11549 research outputs found
Sort by
Evaluation of Patient Engagement on Driveline Infection Rates in LVAD Patients through Digital Education
No full textMechanical circulatory support in the form of a left ventricular assist device (LVAD) can support patients with advanced Heart Failure (HF). The most common complication following LVAD implantation is driveline infection (DLI) leading to increased morbidity, mortality, and costs. Management of the driveline insertion site by the patient at home after discharge is critical in prevention of DLI. A quality improvement project utilizing the FADE model was conducted by leveraging video-based education delivered via an electronic health portal and evaluated the impact on infection rates, 30-day readmission rates in LVAD patients, and patient engagement. Post-implementation, the DLI rates remained unchanged, 30-day readmission rates improved slightly, and patient engagement was low with newly implanted patients although higher in prior implants. Limitations included types of delivery mechanisms within the electronic health portal and overall engagement and activation of the electronic health portal. The use of video-based education allowed for consistent delivery of educational material and has the ability to impact morbidity, mortality, and costs. A multi-modal approach to LVAD education supports enhanced patient education and earlier engagement may be more beneficial to enhance utilization. Future recommendations include evaluation of timing of delivery and other delivery methodologies such as QR codes.D.N.P
EXPLORING THE CULTIVATION OF BODY APPRECIATION AND ACCEPTANCE IN FAT, GENDER DIVERSE PEOPLE OF COLOR: AN INTERPRETATIVE PHENOMENOLOGICAL STUDY
No full textPositive body image is a construct that extends above and beyond the absence of negative body image or body dissatisfaction. However, most of the research operationalizing and exploring positive body image have predominantly centered White, thin, cisgender individuals. This dissertation explores the experiences of fat, gender-diverse people of color and their experiences of cultivating intersectional positive body image across the lifespan and how it impacts their intimate relationships and relationships with healthcare providers. The purpose of this dissertation is to help medical family therapists and other healthcare professionals facilitate the process of cultivating intersectional positive body image for fat, gender diverse people of color to further health and wellness for patients at these intersections. The following dissertation is divided into six manuscripts: (a) an introduction to the dissertation and the previous research on positive body image, (b) a literature review detailing how “normative bodies” are socially constructed through intersections of anti-Blackness, fatphobia, and transphobia and implications for family theory researchers and practitioners, (c) a systematic review on how positive body image is cultivated in U.S. LGBTQ+ adults, (d) a methods chapter regarding the original exploratory case study through interpretative phenomenological analysis, (e) the original research study examining fat gender diverse people of color’s experiences cultivating positive body image, and (f) a piece for the Family Therapy Magazine on understanding the negative impacts of intersectional fatphobia, racism, transphobia, and both Marriage and Family Therapists and Medical Family Therapists’ roles in advocating within and outside the therapy room. Findings from the exploratory case study delve into four components of positive body image for fat gender diverse people of color encompassing a) positive body image shaped by race, ethnicity, gender, and culture; (b) positive body image as self-process; (c) positive body image as relational; and (d) positive body image and healthcare. For fat, trans and nonbinary people of color, the experience of cultivating positive body image is more nuanced due to their intersectional identities, their relationships, and their body’s physical realities; they experience positive body image on a spectrum rather than as a binary. The larger dissertation expands on this notion and explores how history has shaped the larger thin ideal and how medical family therapists and other healthcare practitioners can challenge this ideal to provide quality care to patients who identify as fat and gender diverse people of color
Nutrient Context and Litter Composition Control Wetland Plant Root Decomposition
