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Combating Dehydration in the Dementia Patient
Full text linkDehydration is a prevalent global health issue impacting individuals across all demographics, with the elderly—especially those suffering from dementia—being particularly vulnerable. As the elderly population grows and dementia rates increase, addressing dehydration becomes crucial to reduce hospitalizations, mitigate healthcare costs, and enhance patient well-being. This executive summary outlines a proposed intervention aimed at improving fluid intake among elderly dementia patients residing in residential care facilities.
Research indicates that dehydration significantly impacts the health and financial costs associated with dementia care. Studies have shown that dehydration exacerbates cognitive decline and behavioral symptoms in dementia patients, leading to increased dependency and healthcare costs (Edmonds, 2021; Nishi, 2023). Prolonged dehydration can result in severe health issues, including kidney stones, cognitive impairments, and cardiovascular strain (Mayo Clinic, 2021; American Heart Association). The high costs associated with dehydration-related hospitalizations, estimated at over $446 million annually in the U.S. alone (Nagae, 2020), underline the urgent need for effective hydration strategies.
A literature review focused on interventions to improve hydration in elderly dementia patients revealed a lack of a standardized method for diagnosing dehydration, with most research emphasizing the negative long-term effects of dehydration rather than effective intervention strategies. Existing studies suggest that behavioral interventions, such as providing choices and encouragement, are more effective in enhancing hydration than environmental or nutritional approaches (Bruno, 2021; Beck, 2021). The absence of a universally accepted gold standard for diagnosing dehydration and the challenges faced by caregivers in long-term care settings highlight the need for innovative and practical solutions
Preceptor Toolkit Effects on New Graduate Nurse Orientation Experience
Full text linkThe role of the nurse preceptor is vital to the successful onboarding of new graduate nurses to the organization. By focusing on preceptor support methods in addition to the established nursing preceptor programs, organizations can improve the nurse preceptor’s confidence and competency levels. The opportunities for improvement, solution recommendation, timeline, and associated costs are provided in this summary.
Many organizations have seen an increase in new graduate nurses leaving their jobs within their first year of hire. The transition period of new graduate nurses is often a period of transition shock while they acclimate into professional practice from academia (Fink et al., 2008). Structured nurse residency programs, or transition to practice programs, have shown to support new graduate nurses during this transition period and improve new graduate nurse retention within their first year of hire (Edwards et al., 2015; Silvestre, 2017; Van Camp & Chappy, 2017; Asber, 2019; Brook et al., 2019; Aparicio & Nicholson, 2020; Shinners et al., 2021).
Negative preceptor experiences can be associated with some of the new graduate nurse’s departure from an organization. The nurse preceptor role is a critical component of this transition period and can positively or negatively impact the new graduate nurses experience (Edwards et al., 2015; Watkins et al., 2016; Brook et al., 2019; Aparicio & Nicholson, 2020; Shinners et al., 2021; Durkin et al., 2023). Finding ways to support the nurse preceptor can help improve preceptor confidence and competence, and consequently improve new graduate nurses’ confidence, competence, and job satisfaction
Developing a Model to Predict Bleeding Areas in Asphalt Pavements Using Artificial Neural Network
