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Investigating the Modulation of Metastasis by DAX-1 in Adrenal Carcinoma Cells
Get PDFThe nuclear hormone receptor (NHR), DAX-1 (dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1), is important in adrenal and gonadal development as well as steroidogenesis. It is encoded by the NR0B1 gene and functions mainly as a transcriptional repressor. Classified as an orphan receptor within the NHR superfamily, DAX-1 has been shown to inhibit other NHRs including estrogen receptor, androgen receptor and steroidogenic factor 1. DAX-1 is found to be underexpressed in breast and prostate cancers and, specifically in prostate cancer, is believed to be a transcriptional repressor of genes that are involved in epithelial-mesenchymal transition (EMT). EMT is a mechanism by which epithelial cells are able to assume a phenotype that allows them a degree of migratory capacity. Research has been conducted regarding the reintroduction of DAX-1 into CRISPR DAX-1 knockout (KO) prostate cancer cells, including analyzing DAX-1 and AR metastatic marker regulation following androgen stimulation. However, there is little research on the effect DAX-1 has on metastasis in adrenocortical carcinoma (ACC) cells, where it is overexpressed. This work investigates how DAX-1 modulates two metastatic markers in ACC cells: GATA6, a transcription factor involved in steroidogenesis, and ZEB1, a transcription factor that helps induce EMT in cancer cells. I investigated the relationship of DAX-1 with GATA6 and ZEB1 in SW13 cells, a human ACC cell line. I developed an RNAi knockdown model of DAX-1 to compare DAX-1’s modulation of metastasis against DAX-1 knockdown SW13 cells and wild-type SW13 cells. Wild-type SW13 qPCR results show DAX-1, ZEB1, and GATA6 expression in SW13 cells with a difference between ZEB1 and GATA6 levels. Following the DAX-1 knockdown by RNAi in SW13 cells, ZEB1 and GATA6 gene expression levels decreased in comparison to wild-type SW13 cells. A ChIP (chromatin immunoprecipitation) assay was also performed using the GATA6 promoter region where DAX-1 was found to be associated. These results currently indicate DAX-1 may act as a transcriptional activator of ZEB1 and GATA6, either directly or indirectly
PREVENTING CONFLICT-RELATED SEXUAL VIOLENCE IN ETHIOPIA: AN APPLIED APPROACH TOWARDS PREVENTION
Get PDFThe Ethiopia-Tigray civil war is one of the deadliest conflicts in recent world history and quickly drew international attention for the mass reports of sexual violence, war crimes, and ethnic cleansing by federal militants. Mass rapes and sexual violence were used along ethnic lines to devastate and displace communities in Ethiopia. Despite the signing of the peace agreement in November 2022 to cease hostilities, the sexual violence has not come to an end. The violence has consequently spread to the Afar, Amhara, and Oromia regions, neighboring Tigray. The sexual violence in Ethiopia was core to the armed conflict. Nonetheless, the government’s response to the occurrences of sexual violence is deemed to be inevitable in war, an ugly part of war, an agenda against the government, dismissed as an “exaggeration.” With little effort toward reconciliation, along with Ethiopia’s deep-rooted ethnic-based federal system; the climate of the Ethiopian community has become a strife in which ethnic groups have suffered the most. Conflict-related sexual violence occurs in contemporary armed conflicts to such an extent that preventative initiatives have ignited across the globe to end sexual violence as a tactic of war. This project aims to assess the consequences of sexual violence in conflict to contribute to initiatives towards prevention. The prevention framework in this project was created throughout my travel across various regions in Ethiopia while observing the escalation of this armed conflict. The findings of this project are incorporated into a collection of stories and experiences from the voices of the impacted beyond the traditional language. The findings of this project validate that sexual violence conducted in war is deliberate and not dismissible. The evitable can always be prevented. The impacts of conflict-related sexual violence affect survivors in different ways, times, and places, and each analysis needs to consider the situational context of the conflict setting. This project uncovers the importance of storytelling and documentation in creating visibility for the problem. Understanding and awareness can serve as a pathway toward change and prevention. Furthermore, this research explores the dangerous potential for previous occurrences to continue if there are no efforts to prevent sexual violence in conflict situations
Matrilineal Ethnic Affiliation and Female Empowerment: Investigating Attitudes towards Female Autonomy and Health in Ivorian Households
