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The responsibility of raising a child is demanding on all parents, but immigrant parents with limited literacy skills in English may find parenting even more demanding than native born parents. Hispanic immigrant parents are rarely consulted about their literacy needs. Furthermore, they are often overlooked as experts on their own needs. Using two of the most widely accepted models of literacy, The Simple View of Writing and The Simple View of Reading, this study explored Hispanic immigrant parents' literacy needs in the United States. The current study was conducted on N=30 Hispanic Immigrant parents, ages early 30s to mid 70s. A qualitative open-ended questionnaire was used to provide information regarding Hispanic immigrant parents’ literacy needs. The conceptual frameworks used, emerging patterns of learners’ perspectives of their literacy needs were analyzed under six categories: Three reading elements- Decoding, language comprehension, and reading comprehension, and three writing elements- text generation, transcription, and self-regulation. Findings of the present study provide initial insights on the literacy needs of Hispanic immigrant parents in light of The Simple View of Writing and The Simple View of Reading literacy frameworks. These insights can be used to inform and advance literacy interventions and programs that can be tailored to parents' specific needs moving forward as we seek to provide person centered care for this population. The implications of these findings of parents’ literacy needs are discussed in terms of its impact on parents education and the quality of the outcomes so that a literacy program that meets Hispanic immigrant parents’ needs can be built in the future.

The purpose of this causal-comparative study was to determine if differences exist between the use of mHealth wearable devices, specifically smartwatches, and the improvement in hypertension control. The target participants were 100 African-born immigrants, both males and females aged 45-75 who lived in Maricopa County, Arizona. In the study, 100 research participants with a hypertension diagnosis were divided into two equal groups. Group 1 consisted of 50 African-born immigrants who used mHealth wearable devices, specifically the Dafit M2 smartwatches to manage hypertension (which they received for free from the researcher). Group 2 consisted of 50 African-born immigrants who used a regular sphygmomanometer to check their blood pressure. All participants measured and recorded their blood pressure for six weeks on blood pressure forms and completed questionnaires at the conclusion of the study via encrypted Google Form links. The researcher used independent, paired samples T-test and Pearson Chi-square statistical tests for data analysis in SPSS 29.0. The study yielded two statistically significant results for RQ1. First, the MAP at the end of six weeks of the study was lower in group 1 than in group 2 (p < 0.001) with a - 4 mmHg difference based on independent samples T-test, resulting in H02 rejection. Second, the paired samples T-test showed that group 1 participants achieved a better MAP at the end of the study than before they participated in the study, with a reduction in MAP of - 3 mmHg (p = 0.005), leading to reject H07. For RQ2, the Chi-Square test of independence results showed no significant differences in the crosstabulation of several variables with the awareness of the highest consequences of poorly managed hypertension, which correlated with several previous studies.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by persistent hyperglycemia. This condition occurs due to two main factors: β-cell dysfunction and reduced response to insulin by cells and tissues with insulin receptors (insulin resistance). Insulin resistance occurs when the body fails to respond to insulin; therefore, cells and tissues are impaired in transporting glucose, leading to abnormally high glucose levels in circulation. Insulin resistance is a multifactorial condition; thus, the eminent cause is not fully known. Individual health conditions and genetic predisposition have been postulated to cause it. Molecularly, insulin resistance has been associated with complications in the glucose-fatty acid (Randle’s cycle) and the activation of specific transcription factors such as FOXO1. There is no cure for T2DM, but a combination of both pharmacological and non-pharmacological therapies has been effective in managing the progression of the disease. Oral hypoglycemic agents, for instance, promote insulin sensitivity, facilitating glucose uptake. These include thiazolidinediones, sulfonylureas, and biguanides. Other agents such as dipeptidyl peptidase 4 (DPP-4) inhibitors, a-Glucosidase inhibitors, sodium-glucose co-transporter two, and glucagon-like peptide-1 receptor analog have been used in T2DM treatment. Other potential treatment options include stem cell therapy, direct lineage programming, bromocriptine, statin therapy, and inceptor receptors. Non-pharmacological approaches incorporate lifestyle changes like diet, physical exercise, and emotional treatment to manage the disease. An overview of these therapeutic strategies reveals the progress in the research aimed at finding a feasible cure for T2DM.

Bronchopulmonary dysplasia (BPD) is a chronic neonatal lung disease that occurs in over 50% of premature infants. BPD is characterized by damage to the alveoli and bronchioles and improper vasculature formation. It is primarily caused by overexposure to oxygen through mechanical ventilation, but there are other risk factors that make infants more susceptible to BPD. Microbial composition impacts risk for developing BPD, and research is ongoing about the effects of the microbiome on BPD pathogenesis; this information is also valuable for preventative treatment. This paper reviews the normal function of the lungs, pathogenesis of BPD and how it affects normal lung function, and the current and ongoing research concerning the effects of the microbiome on BPD.

Over 21 million people in the United States (U.S.) require substance use disorder (SUD) treatment; yet less than 4 million people receive treatment (Bressan & Kening, 2023). According to Thomas et al. (2022), opioid overdose deaths are increasing, and improving access to evidence-based treatment is critical. Hospital emergency departments (EDs) play a lifesaving in the emergency treatment of opioid overdoses; but can also serve as gateways to opioid treatment by healthcare providers for opioid addictions (Reuter et al., 2022). Mortality, after an ED visit for opioid overdose, is high (Thomas et al., 2022). Community resources are limited, thus making it difficult for patients to have follow-up care (Madras et al., 2020). Emergency departments (EDs) can serve as critical access points for the initiation of buprenorphine/naloxone or Suboxone for opioid overdoses or opioid use disorders (OUDs) (refs). The purpose of this project is to evaluate the impacts of an ED provider information update on the initiation of Suboxone, with a community treatment program referral, on patients treated for an opioid overdose (OD) and/or opioid use disorder (OUD) in an emergency department. The findings of this project will describe the impacts of low barrier treatment, including access to Suboxone and a referral to a community treatment program, on patients treated for an OD and/or OUD in the ED.

Background: The US population is more culturally diverse than ever. Although advancements have been made in improving the nation’s overall health, health disparities continue among different racial and ethnic groups. To promote person-centered care practices, medical students must be ready to serve diverse patient populations and provide equitable care. Despite their training, some medical students report feeling unprepared to treat diverse patient populations, potentially impacting their clinical practice and patient care outcomes. Purpose: This study’s purpose was to explore the perceived readiness of final-year medical students in the US to provide culturally competent care utilizing the Readiness Theory and The Purnell Model for Cultural Competence. As noted in the literature, readiness is a state of preparedness. Readiness Theory infers that one’s readiness encompasses their situational knowledge, attitude, and confidence. Methods: A mixed-method approach was utilized in this study; it involved semi-structured interviews that explored the constructs of readiness via open ended questions and included the completion of a quantitative validated instrument (GWCCS) measuring culture competence via the lens of The Purnell Model for Cultural Competence. Sixteen participants from various institutions and regions of the US engaged in this non-experimental, cross-sectional research. Results: All students demonstrated cultural competence knowledge, quantitatively, as measured by the GWCCS. Additionally, their culturally competent knowledge base was also supported by their self-reported responses to knowledge questions posed during the interviews. Surprisingly, emerging from the qualitative data, while most students voiced positive attitudes towards culturally competent practice, their confidence levels varied. Conclusion: Majority of the medical students perceived that they were ready to serve as culturally competent practitioners, however inconsistencies surfaced regarding their confidence levels. Based upon the readiness theory, confidence is one of the three constructs which defines one’s overall readiness thus the findings left us with concerns regarding students' actual readiness. These results highlight the need for a more uniform and robust cultural competence curricula in medical schools that promotes students’ cultural competence knowledge and perceived importance and confidence as we seek to address health disparities by ensuring that health professionals are ready to address them. Keywords: Medical Education, Cultural Competency, Medical Students, Physicians, Readiness, Diversity, Medical School Curriculum

Purpose. This study aimed to explore what factors are related to Black men’s shared decision-making (SDM) preferences for selecting hypertension (HTN) treatment and management options with a healthcare clinician. Methods. Researchers employed an exploratory sequential mixed methods design to explore factors influencing Black adult men's preferences for involvement in SDM regarding HTN treatment. Qualitative interviews with N=16 Black men identified factors related to SDM involvement, while a quantitative phase with N=105 Black men examined factors that could predict the level of involvement in SDM for HTN treatment. Results. Trust and having a female clinician were a significant independent predictor of decision-making involvement among men in this study (b = 9.09; t(102) = 3.07; p = .003). Engaging in the SDM process with a female clinician increased the desired level of decision-making involvement for HTN treatment and management. Conclusion. Findings from this study suggest that clinician gender is a key factor that influences SDM involvement preferences. Future research should focus on targeted questions to delve deeper into the specific aspects of SDM in gender-discordant patient-clinician relationships.