Full text linkBleeding can have a negative effect on the performance of a pavement, as the layer of asphalt on the surface can become slippery, reduce skid resistance, and lead to premature wear and tear. Therefore, predicting the bleeding area in asphalt pavements will help in maintaining better pavements, increasing the safety of the drivers, and delivering timely maintenance. The aim of the study is to develop a model using a highly sophisticated analysis tool called an artificial neural network (ANN) to predict the bleeding areas in asphalt pavements as output, with one hidden layer and several neurons and using several independent variables as inputs, such as lane annual average daily truck traffic, lane annual truck volume estimate, pavement thickness, average asphalt content, average annual temperature, annual total snowfall, and total annual precipitation. The Long-Term Pavement Performance database will be employed in this study to extract data for the states of Texas, Arizona, and New Mexico. The ideal architecture for forecasting the bleeding of asphalt pavements was concluded to be an ANN model with several neurons in one hidden layer and with 160 data sets, with R2 = 0.71. A standalone ANN equation was also extracted. Additionally, a sensitivity analysis was conducted to determine the sensitivity of the model to a particular change in an input parameter
Working-Age Caregivers of Stroke Survivors: Needs, Concerns, and Quality of Life
No full textPresented at Great Plains Honors Council (GPHC) Conference, March 22, 2024; Oklahoma State University, Stillwater, Oklahoma.https://scholarworks.uttyler.edu/honors_nursing_posters/1004/thumbnail.jp
IMMUNE RESPONSES OF NEONATAL (14-DAY OLD) AND ADULT (6 WEEKS OLD) MICE LUNG AND SPLEEN CELLS TO GAMMA-IRRADIATED MYCOBACTERIUM TUBERCULOSIS STIMULATION
Full text linkTuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) is a global health challenge, especially in vulnerable populations like neonates, whose immune systems are still developing. Understanding the immune responses to Mtb in neonates is critical for the development of better vaccine and treatment strategies. Building upon previous research from our laboratory, which demonstrated that γMtb stimulated neonatal mice (0, 3, and 7 days old) lung cells displayed distinct cytokine profiles and increased expansion of myeloid-derived suppressor cell subpopulations than adult mice lung cells. In the current study, we investigated age-dependent immune responses in 14-day-old (neonates) and 6-week-old (adults) mice. We found that IL-6, TNF-a, and IL-10 cytokine levels were significantly higher in γMtb stimulated neonatal lung cell culture supernatants than in unstimulated controls and adult mice lung cells stimulated with γMtb.CD45+CD4+CD8+ cell population was significantly higher and CD11c+MHCII+ and NK1.1+ cell populations were lower in freshly isolated lung cells of neonatal mice than in adult mice lung cells. γMtb stimulated neonatal lung cells had a higher percentage of CD11b+Ly6G+, CD4+, and CD4+CD69+ cell population and lower levels of NK1.1+ and B cell populations than in γMtb stimulated adult lung cells. Overall, our study demonstrated that neonatal and adult mice immune cells respond differently to γMtb stimulation. These findings enhance our understanding of age-related variations in host immune responses and may help guide the development of targeted interventions to combat TB, particularly in newborns
The Case for Crisaborole
No full textTo begin, topical corticosteroids (TCS) have been the standard first-line treatment medication for atopic dermatitis (AD) since the Federal Drug Administration (FDA) approved them in 1955 (Siegfried et al., 2016). Given that evidence-based practice (EBP) usually changes every few years for many other issues, that is a long period of time. This long-standing standard unfortunately leads many clinicians to the classic “we have always done it this way” conclusion. However, with scientific advancement, there are many more treatments available for AD today. One that is particularly promising is crisaborole, which is currently available under the brand name Eucrisa.
This medication is a PDE4 inhibitor, meaning that it binds to the PDE4 enzyme and inhibiting its activity. By this inhibition, crisaborole suppresses cytokine production and therefore the symptoms of AD (Papier et al., 2018). It is FDA approved for adults and children greater than three months old for the treatment of mild-to-moderate AD (Kondratuk et al., 2023). Clinical trials show that it not only improves lesions, but associated symptoms such as pruritis. Another important component is crisaborole’s unique advantage over TCS to be used on thin and sensitive skin areas such as the face, genitalia, and skin folds (Papier et al., 2018).