No full textAnthropogenic factors such as deforestation and agriculture have both a direct and indirect impact on nutrient availability and carbon (C) storage potential. Deposition of nutrients can modify plant uptake of nutrients, plant composition (quality of litter), soil microbial communities, plant-microbe associations and availability of organic C and nitrogen. Decomposition rates are dependent on a few of these factors such as plant composition, moisture availability, and concentrations of carbon to nitrogen (C:N) ratio in soils and litter. In this study, I addressed how nutrient enrichment influences the plant root decomposition rate and C storage potential. I hypothesized that if plant species vary in growth response to different nutrient context histories, then root decomposition rates will depend on nutrient context (long-term fertilization vs. ambient) and plant functional group (grass vs. shrub). I tested this hypothesis by conducting a long-term wetland ecology experiment at East Carolina University’s West Research Campus in Greenville, North Carolina by measuring mass loss of different plant litters (grass Chasmanthium laxum and shrub Rhus copallinum) sourced from different soil nutrient histories and buried in different soil environmental conditions and associated microbial communities. Additionally, I analyzed C:N ratios for both plant litter and soil collected from mowed fertilized and mowed unfertilized plots. Results revealed that plant root litter C:N ratios were different based on the interaction between plant type (grass vs shrub) and fertilization (fertilized vs unfertilized). Soil C:N ratio showed a difference across fertilization. The variation in fertilization effects on soil C:N ratio and root litter properties influenced plant root litter decomposition to different degrees. Percent mass loss of grass roots was similar across all main effects of fertilization, plant nutrient history, and mesh size, while there was a difference across buried plots and mesh size (µm) for the shrub roots. Shrub roots buried in fertilized plots within 200 µm nylon mesh bags had higher percent mass loss than those buried in unfertilized plots within 20 µm nylon mesh bags due to the access of macrofauna allowed with the larger mesh size. Additionally, shrub roots buried in fertilized plots within 200 µm nylon mesh bags had higher percent mass loss compared to unfertilized plots. The soil C:N ratio combination with differences in root litter C:N ratio influenced rates of decomposition where shrub litter with high C:N ratios had faster decomposition rates when buried in fertilized soils (with lower soil C:N ratio), while grass litter with low C:N ratio had similar effects on both fertilized and unfertilized plots. This study provided insight into how nutrient enrichment influences native plant root decomposition rates and C storage potential by measuring mass loss of different plant litter sourced from different soil nutrient histories and showed higher mass loss rates led to greater soil C stocks. Since long-term fertilization increases the relative abundance of woody species such as Rhus copallinum over time, the higher mass loss of these roots could negate carbon gains from higher biomass due to root turnover outweighing the plant biomass inputs. Therefore, understanding the relationship between long-term fertilization and plant functional groups is important for evaluating plant root composition and its influence on microbial activity and the role wetlands can play in climate change mitigation
Evaluating Treatment Efficacy of a Novel Nano-Antibiotic against Drug-Resistant Pseudomonas aeruginosa Planktonic and Biofilm Forms in a Chronic Obstructive Pulmonary Disease (COPD) Model
No full textBackground: Pseudomonas aeruginosa (Pa) is a bacterium often found during advanced stages of muco-obstructive lung diseases, such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). Patients with COPD hyperaccumulate thick mucus that impairs ciliary movement within the airways. Pa binds to glycosylated mucin proteins in the mucus, which enables Pa to evade antibiotic treatment (i.e., Tobramycin) regardless of frequency or dosage; this forms a favorable environment for recurrent and chronic bacterial lung infections, exacerbated symptoms, and higher mortality rates. Antibiotic treatment failure remains a challenge, contributing to 4.95 million deaths in 2019, globally.
Objectives: This study’s objective was to determine the efficacy of amino-functionalized silver nanoparticles (NH2-AgNPs) in inhibiting both planktonic and biofilm forms of Pa growth under low and high mucin environments, mimicking the airway milieu of patients with early and chronic stages of COPD.
Methods: PAO1 strain was used for multiple toxicity bioassays, including growth assay, cell leakage assay, resazurin cell viability assay, crystal violet biofilm inhibition assay, and Pierce Bradford protein assay.
