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Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a thorough literature review focusing on intravenous ketamine as an adjunct to standard opioid-based analgesia for postoperative pain. Four systematic reviews published in the last 10 years support the safety and efficacy of ketamine when administered intravenously in sub-anesthetic doses. The purpose of this project was to provide evidence-based education to anesthesia providers regarding the benefits of ketamine and follow-up to evaluate for evidence of changes in practice after the educational At a large community hospital data concerning ketamine utilization by anesthesia providers as a component of multimodal analgesia was collected for a six-month period, including three months pre- and three months post-educational intervention. Despite various methods utilized to present evidence regarding the safety and efficacy of ketamine, the results of this study demonstrated no significant change in practice. Based upon the extensive published literature the evidence is compelling that the addition of a sub-anesthetic (0.5 mg/kg) dose of ketamine to the surgical patient’s operative pain management plan would improve comfort and decrease opioid-related side effects with minimal negative impact.

Ce travail de thèse porte sur l'étalement de fluides complexes. Il met en évidence la riche phénoménologie d'un acte simple : celui d'étaler avec un racloir (rigide ou souple) une émulsion ou une solution de polymères sur un substrat. Pour chacun des fluides modèles étudiés, nous nous sommes focalisés expérimentalement sur l'observation de l'écoulement au cours de l'entraînement de la solution. Dans des conditions données d'étalement, il apparaît qu'une émulsion o/w peut s'inverser via plusieurs mécanismes de déstabilisation, ou encore, dans le cas d'une solution de polymères, exhiber une instabilité de sa ligne de contact, donnant naissance à des filaments de tailles et de longueurs d'ondes spécifiques. Nous montrons que les différents paramètres d'étalement, comme par exemple la hauteur du racloir, la vitesse d'étalement, les propriétés du substrat ou encore la rhéologie des solutions, doivent être pris en compte pour construire des diagrammes de phase d'étalement séparant les domaines d'existence des instabilités observées (régime de recouvrement partiel), des domaines où la solution transite vers le recouvrement total du substrat. D'autre part, nous tirons l'avantage de ces instabilités pour nous permettre de déposer de façon contrôlée des structures variées, offrant d'intéressantes perspectives en termes d'applications. / This study shows the rich phenomenology of a simple act : spreading complex solutions such as emulsion and polymer solution on a plate, by using a rigid and flexible blade respectively. Here, we experimentally study the flow of the solution over the course of its spreading. During the spreading and in certain conditions, different phenomena occur, namely, emulsion inversion in the case of o/w emulsion or a contact line instability in the case of the polymer solution, which gives rise to the formation of polymer filaments with a well-defined wavelength and characteristic sizes. We showed, thanks to spreading phase diagrams, that the the existence of the instability (partial wetting regime) is separated to a domain where the solution cover the substrate. Spreading parameters such as the height of the scraper, spreading velocity or properties of the fluids turns out to be crucial. Finally, we take advantage of the instabilities to print a variety of interesting patterns for further applications.

In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition of master’s prepared nurses to coordinate and supplement the care of the staff RNs for complex patients. While inconclusive, the literature review confirmed the impact of master’s prepared nurses on quality metrics and did not conclusively confirm that delivering high quality, safe care was not possible with nurse/patient ratios of 1:6. The goal of the project was to determine if the presence of the master’s prepared nurse could mitigate the changes in ratios and produce high quality and satisfaction outcomes. Measures of success were drawn from archived standardized quality measures in the realms of service (HCAHPS questions), patient safety (CABSI, HAPU) and quality outcomes (core measures and 30 day readmissions). The project design was a retrospective, one-group pre-post design looking at two six-month intervals—before and after project implementation. Results demonstrated sustained or improved quality in six of ten measures. Highest positive impact was in readmissions and nurse sensitive indicators. The most negative results were in patient satisfaction. Modifying the model of care is an iterative process requiring continued evaluation and changes to improve outcomes. Results of this project supported the further evaluation of staffing and expansion of the number of master’s prepared nurses on medical surgical units.