Get PDFKinship structure is a fundamental aspect of anthropology, however, there is still a gap in literature on its impact on economic research, particularly regarding female autonomy and health. This study aims to address this gap by examining the influence of matrilineal ethnic affiliation on attitudes towards female autonomy and health within Ivorian households. Using data from the 2011 IPUMS Demographic and Health Survey for the Ivory Coast, using female responses, this study investigates the complex dynamics shaping attitudes towards female autonomy and access to health care. Analysis on these aspects is done using ordinary least squares (OLS) and logistic estimations. Suggesting that within Ivorian households, female decision-making, and access to healthcare show no significant association with matrilineal or patrilineal ethnic affiliation. While attitudes towards discontinuing female genital mutilation and the ability to justify refusing sex show a positive and significant association with respondents from matrilineal ethnic groups, and to some extent, patrilineal groups. These findings highlight the necessity of culturally sensitive policies to promote female empowerment and autonomy within diverse kinship structures. It is important to note that these conclusions are drawn from specific kinship groups within the Ivory Coast, indicating that there is a need for further research for broader generalizations regarding the effects of kinship structure on female empowerment outcomes
FROM CREAMY CRACK TO LOCS: THE OPPRESSION AND LIBERATION OF BLACK WOMEN EDUCATORS THROUGH BLACK HAIR IDENTITY
No full textThis study investigated the experiences of seven Black women educators by exploring how they navigate the complex intersections of Black hair identity and the institution of education through collective healing circles. It aims to add dimension to the conversations around intersectionality by including hair and education as they are both vital to the way Black women’s worlds are animated. By foregrounding hair as a pivotal component of Black women’s intersectional identities, I aim to uncover how it impacts both pedagogy and praxis. Rooted in critical race theory, Black feminist thought, BlackCrit, and critical pedagogy, this work challenges conventional research paradigms by centering healing and restoration and challenging the dearth of literature on the pedagogies of Black women educators. The findings of this study explore the way Black women process messages around their identity through hair and race, how they rescript trauma through what I call post-traumatic hair subversion, and how they express liberation by remembering their past, their pain, and their power in a way that is restorative, healing, and reflective of who they are as educators. Ultimately, this study aims to celebrate and highlight the artillery Black women use to positively affect the lives of their students while thriving, healing, and subverting within the apparatus of education
Addressing the Increased Prevalence of Gestational Diabetes among Hispanic/Latino Pregnant Persons in the Central Valley of California
Get PDFGestational Diabetes (GDM) is a preventable noncommunicable disease that has been on the rise over the last 60 years. Pregnant persons with gestational diabetes are 10 times higher of acquiring Type 2 Diabetes after pregnancy (Ionannou et al., 2024). There is an urgent need to address this public health threat because of its increase in mortality. To address this complex chronic disease, this literature review explored multi-level interventions using the socioecological model to mitigate GDM in the Central Valley’s, Tulare County. Tulare County is disproportionately affected by chronic diseases like diabetes especially among the Hispanic and Latinx communities. Therefore, it is the population of focus. The socioecological model helped illustrate and categorize the facilitators and barriers at each level. This literature review was able to identify ways to mitigate and improve GDM outcomes from different interventions levels. Furthermore, this review discovered gaps in current research to address environmental impacts on GDM and proposed recommendations to incorporate an environmental health assessment on all OB/GYN patients. The data collected from this scoping review can guide public health practitioners to implement effective programs and education supporting pregnant persons to reach a healthier lifestyle for themselves and their children
Increasing Resiliency in Front-Line Nurse Managers
Get PDFProblem
According to Membrive-Jimenez et al. (2020), 29% of nursing managers experience emotional exhaustion due to work overload, conflict mediation, and a lack of support from senior leadership. In a central California hospital, front-line nurse managers struggle to meet organizational goals and support their teams, with 64% indicating dissatisfaction in their roles in fall 2023. This highlights the need to improve job satisfaction and retention.
