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Administrative Changes to Improve Appointment Adherence: A Quality Improvement Project
No full textD.N.P
Directing and Acting for the Camera
No full textThis paper describes my takeaways from my experience in Directing I (THEA 4040) and Acting for the Camera (THEA 4025)
Investigating the Role of pH-sensing G Protein-Coupled Receptors GPR4 and GPR132 in Colorectal Cancer: Multi-Statistical, Survival, and Structural Analysis Approach
No full textColorectal adenocarcinoma (COAD) is one of the leading causes of cancer-related mortality worldwide. Understanding the molecular mechanisms that contribute to cancer progression is a critical step for identifying therapeutic targets to combat COAD. GPR4 and GPR132, which are pH sensing G protein-coupled receptors (GPCRs), have recently emerged as a point of interest and linked to tumor progression, tumor microenvironment, and molecular signaling pathways. However, despite this, the roles these GPCRs play are still not fully understood. This study investigates the clinical and structural relevance of GPR4 and GPR132 in COAD through gene expression, survival, and structural analyses.
Gene expression and clinical data were collected from The Cancer Genome Atlas (TCGA) and analyzed using various statistical and survival methods. Statistical tests and survival models revealed an increase in GPR4 expression and that higher stages were significantly associated with worsening patient survival outcomes, which suggests GPR4 to be a potential biomarker and therapeutic target. In contrast GPR132 showed a limited amount of clinical significance and was hindered by a lack of comprehensive clinical data. Additionally, AlphaFold and APBS were used to model wildtype and mutation GPR4 structures and electrostatic potential (ESP) maps across different pH levels. While electrostatic differences were inconclusive and need further in-depth investigation, structural comparisons discovered notable spatial changes between the transmembrane domain that contains position 115 and two other transmembrane domains. Overall, this study highlights prognostic potential in COAD and provides preliminary insights into how mutations may influence its structure and function
No Crumbs in Bed: A Nurse-Led Initiative for Mealtime Mobility
No full textIntroduction: Low physical activity among hospitalized patients significantly contributes to poor health outcomes, such as physical deconditioning, pressure ulcers, pneumonia, and increased mortality. This issue is especially concerning for older adults, who often spend over 90% of their hospital stays in sedentary states, frequently taking fewer than 1,000 steps daily.
Design: This project utilized a quality improvement design, employing an iterative approach to implement and evaluate a nurse-led initiative aimed at increasing patient mobilization during mealtimes.
Methods: The "No Crumbs in Bed" initiative was carried out in a specialized medical-surgical progressive care unit at a large regional medical center. The project aimed to implement a mealtime mobilization protocol, encouraging eligible patients to move from bed to a chair for all meals. The Institute for Healthcare Improvement (IHI) Model for Improvement, specifically its Plan-Do-Study-Act (PDSA) cycles, guided the implementation. Data on the documented times and frequency of patients moving from bed to a chair, along with daily Johns Hopkins Highest Level of Mobility (JH-HLM) goals and scores, were systematically collected from Epic electronic health record reports. Staff perception surveys were administered using REDCap for data collection and analysis.
Results: The initiative successfully increased documented patient mobility from a 2024 baseline of 21% to 33% by April 2025, surpassing the project's target of 31%. While a high percentage of patients (ranging from 79% to 84%) consistently had a JH-HLM goal assessed at four or greater (indicating a goal of out-of-bed to chair or higher), the proportion of patients meeting this assessed goal remained between 45% and 50% throughout the project period. Pre-intervention surveys revealed a strong staff perception of the severity and likelihood of complications from immobility, while also highlighting significant barriers related to time constraints, patient factors, and staffing issues.
Conclusion: This nurse-led initiative demonstrated that structured interventions can significantly improve patient mobility documentation within an acute care setting. Despite the identified barriers to consistently achieving assessed mobility goals, including inconsistent meal delivery, limited seating, and established cultural norms that favor bed rest, the project provides a practical framework for fostering a culture of mobility. This approach promises to improve long-term patient outcomes by reducing complications associated with immobility, aligning with the IHI’s Triple Aim framework and Healthy People 2030 goals.
Clinical Relevance: This nurse-led initiative offers a practical framework for enhancing patient mobility during hospitalization, thereby reducing complications and promoting patient recovery through structured mealtime interventions.
Keywords: mobility, hospitalization, nurse-led initiative, deconditioning, patient outcomes, Triple Aim, mealtimeD.N.P
INVESTIGATING THE ROLE OF THE PERIPLASMIC BINDING PROTEIN, FAT B, IN THE BINDING INTERACTION OF [IRON (III)-SIDEROPHORE] COMPLEXES IN BRUCELLA SPP.