The present study examined the relationship between aspiring school principals’ self-perceived competency regarding expected leadership behaviors as indicated by the domains identified in the 2011 Florida Principal Leadership Standards and their perception of their leadership style as indicated by the Multifactor Leadership Questionnaire (Bass & Avolio, 1994). The conceptual frameworks of this study included leadership style, as defined and conceptualized by Bass and Avolio’s Full Range Leadership Model and measured by the Multifactor Leadership Questionnaire (MLQ), and leadership behavior, as defined through the domains of the Florida Principal Leadership Standards (FPLS, 2011). Both the MLQ and the FPLS questionnaire served as data collection instruments. The three main leadership styles measured by the MLQ (including transformational, transactional, and laissez-faire leadership) served as the independent variables, and the four leadership domains measured by the FPLS questionnaire (i.e., student achievement, instructional leadership, organizational leadership, professional and ethical behavior) served as the dependent variables. The research sample included participants currently enrolled in a state-approved Level 1 Educational Leadership Program and were recruited to participate from 3 state universities in Florida. Both survey instruments were administered via a single, anonymous link embedded in an email containing both an introduction and description of the research study and informed consent. Of 200 potential participants, 48 respondents or 24% of the original sample returned completed surveys. Using canonical correlation analysis, the study found that the degree of respondents’ self-perceived ability to competently perform the leadership behaviors as identified by the four 2011 FPLS domains could be explained to some degree by respondents’ self-perceived leadership style (as identified on the MLQ). Two canonical roots were interpreted. The MLQ predictor variables accounted for 48% of the variance in the FPLS subscale scores (root 1 Rc2 =.48; p < .001). For this root, transformational leadership was the primary independent variable accounting for variance across all 4 FPLS domains. Canonical root 2 (Rc2 = .117) accounted for a moderate amount of the shared variance between the two sets (i.e., 12%) and was not statistically significant (p > .05). The correlation in this root was due primarily to a direct relationship between MLQ transactional leadership and the professional and ethical behavior domain of the FPLS. Additionally, the findings indicated that participants of Level 1 Educational Leadership programs felt confident in their ability to competently perform the expected behavioral indicators of the 2011 FPLS domains.

This study explored parent perspectives about their participation in a federal TRIO pre-college program. Specifically, parents were asked to identify the program elements that encouraged and supported their participation in the college-going process of their child in a TRIO pre-college program. Forty parents of low-income, first generation TRIO students were purposefully selected for this study because they had participated in the parent component and because their child had enrolled in college within a year of high school graduation. Q methodology was used for this study because it is designed to address the subjective first person viewpoint. In this Q study, the forty parents were asked to sort 33 value statements according to what was most like their perspective and least like their perspective, with regard to the program elements that encouraged and supported their participation. The 33 statements were derived from the current research on parental involvement and a parent survey to produce the Q-sort. Parents were also asked to explain why they sorted the statements holding the highest and lowest positions, as they did. Subsequently, the parents identified five particular program elements that encouraged and supported their involvement in the college-going process. These factors were named: (a) A sense of community ”village”, (b) A sense of shared accountability and increased parental self-efficacy (c) A sense of the parent and student increasing social capital, (d) A sense of program relevance and (e) A sense of having highly committed program staff. The research findings have implications for program development, program practices, and staff training. Recommendations for future research have been included.

The purpose of this study was to explore what institutional factors affect retention and student success at a Florida public, 4-year university for commuter students. This study included institutional factors controlled by the university that affect retention with students who commute to the institution. Commuter students compose over 80% of enrollment at the nation’s college and university campuses. This mixed-method study included both a survey and focus groups. In the first part of the study, quantitative data were collected, using the Noel-Levitz Student Satisfaction Inventory (SSI). The survey analysis of the data collected using the SSI indicated that the scores for the scales were not statistically significant in determining whether or not a student would choose the university again. In the second part, focus groups were conducted to better understand student satisfaction with the institutional factors. Four main themes emerged from data analysis: (a) location and other reasons to attend the institution, (b) connectedness to the institution, (c) institutional factors that assist with progression toward degree, and (d) obstacles to graduation. Four major conclusions were addressed: students who participated in this study had higher levels of satisfaction with library services and academic advising services than with other institutional factors, commuter students were not participating in student organizations or social activities on campus because they needed to balance external obligations with their academic careers, that students in the focus groups appeared to have an instrumental view of their college experiences and are focused on what they needed to do to complete course and degree requirements, and commuter student desired to have increased regular interactions with faculty teaching courses in their major fields. In conclusion, because commuter student are the majority population on many campuses, college administrators and faculty will need to continue providing opportunities for commuter student engagement and academic success.

