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CRNA Airway Assessment in Patients with Obesity: A Quality Improvement Project
No full textOver 40% of adults in the United States are categorized as obese. Although obesity alone is not an independent risk factor for difficult airway, CRNAs may have more difficulty with perioperative airway management due to changes in physiology and development of comorbidities. There are many different techniques that can be used to properly assess the airway in the preoperative period, but no single source succinctly incorporates this information for managing potential difficult airways in patients with obesity. The purpose of this quality improvement project was to assess CRNAs’ perception of adequacy of a quick reference guide (QRG) as a useful tool for their practice as it pertains to assessment of the airway of patients with obesity. CRNAs at an outpatient center were asked to complete a pre-implementation survey, watch an educational video, use the QRG for two weeks, and complete a post-implementation survey. Results revealed that almost all CRNAs were already using at least two preoperative assessment techniques when assessing the airway of patients with obesity, currently recommended by the literature. The overall perception of the QRG was mostly positive, as all respondents to the post-implementation survey found the QRG to be at least mostly useful. Limitations of this project include a small sample size and lack of full participation in the pre-and post-implementation surveys. Recommendations for future studies include a larger number of participants and a longer implementation period.D.N.P
Making Korean Onggi Pottery in North Carolina: Clay Body, Glaze, Firing and Aesthetic Approach
No full textOnggi is a traditional style of Korean utilitarian pottery. Potters have been using the Onggi traditional building, glazing and firing techniques to make pottery for storing and fermenting food for thousands of years. Although no longer relevant as the main storage vessels for food in Korea, Onggi jars have become an art form in recent times. As a potter still tied to traditional building and firing techniques, I am making large vessels based on the Korean tradition of Onggi, and infusing them with an artistic interpretation. Making the transition to an American pottery environment posed four avenues of research necessary to produce large vessels: clay body, glaze, firing environment, and the artistic elevation of traditional Onggi jars. My research shows how traditional Onggi building methods can be used to make large vessels using the materials, equipment, and atmosphere in North Carolina and how these same circumstances enhance the artistic evolution of the simple Onggi storage vessel
Investigation of Neurodegenerative Disease-related Cofilin-Actin Rod Dynamics Using a Novel Optogenetic Approach
No full textThe presence of actin-cofilin rods in neurons is a common feature of a multitude of neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and Huntingtin’s disease (Bamburg, et al 2010). These rods form under oxidative and energetic stress conditions such as ATP depletion, glutamate excitotoxicity, or a highly oxidative environment, and ultimately lead to synapse loss. These stress conditions shift the equilibrium of actin, an ATP binding protein, to a primarily ADP-bound state. In our lab, we have created a light activated switch (‘CofActor’) for monitoring cofilin-actin rod formation in living cells. This allows real-time monitoring of cofilin-actin interactions in cells undergoing applied energetic or oxidative stress. In previous work, we used the CofActor system to monitor these interactions over short time scales (10 – 20 minutes). In this work, we investigate whether we can use the CofActor system to monitor cofilin-actin interactions over longer time periods (3 – 4 hours). We specifically asked whether the rounded cofilin-actin clusters formed over the short time scale could eventually transition into linear cofilin-actin rods. We used fluorescence microscopy to monitor the CofActor system expressed in HeLa cells under energetic stress (ATP-depleted) conditions induced with a cocktail of Sodium Azide (NaN3) and 2-deoxy-D-glucose (2-DG). Our findings demonstrate that cofilin-actin clusters can transition to linear cofilin-actin rods and that they provide a unique way to assess the dynamics of cofilin-actin rod formation in living cells
Identifying the Role of FGF Receptor 1 in AgRP Neurons to Regulate Energy and Glucose Homeostasis
No full textThe arcuate nucleus of the hypothalamus (ARC) is an epicenter for metabolic regulation, housing neurons critical for interpreting afferent signals of energy status and delivering diverse efferent outputs to metabolically active tissues to regulate energy homeostasis. Within the ARC, Agouti-Related-Peptide-expressing (AgRP) neurons promote weight gain by triggering intense hunger and reducing energy expenditure. Importantly, overactivity of AgRP neurons is highly associated with increased food intake, weight gain, and elevated blood glucose levels. While previous investigations have indicated an important role for Fibroblast Growth Factor Receptor 1 (FGFR1) ligands in regulating metabolism via the central nervous system (CNS), the understanding of how this occurs remains incomplete. Therefore, the goals of this dissertation were to investigate the role of FGFR1 in AgRP