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I'm thinking, I think, I thought
Get PDFThe author submitted this entry in the Open Verse Poetry category (Amateur division) for the 2025 On My Own Time™ (OMOT) Art Show.A ticking clock meets a ticking mind
The ethics of access: obstetric emergency care and reproductive counseling after Dobbs
No full text[Note: The slides are not available from this event.] Tuesday, November 11, 2025; noon-1:00 p.m. (Central Time); via Zoom. "The Ethics of Access: Obstetric Emergency Care and Reproductive Counseling after Dobbs". Katie L. Watson, J.D., Professor of Medical Education, Medical Social Sciences, and Obstetrics and Gynecology and Faculty of the Medical Humanities and Bioethics Graduate Program at Northwestern University Feinberg School of Medicine.[Note: The slides are not available from this event.] In states that have criminalized abortion provision, much of the healthcare conversation has focused on what care is, and is not, legal. This lecture will begin with a short update on the legal landscape for obstetric care in the US and Texas, then it will shift focus to an ethical analysis of the unique combination of patient need plus legal uncertainty and risk clinicians now confront. What are the ethical obligations of institutions and individual clinicians caring for pregnant patients in restrictive states, and have any new opportunities for ethical care arisen since these laws were first enacted?UT Southwestern--Program in Ethic
Mineralocorticoid receptors: evolutionary mediators of wound healing, turned harmful by modern lifestyle
No full textDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Molecular phenotyping of critical illness: moving towards precision critical care
No full textDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Delirium dilemmas: the patients are not the only ones confused
No full textDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Yeast Ataxin-2, A Protein with Many Friends: Identification of a Novel Role for Pbp1 in Mitochondrial Biogenesis
Get PDFMitochondria need to adapt quickly to environmental challenges to meet metabolic demands. Switching yeast cells from growth in a glycolytic to a respiratory environment forces the cell to use mitochondrial respiration, and as a result, mitochondrial biogenesis is induced. Puf3 functions as a glucose sensor in yeast to support mitochondrial biogenesis in respiratory conditions. It facilitates a rapid stabilization of its target transcripts, such as cytochrome c oxidase components. Yeast-Ataxin2, Pbp1, is a poly(A)tail binding protein and a negative regulator of TORC1. Previous work showed that cells lacking Pbp1 in respiratory conditions exhibited mitochondrial dysfunction. I thus hypothesized that Pbp1 has an essential role in mitochondrial respiration. Utilizing genetics and biochemical assays, I discovered that loss of Pbp1 leads to decreased Puf3-specific mitochondrial proteins, suggesting a functional relationship between Pbp1 and Puf3. I also found that Pbp1 stabilizes and promotes Puf3-target mRNAs in respiratory conditions using a Puf3 reporter assay. Lastly, I showed genetic and physical interaction between Pbp1 and Puf3 through their low complexity domains. These findings provide clear evidence that Pbp1 works together with Puf3 to regulate mitochondrial biogenesis. It also sets the stage to investigate whether similar mechanisms for Ataxin2 in mitochondrial biogenesis exist
WWC2 Is a Novel Regulator of GABAAR Expression, Synaptic Function, and Dendritic Morphology in Excitatory Hippocampal Neurons
Get PDFThe members of the WWC protein family have been implicated in numerous neurodevelopmental, neuropsychiatric, and neurodegenerative disorders, including autism spectrum disorder, bipolar disorder, major depressive disorder, schizophrenia, Alzheimer disease, and Huntington's disease. Despite the wide range of pathologies associated with WWC proteins, only WWC1 (KIBRA) has been the subject of functional or mechanistic study in the central nervous system. Here, I present the first data describing the function of WWC2 in the mammalian hippocampus. Using a forebrain-specific knockout model, I demonstrate that WWC2 negatively regulates surface GABAAR expression in the 1-month-old mouse hippocampus. Additionally, I demonstrate that the GABAAR recycling regulators HAP1 and GRIP1 are overexpressed in the membrane fraction of WWC2 KO hippocampal tissue, suggesting that WWC2 regulates GABAAR recycling. These changes to receptor expression and trafficking are specific for GABAARs, as WWC2 KO animals have unchanged expression of AMPAR subunits GluA1 and GluA2. I further make use of conditional knockout models to show that WWC2 loss leads to dysregulated baseline synaptic function and decreased dendritic branching in hippocampal neurons. Preliminary studies indicate that CA1 pyramidal cells from WWC2 KO animals exhibit a trend toward increased stubby spine representation on basal dendrites. Additionally, I report preliminary data describing deficits in GABAAR expression and trafficking in the adult WWC2 KO and heterozygous KO hippocampus, indicating that regulation of GABAAR expression and trafficking by WWC2 is likely age-dependent. Finally, I describe hypothetical mechanisms by which WWC2 may regulate GABAAR recycling and basal synaptic strength.
In Chapter 1, I review the relevant literature which has shaped this dissertation. In Chapter 2, I present data which show that loss of WWC2 leads to overexpression of surface GABAARs, dysregulated synaptic strength, and decreased dendritic branching in hippocampal neurons. In Chapter 3, I describe preliminary data on the effects of WWC2 loss on dendritic spine morphology and adult GABAAR expression, as well as evidence that WWC2 may interact with GABAARs and KIBRA. In Chapter 4, I describe the implications of this work and propose additional lines of experimentation to further clarify the function of WWC2 in the brain
The Right Uterotonic at the Right Time
Get PDFThe file named "MOLLINGS PUENTES-PRIMARY-2023.pdf" is the primary dissertation file. Four (4) supplemental files are also available and may be viewed individually.BACKGROUND: Postpartum hemorrhage (PPH) causes significant obstetric morbidity and is a leading cause of preventable maternal mortality . While there are numerous potential causes of PPH, uterine atony is by far the most common etiology, accounting for 70-80% of hemorrhage cases.. In the United States, prophylactic administration of Pitocin, a synthetic version of oxytocin that promotes smooth muscle contraction, is universally administered after delivery as a first-line strategy to prevent bleeding and reduce the risk of PPH. However, hemorrhage still occurs in 3-5% of all deliveries despite Pitocin prophylaxis and requires additional interventions.