Purpose/Background Type 2 diabetes is a chronic metabolic disorder affecting millions of individuals worldwide. Research has shown that individuals with diabetes are at a higher risk of developing depression in comparison to those of the general population. Depression affects the individual's emotional well-being and has a significant impact on the management and outcomes of diabetes (Mather, 2022). This research study aims to investigate the feasibility and effectiveness of implementing the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is one the most effective assessment tools available to identify symptoms of depression (Celik, 2020). Methods In this retrospective chart review, at least 50 charts of patients that ranged ages 30 to 78 with a diagnosis of type 2 diabetes were screened for depression from September 18, 2023 to November 29, 2023. The reviewers were assessing whether or not the PHQ-9 was administered to assess for comorbid depression in patients with Type II Diabetes diagnosis. Results This protocol was approved by the University of Tennessee Health Sciences Center (UTHSC) internal board review. Data was collected from the University Clinical Health/UT Family medicine in Memphis, TN with the assistance of Laura Reed, DNP-FNP. Of the 29 charts reviewed, 16 of the patients that met the criteria were assessed with the PHQ-9, and 13 were not. The data revealed there was a possible decrease in the likelihood of administering the PHQ9 to patients as they get older. On average, women were screened higher in comparison to men. Implications This research study will contribute to understanding the prevalence and impact of depression in individuals with type 2 diabetes. The findings may inform healthcare providers about the importance of routine depression screens and its potential benefits of early intervention. Implementing the PHQ-9 as a screening tool within the diabetes population can facilitate the identification and management of depression which can potentially lead to improved overall health outcomes for patients with type 2 diabetes.

Purpose/Background Ventilator-associated pneumonia (VAP) is a severe problem in pediatric intensive care units (PICUs), resulting in increased morbidity, mortality, duration of stay, and healthcare expenses. Traditional preventative measures are well-established, but the influence of ventilator filters in preventing VAP is unknown. The current evidence on the efficacy of VAP bundles and ventilator filters is variable and challenging to address. This scoping review aims to determine how VAP bundle compliance and ventilator filter utilization impact the incidence of VAP in mechanically ventilated pediatric critical care patients. Methods A scoping review was carried out per the Population, Concept, and Context (PCC) framework. We conducted a scoping literature review utilizing CINAHL and PubMed databases. 241 articles were initially identified and assessed, yielding 12 that met qualifying standards and were accepted. The Rapid Critical Appraisal (RCA) instrument from Ohio State University College of Nursing was used for data extraction, classification, and quality assessment. An outcome synthesis table and level of evidence table were used to synthesize the results. Results The scoping review included data from various Level I to VII studies, highlighting the importance of ventilator filters and VAP bundles. Although VAP bundles were consistently shown to reduce the incidence of VAP, the effects of HEPA filters varied in research findings. No literature discussed the direct correlation between HEPA filters and VAP incidence. This review concluded that the implementation of VAP bundles was consistent with a decrease in the duration of mechanical ventilation, hospital stay, ventilator-associated pneumonia incidence rates, mortality rates, and economic cost. Implications for Nursing Practice Ventilator filters, especially the HEPA variants, can stop disease spread. Numerous studies revealed modest reductions, underscoring the necessity for context-specific research. Since there are limitations due to the variability of patient demographics and interventions among studies, future research should adopt standardized methodologies to improve generalizability and identify the most effective preventative treatments for ventilator-associated pneumonia in pediatric critical care.

Decreasing Re-Intubation Rates in Mechanically Ventilated Adult Patients: A Scoping Review Purpose/Background Critically ill patients often require mechanical ventilation to support respiratory function. Prolonging mechanical ventilation can increase adverse outcomes. Weaning patients from the ventilator as soon as clinically appropriate can decrease adverse outcomes. The decision to wean mechanical ventilation lacks a standardized approach. This scoping review will evaluate the literature about the effectiveness of a standardized weaning protocol in decreasing the number of reintubations within 72 hours of extubation. Methods We conducted a literature search on PubMed, CINAHL, Scopus, and Medline between November 2020 and November 2023 using key terms such as adult, critically ill, intubation, mechanical ventilation, ventilator weaning, reintubation, and others. Inclusion criteria included English language, peer review, and publication within the last ten years. Ten articles were included after rapid critical appraisals. Results Ten articles that studied mechanically ventilated adult patients were reviewed between 2006 and 2021. None of the articles found any practices that decreased re-intubation rates. However, most of the articles in this scoping review supported practices that helped decrease time spent on mechanical ventilation, ICU length of stay, and mortality rate. Implications for Nursing Practice The evidence gathered from this scoping review showed no benefit in decreasing re-intubation rates in mechanically ventilated adult patients. That does not mean the data lacked benefits for future practice. The evidence showed the benefits of nurse-driven extubation protocols and early extubation to noninvasive positive pressure ventilation. ICU and Pulmonary teams should be shown the benefits of these nurse-driven extubation protocols and the effects they can have on their patients.

Background The Centers for Disease Control and Prevention (CDC) found that each day more than 140 U.S. residents die from drug overdoses, specifically due to opioids. Due to this, alternatives were created to reduce overdoses and ensure safety. Medication assistance therapy (MAT) is an effective form of treatment for people with substance use disorders and is defined as the use of medication in conjunction with counseling or therapy for the treatment of substance use disorders. The efficacy of MAT is used adjunctively with psychotropic medications compared to using no MAT and using psychotropic medications alone with individuals who are experiencing first-episode psychosis and have a co-occurring substance use disorder with an overall goal to reduce hospital re-admissions and psychosis. Methods Many sources such as Google Scholar, EBSCO, Elsevier, and the University of Tennessee Health Science Center (UTHSC)’s electronic library. All articles that were chosen were critically appraised via rapid critical appraisal to identify the type of evidence and study such as randomized control trials, cohort studies, and systematic reviews. strategically selected articles that also had recommendations to treat substance use disorder and first-episode psychosis. Results Many articles came to the same conclusion that for a patient who is experiencing their first episode of psychosis and MAT treatment with psychotropics is initiated at this time, the overall patient outcomes in terms of hospital readmission rates and quality of life are better. There were inconclusive results on hospital admission rates likely due to the nature of the patients that researchers are dealing with for these studies. Conclusion To conclude, it is apparent that the correlation between substance use disorder and psychiatric illness is complex and difficult to treat concurrently. More research is needed to fully understand its efficacy when used adjunctively with psychotropic medications in individuals experiencing first-episode psychosis.

Purpose/Background Delirium is a prevalent challenge among ICU patients, impacting approximately 30% of admissions (Brennan et al., 2023). If left untreated, delirium can increase use of restraints, hospital length of stay, intensive care unit length of stay, and ultimately, morbidity and mortality. This scoping review assesses the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to gauge its efficacy in reducing the length of stay in the ICU for adult patients with delirium. Methods A literature review from 2018 and 2023, using PubMed, CINAHL, and Medline were utilized for the search along with key words such as: length of stay, confusion assessment method (CAM), intensive care unit, and delirium bundle. Ten articles consisting of meta-analyses, systematic reviews, controlled trials, and observational studies met our inclusion criteria. The focus was on CAM-ICU's role in identifying delirium and its impact on the ICU length of stay. Results CAM-ICU, with 94% sensitivity and 89% specificity, emerged as an effective tool for delirium identification in the ICU setting (Mailhot et al., 2022). The selected articles revealed diverse outcomes regarding ICU length of stay. Three studies reported a decrease, while five indicated an increase in ICU stays when delirium was present. Importantly, CAM-ICU consistently operated within comprehensive delirium bundles challenging assumptions that CAM alone decreases length of stay without other interventions in the bundles. Implications for Nursing The findings underscore the effectiveness of CAM-ICU for delirium identification. With its high sensitivity, CAM-ICU proves valuable in early detection of delirium. However, the varied impact on ICU length of stay emphasizes the necessity for nursing involvement in the execution of CAM-ICU assessments within the broader framework of delirium management. Ultimately, nurses can play a pivotal role in contributing to enhanced patient outcomes by utilizing CAM-ICU as part of comprehensive delirium interventions in the ICU.

Purpose/Background The need for effective pharmacological management in patients with congestive heart failure (CHF) and type II diabetes mellitus (T2DM) is an ever-growing task for healthcare providers, especially in the primary care setting. Patients with multiple comorbidities are less likely to adhere to required rigorous medication schedules and lifestyle modifications, resulting in accelerated disease progression and defeated efforts of healthcare providers. Traditionally, sulfonylureas have been the medication management of choice by healthcare providers due to their affordability compared to modern medication. Current guidelines recommend that individuals with poor glycemic control could benefit significantly from using older sulfonylureas with other antidiabetic medications, although the non-sulfonylureas are the safer option. This scoping review examines the benefits of initiating either a sodium-glucose co-transporter 2-inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP1RA) versus a sulfonylurea in reducing hospital readmissions within 30 days of discharge in adults hospitalized with T2DM and CHF. Methods A literature review was conducted from August 2021 to November 2023 through PubMed, CINAHL, Medline, and Ovid databases with 81 articles containing our keywords. The authors reviewed the abstracts and found 18 eligible articles meeting the inclusion criteria for the review. Inclusion criteria included peer-reviewed, free access, full-text availability, English language, and publication within the past five years. A rapid critical appraisal tool was used to determine the validity and reliability of eligible articles. Ten articles were selected based on quality and relevance. An evaluation table evaluated the efficacy and outcomes of initiating sulfonylurea medications versus SGLT2i or GLP1RA medications in adults with T2DM and CHF. Results The articles in the review consisted of five systematic reviews, three randomized controlled trials, and two cohort studies. Eight articles found a decrease in heart failure hospitalizations, decreased risk for cardiovascular outcomes, and decreased all-cause mortality with the initiation of SGLT2i. With sulfonylureas, five articles showed a neutral impact on heart failure hospitalizations, one article found an increase in heart failure hospitalizations, two articles showed a neutral effect on cardiovascular outcomes, and three studies found an increased risk in cardiovascular outcomes. GLP1RAs decreased the risk for cardiovascular outcomes and all-cause mortality in four articles with reduced heart failure hospitalizations compared to sulfonylureas but a neutral impact on hospitalizations compared to SGLT2i. We could not find a single study that directly compared the efficacy of SGLT2i or GLP1RA to sulfonylureas as monotherapies in reducing 30-day hospital readmissions.

