Environmental and Occupational Health Sciences Institute
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Fabrication of homogeneous and heterogeneous surface enhanced Raman spectroscopy substrates for the detection of genetic biomarkers of diseases
No full textThe demand for cost-effective, rapid, and precise diagnostic tools for genetic diseases, such as cancer, remains unmet. Detecting mutations in disease-specific micro-RNA biomarkers presents a promising avenue for early disease screening. Liquid biopsy-based noninvasive diagnostic methods are gaining traction. Surface-enhanced Raman spectroscopy (SERS), renowned for its sensitivity, specificity, and multiplexed analysis capabilities, stands out for identifying single-base variations in nucleic acid sequences. Our hypothesis centers on leveraging SERS to detect nucleotide changes, like substitution or transposition, within these sequences. To this end, a homogeneous SERS substrate comprising colloidal silver nanospheres was meticulously developed and optimized via wet chemical synthesis. This substrate showcases homogeneity in particle size, optimal nanoparticle-analyte interaction, and substantial SERS signal enhancement. Our analysis of short single-stranded DNA and RNA sequences using this platform revealed its sensitivity in detecting single-base changes, reflecting as shifts in spectral peak intensity or position. To enhance the platform's efficiency in discerning oligonucleotide changes, we employed a Gaussian process-based hypothesis testing algorithm. This approach achieved a remarkable 95% accuracy in distinguishing between two nucleic acid analytes. Integrating SERS with machine learning proved highly sensitive in detecting sequential changes in the well-established prostate cancer biomarker, micro-RNA miR-21, thus validating the SERS platform's diagnostic potential. Moreover, beyond colloidal silver nanoparticles, we engineered a heterogeneous SERS substrate comprising a uniformly arranged array of gold nanostars. The three step-based bottom-up fabrication method used to develop the heterogenous substrate was highly cost-effective and resulted in nanoparticle arrangement precision similar to top-down lithographic techniques, which enables exceptional SERS enhancement for the analysis of oligonucleotides, offering reusability and maintaining stability over extended periods. Our work meticulously details the successful fabrication of SERS substrates and their application in detecting alterations in nucleic acid sequences. This research underscores the promising prospects of SERS-based platforms for diagnostic applications.Ph.D.Includes bibliographical reference
"The commitment of a lifetime": the role of emotionally focused therapy in strengthening attachment bonds and improving relationship health in later-life couples
No full textA healthy marriage is a crucial protective factor for adapting to the challenges of late life. Emotionally Focused Therapy (EFT) for couples is an attachment-based model of psychotherapy that emphasizes here-and-now processing of emotion in a safe holding environment, enhanced understanding of the patterned interactions between self and other, and a non-pathologizing, growth-oriented approach toward couples’ difficulties. This pragmatic case study examines the benefits of EFT for addressing issues specific to late life, including existential concerns such as aging, illness, and mortality, caregiving burdens and stress, cumulative relational trauma over the lifespan, and forgiveness and healing from emotional injuries. The study involved a 20-session treatment of a couple named “Alice and Steve,” aged 74 and 75, with Steve suffering from advanced Parkinson’s Disease. The couple presented with hopelessness and resentment about their caregiving situation, unresolved traumas from early childhood fueling their relationship’s sore spots, and unprocessed grief and fears concerning losses at the end stage of life. The EFT-guided treatment focused on promoting transformational and corrective experiences of secure attachment bonding. Throughout therapy, Alice and Steve cultivated coherent, positive perspectives of their marriage and related hardships by engaging in reminiscence, embraced their longings for each other by relinquishing their defenses against loss and mourning, and strengthened the legacy of their marriage by exploring their shared values and vision of family life. Several outcome measures assessing emotional and relational health evidenced their heightened emotional awareness and acceptance, increased marital adjustment and satisfaction, and improved attachment security. This study highlights EFT as a potent therapeutic intervention for fostering relationship health in later-life individuals to reduce the public health risks associated with social disconnection and loneliness in the aging population.Psy.D.Includes bibliographical reference
