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Pediatric Trauma Informed Care
No full textThis integrative literature review aims to research the purpose of pediatric trauma-informed care and how it can help patients in their present and future. Through this integrative literature review, I researched the importance of trauma-informed care(TIC), what TIC is, and how it can be applied in the healthcare system. This literature review's research questions and aims include: How can implementing pediatric trauma-informed care create a better future/outcome for patients? Why is pediatric trauma-informed care important? What are the lasting impacts of pediatric trauma-informed care? How can we implement pediatric trauma-informed care? What is pediatric trauma-informed care
Exploring the Use of Music-Based Interventions by Certified Child Life Specialists for Children in Healthcare Settings
No full textCertified child life specialists (CCLSs) use interventions within their scope of practice to promote coping for patients and families in healthcare settings. This study addresses a gap in the literature by exploring how CCLSs use music-based interventions (MBIs) within an arts-in-medicine framework and how they collaborate with board-certified music therapists (MT-BCs) in pediatric settings. This study received IRB approval. Using a cross-sectional design, this exploratory, survey-based, descriptive study reports findings from the experiences of 91 CCLSs. Findings showed that CCLSs provide various MBIs, such as listening to recorded music with their patients in different age groups and singing songs, especially with preschool-aged or younger patients. CCLSs reported using MBIs for providing developmental support, normalization, and as a non-pharmacological pain management intervention during procedural support. Based on their perceptions, CCLSs reported positive outcomes in patients receiving MBIs, including increased relaxation, playfulness, and exhibiting less stress during procedures. Notably, few CCLSs (n=17, 18.7%) reported receiving specific training to use MBIs. Barriers to receiving training included a lack of awareness regarding training offered, financial costs, and time to attend training. CCLSs generally support co-treating patients with MT-BCs, but some also reported a lack of clarity regarding the scope of practice to use MBIs. Findings suggest that CCLSs would benefit from professional development opportunities to increase their intentionality in using MBIs. Implications for training, practice, professional considerations, and future research are provided to increase the understanding of the child life role in using MBIs within pediatric healthcare settings
The Hands of Life: A Study of Growth and Change
No full text“The Hands of Life” is a personal exploration of the human experience expressed through the evolution of hand and facial shapes. This series reflects my fascination with how hands reflect one's individuality and the passage of time. Initially, I had difficulty understanding their proportions, and I struggled to draw them with accuracy. However, through perseverance I transformed my frustrations into expressive pieces that convey a multitude of emotions. Each piece features family members and loved ones at different stages of life, highlighting the beauty of our shared experiences in the stages of life
Influence of Glucose Concentration on Macrophage Polarization in vitro
No full textThe innate immune response represents a critical piece of overall immunity, driving the immediate reaction to a variety of conserved antigens which are known to cause a multitude of diseases. Central to the innate response are macrophages, a heterogeneous population of monocyte derived immune cells capable of both killing bacteria directly as well as orchestrating a more complex innate and adaptive immune response. Indeed, macrophages provide both inflammatory responses to rid the body of bacteria while also helping to control inflammatory responses through the production of immune regulators such as interleukin 10 and transforming growth factor beta. Growing evidence indicates that environmental factors may influence this balance of inflammatory, or M1 macrophages, and regulator, or M2 macrophages. Intriguingly, the macronutrient fuel source itself powering the macrophage may influence its polarization dynamics. This study will evaluate the impact of glucose concentration on the in vitro polarization of murine macrophages. Given that hyperglycemia is associated, in humans, with chronic low-grade inflammation, it is hypothesized that macrophages cultured in high glucose conditions will present with increased M1 macrophage marker production (e.g. tumor necrosis factor alpha, TNFa; macrophage chemotactic protein 1, MCP-1; inducible nitric oxide synthase, iNOS) upon activation with inflammatory stimuli (lipopolysaccharide, LPS) and suppressed M2 (anti-inflammatory) responses following treatment with interleukin 4 (IL4) including decreased mannose receptor expression, interleukin 10 (IL10),and transforming growth factor beta (TGFb) expression. To this end, murine macrophages were cultured in either normal glucose (100 mg/dL) or high glucose (450 mg/dL) in the presence or absence of M1 or M2 activating stimuli (LPS/IFNg or IL4 respectively). Following 3hr of exposure to stimuli, cells were harvested and RNA isolated for quantitative PCR analysis. High glucose conditions enhanced the expression of TNFa and iNOS in response to M1 stimuli when compared to normal glucose conditions. M2 responses were impaired in the high glucose group when compared to normal-glucose conditions as assessed by gene expression for Arginase I and IL10. High glucose alone appears capable of altering macrophage responses, augmenting standard inflammatory reactions to conserved stimuli like LPS while also impairing regulatory, or M2 macrophage development. Therapeutics aimed at limiting M1 responses may prove useful in treating or preventing chronic health conditions associated with diabetes among other disease states
Modeling Call Synchronization in Sciaenidae Fish Aggregations: Is There an Advantage?
