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  • Current literature suggests that, in general, RRSO is valuable for women who carry a BRCA1/BRCA2 mutation, but there is limited literature regarding the benefits and risks of RRSO for BRCA1/BRCA2 positive women over the age of 75. National Comprehensive Cancer Network (NCCN) guidelines recommend risk-reducing salpingo-oophorectomy (RRSO) for women with a BRCA1 mutation by the age of 35-40 and women with a BRCA2 mutation to have a RRSO by the age of 40-45 or after the completion of childbearing. NCCN does not provide upper age limit recommendations for RRSO and ovarian cancer management. Therefore, limitations to current studies and lack of professional guidelines for BRCA1/ BRCA2 positive women over the age of 75 pretenses the question if RRSO is an appropriate medical management option for this patient population. A survey was sent out through the National Society of Genetic Counselors (NSGC) to genetic counselors registered to the Cancer Special Interest Group (SIG) email listserv to investigate if cancer genetic counselors feel RRSO is an appropriate medical management option for women over the age of 75 who carry a BRCA1/BRCA2 mutation, and if they feel confident counseling this patient population. In addition, it explored if differing patient factors influence cancer genetic counselors’ feelings toward RRSO as an appropriate option and what resources are used when counseling this patient population. Overall, the majority of survey respondents (70%) reported that they felt RRSO was appropriate for a 77-year-old woman who carries a BRCA1 mutation. Answers differed significantly when the patient was 85-years-old or had comorbidities such as hypertension and type 2 diabetes. Overall, there is inconsistency in survey respondents’ opinions regarding RRSO for this patient population, and our study results found this to be particularly true when counseling BRCA1/BRCA2 positive patients who are 85-years-old or have comorbid conditions. Additional research and development of professional guidelines are needed to help standardize care in regard to ovarian cancer risk reduction for this patient population.
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  • This thesis examines the heritage value of the Rutgers Geology Museum and the ways in which this value has changed over time by focusing on three distinct historical moments. This is not an historical narrative but rather a critical examination of how people have ascribed value to the Rutgers Geology Museum at specific moments in the past and continue to do so. This analysis provides insight into how language functioned to structure the social institutions that influenced the Rutgers Geology Museum throughout its history and provides evidence of the articulation of heritage value of the Rutgers Geology Museum over time, revealing the people and processes involved in the formation of the heritage value of the site. Furthermore, this analysis reveals how value was applied, providing a comprehensive picture of the heritage value of the Rutgers Geology Museum at three points in time, allowing changes in heritage value to be observed and analyzed on a continuum.
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  • This mixed-methods grounded theory study investigates the development of engineering identity cultivated through engagement in informal learning experiences. In addition, the retention of engineering students and academic performance are investigated for connections to these learning environments. This is the beginning of work to identify best practices for engineering education outside of the formal undergraduate classroom experience. This research provides a framework for investigating the various factors that contribute to the success of low performing engineering students. The essential research categories to the study are (1) Informal learning Environments, (2) Engineering Identity, (3) Academic Performance, and (4) Retention. The tools used to investigate these categories include peer focus groups and the Academic Pathways of People Learning Engineering Survey (APPLES). APPLES is a research tool developed and used by the National Science Foundation-funded Academic Pathways Study (2010). It is designed to measure engineering students’ educational experience, knowledge of the engineering field, and post-graduation plans. The collected data on existing programs and activities- including summer bridge engineering programs, internships, coops, tutoring, study groups, mentoring, etc. – suggest that there are connections between the out-of-class commitments of students and their ability to identify with the engineering field. The study also offers performance and retention implications for our low performing engineering students. The research findings unpack salient features for the most noted learning environments and their impact on engineering identity. Through this investigation, the researcher can make recommendations for services, programs, and experiences that can support at-risk students completing their engineering degree.
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  • Mathematics is an important and hotly contested aspect of U.S. postsecondary education. Its importance for academics and careers and the extent and impact of math achievement disparities are all subject of longstanding debate. Yet there is surprisingly little research into how much and what types of mathematics courses are taken by U.S. undergraduates and the extent of math achievement differentials among students. This article advances the understanding of math course taking by developing course-taking metrics for a nationally representative cohort of bachelor’s graduates. Using NCES transcript data to construct consistent measures of mathematics and quantitative course taking, our analysis finds large variability both within and between STEM/non-STEM majors and a large population of non-STEM graduates earning mathematics credits comparable to their peers in STEM fields. Mathematics course taking differs substantially from course taking in other subjects.We also find that often observed gender differentials are a function of major, not gender, with females in the most mathematics-intensive programs earning as many or more mathematics credits than their male peers.