Deconstructing assumptions of universality in attachment theory: an examination of applicability to Eastern Asian culture
No full textJohn Bowlby’s attachment theory revolutionized psychologists’ understanding of the intricate dynamics between children and their parents. This groundbreaking theory not only spurred further research on attachment, but also prompted Mary Ainsworth’s influential Baltimore study. Ainsworth’s laboratory research revealed three distinct patterns of children’s responses to novel environments, maternal departures, and reunions, resulting in the classification of attachment into secure, ambivalent, and avoidant types. Bowlby’s attachment theory, along with Ainsworth’s contributions, garnered widespread international attention and application. Its dominance, however, along with other Western, educated, industrialized, rich, and democratic (WEIRD) ideas and theories, has historically wielded outsized influence over multiple scholarly fields, including psychology. Researchers have generally perpetuated this dominance in assuming that theories developed in one cultural context would seamlessly apply to others, a limitation in the field. To address this limitation and foster a more nuanced understanding of attachment in a culturally diverse world, this dissertation explores the applicability of Western attachment theory in the context of East Asia—a region known for its unique cultural characteristics that in many ways contrast sharply with the West. To achieve this objective, this dissertation examines parenting practices in China, Japan, and Korea, seeking common threads that significantly impact individuals living in these societies. Despite the scarcity of research on East Asians with a collectivistic background, the literature frequently references interdependence and filial piety as fundamental influences on parenting and children’s socialization in these communities. This theoretical paper emphasizes the importance of integrating the notions of interdependence and filial piety when working with Asian Americans of East Asian descent. By highlighting the complexities of cultural influence on attachment, it endeavors to contribute to a more culturally appropriate and relevant application of attachment theory in psychological practice. This deeper understanding of attachment in East Asian contexts can ultimately enhance therapeutic interventions and support for individuals with East Asian cultural backgrounds.Psy.D.Includes bibliographical reference
Human trafficking identification in the emergency department
No full textPurpose of the Project: This project aimed to improve human trafficking identification in the emergency department of a New York City hospital by increasing nursing mandatory eLearning Human Trafficking training, patient screening embedded within the electronic medical record, and referrals.
Methodology: This quality improvement project measured human trafficking training compliance and screening tool documentation and referrals at baseline and during the two-month implementation period. The intervention included delivering two weeks of informal human trafficking in-service training and human trafficking brochure distribution about screening and referral processes. Human trafficking training and documentation data were collected for a period of two months and compared to the month prior to implementation.
Results: Of the 177 nurses eligible to complete the eLearning mandatory module, 32 (18.07%) were compliant before the intervention, and 72 (41%) completed the module during the data collection period. There was an increase of 125% in training compliance. In addition, data showed slightly improved screening rates from 76.50% at baseline to 84.18% post-intervention. Though no individuals experiencing human trafficking were identified during the project period, four individuals were identified with the majority referred to social work.
Implications for Practice: Although brief, this project demonstrates improved education and awareness about human trafficking positively effects e-learning mandatory module completion and screening rates among nurses. Ongoing efforts to encourage education, awareness, and screening are imperative to ensure individuals experiencing or at risk for human trafficking are identified and referred.D.N.P.Includes bibliographical reference
Preventing falls in the emergency department: a DNP quality improvement project
No full textBackground: Falls in the ED present a significant threat to patient safety (CDC, 2019). This DNP QI project aimed to implement targeted fall prevention strategies in an adult acute care ED.
Methods: Following the IHI's PDSA framework, the study assessed interventions using the Kinder 1 Fall Risk Assessment Tool and a color-coded fall risk bundle (Ghosh et al., 2022; LeLaurier & Shorr, 2019). Educational sessions were conducted for staff, and data from 601 patients were collected before and after the two-month intervention period.