In continuation, crisaborole has many advantages over TCS. It is long known that TCS can cause unwanted side effects for patients, such as striae and skin atrophy (Papier et al., 2018; Butala & Paller, 2022. These effects become more likely with long term use (Eichenfield et al., 2017). These negative side effects put AD patients in a difficult position to either adhere to medication long-term and possibly suffer from premature skin-thinning, or deviate from treatment and risk worsening AD. This conundrum is often what is cited when patients report noncompliance (Papier et al., 2018; Lundin et al., 2021). In contrast, crisaborole is not associated with cutaneous side effects. The most common side effect is a burning sensation at the site of application (Eichenfield et al., 2017)
For these reasons, this proposed project suggests an EBP change regarding initial treatment of AD. Based on key factors, a clinician can predict with reasonable certainty whether a child or adolescent will continue to have AD into their adult life. It is the responsibility of the clinician to provide an individualized plan of care for these patients, which includes a long-term plan for successful treatment with the least harm, or potential harm, to those patients
The Role of Myocardin And Its Effector Proteins In TGF-β Induced Cytoskeletal Remodeling of IPF Fibroblasts
Full text linkIdiopathic pulmonary fibrosis (IPF) is characterized by thickening and stiffness around the air sacs. Approved treatments like nintedanib and pirfenidone slow disease progression in IPF and often have tolerability issues. More research is needed to fully grasp the mechanisms behind abnormal cytoskeletal changes in lung cells, notably fibroblasts and epithelial cells, and their role in fibrosis progression. Previous studies suggest that myocardin expression and function, traditionally limited to smooth/cardiac development in physiology, become active in pathophysiological conditions like pleural fibrosis. Myocardin\u27s role in liver and kidney fibrosis is known, but its involvement in IPF is unclear. To get more insights, we conducted mRNA sequencing, and the results revealed the downregulation of fifty-five candidate genes, including PAI-1, following myocardin knockdown. Upon TGF-β stimulation, PAI-1, FN-1, α-SMA, and collagen significantly increased, whereas myocardin knockdown decreased their expression as shown by qPCR and western blot. Colocalization analysis showed a higher extent of colocalization of PAI-1 with tubulin than actin across all conditions, suggesting its transportation on microtubules rather than microfilaments. Proximity Ligation Assay identified a reduction in PAI-1 and KIF5, a microtubule-associated motor protein, association post- myocardin knockdown, though TGF-β did not show a significant difference in PAI-1 and tubulin proximity. These results suggest that myocardin regulates the expression of PAI-1 and its association with microtubule-associated motor protein, KIF5, thus controlling the transportation and secretion of PAI-1 that contributes to the progression of IPF
Novel Role and Mechanisms of BRD4 in Mediating Mesothelial to Mesenchymal Transition and Pleural Fibrosis
No full textPleural fibrosis is characterized by myofibroblast accumulation and increased expression of collagen and other extracellular matrices due to injury to the pleura and remodeling. Mesothelial to mesenchymal transition (MesoMT) is an important pathological event that contributes to the pool of myofibroblasts although its regulation remains incompletely understood. Recent research has reported the role of BRD4, a member of the bromodomain extra terminal domain (BET) family, in developing fibrosis in the heart and the lungs. One recent study showed that MEOX1 is a downstream target of BRD4 and mediated cardiac fibroblast activation. Our joint work also demonstrated that NOX4 is implicated in pleural MesoMT. However, it remains unclear about the role of BRD4 in pleural fibrosis, particularly, the mechanisms of BRD4 in regulation of MesoMT. In this study, we hypothesized that BRD4 mediates MesoMT through MEOX1 and NOX4 and contributes to pleural fibrosis development. To test this hypothesis, primary human pleural mesothelial cells (HPMCs) were treated with different doses of ARV-825 or JQ1, small molecule inhibitors of BETs, followed by TGF-β stimulation to test the effects of BRD4 inhibition on MesoMT. In addition, siRNA targeting BRD4 was used to knock down BRD4, followed by TGF-β treatment to examine its effect on MEOX1, NOX4, and MesoMT markers. The results showed that ARV-825 and JQ1 suppressed TGF-β-induced MEOX1 and NOX4 expression along with MesoMT markers in a dose-dependent manner. In addition, BRD4 knockdown suppressed the expression of MEOX1 and NOX4 at both protein and mRNA levels. Importantly, the knockdown of MEOX1 and NOX4 individually attenuated TGF-β-induced MesoMT marker expression in primary HPMCs. These findings suggest that BRD4 mediates MesoMT through MEOX1 and NOX4 and may hold promise as a novel effective therapeutic target for pleural fibrosis. Further studies can be conducted to investigate the effects of JQ1/ARV-825 in inhibiting pleural fibrosis in vivo. Additionally, a study can be undertaken to find out the effect of JQ1/ARV-825 in suppressing MesoMT and MEOX1/NOX4 expression in vivo, as well as on oxidative stress