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  • One of the key factors for child cognitive and behavioral functioning is adequate amount of sleep (Touchette et al., 2007). Night awakenings and sleep disordered breathing are two factors that can negatively impact a child’s sleep quality (Lavigne et al., 1999). Some research suggests that externalizing behaviors are related to insufficient sleep or poor sleep quality (Lavine et al., 1999; Gottlieb et al., 2003). The current study hypothesized that children with insufficient sleep and poor sleep quality would exhibit more externalizing behaviors. This study also explored the differences in sleep among different ethnic groups. 141 caregivers of children between the ages of 1 and 5 completed three surveys assessing demographic variables, sleep quantity, and sleep quality. Teachers completed two surveys assessing daytime sleepiness and daytime behaviors. On average, the children were reported as receiving 11 hours of 24-hour sleep and a sleepiionset latency of 28.1 minutes. Thirty-four percent of children had one or more-night awakening and 12.1% had high risk symptoms of sleep disordered breathing. After controlling for child sex, teacher report of daytime externalizing behaviors was significantly associated with teacher report of daytime sleepiness (β=0.37, p
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  • Rights won by workers through mass mobilization and collective bargaining, even when extensive, normally stop short of significant worker ownership or control of the firm. Worker cooperatives – businesses owned and controlled by their worker members – can, in theory, offer a radical organizational, legal, and ideological alternative to the hierarchical governance and worker dispossession characteristic of the modern firm. Yet whereas some ethnographic research has shown that worker cooperatives can preserve democratic control and accountability in the face of competitive pressures and corporatization, a number of studies have suggested just the opposite, finding that many worker members report feeling distant from the management of their cooperative and alienated from their work. Moreover, some observers argue that contrary to the assumption that cooperative workplaces should foster solidaristic and anti-capitalistic values, they can in fact promote individualism and a petit-bourgeois sensibility, and weaken labor solidarity. In-depth, semi-structured interviews with 32 members at a dozen worker cooperatives throughout England show that the British worker cooperative movement has cultivated a participatory, communitarian, and egalitarian legal consciousness and workplace culture that is undergirded by the institutionalization of democratic governance, common property, and equal wages. However, members feared that a lack of social support, combined with pressures to grow in order to compete with large and international firms, could compel their cooperative to compromise principles, lower standards, and lose their character. Analysis of the history of the British cooperative movement and evaluations of cooperatives by foundational political economists underline worker cooperatives’ enduring importance to – yet persistent marginality within – working class politics and socialist theory. By merging labor and capital rather than attempting to equalize them, and by socializing capital chiefly at the level of the enterprise rather than the state, worker cooperatives have appeared to work at cross-purposes with broader labor and leftist movements. Worker cooperatives however offer a tried-and-tested model of workplace democracy and economic equality that depends on the success of those movements for their own.
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  • The dissertation consists of three independent and interrelated essays focusing on CEO career concerns, management forecast characteristics, and regulatory scrutiny on disclosure practices.The first essay argues that CEOs with career concerns may use a forecast precision strategy to highlight or obfuscate information disclosed in management forecasts. This study suggests that new CEOs are more likely to increase forecast precision when the underlying forecast news is more positive and reduce forecast precision when the news is more negative. Further, the findings suggest that CEOs especially use this approach when the career concern problem is more severe and when there are more opportunities for strategic disclosures. The second essay investigates the changes in firms’ voluntary disclosure of forward-looking information after receiving critical comment letters issued by the Securities and Exchange Commission. The study focuses on revenue recognition comment letters and analyzes several management forecast characteristics. I find that firms tend to issue more management forecasts and supplement earnings forecasts with disaggregated forecasts on other line-items, especially the forecasts for revenue account. I also find that the effect is stronger for negative news forecasts and market reactions to the comment letter release are attenuated if managers provide more frequent and transparent forecasts. The third essay evaluates the impact of Securities and Exchange Commission disclosure scrutiny on corporate hedging activities. I find that firms’ risk exposures decrease after receiving derivatives-related comment letters, possibly indicating hedging efficiency improvements. Further, derivatives comment letter receiver firms are more likely to stop or reduce derivatives usage during the post-letter period. The study adds to the research that examines how SEC regulatory scrutiny on disclosure practices may influence firms' real behaviors. The first and the second essays respond to the call by Hirst et al. (2008) to extend research on the management forecast attributes. The first essay is also related to the literature that examines the impact of career concerns on managerial behaviors. The second and third essays add to the comment letter literature. I extend the growing research that examines the efficacy of the SEC comment letter review process and its impact on the information environment.