Purpose/Background Hypoxia is a severe adverse event that is often associated with sedated endoscopy procedures, and bariatric patients have a significantly higher risk for complications related to oxygenation during sedation due to pathophysiological changes to the respiratory system. This scoping review compares the rate of hypoxemic events with the use of a binasal cannula versus a procedural oxygen mask during inpatient endoscopic procedures in patients aged 19-64 with a BMI greater than 40. Methods The scoping review includes control trials with and without randomization, case-control/cohort studies, systematic reviews, and qualitative/descriptive studies. With limited research regarding the PICOT, extending the age of qualifying articles beyond the desired five years was necessary. This scoping review focuses on utilizing the POM mask to prevent hypoxia during upper endoscopies and some alternative approaches. Databases utilized for this review include EBSCO, CINAHL, Pubmed, and Medline. The literature search initially resulted in 10,525 articles, which then were narrowed down to 10 based on their pertinence to the PICOT question. Results Many outcomes were reported, the most commonly being hypoxemic events with a BMI >30 without preoxygenation, hypoxemic events with a BMI >30 with preoxygenation, hypoxia with a bi-nasal cannula, and procedural termination with preoxygenation. Data from randomized control trials and case-control studies showed a decrease in both hypoxemic events and early termination of the procedure with adequate preoxygenation. Four reports of decreased instances of hypoxemia were reported with the bi-nasal cannula; however, there were also four reports of increased instances, leaving mixed results. Implications for nursing practice A summary of the evidence supports using the procedural oxygen mask in the bariatric population undergoing endoscopy procedures. Current research indicates that the POM should be the new standard of care due to this population's dramatic decrease in hypoxemic events. Anesthesia providers should stay updated on the standard of care and best practices related to bariatric endoscopies.

Purpose/Background The induction of anesthesia using hypnotic sedatives, such as etomidate and midazolam, is common practice. Etomidate and midazolam are commonly employed in the induction of anesthesia in the septic patient population, each with its unique advantages and drawbacks. This scoping review aims to synthesize evidence on the effects of anesthetic induction with etomidate versus midazolam in adult septic patients, focusing on the incidence of mortality and associated adverse effects during hospitalization. The purpose is to establish a standard of care for anesthetic induction in this population. Methods A literature review was conducted from September 2022 to March 2023 utilizing CINAHL Complete, SCOPUS, Access Medicine, Cochrane Library, and PubMed databases. Over 100 articles were found utilizing our keywords, which included induction agent, etomidate, midazolam, critical illness, sepsis, septic shock, severe sepsis, mortality, and hospital length of stay. Of these, 25 articles met the author’s inclusion criteria and underwent Rapid Critical Appraisal (RCA) to assess the quality and validity of the studies. This appraisal yielded ten articles that were further synthesized and classified by their level of evidence table. Results Ten studies were examined to assess the effects of etomidate and midazolam on septic patients. The results showed that when etomidate is used to induce anesthesia in septic patients, it can lead to increased in-hospital mortality rates and longer ICU and hospital lengths of stay. Additionally, six studies found that etomidate can cause adrenal gland suppression. On the other hand, midazolam was associated with lower mortality rates when used to induce anesthesia in septic patients. However, there is insufficient data concerning its ability to produce profound anesthesia in septic patients without causing undesirable hemodynamic changes. Based on the available data, midazolam is considered to be the safer option for inducing anesthesia in septic patients. Implications for Nursing Practice The results of the scoping review support that etomidate usage is linked to longer stays in the ICU and hospital and higher hospital-wide mortality compared to midazolam. These findings indicate that the use of midazolam to induce anesthesia in septic patients is preferred but not without risks to patients. Anesthesia personnel should be educated when utilizing midazolam, blood pressure should be monitored closely, and timely intervention should be conducted to prevent hemodynamic changes. The results of this scoping review highlight the need for a standard of care to be established on what medications to use during the induction of anesthesia in septic patients. Further research is needed to guide nurse anesthesia practice for improved septic patient outcomes.

Diets are often viewed as a quick fix to obtaining a goal weight or achieving a dream body. What people fail to understand are the processes that take place within the body while undergoing a particular diet. While some diets may aid in weight reduction, the harm put on the body is easily overlooked. Through an in-depth analysis on three of the most popular fad diets—the ketogenic diet, intermittent fasting, and the Paleolithic diet—shows how the diet came about, how it works in the body from a basic to a cellular level, and the risks posed by these diets. Knowledge in this area might change the perspective of dieting as a whole with information about what the body is undergoing.

Oral hormonal birth control is frequently used by women for the regulation of medical conditions or as a contraceptive method. However, many women are dissatisfied with the side effects they experience while taking birth control, such as mood changes or oligomenorrhea. The primary objective of this paper is to conduct a scholarly literature review of the side effects caused by oral hormonal birth control, including an explanation of the mechanism of action of these contraceptives on the female reproductive system. The results of this review showed that some perceived side effects, such as weight gain, have little scientific basis, while other side effects, such as stroke, myocardial infarction, and mood changes, are significantly affected by risk factors women may possess.

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid Purpose/Background Smoking increases an individual’s risk of acute and chronic disease morbidity and mortality, as well as creating a financial burden for the individual and healthcare system. In the United States, tobacco smoking is the leading cause of preventable death. There are an estimated 5 million tobacco-related deaths each year due to tobacco smoking. Additional healthcare costs are also seen due to the need for increased treatments, medical supplies, and staffing. Previous research for smoking cessation resources has primarily focused on traditional primary care offices. Research shows that in-person counseling may be used as a behavioral modification tool to increase smoking cessation rates. Individual counseling alone was seen to be effective and increase the likelihood of cessation compared to less intense treatment. The purpose of this quality improvement project is to assess the number of patients who are current tobacco smokers and were referred to in-person smoking cessation counseling. Methods Electronic medical records (EMR) from a metropolitan underserved primary care clinic in Memphis, TN were queried for patient-reported smoking and tobacco use from January 1, 2023-June 30, 2023. Fifty EMRs were identified and reviewed for the number of patients referred to an in-person smoking cessation counseling program. For the study population, patients were randomly selected and had to be 18 years or older. Included were adult patients ages 30-78 with a diagnosis of tobacco/ smoking use documented in the EMR. Of the individuals referred, groups were divided by gender and by those who attended in-person counseling and those who did not. Results Of the 50 identified patients, 29 (58%) were referred to an in-person smoking cessation counseling program. Patients referred were predominantly female (72.4%) with a mean age of 52.8 [range 30-78] years. Among those referred, 55.2% attended the counseling program. Implications for Nursing Practice In-person smoking cessation counseling is an effective aid for smoking cessation, with more than half of those referred attending the program. Females are more likely to be referred to smoking cessation counseling and attend. Implementing referrals to smoking cessation counseling may be an effective smoking cessation intervention, specifically for females. More research is needed regarding patient follow-up and long-term smoking cessation, as this study did not include these measures. This study is feasible and may be replicated in practice. In-person counseling is another method that may be used to aid in smoking cessation. Future research should include identification of patient demographics, like smoking history, socioeconomic status, current comorbidities, and previous attempts at smoking cessation.

Full Study Title: Food Insecurity Screening of Families in a Level III Neonatal Intensive Care Unit Background: Early infancy food insecurity (FI) is linked to poor health later in life, and Neonatal Intensive Care Units (NICUs) are often overlooked. Routine FI screening can help identify and assist the families suffering from FI seen in the NICU before being discharged home. Purpose: The aim was to identify if families were assessed for FI by social workers or if they were more likely to report FI in a brief survey. Method: A randomized chart review of social work notes for 30 NICU patients at Regional One Health from January 2023 to June 2023 was conducted to determine if FI was screened. A three-question-FI screening tool was placed in all patient charts from October 2023 to December 2023. The NICU nurses and researcher asked admitted families to complete the survey during visits. Inclusion criteria included parents greater than or equal to 18 years old and English-speaking. Results: The chart review identified no explicit statements surrounding FI in the social work notes. The team anticipated 50 or more returned surveys throughout the study but received only 33 completed surveys. Thirty surveys were included in the study. Around 17% of families discussed receiving food assistance with social workers, whereas 39% reported FI via the survey. Conclusion: Screening via a brief survey was successful but not cohesive to the Regional One Health NICU. A different distribution method may offer better results.