Results: NH2-AgNPs were significantly inhibitory to both the planktonic and biofilm forms of Pa at ≥1 µg/mL compared to Tobramycin. These results suggest higher potency of NH2-AgNPs over Tobramycin in inhibiting Pa infections in in-vitro COPD model
Pathways to Health Professions
No full textBackground
Interprofessional Education (IPE) is essential for fostering collaboration and communication among healthcare professionals to improve patient outcomes. Early IPE training for pre-health undergraduate students has been shown to enhance teamwork, dismantle stereotypes, and build self-efficacy in healthcare settings. Self-efficacy is the belief that one can achieve their goals and succeed at tasks. These outcomes contribute to creating a cohesive and equitable healthcare environment focused on patient-centered care. Despite evidence supporting the benefits of IPE training, there is a lack of consistent implementation at the undergraduate level across institutions.
Objective
Programs that have adopted IPE have demonstrated improved student preparedness, better interprofessional collaboration, and enhanced patient care outcomes. Our study addresses this gap in undergraduate IPE by examining the impact of a structured IPE training program, Pathway to Health Professions, designed for pre-health ECU undergraduate students who are members of ‘Buff in Scrubs’, an ECU organization.
Methods
Our study employs a mixed-methods approach, including retrospective surveys and open-ended questions, to assess changes in participants' attitudes, skills, and competencies pre-and post-trainings. Data will be collected from January 2025 to April 2025.
Results
We hypothesize that early and structured exposure to IPE training will significantly enhance pre-health undergraduate students' confidence, understanding of interprofessional roles, and ability to collaborate effectively. By focusing on self-efficacy-based skills, we hope to equip pre-health students with critical collaboration and communication skills early in their education. We expect improvements in participants’ perceived preparedness for advanced healthcare education and patient-centered care.
By improving perceived preparedness, we aim to also increase students’ self-efficacy and preparedness for graduate school applications. Our undergraduate IPE program, Pathway to Health Professions, seeks to bridge the gap in IPE implementation at the undergraduate level. We aim to prepare future healthcare professionals to contribute to cohesive teams and improve patient outcomes. This work underscores the need for broader adoption of IPE training in undergraduate education to enhance healthcare collaboration and equity
Physical Characterization and Cellular Testing of Polymeric Micelle Formulations for Intravenous Delivery of Hydrophobic Anticancer Drugs
No full textColorectal cancer ranks amongst the top three types of cancer diagnosed in the United States and is the second most common cause of cancer death. There are several drugs approved for the treatment of colon cancer. However, one of the more commonly used treatments, immune checkpoint inhibitors, are only effective in around 15% of patients diagnosed with metastatic colon cancer. Furthermore, many anti-cancer drugs specific to colon cancer are hydrophobic and thus have poor water solubility. Therefore, there is a need for a delivery formulation that is water soluble so that the drug can be introduced to the blood stream. With these requirements in mind, the overarching goal of this project is to develop a delivery system using micelles that are water soluble, and that can hold hydrophobic anti-cancer drugs. To achieve this goal, there are a few characteristics of the micelles that need to be ascertained to determine their suitability in tumor treatment. These include critical micelle concentration (CMC), encapsulation efficiency, size and cytotoxicity. These characteristics denote the concentration at which micelles form, how much drug they can hold, their diameter, and whether they are toxic to cells.