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  • Handoff involves the transfer of patient care from the anesthesia provider to the post- anesthesia care unit registered nurse (PACU RN) in the post-perioperative period (Rose & Newman, 2016). Handoff is a period of time where a large amount of important information is transferred and can be considered an extremely vulnerable period due to the potential for distractions and transmission errors (Robins & Dai, 2015). The lack of a standardized handoff format can contribute to this issue. Inconsistent handoffs from anesthesia providers to the PACU can lead to low satisfaction among PACU RNs (Petrovic et al., 2015). Standardizing the handoff process and utilizing a tool has shown to improve team dynamics and reduce medical errors (Boat & Spaeth, 2013). This project utilized a non-experimental predictive correlational design. Rutgers Student Registered Nurse Anesthetists (SRNAs) were given an educational lecture and provided with a standardized handoff tool based on AANA (American Association of Nurse Anesthetists) handoff elements to be utilized at clinical for 4 weeks. The study aims to assess the effect of implementing a standardized handoff tool on SRNA self-efficacy and PACU satisfaction. 42 Rutgers SRNAs representing two cohorts and 10 PACU RNs were part of this study. Preintervention and postintervention surveys of both SRNA cohorts were analyzed using paired t-tests. Both cohort's data showed a p
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  • Personalized medicine strives to deliver the ‘right drug’ at the ‘right dose’ at the ‘right time’ by considering the unique characteristics that define specialized populations of patients and contribute to inter-individual variability, a leading cause of therapeutic failure when not properly considered. Given the challenges of studying specialized patient subgroups in clinical trials as well as the high degree of control necessary to tease out differences across populations, physiologically based pharmacokinetic (PBPK) modeling emerged as a key tool to evaluate complex clinical phenotypes and to predict the potential distribution of patient responses. Unfortunately, the inherent variability of biological systems and knowledge gaps in physiological data often limit confidence in model predictions for special populations. Thus, a critical step in model development for special populations involves an in-depth analysis of estimated model input and evaluation of the underlying physiological mechanisms leading to variability in pharmacokinetics, both of which may be guided by global sensitivity analysis and advanced statistical techniques.The benefits of global sensitivity as a means to refine parameter estimates and to understand how model behavior depended on the input parameter space were demonstrated using GastroPlus™ model, a well-known commercially available platform. Global sensitivity analysis was performed in two stages using the Morris Method to screen for significant factors followed by quantitative assessment of variability using Sobol’s sensitivity analysis. The 2-staged approach significantly reduced computational cost without sacrificing interpretation of model behavior, revealing nonlinearities and parameter interactions that would have been missed by local approaches. Furthermore, the utility of pharmacokinetic models to study the underlying and complex physiological mechanisms contributing to clinical differences across patient subgroups was revealed using Monte Carlo simulations by restricting model input to parameter combinations that described only biologically plausible model output. Through an integrated approach using a support vector machine, principal component analysis and global sensitivity analysis, specific combinations of parameters were shown to give rise to clinical phenotype, while individual parameters influenced the shape of the exposure profile. Augmenting analysis of the model input with global sensitivity analysis enabled an understanding of sexual dimorphism and inter-individual variability in pharmacokinetics.Finally, a dynamic semi-mechanstici model that considered pharmacokinetics and pharmacodynamics was used to demonstrate how patients benefit from careful timing of drug delivery. In this study, a mathematical model was developed to explore chronopharmacological dosing of synthetic glucocorticoids and its influence on the endogenous glucocorticoid secretion. Considering the central regulatory function of endogenous glucocorticoids for metabolic, anti-inflammatory, immunosuppressive and cognitive signaling, maintenance of normal physiological functions regulated by glucocorticoids is essential to host survival, while chronic disruption leads to severe systemic complications. Therefore, a key objective in glucocorticoid research is the development of novel dosing regimens that minimize the disruption of endogenous activity, while maintaining the pharmacological benefits of long-term therapy. Physiologically based modeling showed how chronic daily dosing resulted in modification of endogenous glucocorticoid activity with the extent of said changes dependent on the administration time and dose. However, simulations also revealed that endogenous glucocorticoid activity was preserved with proper timing of administration dependent on the dosage form. Furthermore, amending the model to account for inter-sex and inter-individual variability showed chronopharmacological dosing regimens can be further optimized by identifying the ‘right dose’ and ‘right time’ in the targeted patient populations by considering the underlying regulatory differences between males and females.
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