Background Although more commonly diagnosed in adults, type 2 diabetes is increasingly diagnosed in pediatric populations in the United States. Research suggests a correlation between depression and type 2 diabetes, however, a gap in research exists regarding depression and type 2 diabetes among pediatrics, specifically adolescents. This scoping review aims to address this gap by assessing the impact of depression screening on glycemic control in this specific population. Purpose The goal of the review is to contribute to the development of effective strategies for depressing screening in adolescents with type 2 diabetes, with the expectation this may positively impact glycemic control. Methods Between August 2022 and November 2023, a journal review was conducted to identify studies that examined adolescent depression in those with a type 2 diabetes mellitus diagnosis. Individual searches were conducted across various sources such as PubMed, Medline, and CINAHL. The following keywords were used to identify articles: adolescent, youth, depression, type 2 diabetes, depression screening, standardized screening, glycemic control, and HbA1c. Results Thirteen articles were identified following rapid critical appraisal, which yielded a final selection of eleven articles used in this review. Prior studies have primarily been limited to either type 1 diabetes or adults without fully exploring the relationship of depression in adolescents with type 2 diabetes. Thirteen articles were identified, yielding a final selection of 11 articles after rapid critical analysis used in this review. These consisted of five cohort studies, two descriptive studies, and four quality-improvement studies. All studies completed baseline depression screenings while most obtained HbA1c, but less than half examined any relationship between the two, yielding inconsistent findings. Implication for Nursing Practice The outcomes in this scoping review identified that more research is needed to establish any correlation between depression screening and type 2 diabetes. The articles used in this scoping review evaluated HbA1c measurement, glycemic control, and mood regulation in the adolescent population but not how they co-relate. These findings support the idea that incorporating depression screenings at regular intervals into the care of adolescents with type 2 diabetes may help providers prioritize both the physical and mental health of at-risk patients.

Purpose/Background Depression in adolescents is rising each year. Early detection of depression has been shown to result in better health outcomes and success in school. This scoping review aims to evaluate the implementation of universal depression screenings in the high school setting and how this detection of depression and initiation of treatment. Methods From August 2022 to November 2023, we used the Medline, PubMed, Elsevier, Google Scholar, and PsycINFO databases, using specific keywords related to depression in adolescents. Of the 38 articles found, 10 were chosen after extensive article critique. The publication dates ranged from 2014-2023, were full-text, and from peer-reviewed sources. Results One study comparing the use of the PHQ-9 and PHQ-2 showed that even though the PHQ-2 was easier and simpler to administer, the PHQ-9 proved to be superior in identifying depression. An interesting finding in another study shows that the use of the Beck Depression Inventory may be the most helpful in community settings but not with those with poor self-image or where comorbidity is high. Implications for Nursing Practice Results in this scoping review show that implementation of depression screenings in high school adolescents not only helps identify depression earlier but also helps patients initiate treatment. Implementation of depression screenings is needed in high schools and will only help the adolescent population receive the help they need.

Purpose/Background Urinary tract infections (UTIs) are a common diagnosis among children. Patients must fully comply with treatment regimens to reduce the risk of recurring UTIs and prevent long-term complications. This scoping review aims to evaluate the literature and examine the association between screening for social determinants of health (SDH) and adherence to UTI treatment. Methods A thorough literature search via PubMed, Cochrane Library, Elsevier Clinical Key, CINAHL, and JAMA was conducted with the following keywords: Pediatric UTI, Adherence to Treatment Plans, Social Determinants of Health, Social Needs Screening, and others. Ten articles were appraised for their evidence and quality. The articles focus on the diagnosis of a UTI in the pediatric population, social needs screening, SDH, and treatment compliance. A synthesis of results table was composed to examine SDH and evaluate the association between social needs screening and improved outcomes. Results The literature review indicates a correlation between unmet social needs and patient outcomes. UTIs can affect patients and their families, and in-person interventions can improve compliance and health outcomes. Two studies reported improved health outcomes following social needs screening and allocation of resources. Two studies highlight the importance of the medical home and provider's role in assisting with social needs. Implications for Practice The results of this scoping review highlight the need for social needs screening and provide insight into the effects that unmet social needs can have on treatment compliance. Providers can strive to improve patient outcomes by screening for social needs and allocating resources. This review highlights the need for further research into implementing social needs screening in clinical practice to reduce UTIs and improve compliance in the pediatric population.

Infection control practices (ICPs) are crucial for maintaining the health and safety of residents in a residential care community (RCC). This paper examines the differences in COVID-19 infection rates and cases based on the characteristics of RCCs, such as ICPs, personal protective equipment (PPE) shortages, ownership type (for-profit vs. nonprofit), census regions, and RCC size. While ICPs contribute significantly to preventing and controlling the highly contagious virus, a comprehensive program is encouraged to provide a targeted intervention based on RCC’s environmental factors. The importance of the characteristics of the RCCs must be considered in combing with the ICPs to enhance the impact of the infection practices, which will substantially improve the overall success of the infection control and prevention in COVID-19 outcomes. Systems Theory offers the lens for researchers to evaluate, examine, and compare various factors that are associated with the outcome of disease transmission and how those factors are related in certain settings. It facilitates the components such as census region, PPEs, size of the facility, and ownership type (for-profit vs. nonprofit) that are closely linked and provides feedback in a more accurate way to improve the overall success of the process. The study employed ANOVA to test the mean difference between each characteristic, revealing that for-profit and larger organizations tend to have higher infection rates in terms of the ICPs outcomes. However, there were contradictory results concerning other variables for PPE shortages and geographical variations (p>0.05), calling for more diverse explorations regarding the prevalence of ICPs and characteristics of RCCs in the future research.

The purpose of this study was to investigate the acute responses of accentuated eccentric loaded (AEL) back squats to induce a postactivation performance enhancement (PAPE) effect in youth athletes across three jump conditions: countermovement jump (CMJ), squat jump (SJ), and novel propulsive-only jump (POJ). Fifteen participants (age: 15.6 ± 1.1 years; RT experience: 1.3 ± 0.9 years; relative strength: 1.32 ± 0.3) three sessions (one familiarization, two experimental). AEL interventions were performed on each experimental session, (3 sets x 3 repetitions) (ECC: 95%, 105%, 115%: CON: 60% 1RM) with pre- and post-testing (3 min, 6 min, 9 min, 12 min). Using a crossover design, random assignment to either (a) CMJ, (b1) SJ+POJ, or (b2) POJ+SJ, where jump height (JH), net propulsive impulse (NPI) and peak relative propulsive power (PRPP) were assessed for each jump. Three 3x5 repeated measures ANOVAs were used to analyze each dependent variable across jump conditions and time. Results revealed a significant increase in POJ JH performance at 9 min (+12.26% ± 13.65%, p < 0.05), whereas CMJ and SJ performance did not show statistically different values from pre-testing for JH, NPI, or PRPP. No significant changes were found for JH, NPI, or PRPP for CMJ or SJ. Although, JH performances peaked at 12 minutes for CMJ (+2.22% ± 7.71%) and SJ (+5.03% ± 12.77%) but did not reach statistical significance. The findings of the study suggest that male high school basketball players may realize superior or unaffected jump performances at 9-12min post-supramaximal AEL back squats. In addition, no significant deficits in performance outcomes were found for any condition from pre- to post-testing. Future research should expand the use of AEL with youth populations, and the practical use of the POJ as a training and performance tool.

Purpose/Background Cervical cancer is the fourth leading cause of cancer affecting women worldwide (Staley et al., 2021). With cervical cancer being a preventable disease, an effective method of reducing healthcare costs and mortality is primary prevention, such as screenings. Financial burdens and barriers to accessing medical care may result due to the lack of proper cervical cancer screenings. Detecting cervical cancer includes screening women 21 to 65 years old with a Papanicolaou (PAP) test every three years. Women aged 30 to 65 years old can extend the screening of cervical cancer by having a Human Papillomavirus (HPV) test along with a PAP test conducted every five years, according to the United States Preventative Service Task Force (USPSTF) (National Cancer Institute, 2022). The cessation of cervical cancer screening can occur for women aged 65 years or older who have had three sequential negative PAP tests or two sequential negative HPV results within ten years (U.S Preventive Services Task Force [USPSTF], 2008). Patient education emphasizing the benefits of cervical cancer screenings has been shown to improve compliance with screening recommendations. Methods A retrospective chart review at a metropolitan underserved primary clinic in the Midsouth was conducted consisting of 29 charts from women ages 18 and above with visit dates between January 1, 2023 and August 31, 2023. Descriptive statistics were generated and analyzed of the women’s age, race, visit date, insurance type, and their presence of an up-to-date pap smear per USPSTF guidelines. Results Between January 4, 2023 and August 15, 2023, 29 women (N=29) met eligibility criteria. Women’s ages ranged from 24 to 66 (M=46.97, SD 10.39). Findings indicate that 16 women (55.2%) had up-to-date PAP smear testing per USPSTF guidelines. Women who received up-to-date PAP smear testing had a mean age of 45.1 compared to the mean age of 49.3 in women without up-to-date screening. Implications for Nursing Practice The results of this retrospective chart review provide valuable insight into how many women prioritize having an up-to-date PAP smear in a primary care clinic. While the data indicates that 55.2% of women had up-to-date PAP smear testing, the mean age of women without up-to-date screening was only 4 years older (49.3) than the mean age of those who did have up-to-date PAP smear testing (45.1). At the same time, only slightly more than half of women had up-to-date PAP smear testing, leaving a significant portion of women still requiring valuable education. While further study is required to better understand the prevalence of cervical cancer screening, it is evident that further education on proper cervical cancer screening is recommended.