No full textBrucella abortus, an obligate intracellular Gram-negative bacterium, is the causative agent of brucellosis in ruminants. As an intracellular pathogen, Brucella survives inside macrophages or placental trophoblast cells (for pregnant cattle). Like most living organisms, Brucella strains require the micronutrient, iron, for their survival. Brucella abortus produces two siderophores, Brucebactin (BB), a di-catechol chelator, and 2,3-dihydroxybenzoic acid (2,3-DHBA), while proliferating in placental trophoblast to meet the higher iron demand. Previous genome profiling of Brucella abortus has identified the fatBCDE genes as the putative Fe(III)-Siderophore inner-membrane ABC-type (ATP Binding Cassette) transporter. The fatB gene encodes, bi-lobal Periplasmic Binding Protein (PBP) and is expected to bind the Fe(III)-Siderophore complexes in the periplasmic space. Although Brucella abortus does not need to express the siderophore production and uptake genes during colonization of macrophages, but the expression of this system is essential for the placental infection, which has been attributed to infertility and abortion in cattle. Moreover, biochemically, this siderophore uptake system is important as brucebactin is predicted to be a di-catechol, and unlike its tri-catechol counter parts produce coordinatively unsaturated Fe(III) complex. The mechanism of Fe(III) release from such di-catechol complexes are not well understood, creating a knowledge gap in the siderophore mediated Fe(III) uptake field. Because of these, understanding the mechanism of Fe(III) uptake through the Fat system is essential and the subject of this research work.
Homology modeling and bioinformatics studies performed on FatB conducted show an α-helical hinge, typical of Fe(III)-siderophore binding proteins with conserved R, H, and Y residues. Superposition of the FatB model with the crystal structures of its homologs (CeuE, YclQ) show these conserved residues to play direct roles in Fe(III)-siderophore recognition (R) and Fe(III) binding (H and Y). Equipped with this information, I successfully cloned Brucella abortus 2308 FatB gene in pET 32a+ vector and expressed the protein from E. coli BL21 to conduct spectroscopic studies (CD, DSC, Fluorescence, UV-Vis, etc.). Data from these experiments confirm that recombinant wild-type FatB can differentiate between 2,3-DHBA (one of the native siderophores) bound Fe(III) from 3,4-DHBA bound Fe(III). Further, results from my experiments also confirm that FatB folds forming α-helix and β-sheets in solution, as predicted by the homology model, and the percent compositions of these secondary structural elements are significantly altered when Fe(III)-2,3-DHBA or Fe(III)-BB are titrated into this protein. Finally, I determined the binding affinities of Fe(III)-2,3-DHBA and Fe(III)-BB with FatB using isothermal titration calorimetry, showing µM affinities. This thesis is the first comprehensive study on the siderophore mediated Fe(III) transport in Brucella abortus
EXAMINING THE IMPACT OF A MOTHER’S HEALTH AND ENVIRONMENT ON HER CHILD’S HEALTH IN UTERO AND PERSONAL HEALTH OUTCOMES
No full textIt is clear that the number of pregnancy complications and maternal mortality rates are rising, and healthcare is thoroughly concerned with treating complications such as preeclampsia and gestational diabetes once they arise. However, healthcare practitioners would benefit from a shift to focus more energy on providing women with education regarding risk reduction prior to and during pregnancy. If we can improve our overall health and particularly health during pregnancy, it will lead to a decrease in complications and a reduction of risk factors. In order to make improvements and changes, both practitioners and pregnant patients need to be educated on what lifestyle factors affect the health of a pregnancy and how to optimize their health during pregnancy. Significant strides are needed in patient education, and this study aims to serve as a resource for pregnant women and healthcare providers, including Obstetricians (OB), Registered Nurses (RN), and Midwives, to enhance their knowledge and educate their patients effectively. This study will review the literature on preventing the complications previously mentioned through diet, exercise, mental health interventions, trauma informed care and more. The goal of this study is to summarize how lifestyle choices can impact the health of a mother, her pregnancy, and her infant
Executive Summary: A Quality Initiative to Improve Transitional Care for Patients with Opioid Use Disorder in Rural North Carolina
No full textThe opioid epidemic is a significant health issue in the United States, affecting about 3 million people. Over the past 15 years, opioid-related deaths have continued to rise due to the widespread availability of heroin and synthetic opioids like fentanyl. Effective medications such as buprenorphine, methadone, and naltrexone are available to treat opioid use disorder (OUD). However, despite the high death toll and associated health problems like HIV, hepatitis C, and infective endocarditis, only around 20% of individuals with OUD receive treatment. This is mainly due to social stigma, costs, transportation barriers, and health disparities. Communities in North Carolina are also impacted, with opioid-related deaths increasing by 72% from 2019 to 2022 across all races in the state. This Doctor of Nursing Practice project aimed to develop a sustainable transitional care process that facilitates referrals to community resources for these patients at the time of discharge from the emergency department. The project successfully aligned care delivery with the goals of Healthy People 2030 for patients with OUD.D.N.P
Feasibility and Acceptability of a Self-Care Intervention for Implantable Cardioverter Defibrillator Patients: A “Systems Check” For ICD Patients
No full textImplantable cardioverter defibrillators (ICDs) are a foundational component of management of patients who are high risk for sudden cardiac death (SCD), and efficacy of ICD therapies for both primary and secondary prevention have been well evidenced (Kusumoto et al., 2014). Despite the life-saving benefits of the device, however, poor adjustment to the ICD is common, and rates of psychological distress are high (Sears et al., 2014). Maladjustment to the device can result in adverse clinical outcomes including diminished quality of life and disease progression.