Context
A large healthcare system in Northern California has implemented Caring Science (Foss et al., 2015) and HeartMath® (HeartMath, 2023) techniques in a rural hospital to improve nurse manager retention and job satisfaction. The project involved training assistant nurse managers and house supervisors in HeartMath® techniques to build a resilient and caring culture.
Intervention
A clinical nurse leader (CNL) student and HeartMath® certified trainer taught three HeartMath® educational modules, which included three HeartMath® techniques.
Measures
The primary outcome measure was the participants’ (N=6) job satisfaction and resilience level, measured using two validated and publicly available surveys conducted at pre- and post-educational training.
Results
The resiliency post-survey revealed that the front-line nurse managers sustained their baseline high level of resilience at 100%. The post-survey results showed a 25% increase in overall job satisfaction.
Conclusions
Front-line nurse managers in healthcare organizations face high rates of burnout and turnover. Applying Caring Science principles and techniques like HeartMath® can increase resiliency while creating a supportive culture and psychologically safe work environment. Disseminating these practices to more nurse managers is crucial to supporting their well-being and improving organizational effectiveness
Improving Compliance in Missed Visits Documentation
Get PDFProblem: Within the South Bay Hospice Agency, documentation compliance for missed visits was 68% in the first quarter of 2024, when the national standard should be 100% according to the Centers for Medicare & Medicaid Services.
Context: Inadequate nurse documentation and communication between health professionals can lead to medical errors, poor team communication and suboptimal patient outcomes (Tasew et al., 2019). Therefore, the importance of documentation compliance is imperative. Hospice staff perform scheduled visits for terminally ill patients 1-2 times a week; however, a missed visit can occur when a patient declines it for a variety of reasons.
Interventions: The interdisciplinary team and volunteer leadership staff attended two trainings to reinforce agency policy; electronic smart phrase was created to standardize communication; supervisor responsibility was increased to include weekly Electronic Health Record audits.
Measures: The percentage of documented reasons for missed visits per month and the percentage of staff notifying a medical doctor (MD) of a missed visit were tracked through weekly audits.
Results: April was at a 96.55% compliance rate; May at 91.22%; and June at 100%
Conclusions: The patient’s hospice journey must be completely and clearly documented to prevent negative patient experiences and regulatory non-compliance. A multi-faceted intervention including team education, standardized electronic workflow using a smart phrase, and weekly audits are recommended to ensure continuity of care and condition of participation compliance with regulatory agencies.
Keywords: documentation compliance, hospice, missed visits, audits, home care,
communicatio
Decreasing Incivility and Bullying Through the Development of a Healthy, Respectful Work Culture
Get PDFAbstract
Problem: Incidents of bullying and incivility, including verbal aggression and exclusionary practices within the Telemetry department.
Context: This quality improvement project addresses workplace incivility, bullying, and harassment. The project aims to develop and implement a Compact Agreement of Unit Norms to foster a healthier work environment.
Interventions: Interventions included leadership education on bullying and conflict resolution, team awareness was heightened through workshops defining bullying and incivility, and a collaborative Compact Agreement of Unit Norms was developed and implemented.
Measures: An analysis of reported incidents for the first quarter of 2024 through the Electronic Reposting System (ERRF) on the Telemetry floor revealed over 50 incidents of uncivil or bullying behaviors, including verbal aggression and exclusionary practices.
Results: By June 2024, a significant improvement was observed with a total of 8 ERRFs, indicating a reduction of over 30% compared to the first quarter of 2024.
Conclusions: The implications for practice based on this project highlight that reducing workplace incivility and bullying through the implementation of a Compact Agreement of Unit Norms fosters a healthier and more supportive work environment (Namie & Namie,2009).