This study encompasses three significant chapters focusing on diverse yet interconnected aspects of pharmaceutical research. Chapter 1 delves into the complexities of drug development, emphasizing the challenges and the pressing need for advanced technologies to streamline the process. Computational methods like Computer-Aided Drug Design (CADD) extend their scope beyond small molecules, aiding in the design of intricate biomolecules vital for biomedical advancements, especially in immunotherapy. Chapter 2 introduces the Near-Neutral Balanced Selectionist Theory (NNBST) validated through analysis of Dengue virus evolution. The unique features observed align with NNBST, surpassing existing theories. This approach offers a deeper understanding of viral evolution dynamics, identifying conserved segments critical for vaccine development and shedding light on potential drug targets, amplifying the battle against Dengue. Finally, Chapter 3 focuses on molecular dynamics simulations of a novel anti-HER2 Chimeric Antigen Receptor (CAR) for HER2-positive cancer treatment. The proposed Binding Induced Domain Dynamics Switch (BIDDS) unveils a new signal transduction mechanism, revolutionizing the understanding of CAR activation. This breakthrough not only challenges existing models but also opens avenues for broader applications in receptor-based therapies. These chapters collectively represent a multidisciplinary approach merging computational techniques, evolutionary biology, and molecular dynamics simulations, promising significant contributions to drug development, viral evolution understanding, and therapeutic advancements in cancer treatment.

Purpose/Background Schizophrenia is a lifelong illness with recurrent and often debilitating symptoms that may impair daily functioning, cognition, behaviors, socialization, emotions, and expression. It is recognized as a global mental health burden that affects the individual, their family, and society. Medication nonadherence and resulting relapse detrimentally affect the patient’s physical and mental health and quality of life. They are associated with increased hospitalization and emergency room visits, substance use, suicide, and homelessness. Current guidelines endorse second-generation antipsychotics such as Risperidone and Aripiprazole as the first-line treatment for most cases of psychosis. However, long-acting injectable (LAIs) atypical antipsychotics are a promising alternative to overcome noncompliance in treating Schizophrenia and help increase treatment adherence, decrease the likelihood of discontinuation, and provide better symptom management. The purpose of this project is to assess the benefits long-acting injectable antipsychotics have on treatment adherence, decreased re-hospitalizations, and relapses for treating individuals with schizophrenia. Methods This retrospective chart review was performed at Vanderbilt Adult Psychiatry Outpatient Clinic (VPH-OP) via electronic database access by an EMR Analysts (EStar), where participants were selected based on inclusion criteria for the long-acting injectables group and the oral antipsychotic group. Inclusion criteria included current establishment as a patient at the VPH-OP Clinic, greater than 18 years of age, a diagnosis of schizophrenia spectrum disorders and bipolar disorders per the DSM-5, and current treatment with antipsychotic medication. Participants who met criteria based on medication were randomized into the long-acting injectable group (n-15) and oral antipsychotic group (n=15). Data was collected in the Redcap data collection tool for deidentification and included age, race, gender, diagnosis, oral or long-acting injectable medication, missed appointments, in-patient hospitalizations, and whether the medication was changed, maintained, or discontinued. Data was collected from October 1, 2022, to October 31, 2023. The study was approved by the respective Institutional Review Boards. Results The study showed that there is no significant difference in inpatient hospitalization between oral antipsychotics and long-acting antipsychotics. 3 out of 15 LAIs compared to 3 out of 15 oral antipsychotics participants had inpatient hospitalizations. The study showed a slight significant difference in medication changes, discontinuation, and missed medication appointments. In 3 out of 15 LAIs compared to 4 out of 15 oral antipsychotic participants, medication was changed or discontinued. 9 out of 15 LAIs compared to 10 out of 15 oral antipsychotics out of 15 LAIs compared to 10 out of 15 oral antipsychotics participants missed medication appointments. Implications for Nursing Practice The study shows there are some beneficial aspects to using LAIs compared to oral antipsychotics. Future studies with a larger sample size would be beneficial to evaluate treatment adherence and examine statistical differences between LAIs and oral antipsychotics in patients with schizophrenia. Adherence to treatment for schizophrenia has been a difficult task due to the complicated symptomology of side effects associated with antipsychotic medications. Continuous studies to find the most efficient medications are imperative to help advance the treatment of individuals with schizophrenia.

Purpose/Background Type 2 diabetes mellitus (T2DM) is a common, chronic disease that increases the risk of coronary artery disease and stroke fourfold, which makes protecting cardiac function a priority. The American Diabetes Association (ADA) and American Heart Association (AHA) recommend the prescription of statins to reduce cardiovascular complications. Unfortunately, provider and patient adherence to this recommendation is poor.This study aimed to determine if shared-decision making and patient follow-up within a 6 month period of being newly diagnosed with T2D has an effect on the initiation rate of statin therapy. Methods In this retrospective study we requested data from the University of Tennessee Family Medicine clinic on newly diagnosed diabetic patients from December 2021 to December 2023 that met criteria (40 years or older, eligible for statin therapy, new diagnosis of T2D, had at least one follow-up appointment within the last 2 years). Information requested included the patient’s sex, age, baseline HbA1C, referral date, and whether or not statin therapy was initiated within 6 months of diagnosis. The data was then analyzed for descriptive statistics using Intellectus statistical analysis software. Results Twenty-nine patients (8 male, 21 female) met inclusion criteria. The mean age of the participants was 52.8 years (female mean age: 54.9 years; male mean age: 47.5 years), and the mean baseline HgA1C was 9.16%. Of the 29 patients included in the study, 100% of them had statin therapy initiated within 6 months of diagnosis. Implications for Nursing Practice The results of this study are reassuring that patient follow up within 6 months of a new T2D diagnosis is key in initiating current statin therapy guidelines. These findings reinforce the essential role of nurse practitioners in the management of T2D and associated cardiovascular risk, highlighting the importance of patient education, regular monitoring, and collaborative care.

Purpose/Background The 988 Suicide & Crisis Lifeline is a mental health-specific emergency line that became nationally available in July of 2022. This resource allows callers in crisis to connect with trained mental health professionals. Despite the initiation of this new dispatching service, there is still a significant shortage of trained mental health professionals to respond to these calls when they require emergency intervention. The present scoping review aims to determine whether non-police crisis responses correlate to improved outcomes when compared to police response as evidenced by reduced inpatient admissions, reduced arrests, and decreased presence of intrusive traumatic symptoms following intervention. Methods CINAHL and PubMed were searched using the University of Tennessee Health Science Center (UTHSC) library from September 2022 until November 2023. These search terms yielded 377 articles. Of those articles, only 335 were published in English, 200 were published after 2013, 198 had full-text publications available, and 21 were either a review or systematic review rather than an article or abstract. The remaining 21 articles were assessed using a Rapid Critical Appraisal tool. Ten articles remained after critical appraisal; the results of these articles were charted within the scoping review. Results This scoping review compared police versus non-police response to crisis calls. The synthesized results were obtained by critically appraising ten articles. This scoping review indicates that non-police response may result in the following improved patient outcomes: a decrease in involuntary hospital admission, arrest, and violence between the crisis caller and police. However, the shortage of quality experimental evidence limits the power of this indication. Implications for Nursing Practice The results of this scoping review indicate that non-police response to 988 calls may result in better patient outcomes. Due to this topic's recency, nurses should advocate for more quality research to provide patients with the best possible evidence-based crisis response.