Results: Post-intervention, the percentage of patients receiving fall risk assessments increased significantly (60.8% to 96.7%, p < 0.0001). There was also a notable association between pre- and post-intervention and fall risk designation (p < 0.0001). Implementation of the color-coded fall risk bundle increased from 15.0% to 27.4% (p = 0.0002). While fall rates did not significantly differ (1.0% to 2.3%, p = 0.2002), the project demonstrated substantial improvements in fall prevention measures.
Conclusion: This DNP QI project successfully implemented targeted interventions in the ED, resulting in increased fall risk assessments and adoption of color-coded fall risk bundles (Ghosh et al., 2022). The findings emphasize the potential impact on patient safety and underscore the need for ongoing training and policy enhancements. The project offers valuable insights for healthcare professionals and institutions striving to enhance patient safety in the emergency department.D.N.P.Includes bibliographical reference
Implementing a gender diversity bundle to improve care of transgender and gender diverse patients
No full textPurpose of the Project: The aim of this quality improvement project was to identify the presence of a Transgender or Gender Diverse (TGD) population using a practical gender and pronoun bundle involving staff education and improved, comprehensive documentation of sexual orientation and gender identity (SOGI) data.
Methodology: At a primary care practice, a retrospective/prospective chart review was completed over a 28-day collection period following the implementation of a practical gender and pronoun bundle. Staff were trained on updates to the registration form, electronic health record (EHR) documentation, and using patient-preferred names and pronouns. Registration forms expanded data collection to include sex, gender identity, sexual orientation, and preferred pronouns. SOGI data was compared before and after implementation. A post-project survey was distributed to staff to assess perception of documentation changes.
Results: Descriptive statistics were used to compare changes in frequency for sex, gender, sexual orientation, and preferred pronouns before and after bundle implementation. After analysis using a McNemar’s test, documentation of gender identity, sexual orientation, and preferred pronouns in the EHR all showed statistically significant improvement after bundle implementation, X 2(1) =105.009, p <.001; X 2 (1) =104.009, p <.001; X 2 (1) =81.201, p <.001. The post-project survey indicated a generally positive response to the project.
Implications for Practice: This project highlights the importance of collecting accurate SOGI data; patient providers can suggest individualized preventative medicine when they have frank conversations about gender identity, sexual orientation, and sexual practices.D.N.P.Includes bibliographical reference
Experiences of stigma among family members of persons living with schizophrenia: a systematic review
No full textPurpose of Project: This systematic review sought to explicate the experiences of stigma among family members of persons living with schizophrenia.
Methodology: The review followed the Joanna Briggs Institute (JBI) approach for qualitative systematic reviews. Studies included in the search were those published in full text, English between 1963, when Erving Goffman published his major work on stigma and May of 2023.
Results: Thirty-eight papers, representing studies conducted in 20 countries and involving 712 family members, met the criteria for inclusion. From these, a total of 134 findings were extracted and combined to form 17 categories based on similarity in meaning. Four final syntheses were derived: i) Held hostage by stigma hiding the secret: ii) Isolated and constrained by stigma imposed by others: iii) Family carries the burden with little support: iv) What do I need?
Implications for Practice: 1) There is a critical need at the time of diagnosis as well as throughout the illness life course of those caring for someone with schizophrenia to minimize self-stigma and anticipated stigma through intrapersonal interventions in the form of education, counseling, and expressive writing interventions. 2) There is a need to empower family members caring for a person with schizophrenia to cope with stigma and decrease isolation through connection with caring others and interpersonal interventions such as support groups, psychoeducational groups, and problem-solving around anticipated stigma. 3) The stereotypes surrounding schizophrenia must be refuted in order to decrease public stigma through ongoing social marketing campaigns, public service announcements, and interaction/contact approaches between the stigmatized group and those displaying stigmatizing attitudes. 4) Healthcare providers need education regarding: a) the different types of stigma; b) the relationship between stigmatized conditions and poor quality of care outcomes; c) the ongoing perception of patients and family members that healthcare providers stigmatize those living with or affected by mental illness; and d) time and training for health workers to learn about and enact universal precautions for stigma reduction in daily care. 5) Healthcare organizations need to mitigate the harmful effects of stigma through: a) collection of data on health, well-being, and satisfaction outcomes of persons with schizophrenia and mental illness; b) establishment of policies and procedures and systems to support family involvement in the plan of care; and c) adoption of policies and practices that reduce stigma and discrimination in care practices.D.N.P.Includes bibliographical reference
A quality improvement project to improve depression screening in a primary care office
No full textPurpose of Project: Depression can be devastating for individuals afflicted by this disorder. Screening for depression remains at the forefront of depression identification and management. The U.S. Preventative Services Task Force (2016) recommends that all adults undergo screening for depression. However, primary care practices struggle to implement an effective workflow to screen and document positive depression screenings. This quality improvement project aimed to improve the depression screening rate and the quality performance metric CMS2v12 by implementing an electronic version of the Patient Health Questionnaire-9 (PHQ-9) through the patient portal.