Similar patient concerns have been addressed in heart failure patient populations utilizing a model for self-care although no model for ICD-specific self-care has been tested. As such, the present study employed a self-care intervention for ICD patients in rural-serving cardiology clinics. This three-part, in-person, group-based intervention utilized the American Heart Association’s conceptualization of self-care behaviors and was tailored for ICD management to include disease, device, and shock management, promotion of psychological well-being, and behavioral and lifestyle modification. The current study aimed to examine the feasibility and acceptability of this program and examined changes in primary outcomes of self-care activity engagement and overall shock anxiety ratings. Changes in subjective ratings of self-efficacy, ICD-specific knowledge, device acceptance, fear of exercise, and cardiac anxiety were also measured, and objective activity data was collected via wearable actigraphy watches. At the conclusion of the study, participants were asked to complete a brief evaluation of the intervention, designed to capture patient satisfaction with the program, perceived improvements in knowledge and confidence in device management, and interest in future ICD self-care programs.
At the East Carolina Heart Institute, 468 ICD patients screened eligible across cardiology clinics, and 123 were approached for participation in the study. Of those approached, 62.61% either expressed interest in the study or agreed to participate and 17.07% (21 patients) were consented. The most common reasons for declining to participate were transportation (28.46%) and time conflict (17.07%). A total of 16 ICD patients (M age = 64.13, SD = 12.23) consented and attended all three sessions. Attrition rate was 23.80% when accounting for all patients who consented but did not complete the intervention. Among the sample, 56% identified as women, and 75% identified as Black. Only a small portion of the sample (18.8%) had a prior history of shock. Ten patients (62.5%) showed improvements in self-care activities, and overall mean changes in engagement in self-care activities approached significance, p = .051, with moderate effect (Cohen’s d of .44). Six patients (37.5%) showed improvements in overall shock anxiety, although overall mean differences in shock anxiety pre and post were not significant. Changes in sedentary time and active time pre and post were not significant; however, 6 reduced sedentary time by >15 hours/week and 3 improved continuous exercise time by >2 hours/week. At completion, 87.5% of the sample endorsed improved ICD knowledge, confidence, and high satisfaction with the program. 75.1% indicated interest in self-care programs in the future. While feasibility metrics were poor, patient satisfaction reports point to high acceptability of the program, and individual improvements in self-care activities indicate benefit from self-care interventions for ICD patients. Findings suggest that programs focused on ICD self-care have the potential to improve psychological and behavioral factors integral to device and disease management and were acceptable in this patient population. Mode of delivery, recruitment constraints, and patient barriers should be considered in future studies
The Impact of a Positive Learning Environment in Elementary Education
No full textAs both a teaching student and a creative endeavor pursuant, I believe that stories shape the way we understand the world, as well as the classroom. Belong began as a Signature Honors Project with the intention of showcasing the emotional and academic transformation a child experiences when welcomed into a positive learning environment. Based around my experiences as an education major and intern, I envisioned a story that would reflect what it feels like to be the new kid: nervous, overwhelmed, and unsure of one’s place. But as the child in the story is loved, supported, and invited into community, the world around her becomes brighter, both literally and figuratively. This book uses the metaphor of color to explore belonging, and in doing so, hopes to inspire educators to reflect on the environments they create for their students
EFFECTS OF PRE- VS. POST-TBI CANNABIDIOL ON EXPRESSION OF A NEUROINFLAMMATORY MARKER IN MALE AND FEMALE ZEBRA FINCHES
No full textTraumatic brain injuries (TBIs) cause significant morbidity through primary and secondary mechanisms, the latter involving chronic neuroinflammation from persistent microglial activation. Current treatments (e.g., NSAIDs, glucocorticoids) for chronic neuroinflammation have dose-limiting side-effects, and therefore potential anti-inflammatory alternatives, like cannabidiol (CBD) are being investigated. Songbirds like zebra finches are an ideal model for studying functional recovery following TBI, as their song development and associated neural circuitry share well-documented parallels with human speech acquisition and sensorimotor learning. Prior studies in male zebra finches showed CBD treatments pre-TBI (7 days) reduces neuroinflammation and accelerates vocal recovery. But key questions about post-injury efficacy and sex differences remain untested. As females don’t sing, we used IL1β transcription, a neuroinflammation marker, via qRT-PCR to assess CBD’s effects across sexes. We hypothesized that post-TBI CBD (10 mg/kg, short or long treatment) would decrease IL1β transcription following HVC lesions, with potential sex differences given some evidence for a neuroprotective role for female hormones1–9. Male and female zebra finches received unilateral HVC microlesions, with CBD or vehicle given pre- (7 days) or post-injury (2 days). No statistically significant differences emerged across drug, treatment timing, or sex (three-way ANOVA, p > 0.05). However, males showed a trend toward reduced IL1β with short-term CBD (despite variability). Females exhibited wider spread in IL1β expression levels, possibly reflecting hormonal effects. A larger sample size and better optimization of experimental conditions might reveal significant trends, including previously noted male efficacy. This study highlights CBD’s potential post-TBI efficacy and the need to explore sex-specific responses