In direct contrast to the virtually ubiquitous approach to PPH prevention with Pitocin administration, treatment of PPH is highly variable from hospital to hospital and provider to provider. While one of three available second-line uterotonic agents (Methergine, carboprost or misoprostol) is usually administered alone or in combination when hemorrhage occurs, the timing, dosing frequency and order of use diverges significantly based on local protocols, level of provider comfort and prior training experience. Methergine and carboprost are both administered intra-muscularly and have similar rapid therapeutic efficacy. Conversely, misoprosol, which is administered either buccally, sublingually or rectally, lags these parenteral agents in reaching therapeutic levels, especially when given via the rectal route as is often the case. The delayed pharmacokinetics of misoprostol may, therefore, hinder efficacious treatment of uterine atony, potentially leading to unnecessary blood loss and excess morbidity.
Timely administration and appropriate selection of faster-acting parenteral treatment agents over misoprostol can reduce postpartum hemorrhage caused by uterine atony. Inconsistent use of uterotonic agents and the absence of monitoring practices could result in preventable cases of PPH requiring significant surgical interventions. Best practices indicate that maintaining uterotonic agents readily available prior to delivery, and during the two-hour postpartum observational period improves the response and outcomes of postpartum hemorrhage. The goal of this quality improvement project was to increase the selection of a parenterally administered uterotonic as second-line therapy and reduce the time to treatment onset in the setting of uterine atony.
LOCAL PROBLEM: In contemporary obstetric practice uterotonic agents utilized are prostaglandins (PG) or ergot alkaloids [6]. Among the prostaglandins, Hemabate (15-methyl PG F2a) also known as carboprost and misoprostol (PGE1 analog, Cytotec) are the most commonly used.
Although these three uterotonic agents are used widely to treat uterine atony, the available data suggests that they are not equally effective[7]. William Clements University Hospital (CUH) is a teaching hospital within the UT Southwestern Medical Center. The hospital is part of an academic training center located in Dallas where the obstetric hemorrhage rates for the county range between 118.8 and 202.4 cases for every 10,000 deliveries. In accordance with the maternal safety bundle published by the Alliance for Innovation on Maternal Health (AIM), postpartum hemorrhage kits containing Methergine and Hemabate have been integrated into the labor and delivery unit. The ability of readily available parenteral uterotonic kits to improve readiness to postpartum hemorrhage and function as a sustainable practice had not been evaluated in previous studies or guidelines.
METHODS: CUH implemented a process that placed "PPH kits" containing methergine and carboprost at the bedside of laboring patients. Staff used PDSA cycles to improve adherence to the protocol. We compared data on presence of kit at delivery, medication selection, time to administration, and other delivery outcomes pre- and post-implementation. The utility of the postpartum hemorrhage kit was established by comparing the baseline values for rates of postpartum hemorrhage, uterotonic agent utilization, compliance, and administration time for deliveries in 2018 with deliveries in 2019-2022. A process map was developed to identify elements which hindered the retrieval of PPH kits prior to delivery. The list of possible interventions was determined via a multi-voting exercise among labor and delivery unit nurses and FMEA analysis was completed to identify the most effective intervention. Four PDSA cycles followed to determine the efficacy of optimizing the PPH kit protocol.
INTERVENTIONS: The current protocol requires several overrides in the medical cabinet system (Pyxis) to retrieve refrigerated UTAs for postpartum hemorrhage kits. Therefore, pyxis overrides were removed and orders for Methergine and Hemabate were integrated in the admission order set for deliveries. This intervention had the capacity to increase access to PPH kits, compliance and improve PPH kit management. To maintain awareness of the PPH kits, education reminder in Quick-kit meetings were given in each nursing shift. Handover charge sheets and 2-step verifications were implemented to record PPH use and encourage storage of unused kits.
RESULTS : In the 4-year period following implementation, kits were present for 94% of vaginal deliveries and 89% of cesarean sections for an overall utilization of 92.2%. Use of Methergine or Hemabate as the second-line therapy for atony increased significantly from 71% to 93.2% (p<0.0001). For vaginal deliveries, the rate of parenteral UTAs as second-line agents increased from 51% to 90.1% (p<0.0001). The median and mean time to administration of any UTA was reduced by 6 minutes (p=0.0007-0.00). Accessibility was most important for vaginal deliveries in which time to administration of parenteral uterotonics was decreased by 23-24 minutes when PPH kits were at bedside (p=0.0005).
CONCLUSION: Placement of a PPH kit containing parenteral uterotonics in the patient's room before delivery and throughout a 120-minute recovery period results in increased utilization of parenteral uterotonics and timely administration. Without interfering with physician autonomy or decision making PPH kits were a sustainable intervention for standardizing parenteral uterotonic usage
Acute kidney injury 2025
Get PDFDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Brown Skin, Full Lips
Get PDFPrompt: "What stories are held in the hands of a woman?"My piece reflects my identity, legacy, and the strength I carry as a Black woman and mother