. These findings are critical as research shows that receptive language skills are predictive of better outcomes and adaptive behaviors in the future.

Mand – to Tact Training Transfer Acquisition Rates in Children Diagnosed with Autism Spectrum Disorder with Limited Verbal Skills

Autism Spectrum Disorder () is defined as “the presence of severe and pervasive impairments in reciprocal social interaction and in verbal and nonverbal communication skills” (Diagnostic & Statistical Manual, 2000). It is estimated that 1 in 68 children across the United States are diagnosed with ASD. One of the most common delays that children diagnosed with ASD experience are language delays. Children with ASD that have a language delay will often develop maladaptive behaviors as a result of poor communication skills (Carr & Durand, 1985). The failure to develop mand acquisition in typical fashion results in behaviors ranging from social withdrawal to self-injurious behaviors (Cooper et. al, 2007). A lack of a strong tact repertoire can further impede and complicate the learning of other necessary components of language due to the inability to successfully label items and events in the physical environment of the child. The purpose of this study is to replicate with a reversal in verbal operant training of the procedures described in Wallace et al. (2006) in which two children with ASD underwent tact training to facilitate the formation of mands; essentially this study aims to accomplish mand training first to establish as tact. It is hypothesized that mand training will result in a greater repertoire of tacts due to strength of the relationship between mands and the control over the social environment (Cooper et al., 2007). The two children in the study will be taught to mand items that will be ranked in order of preference via stimulus preference assessment. This study is of great importance due to the indispensable value of effective social communication skills. Data gathered on improving communication skills is of great value to the ASD community as the implications for functional skills result in better communication with family and greater control of individual functioning.

Mand – to Tact Training Transfer Acquisition Rates in Children Diagnosed with Autism Spectrum Disorder with Limited Verbal Skills

Autism Spectrum Disorder () is defined as “the presence of severe and pervasive impairments in reciprocal social interaction and in verbal and nonverbal communication skills” (Diagnostic & Statistical Manual, 2000). It is estimated that 1 in 68 children across the United States are diagnosed with ASD. One of the most common delays that children diagnosed with ASD experience are language delays. Children with ASD that have a language delay will often develop maladaptive behaviors as a result of poor communication skills (Carr & Durand, 1985). The failure to develop mand acquisition in typical fashion results in behaviors ranging from social withdrawal to self-injurious behaviors (Cooper et. al, 2007). A lack of a strong tact repertoire can further impede and complicate the learning of other necessary components of language due to the inability to successfully label items and events in the physical environment of the child. The purpose of this study is to replicate with a reversal in verbal operant training of the procedures described in Wallace et al. (2006) in which two children with ASD underwent tact training to facilitate the formation of mands; essentially this study aims to accomplish mand training first to establish as tact. It is hypothesized that mand training will result in a greater repertoire of tacts due to strength of the relationship between mands and the control over the social environment (Cooper et al., 2007). The two children in the study will be taught to mand items that will be ranked in order of preference via stimulus preference assessment. This study is of great importance due to the indispensable value of effective social communication skills. Data gathered on improving communication skills is of great value to the ASD community as the implications for functional skills result in better communication with family and greater control of individual functioning.

Evaluating the effectiveness of discrete trial procedures for teaching receptive discrimination to children with autism spectrum disorders

Research has found that children with autism spectrum disorders (ASD) show significant deficits in receptive language skills (Wiesmer, Lord, & Esler, 2010). One of the primary goals of applied behavior analytic intervention is to improve the communication skills of children with autism by teaching receptive discriminations. Both receptive discriminations and receptive language entail matching spoken words with corresponding objects, symbols (e.g., pictures or words), actions, people, and so on (Green, 2001). In order to develop receptive language skills, children with autism often undergo discrimination training within the context of discrete trial training. This training entails teaching the learner how to respond differentially to different stimuli (Green, 2001). It is through discrimination training that individuals with autism learn and develop language (Lovaas, 2003). The present study compares three procedures for teaching receptive discriminations: (1) simple/conditional (Procedure A), (2) conditional only (Procedure B), and (3) conditional discrimination of two target cards (Procedure C). Six children, ranging in age from 2-years-old to 5-years-old, with an autism diagnosis were taught how to receptively discriminate nine sets of stimuli. Results suggest that the extra training steps included in the simple/conditional and conditional only procedures may not be necessary to teach children with autism how to receptively discriminate. For all participants, Procedure C appeared to be the most efficient and effective procedure for teaching young children with autism receptive discriminations. Response maintenance and generalization probes conducted one-month following the end of training indicate that even though Procedure C resulted in less training sessions overall, no one procedure resulted in better maintenance and generalization than the others. In other words, more training sessions, as evident with the simple/conditional and conditional only procedures, did not facilitate participants’ ability to accurately respond or generalize one-month following training. The present study contributes to the literature on what is the most efficient and effective way to teach receptive discrimination during discrete trial training to children with ASD. These findings are critical as research shows that receptive language skills are predictive of better outcomes and adaptive behaviors in the future. ^

The use of computer technology to compare and analyze community college dissertations

A purpose of this research study was to demonstrate the practical linguistic study and evaluation of dissertations by using two examples of the latest technology, the microcomputer and optical scanner. That involved developing efficient methods for data entry plus creating computer algorithms appropriate for personal, linguistic studies. The goal was to develop a prototype investigation which demonstrated practical solutions for maximizing the linguistic potential of the dissertation data base. The mode of text entry was from a Dest PC Scan 1000 Optical Scanner. The function of the optical scanner was to copy the complete stack of educational dissertations from the Florida Atlantic University Library into an I.B.M. XT microcomputer. The optical scanner demonstrated its practical value by copying 15,900 pages of dissertation text directly into the microcomputer. A total of 199 dissertations or 72% of the entire stack of education dissertations (277) were successfully copied into the microcomputer's word processor where each dissertation was analyzed for a variety of syntax frequencies. The results of the study demonstrated the practical use of the optical scanner for data entry, the microcomputer for data and statistical analysis, and the availability of the college library as a natural setting for text studies. A supplemental benefit was the establishment of a computerized dissertation corpus which could be used for future research and study. The final step was to build a linguistic model of the differences in dissertation writing styles by creating 7 factors from 55 dependent variables through principal components factor analysis. The 7 factors (textual components) were then named and described on a hypothetical construct defined as a continuum from a conversational, interactional style to a formal, academic writing style. The 7 factors were then grouped through discriminant analysis to create discriminant functions for each of the 7 independent variables. The results indicated that a conversational, interactional writing style was associated with more recent dissertations (1972-1987), an increase in author's age, females, and the department of Curriculum and Instruction. A formal, academic writing style was associated with older dissertations (1972-1987), younger authors, males, and the department of Administration and Supervision. It was concluded that there were no significant differences in writing style due to subject matter (community college studies) compared to other subject matter. It was also concluded that there were no significant differences in writing style due to the location of dissertation origin (Florida Atlantic University, University of Central Florida, Florida International University).