The impact of high quality early learning experiences on a child's development is profound. Teacher quality has been deemed an important predictor of classroom quality, but currently teachers in Voluntary Prekindergarten (VPK) in the state of Florida are required to meet minimal training requirements. The purpose of this study was to examine an intervention including in-class coaching as a means of professional development to better prepare preschool teachers. The present study included and examination of the changes in environmental quality, child outcomes, and teacher perceptions after the intervention. Scores obtained were compared before and after the intervention. A two-tailed t-test revealed that the post-test was significantly higher than the pre-test. In particular, two sub-scales were statistically significant, including Space and Furnishings and Activities. The other sub-scales, including a measure of teacher-child interactions and language-reasoning were not significantly changed. An ANOVA indicated no significant differences in kindergarten school readiness scores between centers that received coaching for varying amounts of time. Teachers were interviewed to discover their perception of in-class coaching. After examining in-class coaching from the varying angles, conclusions were drawn: In-class coaching may significantly affect the quality of classrooms, as related to environmental aspects of quality but may not be improving child outcomes. In-class coaching may increase teachers’ validation, inspiration and may contribute to the teachers’ understanding of developmental appropriateness. Conclusions suggest that teachers with a native language other than English may receive additional benefits from an in-class coaching and that effective coaches must have many skills in order to create change in the classrooms in which they work. The final conclusion was that despite its merits, coaching may not be a long-term solution to classroom and teacher quality in the context of low educational requirements, minimal pay, high turnover, and low job satisfaction. Recommendations for future practice and research are suggested.

The present study examined how athletic directors perceive their leadership roles in interscholastic athletics and the relationship of their leadership styles to their job satisfaction. The conceptual framework of this study was Bass and Avolio’s (1994) full range leadership model, also known as the transformational-transactional leadership model, which consists of 9 factors—5 transformational behaviors: idealized influence (attributed), idealized influence (behavior), inspirational motivation, intellectual stimulation, and individualized consideration; 2 transactional behaviors: contingent reward and management-by-exception (active); 2 passive/avoidant behaviors: management-by-exception (passive) and laissez-faire. These 9 factors are measured by the Multi-Factor Leadership Questionnaire (MLQ). The study was also informed by Chelladurai’s multidimensional model of leadership in sport which focuses on transformational effects of sport leaders on individual satisfaction and group performance. The study was significant in that the effects of transformational leadership on individuals in sporting organizations have not been fully explored in previous research. Both the MLQ and the Minnesota Satisfaction Questionnaire (MSQ) served as data collection tools. A sample of 500 athletic directors from across the United States was invited to participate in an electronic survey. Usable data were returned by 55 (11%) of the original sample. Participants self-assessed their leadership styles via the MLQ and job satisfaction via the MSQ. Data were analyzed via canonical correlation analysis followed by canonical commonality analysis. One canonical root was interpreted (Rc2 = .22; pCanonical structure coefficients indicated that Transformational and Passive/Avoidant Leadership made major contributions to the predictor canonical variate; the dependent canonical variate was defined by both Intrinsic and Extrinsic Satisfaction. Canonical commonality analysis indicated that Transformational Leadership had the largest unique variance partition; the largest common variance partition was shared by Transformational and Passive/Avoidant. The analysis also indicated two variable suppressor effects. There was a moderate correlation between athletic directors’ leadership styles and their job satisfaction; however, the directionality of the relationships of the variables in the leadership set with satisfaction was unexpected: (a) the relationship between transformational leadership and job satisfaction was found to be negative, and (b) the relationship between passive/avoidant leadership and job satisfaction was positive.

The primary goal of this study was to acquire an understanding of those practices that encourage the sustained use of simulations in support of inquiry-based science instruction. With the rapid distribution of Internet-related technologies in the field of education, it is most important to undertand the function of these innovations. Technology, specifically the implementation of simulations to support inquiry-based instruction, provides new educational strategies for science teachers. Technology also influences the field of education by repeatedly making some teachers' best practices obsolete. The qualitative research design was selected to explore the nature of science leaders' and teachers’ consideration or lack of consideration to incorporate simulations into their inquiry-based instruction. The method for collecting the data for this study included in-depth, semi-structured interviews. The analysis of this interview data was conducted in two phases. Phase I focused on the consensus views of the participants regarding the implementation of simulations. In order to gain a more in-depth understanding of the interview data, Phase II focused on the subtle differences among the participants regarding their execution of this instructional tool. The overall conclusion of this study was that the use of simulations requires a multi-faceted approach to ensure sustainability. As noted, science leaders must continue to encourage the high, medium and low users of simulations to implement the ongoing use of these instructional tools. Also, science teachers must do their part to ensure the success of these programs. By addressing the primary and secondary research questions, five major conclusions were reached. These conclusions include (a) the use of web-based simulations can have a positive influence on inquiry-based science instruction, (b) technology challenges have influenced the teachers’ use of simulations, (c) time influences the use of simulations, (d) ongoing professional development strategies support the sustained use of simulations, and (e) student engagement in inquiry-based science instruction is positively influenced by the use of simulations. This study concludes with suggestions for educational leaders and teachers along with further considerations for future research.