Previous research done for this project investigated a new hydrophobic drug with which to treat colon cancer, as well as a micelle formulation to facilitate the delivery of this drug. The new drug is 15-deoxy, ∆12,14-PMJ2 and was originally investigated for use against melanoma cancer but has shown promising results for treating colon cancer. The first micelle formulation used was a 1:5 ratio of DSPE:TPGS, where DSPE is a polyethylene glycol conjugated phosphatidylethanolamine and TPGS is a polyethylene glycol derivative of α-tocopherol (vitamin E). These micelles exhibited promising characteristics such as a low CMC, a high encapsulation efficiency when loaded with drug, and an appropriate size for nanoparticles used in cancer treatment (between ≈ 10-100 nm). However, it was discovered that this formulation was cytotoxic towards cancer cells, so the project pivoted to investigate pluronic F127 micelles as an alternative delivery system. Pluronic is the trade name for triblock copolymers composed of a central hydrophobic chain of polypropylene oxide (PPO) which is between two hydrophilic chains of polyethylene oxide (PEO); the F127 designation denotes the structure PEO100PPO65PEO100. These micelles were also found to have a low CMC, although not as low as DSPE:TPGS, a high encapsulation efficiency, and an appropriate size for tumor treatment. In addition to these findings, the micelles also showed little to no cytotoxicity towards cancer cells. Thus, pluronic F127 micelles are now the primary candidate for the delivery of PMJ for future research projects
Kininase I Mediated Signaling Evidenced in Hypertension and Target Organ Damage
No full textCarboxypeptidase N (CPN) and Carboxypeptidase M (CPM) are isoforms of kininase I, with CPN restricted to the plasma and CPM located on the plasma membrane. Kininase I is a critical pleiotropic regulator of inflammation, as it cleaves several inflammatory mediators such as anaphylatoxins, creatine kinase MM, stromal cell-derived factor-1alpha and kinins. Kinins are important vasoactive peptides which activate the kinin B2 receptor (B2R), and cause vasodilation. However, kininase I converts these kinins into agonists for the kinin B1 receptor (B1R), a receptor associated with vasoconstriction and hypertension. However, the role of kininase I in hypertension has not been identified. Male and female carboxypeptidase N1 (Cpn1) whole-body gene knockout (CPNKO) mice were utilized to investigate the role of CPN in the development of angiotensin II (Ang II)-induced hypertension and target organ damage. CPNKO and wild-type (WT) mice were implanted with radiotelemetry probes to measure blood pressure, and later with mini osmotic pumps to infuse mice with either saline or angiotensin II (Ang II; 600/ng/kg/min -1) for 4 weeks.
In a separate experiment, we used tail cuff plethysmography to measure blood pressure in WT male and female mice infused with either saline or a combined dosage of the non-selective kininase I pharmacological inhibitor (Mergetpa; 10 mg/day) and Ang II (600/ng/kg/min -1) over 4 weeks. Aortic segments isolated from these mice were subjected to wire myography, to assess the effect of CPN gene deletion on vascular function. The activity and expression of kininase I and B1R were analyzed using various protein detection techniques in the brain, heart, and aorta. Proximity ligation assays were utilized to identify alterations in protein-protein interactions between B1R and other protein partners, such as CPM and aminopeptidase N (CD13), in the hypothalamic paraventricular nucleus (PVN) of WT and CPNKO mice. CPN activity assays revealed that overstimulation with Ang II in WT mice promoted CPN activity in plasma. Interestingly, Ang II infusions did not cause a significant modulation in CPM expression specifically in the PVN, heart, and aorta of CPNKO mice, compared to saline treated CPNKO and WT mice. Alternatively, CPM expression was robustly increased following Ang II infusions in WT mouse PVN, heart and aortic tissues. Mean arterial pressure (MAP), measured using radiotelemetry, was not significantly different in saline treated CPNKO and WT mice in both sexes. However, MAP was significantly elevated in WT mice infused with Ang II, but this effect was attenuated in Ang II infused CPNKO mice. Furthermore, the expression of B1R in the brain, heart and aorta was significantly enhanced by Ang II in WT mice compared to CPNKO counterparts. Based on the extent of hypertrophy and picrosirius red staining observed in Ang II infused WT and CPNKO mice, the genetic deletion of CPN protects against cardiac hypertrophy and fibrosis caused by Ang II in both sexes. Interestingly, markers associated with inflammation (IL-1β, IL-6, MCP-1/CCL2, and TNF) and oxidative stress (superoxide, 3-nitrotyrosine) were also found elevated in the heart,