neurons to regulate energy and glucose homeostasis and identify the underlying mechanisms by which this occurs. Similar to fibroblast growth factors (FGFs), central administration of [alpha]-Klotho, a scaffolding protein that aids in the binding of FGFs to FGFRs, elicits therapeutic effects in rodent models of type I and type II diabetes. While these effects were mediated by modulating AgRP neuron activity, the detailed mechanisms are not fully understood. Using targeted loss- and gain-of-function approaches to manipulate the expression of FGFR1 in AgRP neurons in adult mice, the data presented here shows that the deletion of FGFR1 in AgRP neurons alters energy homeostasis, favoring an obesogenic state, which is exacerbated when challenged with a high-fat diet (HFD). Furthermore, overexpression of FGFR1 in AgRP neurons mildly protects against obesity and improves glucose tolerance. Mechanistically, deletion of FGFR1 in AgRP neurons prevents [alpha]-Klotho mediated suppression of AgRP neuron activity, and mice lacking FGFR1 in AgRP neurons show elevated expression of the AgRP peptide, which is released as a neurotransmitter to elicit orexigenic effects. Providing further evidence of an [alpha]-Klotho-FGFR1-PI3K-FOXO1 signaling axis in AgRP neurons that acts similarly to leptin and insulin, regulating both the electrical properties and gene expression of the AgRP peptide. The work presented here identifies FGFR1 in AgRP neurons as a new therapeutic target to attempt to restore proper signaling in AgRP neurons in individuals with dysfunctional signaling or "resistance" to these metabolic factors and shows that FGFR1 in AgRP neurons is an integral component of regulating glucose and energy homeostasis
Integrative Analysis of Policy Changes for a Coastal Watershed: Implications for Agriculture and Ecosystem Health
No full textThis dissertation explores the integration of hydrological modeling, the effects of sea level rise, and socio-economic factors influencing watershed management in North Carolina, primarily utilizing the Soil and Water Assessment Tool Plus (SWAT+) with four independent publication chapters. The first chapter assesses the effectiveness of various satellite precipitation products and autocalibration techniques on river flow prediction, highlighting the superior performance of the Global Precipitation Measurement Integrated Multi-satellitE Retrievals (GPM IMERG) dataset when combined with the Generalized Likelihood Uncertainty Estimation (GLUE) technique. The second study investigates the effects of sea level rise on nitrate dynamics within the Tar-Pamlico coastal watershed, with adjustments made to SWAT+ parameters to simulate changes in nitrogen processes and their impacts on ecosystem health. This reveals increased nitrate loads under sea level rise scenarios. The third chapter merges econometric and engineering frameworks to evaluate the efficacy of agricultural best management practices (BMPs) as influenced by farmers' behavioral responses. It reveals that despite potential incentives, significant reductions in nitrate loading are not achieved, underscoring the limitations of current models and the importance of comprehensive socio-hydrological frameworks. Collectively, this dissertation enhances our understanding of hydrological processes and their interactions with environmental changes and human factors, offering crucial insights for effective watershed management and policy development
A Review of Parental Bereavement Interventions: Implications for Clinical Practice, Research, and Policy
No full textThe untimely death of a child is an incredibly traumatic experience for parents and their loved ones. It uproots every aspect of their life, leading the bereaved parents to be far more likely to have poorer physical and mental health outcomes. This traumatic form of bereavement should have comprehensive grief-focused, high-quality interventions available for parents and extended family members. The purpose of this rapid review was to explore and describe the bereavement interventions available for parents and family that have been published within the past 5 years. Records identified 123 full-text articles that were reviewed, and 14 of those were included for data extraction and synthesis, using Cochrane Rapid Reviews Methods Group with the addition of keyword searches. The 14 articles were analyzed by evaluating description of bereaved parents, accessibility of interventions, who delivered interventions, and the type and delivery time of interventions. Four types of interventions were identified, including Web-based, community-based, hospital-based, and psychotherapy interventions. This rapid review has implications for clinical practice, research, and health care policy that can increase the availability of support and quality of interventions for bereaved parents and family members
The Value of Real Estate and Property Management
No full textReal estate is around in everyday life from the places that individual’s shop, eat, work and live. This thesis paper will reveal the value that real estate and property management offer not only as a lucrative career and investment opportunity but for the advancement of society both socially and economically. This thesis will do this by discussing in depth extensive research on the real estate and property management industry. The thesis will reveal this by explaining the historical aspect, economic significance, investment value, social and cultural impacts, technological advancements, challenges, and opportunities in the respective industry as well as potential career fields the industry provides. The real estate and property management industry is a real tangible product that has been around forever and is going to be around forever. This thesis discusses how real estate and property management industry is driven for the betterment of society while offering lucrative business ventures