No full textSynchronization of oscillating systems occurs when there is a coupling interaction causing the motions of the system to synchronize over time. First observed (Williams, Kitanov and Langford, 2017) between mechanical clocks hanging next to each other, synchronization occurs in many biological systems (Henry et al., 2021) from calling frogs and flashing fireflies to claw-waving crabs. The mathematics of synchronization are well established. The Kuramoto model (Strogatz, 2000) treats the coupling between oscillators as a perturbation, and each oscillator “feels” the average of the other oscillations resulting in a phase transition between unsynchronized and synchronized behavior as the coupling strength increases.
We have created a preliminary model of synchronized calling in an aggregation of weakfish (Cynoscion regalis) that is based on a successful model (Ramírez-Ávila et al., 2019) for firefly synchronization. Male weakfish produce courtship calls consisting of pulse trains lasting ~ 0.5 s followed by a silent period of ~ 0.7 s. In our model the calling weakfish adjust their silent period based on the loudness of the other weakfish calls they hear until their silent period synchronizes with the silent periods of the other calling weakfish. Our model aggregation contained 1000 calling weakfish distributed in a 30 m radius cylinder in water of depth 5 m. This simulated aggregation produced a sound with peak pressure at the center 2.4 dB greater than for an unsynchronized aggregation with the same spatial distribution calling randomly. The minimum pressure of the synchronized aggregation was 12 dB less than for the unsynchronized aggregation. One advantage of a synchronized aggregation is that the signal will propagate farther (by a factor of 1.7 for cylindrical spreading in our model) before falling below the background pressure. Also, the enhanced differences between the loud and quiet portions of the synchronized call could be a signal to females of the presence of an aggregation and not random noise.
In this presentation, we will show the details of the synchronization model and compare the characteristics of synchronized and unsynchronized aggregations. We will also present simulated aggregation calls of both synchronized and unsynchronized aggregations. Finally, we will propose a study to determine if and to what extent synchronization occurs in sciaenids
Artist Statement
No full textI wanted to pursue a creative SHP project so I could focus on playing and expressing myself through music during my final year at ECU. I also wanted to challenge myself both technically and creatively through this experience. For those who don’t know, music has always been a passion of mine growing up—I originally planned to major in music education and performance when I started college. However, after some personal reflection, I realized that I want to keep performing music as a hobby rather than make it my career. Maybe that will change in the future, but right now, I just want to enjoy performing on the side. Choosing a creative SHP has allowed me to follow one of my passions while pushing myself as both a musician and an artist.;
The focus of this SHP project was learning and then performing a classical piece on piano. I specifically chose to play Beethoven’s Piano Sonata No. 25 in G Major, alternatively titled “Cuckoo.” This piece consists of three movements. I then specifically talk about the piece and what it means to me in my arist statement
Can You Hear Me Now?!: Development of Teacher Voice during Co-Teaching Cycle
No full textThe development of teacher voice and authority is a critical aspect of a teacher’s identity, yet can be easily overlooked by teacher preparation programs. The co-teaching cycle has emerged as a collaborative instructional model that not only benefits student learning, but also provides a special space for preservice teachers to develop the facets that make up their teacher voice. This study used surveys (i.e., P-STMI, Perceptions of Co-Teaching) and transcribed audio recorded co-planning and co-reflection sessions to examine how engaging in the co-teaching cycle impacted the development of my teacher's voice and identity.
Findings showed notable growth of my personal teacher voice. That growth was focused primarily in belonging to a community, self-efficacy, enthusiasm, well-being, and transitioning between student and teacher thinking. Co-teaching provided opportunities to engage in pedagogical synergy, instructional decision-making, adapting to student needs, and fostering confidence within the classroom environment. Additionally, survey results indicated the preservice teachers (PSTs) in the course generally perceived the co-teaching model positively, particularly valuing access to diverse perspectives, individualized support, and authentic modeling of collaboration whilst expressing neutral views on the direct impact to their personal learning outcomes.