Methodology: This quality improvement project used EPIC’s patient portal, MyChart, to administer an electronic version of the PHQ-9 and then assessed the impact of this intervention on the number of screens completed and the overall quality metric performance rate. Depression and performance metrics for four weeks before the intervention were used as a baseline to determine if an improvement occurred.
Results: Eight hundred eighty-five patient charts from the pre-intervention period were compared to the 761 patient charts during the post-intervention period. Based on the metrics obtained, the performance rate for the pre-intervention period was 83.39%, and the depression screening rate was 84.29%. The depression rate for the interventional period was 93.56%, and the performance rate during the interventional measurement period was 90.67%.
Implications for Practice: Patient portals offer a sustainable way to improve the identification of depressive symptoms in the adult population by maximizing the capabilities of the portals to achieve improved outcomes.D.N.P.Includes bibliographical reference
The impact of enhancer proximity on the shared regulation of Drosophila tandem paralogs mid and H15 genes
No full textThis study investigates the regulatory dynamics of the T-box transcription factors midline (mid) and H15 during Drosophila oogenesis, focusing on the pivotal role of the GMR86G04 (G04) enhancer identified in prior research. Leveraging CRISPR/Cas9 technology, we aim to relocate the G04 enhancer from its original position near mid to be proximal to H15. Through targeted genetic manipulations and subsequent analysis of gene expression patterns, our research seeks to unveil the impact of enhancer proximity on the distinct roles played by mid and H15 in the determination of posterior fate. This exploration contributes to a deeper understanding of enhancer specificity, shedding light on the intricate regulatory mechanisms at play in
Drosophila oogenesis.Presented at the annual Celebration of Undergraduate Research and Creative Activity while the author was an undergraduate student at Rutgers University-Camden
The relationship between altruism and knowledge in Influencing the likelihood to join the stem cell transplant registry amongst college students
No full textStem cells donated by younger adults have been found to increase positive treatment outcomes post-transplant (Nayaranan et al, 2016). Research has found altruism as a trait and knowledge on stem cell donation as separate, yet major factors in influencing participation in registry (Nayaranan et al, 2016; Liao et al, 2020). The college population has significant congruency with the desired donor profile. Thus, the study examined the relationship between altruism and knowledge together, on transplant registry participation. The study hypothesized that (1) knowledge on stem cell donation will strongly increase the likelihood to register than altruism, and (2) knowledge of stem cell donation will be strongly related to willingness to help others . Data from a college sample of 361 participants (mean age 21.12 (4.154) range 18-37 years) were analyzed. Measures used the Knowledge Questionnaire (Vasconellos et al, 2011), Self-Report Altruism Scale (Rushton et al, 1981) and two questions asking participants to rate their likelihood to join the transplant registry. Pearson correlations were run on SPSS for altruism, knowledge, and likelihood to register. The results of the study showed altruism has a stronger influence than knowledge on the likelihood to register. These findings are significant as they contribute towards creating eZective interventions to increase participation in stem cell transplant registry amongst college students, and consequently, an increase in positive transplant outcomes.This work was accepted to the annual Graduate Research and Creative Works Symposium while the author was a graduate student at Rutgers University-Camden