Purpose/Background Type 2 diabetes mellitus affects 13.1% of adults living in Shelby County and over 30 million adults in the United States. This chronic disease creates a higher risk of macrovascular and microvascular complications for this population resulting in poor outcomes if not properly managed. Improving glycemic control can help to improve the quality of life for people living with diabetes and reduce healthcare costs. Currently 20% of funds spent in the United States on healthcare is utilized for diabetic care. Certified Diabetes Care and Education Specialists (CDCES) primarily educate patients about managing their diabetes, including health promotion that can improve healthcare outcomes. Data shows that referrals to a CDCES by a primary healthcare provider can help improve A1c levels and diabetes management for people with poorly controlled diabetes. The purpose of this quality improvement project is to show the value of CDCES visits in patients with poorly controlled type 2 diabetes in a metropolitan underserved primary care clinic and implement a successful CDCES referral program to improve the quality of care for these patients. Methods A retrospective chart review was conducted in a metropolitan underserved primary care clinic in the Midsouth region for patients with type 2 diabetes mellitus over 21 years of age who received at least one diabetes education session. Inclusion Criteria: Speaks the English language All races and ethnicities Male or female Age 21 and over Diagnosis of type 2 diabetes mellitus Hemoglobin A1c level greater than or equal to 8% Demographic data, baseline HbA1c, and post-education HbA1c were extracted from 29 random charts. All patients were deidentified to only include gender (21 females, 8 males) along with HbA1c results. A two-tailed paired samples t-test was conducted to determine the mean difference in pre- and post-intervention HbA1c at baseline, 3, and 6 months. Results A two-tailed paired samples t-test was performed to evaluate whether the mean difference of HbA1c pre- and post-intervention by CDCES was significantly different. The observations for baseline HbA1c had an average of 9.16 (SD = 2.84). The observations for the 3-month follow-up HbA1c after CDCES visit had an average of 8.32 (SD = 2.36). The results of the two-tailed paired samples t-test was not significant based on an alpha value of .05, t(28) = 1.64, p = .113. While the results were not statistically significant (p = .113), there was a detectable decrease of the mean HbA1c after CDCES visit. Implications for Nursing Practice The data analysis points to the effectiveness of CDCES intervention for adults living with poorly controlled type 2 diabetes. A team-based approach to managing diabetes can be helpful to people with poorly controlled diabetes. A referral to a CDCES should be offered to any patient struggling to manage diabetes to help improve health outcomes, reduce the total cost of care, and increase the health span of these individuals. Further studies could be conducted to follow patients for an extended duration to assess the effects of CDCES intervention on long-term control of diabetes.

Purpose/Background Postoperative delirium impacts as many as 51% of surgical patients, resulting in increased mortality and morbidity, longer hospital stays, and increased healthcare costs. Adults ≥ 65 have a high risk for developing delirium. This scoping review examines the use of dexmedetomidine in the perioperative period in adults ≥ 65 years old to prevent and treat postoperative delirium. Methods Using relevant inclusion criteria, an extensive review of the literature was performed from September through November 2022, utilizing the Cochrane, CINAHL, ClinicalKey, PubMed, and Embase databases. Search phrases included: dexmedetomidine infusion, dexmedetomidine, intraoperative dexmedetomidine, postoperative delirium, older adults, and elderly delirium. Three thousand one hundred and fifty-six articles met the search criteria. They were systematically pared down based on quality and relevance to twenty articles, and then evaluated with a Rapid Critical Appraisal (RCA) tool and placed in a synthesis table. Eight articles were selected for inclusion as the highest quality level I and II evidence available. Results In seven of the eight selected studies, perioperative use of dexmedetomidine decreased the incidence of postoperative delirium in adults ≥ 65 years. ICU length of stay decreased in five analyses, and mortality rate was unchanged or decreased in five analyses. The presence of dexmedetomidine- related bradycardia was less than other common perioperative medications in two articles and had varied presence in the other reports; use of dexmedetomidine was never reported in the selected studies to increase mortality or morbidity in adults ≥ 65 years old.

Purpose/Background The purpose of this quality improvement project is to provide and increase educational awareness and knowledge regarding iron deficiency anemia (IDA) in pregnant patients at an urban primary care clinic in Memphis, TN. This project is intended to decrease the number of individuals with IDA in pregnancy while decreasing the occurrence of IDA-related complications in pregnancy. The study aimed to introduce a cost-effective approach to help decrease or eradicate complications related to IDA during pregnancy. The World Health Organization (WHO) estimates the prevalence of anemia-complicating pregnancies to be more than 40 percent. Pregnant women with IDA residing in low and middle-income countries are at a higher risk of low birth weight, preterm birth, perinatal mortality, and neonatal mortality. Memphis is known as an urban, predominantly Black city, in which studies have shown that the prevalence of Black gravidas was >15 percent in the first trimester, around 20 percent in the second trimester, and close to 50 percent in the third trimester. Introducing IDA educational sessions can beneficially impact Memphis maternal and infant mortality rates and the number of complications and interventions related to IDA. Methods Researchers collaborated with the Midwives at Regional One Health Center’s (ROH) Hollywood Primary Care Clinic in Memphis, TN, to educate 25 pregnant women. The participants were administered a pretest before reviewing the IDA content. After completion of the pretest, an infographic was given to and reviewed with the patient during a 10-minute session. After reviewing the infographic, the participant took a post-test. All women gave consent to participate in this study in their first trimester (before 13 weeks gestation), were 18 or older, and had no known blood disorders or medical conditions that interfere with liver function. Results The pretest/post-test showed a significant correlation between IDA educational sessions and increased awareness. The results show the benefits of education in increasing awareness to help prevent pregnant women in Memphis, TN, from developing IDA and related complications. IDA educational sessions will continue to increase awareness amongst pregnant women. The likelihood of pregnant women complying with iron supplement regimens will steadily increase, thus decreasing the risk of IDA-related complications. Therefore, the results show that providing short educational sessions to mothers in their first trimester are not only cost-effective, but will also improve maternal and infant mortality rates, especially in underserved communities like Memphis, TN. Implication in Nursing Practice Pre- and post-tests will be administered before and after the iron deficiency anemia education session. The pre- and post-tests will be used to collect data regarding patient education on iron deficiency anemia in pregnancy before and after the education. This information will help determine if there is a correlation between patients receiving one-on-one education on iron deficiency anemia and their knowledge of patient compliance with iron supplementation. Once the education and data collection is completed, strengths and weaknesses should be identified for improvement throughout the project for more organized and efficient education.

This retrospective chart review examined female patients (N=25) who had a postpartum hemorrhage. Electronic medical records from Regional One Health were queried for ICD-10 072 related codes from January 1, 2021-October 31, 2023. Of those, a maximum of 25 charts were identified and the information was deidentified. All data was de-identified, coded, encrypted, housed, and locked securely. Selected records that met the above criteria were then queried for the following: Baseline demographics, gravida, para, amount of blood loss, pharmacological and non-pharmacological interventions, and timing of tranexamic acid (TXA) administration. Data was imported into MS Excel and statistical analysis was conducted using Intellectus Statistical Software. Continuous variables were reported as mean, median, and categorical variables as frequency (%).

A little more than a decade ago, CRISPR-Cas system was identified as a potential gene editing tool. This RNA-guided DNA cleavage system, which naturally provides immunity to the prokaryotic host cell, has been engineered since for its application in agriculture, genomic screening, and hereditary genetic disorder treatment and cures. Recently, a eukaryotic CRISPR-Cas-like system, Fanzor, was reported, under a new class of the RNA-guided system (termed OMEGA). The discovery has increased the potentials of genetic modification more than ever, while simultaneously increasing the need for ethical considerations and guidelines. The history, structure, and functions of the two RNA-guided systems, as well as their current and prospective applications, and the ethical and social issues surrounding genomic modification through specific case studies are discussed in this thesis.

Background: The opioid crisis in the United States has affected millions of individuals, causing high levels of opioid addiction among the population. With the onset of synthetic opioids, deaths from opioid-related causes have increased drastically. This study aims to understand the effect of opioid addiction and methods of controlling the problem for adult African Americans and Latinos at Pathways to Recovery Counseling and Education Services, Hazleton, Pennsylvania. Methods: The theories guiding this study are the Intersectionality Model and the Bay Area Regional Health Inequalities Initiative (BARHII) model. These theories reveal that factors such as age, ethnicity, and gender have a significant impact on opioid misuse patterns. Results: The study revealed that opioid addiction negatively impacted cognition, social life, and emotional control, as 45% of the participants felt isolated from friends and family, 35% of the participants experienced anger issues and frequent arguments, loss of employment among 30%, and an increased tendency to engage in crime, evident by the fact that 30% of the participants had been to prison or a correctional facility. About 60% of the participants started using opioids to control physical pain and emotional trauma, while 55% obtained non-prescription opioids from illegal sources. Gender did not appear to have an impact on opioid use, as men and women showed a similar pattern of using opioids. Conclusion: The use of opioids among adult Latinos and African Americans was influenced by their ethnicities, in addition to other factors, which limited their ability to access quality health services from healthcare facilities.