Overall, this study suggests that the co-teaching cycle can serve as a powerful mechanism for preservice teacher (co-teacher) voice development and intentional use of collaborative structures in undergraduate mathematics education courses may enhance all parties, across the board. Enhancing connection to modern student thinking for mentor teachers, teacher preparation for all PSTs involved, and student engagement for PSTs in the course. Implications for practice and suggestions for future research as also discussed
Resilience Equine-Assisted Learning to Reduce Perceived Stress in Baccalaureate
No full textNursing students across the country are struggling to cope with chronic stress, burnout and decreased resilience. They are constantly juggling between maintaining rigorous studying habits, implementing recently learned skills in clinical practice, caring for patients, and balancing a social life outside of school (Sanad, 2019). Unfortunately, this stress does not diminish with earning a “Bachelor's of Science in Nursing” degree (Kelly et al., 2021). Daily, nurses are confronted with human suffering, decreased resources, and an increased workload. Given these working conditions, nurses often find themselves enduring “high degrees of stress, anxiety, depressive symptoms, job burnout, and unsatisfactory quality of life” (Marchand & Sullivan-Sakaeda, 2022, p.1). However, this vicious cycle of overwhelming stress and burnout can hopefully be broken with the implementation of resilience training. This study aims to explore the changes in perceived stress for baccalaureate nursing students following the implementation of a six-week Resilience Equine-Assisted Learning (REAL) intervention
Beyond Technology Adoption: Exploring the Impact of Public Health Employees' Perceptions and Usage of Patient Portal to Advance Digital Health Equity
No full textBEYOND TECHNOLOGY ADOPTION: EXPLORING THE IMPACT OF PUBLIC HEALTH EMPLOYEES’ PERCEPTIONS AND USAGE OF PATIENT PORTALS TO ADVANCE DIGITAL HEALTH EQUITY
By
Helene Franchanita Edwards
July, 2025
Director of Dissertation: Dr. Doyle Cummings
Major Department: Public Health
ABSTRACT
Background: Healthcare organizations have been at the forefront of health information technology (HIT), striving to promote health equity and improve access to care. The introduction of electronic health records with patient-centric access has been a game-changer, promising to elevate the quality of care and enhance patient-provider engagement. Among these technological advancements, patient portals provide individuals with secure, unrestricted access to their health information. Several studies have revealed disparities in patient portal adoption across multiple levels, including policy and governance, organizational, and individual levels, which are more pronounced among vulnerable populations who are less likely to achieve optimal health outcomes.
There are limited studies assessing the technology acceptance of patient portals in safety net organizations, which provide healthcare services for vulnerable populations. In North Carolina, local health departments (LHDs) promote the health of their respective communities while also organizing and delivering healthcare services to uninsured individuals, Medicaid recipients, and other vulnerable populations. As safety net providers, LHDs play a pivotal role in promoting patient portal utilization among historically marginalized populations and those with limited English proficiency (LEP); therefore, understanding the perspectives of public health professionals on the technology acceptance of patient portals can impact universal adoption.
Objective: This study aimed to identify predictors that influence the adoption of patient portals by public health professionals and their recommendations for others to use them.
Methods: This quantitative cross-sectional study was conducted among local public health professionals, utilizing a 32-question survey, built in Qualtrics, based on the extended Unified Theory of Acceptance and Use of Technology-2 (UTAUT-2) model to investigate consumer acceptance of patient portals and behavioral intention to use and recommend them. Between February and April 2025, snowball convenience sampling strategies were employed to recruit local public health professionals across North Carolina.
The primary theory constructs of performance expectancy, effort expectancy, social influence, and price value were considered independent variables. The dependent variables were behavioral intention to use and intention to recommend patient portals. Age, education, marital status, experience, and residence (urban or rural county) were tested as moderators between the primary theory constructs and behavioral intention to use. The three research questions and six hypotheses were analyzed using descriptive statistical analysis, bivariate analysis (ANOVA and Independent t-tests), and multivariate analysis (multiple regression analyses and Confirmatory Factor Analysis for structural equation modeling).
