The challenge of combating Clostridium difficile infections (CDI) is a major problem within many health care organizations as CDI adds to the cost of care and is an uncomfortable and sometimes fatal complication of hospitalization for the patient. The practice-focused question for this doctoral project was targeted at patients in hospital settings on a medical surgical floor and asked if clostridium difficile preventive bundles reduce the incidence of CDI compared with nonstandardized preventative methods. Using the plan-do-study-act framework, the purpose of this DNP project was to use a clostridium difficile bundle approach to study the effects of clostridium difficile incidence (CDI) decrease on a medical-surgical unit with high CDI incidences. Standardized environmental cleaning practices resulted in improvement of the patient environment. High-touch cleaning improved from 43.7% to 83.3%. Time between CDI events lengthened from 19.9 days to 30.2, environmental cleaning with the use of Dazo auditing improved from 33.4% to 81.6%, isolation practices improved from 62.7% to 90%, and with the implementation of the nurse-driven CD testing protocol, unnecessary testing improved. Results showed that the CDI incidence on an acute care medical surgical unit was reduced through the use of a clostridium difficile preventive bundle in this DNP project. Reducing the incidence of CDI is a significant contribution to social change as this unwanted complication of hospitalization causes discomfort and pain and adds unnecessary cost to health care.

Doctor of Philosophy / Department of Electrical and Computer Engineering / Balasubramaniam Natarajan / Dale E. Schinstock / In this dissertation, two applications related to vision-based localization and mapping are considered: (1) improving navigation system based satellite location estimates by using on-board camera images, and (2) deriving position information from video stream and using it to aid an auto-pilot of an unmanned aerial vehicle (UAV). In the first part of this dissertation, a method for analyzing a minimization process called bundle adjustment (BA) used in stereo imagery based 3D terrain reconstruction to refine estimates of camera poses (positions and orientations) is presented. In particular, imagery obtained with pushbroom cameras is of interest. This work proposes a method to identify cases in which BA does not work as intended, i.e., the cases in which the pose estimates returned by the BA are not more accurate than estimates provided by a satellite navigation systems due to the existence of degrees of freedom (DOF) in BA. Use of inaccurate pose estimates causes warping and scaling effects in the reconstructed terrain and prevents the terrain from being used in scientific analysis. Main contributions of this part of work include: 1) formulation of a method for detecting DOF in the BA; and 2) identifying that two camera geometries commonly used to obtain stereo imagery have DOF. Also, this part presents results demonstrating that avoidance of the DOF can give significant accuracy gains in aerial imagery. The second part of this dissertation proposes a vision based system for UAV navigation. This is a monocular vision based simultaneous localization and mapping (SLAM) system, which measures the position and orientation of the camera and builds a map of the environment using a video-stream from a single camera. This is different from common SLAM solutions that use sensors that measure depth, like LIDAR, stereoscopic cameras or depth cameras. The SLAM solution was built by significantly modifying and extending a recent open-source SLAM solution that is fundamentally different from a traditional approach to solving SLAM problem. The modifications made are those needed to provide the position measurements necessary for the navigation solution on a UAV while simultaneously building the map, all while maintaining control of the UAV. The main contributions of this part include: 1) extension of the map building algorithm to enable it to be used realistically while controlling a UAV and simultaneously building the map; 2) improved performance of the SLAM algorithm for lower camera frame rates; and 3) the first known demonstration of a monocular SLAM algorithm successfully controlling a UAV while simultaneously building the map. This work demonstrates that a fully autonomous UAV that uses monocular vision for navigation is feasible, and can be effective in Global Positioning System denied environments.

Master of Science / Department of Mechanical and Nuclear Engineering / Steven Eckels and Mohammad Hosni / This research presents results from experimental and numerical investigations of two-phase flow pattern analysis in a staggered tube bundle. Shell-side boiling tube bundles are used in a variety of industries from nuclear power plants to industrial evaporators. Fluid flow patterns in tube bundles affect pressure drop, boiling characteristics, and tube vibration. R-134a was the working fluid in both the experimental and computational fluid dynamics (CFD) analysis for this research. Smooth and enhanced staggered tube bundles were studied experimentally using a 1.167 pitch to diameter ratio. The experimental tube bundles and CFD geometry consist of 20 tubes with five tubes per pass. High speed video was recorded during the experimental bundle boiling. Bundle conditions ranged in mass fluxes from 10-35 kg/m[superscript]2.s and inlet qualities from 0-70% with a fixed heat flux. Classification of the flow patterns from these videos was performed using flow pattern definitions from literature. Examples of smooth and enhanced bundle boiling high speed videos are given through still images. The flow patterns are plotted and compared with an existing flow pattern map. Good agreement was found for the enhanced tube bundle while large discrepancies exist for the smooth tube bundle. The CFD simulations were performed without heat transfer with non-symmetrical boundary conditions at the side walls, simulating rectangular bundles used in this and other research. The two-phase volume of fluid method was used to construct vapor interfaces and measure vapor volume fraction. A probability density function technique was applied to the results to determine flow patterns from the simulations using statistical parameters. Flow patterns were plotted on an adiabatic flow pattern map from literature and excellent agreement is found between the two. The agreement between simulation results and experimental data from literature emphasizes the use of numerical techniques for tube bundle design.