The change in payor fee-for-service to value-based care is creating an opportunity for primary care clinics nationally to adjust their focus to meeting key clinical quality measures during patient encounters. Colorectal screening is one of such quality measures. Previous research has shown that early detection saves lives. The guidelines have lowered the recommended age of initial screening to 45 due to the incidence of colorectal cancer in younger patients. But with all the objectives that need to be met in the limited time of the visit, how can nurse practitioners improve their efficiency? This evidence-based project assessed the implementation of eleven interventions combined into a toolkit designed to increase the clinic’s compliance to federally qualified health center (FQHC) standards of care by increasing colorectal cancer screening in the primary care setting. These steps were aimed at identifying patients eligible for screening along with predisposing high-risk factors, arming them with education to understand the importance of screening and the various methods, and priming a shared decision-making conversation with the nurse practitioner on arrival to the exam room. An eight-week trial of the toolkit revealed a significant increase in screening participation of the pilot clinic over the cohort clinic. Additionally, there was an overall increase in a secondary measure of improving staff’s knowledge of colorectal cancer and a third measure of bringing screening rates up to North Carolina benchmarks. A multi-interventional toolkit can improve essential screening and early detection of colorectal cancer, thus meeting clinic goals and standards of care and ultimately improving patient outcomes in the form of quality and subsequent length of life.

The purpose of this qualitative phenomenological study was to investigate whether advanced sonographer certification in the Diagnostic Medical Sonographic profession (general, vascular, and obstetrics) would support the national quality initiatives of the Centers for Medicare and Medicaid Services (CMS) that involve accurate diagnosis, patient safety, and lessening medical diagnosis errors. The research question(s) focused on sonographers and their perceptions of an advanced credential for qualified sonographers that could offer career advancement opportunities, adherence to patient safety, and increased quality initiatives in ultrasound departments in the United States. Consenting participants derived on a volunteer basis through the National Society of Diagnostic Medical Sonography (SDMS) who possess a current sonography credential and five years of minimal experience were completed using virtual online software. The transcripts of interviews, questionnaires, and survey responses combined with robust data analysis provided a complete description of the phenomenon. United States Sonographers support an advancing pathway for their profession that collaborates quality programs in their departments. The research additionally identifies that sonographer motivations change with tenure of service, and tenure is directly related to ergonomic injury susceptibility but that sonography professionals indicate their discontent with employer expectations of volume and scheduling conflicts.

The deoxyribose moiety of a nucleotide in the DNA molecule can act as a quantumlogic gate, in which the enantiomeric shift between the C2-endo and C3-endo conformations of each nucleotide, occurs within a logically and thermodynamically reversible situation of electron spin qubits, that are coherently held within the topologically insulating DNA crystalline nanostructure, and that are coherently conducted along the delocalized electrons of the pi-stacked nucleotide base pairs. The enantiomeric symmetry between the C2-endo and C3-endo conformations is logically and thermodynamically reversible because it functions as a symmetry-breaking Szilard engine that is effectively built out of the physicality of the information by which it functions, and therefore does not require information erasure to maintain function. Such a quantum logic gate is analogous to a Toffoli gate which operates across an energy barrier appropriate to the Landauer limit, to roll the DNA base pair and thereby break the pi-stacking coherence along a segment of the DNA molecule, thus effecting quantum-to-classical transition of information.

The terahertz speed CMOS microprocessor that has been designed by Averoses Incorporated (US11063118B1) utilizes nano-vacuum tube elements with plasma interconnect of those elements, and has the capability to emit, detect, conduct, and analyze electromagnetic signals in the terahertz range. Nano-vacuum tube systems are resistant to ionizing radiation and to high temperatures, and there are emergent potentials of such systems beyond the obvious speed-up of data processing. Such a microprocessor can provide a platform for compact terahertz spectroscopy, especially for organic molecules, and this can also include DNA sequencing and DNA fingerprinting. Another emergent quality of such a system is that, for the first time, a complete operating electromagnetic wavelength (0.3 mm for a 1 THz wave) will fit within the geometric boundaries of the microprocessor, allowing picosecond comparisons of waves and wavelet Fourier transform functions.

This qualitative case study's goal is to identify patterns in the health disparities experienced by African American women and to identify the factors that help and hinder African American females' ability to become health-literate consumers in the commercial and Medicaid markets. This study focuses on African American women's health outcomes and how they relate to health literacy. The purpose of this study is to increase health literacy for the African American population of women, specifically ages 18 and older. Various trends in health literacy are observed among all demographics. An example of this, specifically with African American women, is the misinformation in women’s care. In comparison to previous studies, this research will take a new approach. This approach takes into account the environment in which people reside and receive medical care. These methods include descriptive phenomenology. These secondary analysis and phenomenological research in the form of interviews. A purposive sampling of 15 African American women over the age of 18 participated in this study. Data collection procedures included surveys, interviews, and observations. The interview script and researcher notes, the teleconference and videoconference recordings, the audio transcription, and the data analysis were all employed as data-gathering instruments in this study. According to the participants' HQL survey results, only six out of 15 participants scored proficient in health literacy. This data is a direct reflection of how sociodemographic factors, backgrounds, and extent of health information used are relatable.

Bone marrow lesions (BMLs), occurs from fluid build up in the soft tissues inside your bone. This can be seen on magnetic resonance imaging (MRI) scans and is characterized by excess water signals in the bone marrow space. This disease is commonly caused by osteoarthritis (OA), a degenerative join disease where tissues within the joint breakdown over time [1]. These BMLs are an emerging target for OA, as they are commonly related to pain and worsening of the diseased area until surgical intervention is required [2]–[4]. In order to assess the BMLs, MRIs were utilized as input into a regression convolutional neural network (CNN). Initial experimentation handled the MRI using each individual slice in a 2D convolutional neural network as a baseline model, eventually progressing to a tensor stacked input into a 3D convolutional neural network. The viability and effectiveness of the models were evaluated using mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), and R2. The 3D regression CNN models were observed to perform better than the 2D regression CNN models.

Recovery from aerobic exercise is multifaceted and highly complex. Recovery includes cellular repair, substrate availability, autonomic nervous system status, and many other factors that comprise homeostasis. The present study is designed to assess the influence of diaphragmatic breathing after aerobic exercise to exhaustion. Diaphragmatic breathing is deep rhythmical breathing that is known to influence the autonomic nervous system, specifically through cranial nerve X (Vagus nerve). Subjects (n=12, age = 22.3±1.15 years old, height = 67.882.17 inches, weight =154.4515.20 pounds, BF% = 15.785.43). Performed four VO2max tests on two different days (2 each day). On each day, subjects performed a 20:00 recovery protocol between VO2 max tests. Heart rate (HR), heart rate variability (HRV), and blood lactate was measured directly after each rest protocol. HR, HRV, blood lactate, VO2max, and time to exhaustion (TTE) were compared using paired sample t-tests. Significance is set at p ≤ 0.05.HR was significantly lower after diaphragmatic breathing (p=.012). There were no statistically significant differences in any other variables between diaphragmatic breathing and the control rest intervention.

The purpose of this practicum is to identify the differences between between the athletic training professional and the strength and conditioning professional in a school which may cause barriers in using interprofessional collaboration. Currently, the rate of reinjury in a student-athlete population is quite high due, in part, to the different focuses between athletic trainers and that of strength and conditioning coaches. This practicum prepares a compiled review of the literature of research as well as independent research evaluating the student/athletes’ recovery from injury in relation to reinjury. The findings from the research serve a purpose to establish a deeper relationship between athletic training/physical therapy and strength and conditioning. The framework for rehabilitative protocol from the National Athletic Training Association (NATA) recommendations will be utilized to create a new training platform to be added to a school’s strength program. Current recommendations from the National Strength and Conditioning Association (NSCA) for periodization training of athletes will be utilized to maintain sports performance goals. This practicum will then merge principles in rehabilitation with sports performance based upon guidelines from these leading agencies to create a protocol that will both reduce the rate of reinjury as well as to prevent new injuries without negatively impacting sports performance. A new case study design was then presented applying a new protocol using qualitative analysis to prove value and create future discussion. This study was disseminated to qualified participants to gain insight into the relationship, challenges, and potential resolutions which may be implemented to improve the communication between athletic trainers and strength and conditioning coaches.

There is a lack of treatment guidelines for how to address the impact of nutrition on clients’ mental health. Prior research is limited regarding psychologists’ practices of nutrition counseling and has mostly focused on practices of dieticians and medical doctors. The purpose of this study was to examine psychologists’ beliefs and attitudes about nutrition counseling, amount of training and use of nutrition counseling, self-rated knowledge in the use of nutrition counseling and perceived benefits and barriers to using nutrition counseling. Data was collected using an online survey of 76 licensed psychologists’ training in nutrition and use of nutrition counseling. Findings show that most of the psychologists talk to their clients about nutrition, nearly half report using nutrition counseling, but few received training in nutrition while in graduate school. A statistically significant difference was found between those who use nutrition counseling and those who do not regarding self-reported knowledge, belief about therapy, benefit of outcome, importance of nutrition in the context of mental health, importance of discussing nutrition with clients and confidence as a barrier to using nutrition counseling in practice. A statistically significant difference was found between those who have training in nutrition and those who do not regarding self-reported knowledge, benefit of outcome, and importance of discussing nutrition with clients. The relationship between use of nutrition counseling and training in nutrition was statistically significant. As might be expected, a larger proportion of those who have training in nutrition use nutrition counseling than the proportion of those without training. The result highlights the need for a collaborative approach to client care. Psychologists reported several themes, including need for more training and guidelines for psychologists’ use of nutrition counseling.