Electronic health records: Using polarity thinking to explore the relationship between technology and nursing practice
No full textBuilding a robust information technology infrastructure has been recognized as integral in addressing national concerns about patient safety, healthcare quality, and healthcare costs. Federal efforts to promote the nationwide adoption and integration of electronic health records (EHRs) include the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which provided over $27 billion in federal incentives to healthcare organizations and providers to incorporate EHRs into healthcare practices. Medicare and Medicaid Electronic Health Record Incentive Programs, initiated in 2011, were enacted to expand EHR functionality, encourage EHR system upgrades, and establish nationwide use of certified EHR technology. Subsequently, EHRs have become a prominent part of healthcare informatics and delivery. However, registered nurses, as representatives of the largest group of healthcare professionals, are often overlooked in studies related to EHRs. Therefore, the purposes of this study are to investigate positive features of EHRs that can be leveraged to facilitate nurses’ satisfaction with the use of EHRs in nursing practice and investigate features of EHRs that exert a negative impact or create barriers to nurses’ satisfaction with use of EHRs in 11 nursing practice. Foundational work for this study began with a manuscript exploring nurses’ psychological adaptation to EHR usability through the lens of the Unified Theory of Acceptance and Use of Technology. A second manuscript provided a concept analysis of nurses’ psychological adaptation to electronic health record usability. The final phase was a secondary data analysis of Texas statewide studies conducted in 2015 and 2020 to explore nurses’ satisfaction with EHRs using a polarity model as an underpinning for the study. The secondary data analysis revealed that factors related to technology and practice had a statistically significant impact on nurses’ satisfaction and dissatisfaction with EHRs. When controlling for hospital and nurse factors, magnet status and computer skills had a statistically significant impact on nurses’ satisfaction and dissatisfaction with EHRs, with magnet status displaying the most significant impact
On-Device Intelligence for AI-Enabled Bio-Inspired Autonomous Underwater Vehicles (AUVs)
Full text linkThis paper introduces an innovative approach to underwater exploration by integrating Artificial Intelligence (AI) into Autonomous Underwater Vehicles (AUVs). This collaboration between AI and biomimicry marks a new era for AUVs, enabling them to emulate marine creatures’ graceful and efficient movements. By infusing AI capabilities into AUVs, AUVs are empowered to learn and adapt, making autonomous real-time decisions without human intervention. This dynamic integration equips AUVs to effectively navigate complex underwater terrains, evade obstacles, and seamlessly interact with marine life. Inspired by the remarkable propulsion mechanisms found in marine organisms, this work proposes a pioneering propulsion system tailored for AUVs. Taking cues from the locomotion of creatures like cuttlefish, the biomechanics is translated into a robotic propulsion system. The result is a fluid and energy-efficient propulsion method that mitigates the harmful effects of cavitation, thereby reducing noise pollution and minimizing disruption to marine ecosystems. This research evaluates the performance of on-device AI models for analyzing the sensing environment around the AUV and taking real-time images. This automated sensing and navigation method can help the AUVs independently navigate to the desired location along the water table. The propulsion is achieved by building a crankshaft mechanism and a unified mechanical design to convert rotational motion from a motor into a sinusoidal wave motion to replicate the cuttlefish locomotion pattern. The proposed underwater vehicle, Aquabot, is designed using Fusion 360 simulation and ANSYS software. The results demonstrate the accuracy and efficiency of the autonomous underwater vehicle based on the environmental conditions, thus reducing energy consumption and enhancing aquatic vehicle efficiency