aorta, and PVN of Ang II infused WT mice, and these outcomes were mitigated in Ang II infused CPNKO counterparts. Furthermore, the expression CD13 in the PVN was enhanced following Ang II infusion in WT mice, while CPNKO exhibited significantly lower levels of CD13 expression in the PVN. Astonishingly, proximity ligation assays revealed that protein-protein interactions between both CPM and B1R, as well as CD13 and B1R were heightened in WT mice infused with Ang II but diminished in CPN deficient mice. Mergetpa, the non-selective kininase I inhibitor, was associated with a reduction in MAP and the expression of CPM and B1R in the PVN of WT mice, compared to WT mice infused with Ang II alone. Lastly, vascular function was assessed using wire myography revealed that male Ang II infused CPNKO and Mergetpa treated mice have preserved endothelial dependent relaxation mechanisms, compared to WT mice overstimulated with Ang II. Based on our results, kininase I blockade prevented Ang II induced hypertension and targeted end-organ damage by mitigating B1R activation. B1R mediates inflammation and oxidation and CPM/B1R or CD13/B1R protein-protein interactions may promote Ang II-induced hypertension. Specifically, the pro-inflammatory effects of kininase I initiate B1R activation, leading to the generation of reactive oxygen species (ROS) and subsequent immune cell infiltration/activation and endothelial dysfunction. Alternatively, we suggest that B1R activation mediated by CD13 signaling may contribute to Ang II-induced inflammation and fibrosis, to a lesser extent. Within the context of this study, we did not identify any clear potential sex differences associated with kininase I blockade, in WT and CPNKO mice. We have evidenced for the first time that kininase I mediated B1R activation is correlated with pathogenesis of Ang II and may serve as a potential therapeutic target for the treatment of an overactive RAAS in hypertension
peer mentoring and nurse practitioner retention
No full textnoneThe Association of American Medical Colleges expects there to be a shortage of 54,000 to 139,000 primary care providers by 2033. Nurse practitioners (NP) can help fill that gap and improve access to care. Current literature suggests that there is a nationwide problem with nurse practitioner retention, providing evidence to address the high levels of turnover. Most of the available research has shown that peer mentoring as part of nurse practitioner onboarding can effectively help businesses retain NPs. Retention of NPs decreases organizational costs, as onboarding is a costly process. Poor retention of NPs decreases the availability of medical care to patients. This quality improvement project aims to provide evidence supporting the use of peer mentoring to enhance nurse practitioner retention and reduce organizational costs associated with repeated onboarding due to attrition.noneD.N.P
By Any Means of Making
No full textThis thesis investigates how analog, low-cost making practices—rooted in DIY and punk
aesthetics—can serve as effective tools for teaching foundational principles in graphic design,
offering an alternative to software-dependent learning environments The following document can
be broken into the following activities: Copy & Play, Type Set, and Lock Your Layers, which
utilizes the Principles of Art and Design¹ as learning objectives. These principles are then explored
by the participants through playful interaction. By using commonly understood principles in
design, we create a baseline that can be used to compare with other design education research
HOW TO IMPROVE TEACHING ELECTRONIC FRAUD TO SENIOR CITIZENS
No full textElectronic fraud is an issue that can accompany the use of a computer, tablet, or cell phone with the internet. Electronic fraud can target anyone; however, research has shown that senior citizens over the age of 65 are the most likely group to become victims. The victim’s identity can be breached, costing thousands of dollars in damages. A class was provided to groups of senior citizens to teach them how to detect and avoid electronic fraud. The conclusion of the presentation featured a questionnaire on what the participants learned and how they learn. An optional panel discussion followed to learn different strategies for teaching senior citizens. It was determined that senior citizens learn differently than other age ranges. This project aims to improve how we teach senior citizens to detect and avoid electronic fraud. A senior citizen with a better understanding of electronic fraud will be less likely to fall prey in the future