Movement is a fundamental human activity, enabling us to engage with our surroundings. Consequently, a well-operating neuromuscular system is essential for maintaining quality of life. Motion is not only integral for the basic function of daily living, but also plays a significant role in enhancing our physical, mental, and emotional health. The importance of this system becomes abundantly clear when it is compromised, such as with neurodegenerative disease. Alzheimer’s disease (AD), followed by Parkinson’s disease (PD) are the two most common neurodegenerative diseases that profoundly affect millions of individuals worldwide (Lamptey et al., 2022). Characterized by distinct but sometimes overlapping symptomatology, both conditions lead to significant impairments in daily functioning, autonomy, and quality of life. Presently, there is no cure for these diseases, but rather symptomatic treatment with medication, therapies, and/or surgery. Among the various challenges posed by these diseases, the decline in sensorimotor control, particularly affecting balance and gait, stands out as a critical issue contributing to increased healthcare costs and decreased quality of life (Gras et al., 2015; Hsu et al., 2014). PD and AD impose a significant economic burden on healthcare systems, patients, and their families. The costs associated with these diseases encompass direct medical expenses such as hospitalizations and medications, and indirect expenses such as lost wages and the need for long-term care. Given the global demographic shift towards an older population, the prevalence of PD and AD is expected to increase, amplifying these costs significantly. In the United States, approximately 630,000 people were diagnosed with PD in 2010, with an expected increase to over 1.2 million by 2040. Further, the national economic burden exceeded $14.4 billion in 2010, including medical expenses, and indirect costs such as reduced employment and caregiver support (Kowal et al., 2013). Although dated economic data due to a lack of new surveys, with expenses rising in all areas, we can hypothesize the burden is now even greater. The economic burden of AD is even greater; in 2020, United States healthcare costs were estimated to be $305 billion, with an additional 18.6 billion unpaid caregiver hours valued at $244 nearly billion (Alzheimer’s Association, 2020). Beyond the economic impact, the social implications of PD and AD extend widely. Patients experience a progressive loss of independence, culminating in increased caregiver burden and significant lifestyle alterations. Central to these challenges is the decline in sensorimotor control, particularly affecting balance and gait. This not only deteriorates quality of life, but also raises the risk of falls and subsequent health complications. Addressing the early stages of gait dysfunction and sensorimotor decline in PD and AD through research into their pathophysiological mechanisms is vital for devising interventions to improve mobility, minimize fall risk, and improve patient outcomes. The deterioration of sensorimotor control in PD and AD must be considered in tandem with gait dysfunction, even in early neurodegenerative disease. Research into the underlying mechanisms of sensorimotor control and gait disturbances is crucial for developing targeted interventions that can help improve mobility, reduce fall risk, and enhance overall patient well-being. The assessment and quantification of limb dysfunction in neurodegenerative diseases such as PD and AD are of paramount importance, given the impact of these conditions on motor and cognitive functions, particularly in the aging population. In PD, motor symptoms, including tremors, rigidity, and bradykinesia, are predominantly asymmetric and progressively impair limb function. Traditional clinical scales like the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr are extensively utilized to evaluate motor decline. However, these assessments are somewhat subjective and may not capture subtle motor deficits or the fluctuating nature of symptoms effectively. In AD, while cognitive decline is the most prominent feature, motor impairments such as apraxia, gait disturbances, and coordination problems also significantly affect the quality of life. Conventional measures like the Mini-mental status examination (MMSE) focus primarily on cognitive deficits, with less emphasis on motor dysfunction. Thus, there is an urgent need for more comprehensive evaluation tools that encompass both motor and cognitive aspects of AD. Recent technological advances have led to developing more sensitive and objective measurement tools. Wearable sensors and motion capture systems enable continuous, high-resolution monitoring of limb movements in naturalistic environments, providing data that is not only more detailed but also more representative of daily living conditions than data from time-constrained clinical tests. These technologies can detect minute changes in motor performance and symmetry, which are crucial for early diagnosis and fine-tuning treatment plans, especially in PD. This dissertation will investigate limb speed perception accuracy during split-belt ambulation in individuals with early Parkinson’s disease. Additionally, the effects of Lecanemab, a new monoclonal therapy for the treatment of AD, will be explored in the context of its efficacy in improving motor-related functional outcomes. A multi-part experiment was performed to address these goals. It is organized into 2 research chapters with an additional introductory chapter and a chapter addressing future directions. Chapter 1 describes the anatomical and physiological principles of the human motor system and introduces the reader to the neurodegenerative diseases of interest: PD and AD. Chapter 2 describes a case series study where we investigated functional gait changes pre- and post-Lecanemab infusions over 9-months in an individual with early AD. Our patient demonstrated disrupted visuomotor processing and execution functions during the treadmill obstacle avoidance task. Monoclonal therapy potentially reversed this early functional metric and helped maintain it throughout the treatment period. At the 6-month mark, the participant showed no difference from her neurotypical cohort, with results enduring at 9-months. Psychometric testing indicated stable limb speed perception accuracy over the 9-month period, suggesting no disruption in the representation of limb dynamics. Chapter 3 describes a study of limb speed perception accuracy among people with PD. Advanced age and neurological disorders like PD are often associated with sensorimotor problems of limb control. Limb coordination is linked to the perception of limb movement; given the disruption of the dopaminergic system in PD, exercise may have beneficial effects. Discrimination of limb speed was tested with a 2-alternative forced-choice method during split-belt treadmill walking. Participants chose which limb was moving faster for a representative selection of bilateral speed differences. Findings suggest PD is associated with diminished limb speed accuracy. However, regular exercise may serve as a beneficial intervention to enhance or preserve sensorimotor function. These results advocate for physical activity promotion among those with or susceptible to PD. Further research is warranted to develop targeted therapies to improve sensory perception in PD populations. Finally, further questions and future directions for this work are discussed in Chapter 4.

Triple-negative breast cancer (TNBC) is an aggressive subtype with no targeted therapeutics. The luminal androgen receptor (LAR) subtype constitutes 15% of TNBC and is enriched for androgen receptor (AR) and AR target genes. Here, we show that a cohort of TNBC not only expresses AR at a much higher rate (∼80%) but also expresses AR splice variants (AR-SVs) (∼20%), further subclassifying LAR-TNBC. Higher AR and AR-SV expression and corresponding aggressive phenotypes are observed predominantly in specimens obtained from African American women. LAR TNBC specimens are enriched for interferon, Janus kinase (JAK)-signal activator and transducer (STAT), and androgen signaling pathways, which are exclusive to AR-expressing epithelial cancer cells. AR- and AR-SV-expressing TNBC cell proliferation and xenograft and patient-tumor explant growth are inhibited by AR N-terminal domain-binding selective AR degrader or by a JAK inhibitor. Biochemical analysis suggests that STAT1 is an AR coactivator. Collectively, our work identifies pharmacologically targetable TNBC subtypes and identifies growth-promoting interaction between AR and JAK-STAT signaling.

FcεRI is the ITAM receptor primarily responsible for the allergic response and immune hypersensitivity diseases such as asthma. Regulation of the strength of both FcεRI signaling, and the resulting outcomes, is accomplished via a complex array of molecular mechanisms whose interactions remain unclear. Here, I explored how the biophysical properties of antigens, crosstalk between FcεRI and integrin signaling and Arf6-mediated control of trafficking and exocytosis tune mast cell outcomes. I first found significant differences in FcεRI aggregation, phosphorylation and granule secretion after crosslinking with the multivalent antigen DNP-BSA or the small, trivalent antigen DF3. I also revealed a bi-directional, Syk-mediated crosstalk pathway between FcεRI and integrin β1/7 signaling. Last, I showed that the GTPase Arf6 influences mast cell degranulation, calcium signaling and both receptor and granule exocytosis. The findings here not only deepen the understanding of mast cell signaling, but provide insights into the molecular mechanisms of ITAM receptor activation.

Adverse gestational outcomes of pregnancy are a globally occurring threat to fetomaternal health, with limited clinical prognostic and intervention strategies aside from premature labor induction. Epidemiological data shows strong correlations between gestational exposure to air pollution and the incidence of adverse gestational outcomes. The research presented here was designed to evaluate potential murine models of gestational exposure, as well as quantify maternal cardiovascular damage therein. These studies employ radiotelemetry, echocardiography, single cell RNA-sequencing, and untargeted lipidomic analyses in efforts to study these effects. Results implicate cardiovascular responses to mid-gestational ozone exposure as evidenced by decreased maternal cardiac output and increased blood pressure. Trascriptomic data revealed placental pericytes being the most reactive placental cells to maternal ozone exposure, and overall placental extracellular matrix organization being affected. Lipidomic data identified PS37:5 and PIP2 (20:3) as pulmonary lipids altered during ozone inhalation, which may be relevant for non-pharmaceutical intervention and prevention methods for at risk mothers. Collectively, these data highlight both benefits and challenges of murine models for reproductive toxicology studies, and add important foundations for targeted studies to help expand mechanistic insights on air-pollution derived adverse gestational outcomes.