Results: Of the 431 participants, 392 were included in the final analysis. Healthcare providers offered patient portal access to 98.7% (n = 387) of the respondents. Furthermore, 94.4% (n = 370) of the respondents reported having access to patient portals, and 90.8% (n = 356) used their portals within the last 12 months. Performance expectancy (β = .548, C.R. = 11.050, p < 0.001), effort expectancy (β = .303, C.R. = 7.088, p < 0.001), social influence (β = 0.066, C.R. = 2.021, p < 0.043), and price value (β = 0.100, C.R. = 2.905, p < 0.004) were the influential drivers of behavioral intention to use (R2 = 85.3%). Age (β = 0.949, p = 0.008), education (β = 0.959, p = 0.019), experience (β = 0.919, p = 0.007), and residence (β = 0.959, p = 0.029) had moderating effects on the independent variables of the adapted UTAUT-2 model. In addition, behavioral intention to use (β = 0.864, p < 0.001) had a statistically significant impact on intention to recommend (R2 = 74.7%).
Conclusion: This study confirmed the valuable impact of healthcare providers promoting patient portals to their patients. Furthermore, performance expectancy, effort expectancy, social influence, and price value were statistically significant predictors of public health professionals’ behavioral intention to use patient portals. Behavioral intention to use and frequency of use of patient portals were statistically significant influential drivers of the intention to recommend patient portals to others. The study’s results suggest that local health departments should focus on strategies associated with these factors to expand health information technology policies, thereby improving population health and reducing barriers to the adoption of patient portals. Future research should be conducted in other contexts and explore additional predictors to develop effective interventions that encourage the adoption and sustained use of patient portals in advancing digital health equity
Buprenorphine Prescription in North Carolina
No full textA 2022 report from The Centers for Disease Control and Prevention (CDC) reported that 75% of overdose deaths involved the use of opioids. Medications such as Buprenorphine, Methadone, and Naltrexone can be used to treat opioid use disorder (OUD), and they are referred to as medication-assisted treatment (MAT). Buprenorphine acts as a partial opioid agonist, binding to opioid receptors in the brain and activating them less than a full agonist (e.g., heroin, oxycodone, fentanyl, morphine). This can decrease an individual's reliance on stronger opioids. Increasing the accessibility of Buprenorphine among individuals with OUD is essential to decreasing the prevalence of overdose-related deaths. In June 2023, the Mainstreaming Addiction Treatment Act decreased barriers and eliminated the x-waiver requirement for clinicians to prescribe Buprenorphine. The purpose of this study is to examine the prevalence of Buprenorphine prescription among clinicians in Pitt County, North Carolina, after the x-waiver was eliminated in June 2023. Due to the MAT act and x-waiver elimination, we hypothesize that the prevalence of Buprenorphine prescription will have increased since June 2023. Data was obtained through a convergent mixed methods Qualtrics survey. The survey design was largely based on the Consolidated Framework for Implementation Science (CFIR). Survey constructs included employment demographics, attitudes toward Buprenorphine prescription, Buprenorphine prescription prevalence, the impact of the x-waiver, infrastructure, barriers to prescribing Buprenorphine, and personal demographics. Clinicians were identified using the North Carolina Medical Board roster. Respondents consisted of Medical Doctors, Doctors of Osteopathic Medicine, and Physician Assistants, currently practicing in Pitt County. A recruitment letter outlining the study was sent to clinicians identified from the roster. The recruitment timeline was based on the Dillman Method, which assists with maximizing response rates. Data was analyzed using the SPSS statistics software. Descriptive statistics were applied to summarize the data both graphically and numerically. Qualitative data analysis was analyzed using a combination of deductive and inductive approaches. When assessing the impact of the x-waiver elimination on buprenorphine prescription prevalence, it was concluded that most participants (N = 23; 78.3% Medical Doctors, 65.2% white, 56.5% male) indicated no change in buprenorphine prescription since the x-waiver was eliminated in June 2023. When asked if their buprenorphine prescription habits had changed since June 2023, 13.0% were unsure if their prescription habits had changed, and 8.7% reported prescribing more buprenorphine. No clinicians stated they were prescribing less buprenorphine since the elimination of the x-waiver. Findings demonstrate that buprenorphine prescription habits did not change amongst the sample after the x-waiver was eliminated. A comprehensive approach combining education for clinicians and patients, addressing systemic gaps, and stigma influencing attitudes for MOUD treatment is needed to further improve buprenorphine prescription prevalence