Reducing Workplace Violence with the Use of a Behavioral Emergency Response Team
No full textThe objective of this project was to create a Behavioral Emergency Response Team (BERT) to ultimately reduce the number of workplace violence (WPV) events and associated teammate injuries by training individuals that can verbally de-escalate potentially violent situations from occurring identified clinical triggers. Workplace violence has continued to increase over the years, especially post-pandemic. It puts hospital staff at an increased safety risk and has caused burnout among healthcare workers. This evidence-based project was conducted reviewing all BERT responses and WPV events during January-April 2024 compared to pre-BERT data for the same four months in 2023. Four nursing departments in a small, rural, community hospital served as pilot units for BERT. Those units were the Emergency Department (ED), Intensive Care Unit (ICU), and two Medical Surgical Units (MSU). During the pilot phase, there were 33 BERT responses and 39 WPV events. Injuries towards teammates during the pilot phase were 19. While it was predicted the number of WPV events and injuries would decrease with the initiation of a BERT, the data did not reveal that at the project site. In fact, WPV events and injuries went up from 2023 data. While the results from the project did not show a decrease in the number of WPV events or number of injuries associated with WPV, it could be due to an increased awareness of reporting violent behaviors. Also, there was a particularly violent patient during the pilot phase that accounted for 15 WPV events and 11 teammate injuries.D.N.P
Protein helps us retain muscle mass as we age
No full textMedical and dietetic students often co-author a column for the Daily Reflector under Dr. Kolasa's byline. The students research the topic a reader or patient has asked. Dr. Kolasa reviews their draft for technical accuracy, patient friendly language, people first language. She fact checks the study or other evidence-based reference the student provides. If a physician review is appropriate, Dr. Kolasa requests a colleague from ECU physicians to review the article. The final draft is submitted to the Reflector with the editor having the final say. The headline is written by the Reflector headline writer. The food and nutrition column has run weekly since 1987. Starting in 2020, in addition to the Daily Reflector, the article is published in daily and weekly papers owned by the Adams Publishing Group East.Non
Tobacco Détente: American Leaf in the Cold War, 1964-1977
No full textEverything changed for the American tobacco industry in 1964. Smoking had long since been suspected of being unhealthy. But now the US Surgeon General made it official: smoking is harmful to one's health. Suddenly, tobacco found itself in the crosshairs of antismoking forces in Congress and the American public. New regulatory and public relations challenges did not mean tobacco companies would accept losses; it meant they needed to find new markets. American tobacco companies looked beyond the Iron Curtain. While the Johnson administration encouraged liberalized trade with Eastern Europe during the 1960s, and the Nixon and Ford administrations sought to maintain the difficult balance of détente during the 1970s, tobacco delegations made up of private businessmen and members of the US Department of Agriculture visited the Soviet Union, while Soviet delegations visited the United States. Tobacco firms, chiefly Philip Morris and R.J. Reynolds, set their eyes on vast, untapped eastern markets. In North Carolina, members of the Export Leaf Association and Tobacco Associates Inc. believed U.S. tobacco exports to the Soviet Union and its satellites would help the North Carolina farmer and called for unrestricted trade between the two superpowers. But, as thousands of industry documents available due to the 1998 Master Settlement Agreement show, which include delegation itineraries, business memos, and RJ Reynolds', Philip Morris's, and North Carolina's Tobacco Associates annual reports, tobacco played a bigger role than a simple commodity in an emerging East-West trade. Using an array of telegrams and memorandums found in the Office of the Historian's Foreign Relations of the United States and drawing on works such as Tricia Starks' Cigarettes and Soviets: Smoking In The USSR and Mary Neuburger's Balkan Smoke: Tobacco and the Making of Modern Bulgaria, this work explores tobacco as a microcosm of détente during the years 1964-1977. Within these thirteen years, tobacco played a small but important part in foreign policy and the international economy. Plenty of North Carolinian cold warriors did not approve, but plenty did. Despite public and political protest, the proponents of liberalized trade won out. Tobacco was a moving piece of détente, and by the late 1970s, Marlboros were being manufactured and smoked in the Soviet Union