The effects of auditory efferent activity on peripheral physiology may be examined by presenting broadband noise (BBN) to the contralateral ear during otoacoustic emission (OAE) recordings. The presentation of BBN typically produces a reduction of OAE amplitudes in comparison to a condition without BBN. This is termed contralateral suppression. Limited information exists regarding the effects of contralateral BBN on responses observed at higher levels in the auditory system. The present study employed this paradigm to investigate interactions of attention and laterality on the transient evoked otoacoustic emission (TEOAE), auditory brainstem response (ABR) and cortical auditory evoked potentials (CAEP) P1-N1-P2. TEOAEs were evoked by 60 dB SPL clicks; ABRs and CAEPs were evoked by 60 dB SPL 2.0 kHz tone pips in 15 normally hearing adults. Four conditions were employed for each ear: 1) quiet (no noise); 2) 60 dB SPL contralateral BBN; 3) words (at -3 dB SNR) embedded in 60 dB SPL contralateral BBN while subjects classified words as animal versus food items; 4) words from condition #3 played backwards and embedded in 60 dB SPL contralateral BBN. For TEOAEs: 1) more suppression was evident in the active attention condition than the passive listening conditions and 2) right ear OAE amplitudes for the 8-18 ms time period exhibited more suppression in the presence of BBN for all noise conditions, although this did not meet statistical significance. For the ABR experiment, amplitudes in the noise conditions decreased in all epochs for the right ear, but not for the left. For the CAEP experiment, asymmetries were evident in temporal regions and an effect of contralateral noise was evident. The outcome of this investigation suggests that efferent activation by noise and active attention has diverse modulatory effects on electroacoustic and electrophysiologic responses along the auditory pathway.

BACKGROUND: His bundle pacing (HBP) is a relatively new treatment modality for patients experiencing issues with the cardiac conduction system. The treatment is thought to be an advantageous therapy compared with the standard treatment because it uses the native conduction pathway instead of introducing a non-physiological correction pathway which has been documented to increase the risk of heart failure. First carried out in humans in 2000 (Deshmukh, Casavant, Romanyshyn, & Anderson, 2000), HBP has been shown to be superior to right ventricular pacing and equivalent to cardiac resynchronization therapy. Because of the relative recency of the application of this technique in humans, there is a need for more studies to understand the long-term effectiveness and to guide training for new clinicians. 
OBJECTIVES: The objectives of this study were to (1) define the utility of three-dimensional mapping as a guiding tool for lead placement in HBP, (2) investigate the electroanatomical imaging of the atrioventricular (AV) septum, bundle of His, and other areas of the conduction system, (3) apply these observations to guide optimal pacing lead placement in the clinical setting, and (4) describe the correction of right and left bundle branch blocks by HBP. METHODS: Patients with pacemaker indication due to diseased conduction system were identified and recommended to undergo His bundle lead implantation. The lead was navigated into the heart by fluoroscopy and progressing the catheter through the axillary, subclavian, and cephalic veins. During the procedure, electroanatomical mapping was conducted by a quadripolar catheter to guide lead placement. His cloud, non-selective capture, and selective capture areas were marked and used to generate a 3D model layering the patient conduction system onto the physical anatomy. Pacemapping was then utilized to identify the most suitable area for disease correction.
Results: HBP mapping data were available in 24 patients. Several different responses to pacemapping were observed in the area of the AV septum including selective HBP (S-HBP), non-selective HBP (NS-HBP) (with upper, lower, and common variants), and right bundle branch (RBB) capture. Capture areas were superimposed onto the 3D model in real time and used to guide lead implantation for purposes of correcting various forms of conduction disease. The use of electroanatomical mapping (EAM) reduced the need for fluoroscopic guidance compared with the non-EAM-assisted procedure. Four common patterns were observed while mapping: (1) pattern 1, selective capture surrounded by upper and lower non-selective regions of capture; (2) pattern 2, selective capture surrounded by a common non-selective region of capture; (3) pattern 3, two separate non-selective capture areas with no selective capture; (4) pattern 4, common non-selective capture area with no selective capture. There was no correlation between capture threshold voltage and location of non-selective capture. Also, no correlation was found between capture threshold voltage and presence of common non-selective versus upper and lower non-selective capture areas. Patients with left bundle branch block (LBBB) and RBBB had similar His capture anatomy and were correctable by NS-HBP. CONCLUSIONS: HBP guided by electroanatomical mapping should be considered as a standard approach during pacemaker implantation. Because the underlying conduction anatomy is variable among patients, the use of EAM can direct lead positioning at a more physiologic location. In addition, EAM-guided implantation can reduce the need for fluoroscopy.

Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework for analysis of the organization's planning and implementation of this quality improvement project. Benchmark data from an organization's participation in the ICU Liberation Collaborative served as the primary source of evidence for analysis of outcomes. In addition, baseline data on current practice and outcomes in the organization's trauma ICU was analyzed and compared to the benchmark data. Analyses of data revealed strengths and opportunities for improvement in both the organization's project management and in current practices supporting adherence to the ABCDEF bundle guidelines. Incidence of delirium remained unchanged and far below national averages indicating need for further investigation into practices to verify this finding. Better prevention, identification, and management of delirium will lead to a positive impact on society, as patients who develop delirium rarely return to their baseline level of functioning.

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No description available.

This research project entails analyses of both alcoholic route C8S3 J-aggregate bundles and the interactions of a polyethylene glycol additive with alcoholic route C8S3 J-aggregates. First, the C8S3 J-aggregate bundles are characterized by both polarized and non-polarized spectroscopy methods. Orientation of the tubular bundled molecular complex was achieved, depending on the experiment, through a combination of flow cell experiments and cover slip deposited sample analysis. Next, isolated alcoholic route C8S3 J-aggregates were investigated using a polyethylene glycol (PEG) additive which has been shown, through absorbance and fluorescence emission spectroscopy, to selectively and reversibly remove the outer wall of the J-aggregate tubule. Spectroscopic analyses have indicated that the addition of a PEG additive left behind an in-tact inner wall tubule without the use of oxidizing agents, a feat never before accomplished with the C8S3 monomer. / text

Ovarian cancer is the fifth leading cause of cancer related deaths among women. Early detection improves the chances of survival following diagnosis, and new imaging modalities have the potential to reduce deaths due to this disease. The confocal microendoscope (CME) is a non-destructive in-vivo imaging device for visualization of the ovaries that operates in real-time. Two components of the CME system are evaluated in this paper, and initial results from an ongoing clinical trial are presented.Fiber-optic imaging bundles are used in the CME imaging catheter to relay images over distances of up to 20 feet. When detecting fluorescent signals from investigated tissue, any fluorescence in the system can potentially reduce contrast in images. The emission and transmission properties of three commercially available fiber optic imaging bundles were evaluated. Emission maps of fluorescence from bundles were generated at multiple excitation wavelengths to determine the profile and amount of fluorescence present in bundles manufactured by Sumitomo, Fujikura, and Schott. Results are also presented that show the variation of transmittance as a function of illumination angle in these bundles. Users of high-resolution fiber-optic imaging bundles should be aware of these properties and take them into account during system design.Contrast is improved in images obtained with the CME through the application of topical dyes. Acridine orange (AO) and SYTO 16 are two fluorescent stains that are used to show the size, shape, and distribution of cell nuclei. Unfortunately, little is known about the effects of these dyes on living tissues. This study was undertaken to evaluate the effects of dye treatment on peritoneal tissues in mice. Seventy-five Balb/c mice were split into five groups of fifteen and given peritoneal injections of dye or saline. The proportions of negative outcomes for the control and test groups were compared using confidence intervals and the Fisher's exact test. No significant difference was determined between the groups. These data provide preliminary results on determining the effect of these dyes on living tissues.Preliminary results of a clinical trial are presented showing in-vivo use of the CME for imaging of the ovaries. This is the first portion of a two part study to demonstrate the clinical diagnosis potential of the CME system. A mobile version of the bench-top CME was modified to be used in the clinic. Fluorescein sodium is used as an initial contrast agent in these studies to demonstrate fluorescence imaging. Twenty patients were successfully imaged, and results of this study have allowed progression to a clinical validation study showing the diagnostic capabilities of the CME.