Keywords: Workplace incivility, bullying, harassment, Compact Agreement of Unit Norms
Prospectus for Expected Discharge Date Accuracy (EDD) – Prepare to Go
Get PDFProblem: Accurate Expected Discharge Date (EDD) estimates are not just numbers on a chart. They are crucial for optimizing operations, reducing readmission risk, creating safe, timely discharge plans, identifying obstacles, providing transitional care, and enhancing patient satisfaction (Piniella et al., 2023). A hospital-based organization conducted a quality improvement project to improve EDD predictions and discharges, significantly improving patient satisfaction and outcomes. The project had shown that a 12% increase in accuracy, achieving 60% from the baseline of 48%, can be achieved through strong collaboration, transparent communication, and commitment to real-time documentation.
Context: A team analysis improved EDD accuracy, patient satisfaction, and efficiency, focusing on alignment, collaboration, and evidence-based practice integration. The communication plan addressed weaknesses, enhancing patient accessibility to care.
Intervention: Interventions targeted include improving patient tracking with today\u27s EDD using an EDD filter wrenched in the EHR flowsheet, consistent EDD documentation in physician notes, and prep-to-discharge notes entered in the EHR by 9 AM for leadership to review. Timely escalation to mitigate barriers to discharge and enhance communication is crucial. MD and PCC lighting rounds were completed by 1 PM, and EDD updates were entered in EHR by 5 PM, underscoring the importance of timely updates. Plan/Do/Study/Act (PDSA) cycles facilitated the organization of interventions.
Measure: Three parameters were developed to evaluate the efficacy of these interventions using a daily run chart. First, we tracked EDD documentation based on a larger range of MD recommendations. Second, we reviewed the percentage of PCC prep to discharge documentation for patients with EDD of today. Finally, we ascertained the percentage of EDD updates by 5 PM.
Results: While the project did not reach its goal of 75%, it demonstrated a significant improvement in the accuracy of EDD predictions. The 12% increase, from 48% to 60% accuracy, is a substantial step towards our goal and a clear indication of the project\u27s success.
Conclusions: The data identified clear opportunities for further improvement, and the project showed a crucial impact on hospital capacity, overcrowding in the ED, and member care accessibility. The coordination of care department must coordinate these initiatives daily to ensure success and viability.
Keywords: discharge planning, expected discharge date, hospital quality, electronic health records, length of stay, hospital throughpu
Inservice Education: Management of Fever and Neutropenia Among the Pediatric Oncology Population
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Background: In pediatric cancer patients, comprehensive treatment and its side effects, such as fever and neutropenia (FN), significantly impact physical and emotional well-being. Prompt evaluation and treatment of FN are crucial to prevent complications. Proper training of parents in preventing, recognizing, and managing low-grade fever and administering antibiotics at home or outpatient settings is essential for positive outcomes.
Local Problem: A multidisciplinary pediatric cancer treatment center in Northern California.
Methods: A pre- and post-assessment evaluation was conducted to evaluate the knowledge acquisition of nurses after an educational intervention.
Intervention: This Doctor of Nursing Practice (DNP) project aimed to enhance nurses’ knowledge to educate patients and their families on prompt recognition of FN signs and symptoms, timely treatment effectiveness, and safe management in an outpatient setting to enhance the quality of life (QoL).
Results: Thirteen out of 30 eligible participants listened to a 15-minute pre-recorded presentation. The session was intended to enhance the knowledge and confidence of oncology nurses in caring for and educating families of patients who presented with fever and neutropenia. Although the project’s primary outcome measures could not predict the overall implementation outcomes, nurses expressed increased confidence in providing patient education during each encounter. In general, nurses indicated they would incorporate the information into the care of each patient presenting with FN and recommend the presentation to their colleagues.
Conclusions: FN is the primary cause of emergency room visits, unforeseen hospitalizations, and diminished QoL in children receiving cancer treatment. Educating parents on preventing and managing FN, including the safe administration of antibiotics at home or in outpatient settings, is essential to reducing unplanned hospital stays and improving patient QoL. A brief training session was developed to provide nurses with clear information on preventing, recognizing, and treating infections to enhance positive outcomes for patients and their families. Overall, nurses supported the training session content and value