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Optimizing Treatment for Depression: Integrating TMS and Ketamine Through Provider and Clinical Staff Education
No full textThis Doctor of Nursing Practice (DNP) project aimed to evaluate the impact of an educational intervention created to improve mental health care providers, nurses, and other clinical staff's knowledge of the combined use of Transcranial Magnetic Stimulation (TMS) and ketamine for treating treatment-resistant depression (TRD). TRD affects a significant number of individuals who have Major Depressive Disorder (MDD) and often do not respond to traditional antidepressant therapies, thus leading to a need for other modalities. Novice treatments for TRD include ketamine, an NMDA receptor antagonist, and TMS, a non-invasive brain stimulation technique, both of which have demonstrated effectiveness. However, many of those who are involved in the care of those receiving ketamine, TMS, or both remain unaware of the synergistic benefits of combining the two treatments. This project utilized a quality improvement (QI) framework, specifically the Plan-Do-Study-Act (PDSA) model, to design and implement an educational intervention for mental health providers managing ketamine treatment in outpatient settings. Participants took a 10-question pre-quiz, then engaged in a 10-minute PowerPoint voice-over education session, followed by the same 10-question post-quiz to assess their knowledge of the mechanisms and clinical data supporting the combined use of ketamine and TMS. Data analysis involved comparing pre- and post-quiz results to evaluate a change in knowledge. This project aimed to enhance the clinical teams' knowledge, improve treatment outcomes for patients with TRD receiving ketamine and TMS, and contribute to the growing knowledge of integrating advanced treatment modalities in mental health care. This project aimed to address critical provider education and improve patient care in managing treatment-resistant depression
The Role of AIM2 During Head and Neck Cancer Development and Its Role in Antigen Specific Activation of CD4 T cells
No full textThe immune system is a vital part of mammalian biology that works to protect the individual from microbial invasion and neoplastic transformations. In particular, the immune system plays a complex role during cancer development, promoting anticancer responses, but can also promote cancer under certain contexts. Chronic inflammation is one of the emerging mechanisms by which the immune system can drive cancer development. Pattern recognition receptors (PRRs), like Absent in Melanoma 2 (AIM2), initiate inflammatory responses. Several PRRs have been implicated in cancer development and other inflammatory diseases. AIM2 also acts as a tumor suppressor, helping to restrict cancer development. AIM2 also regulates the differentiation of T cell subsets, which are vital for mounting anti-cancer immune responses. Head and neck cancer is heavily associated with chronic inflammation and immune dysregulation. Survival rates for head and neck cancer patients have not improved in the past decade. The role of the immune system during the early developmental stages of head and neck cancer remains largely unknown. Thus, it is important to investigate the role of the immune system during the development of head and neck cancer. This dissertation outlines two novel roles for AIM2 in the immune system. The first is AIM2’s ability to restrict head and neck cancer development. I discovered that AIM2 restricts tumor sizes in mice during 4NQO-induced head and neck cancer. AIM2 also restricts interferon gamma (IFN-γ) and IFN-γ-associated gene signature in the tongues of 4NQO-treated mice and limits the infiltration of macrophages into the tongue tissue. Also, AIM2’s ability to restrict tongue tumor sizes was dependent on the adaptive immune compartment. This study illuminates a novel role for AIM2 during head and neck cancer development. The second major finding described in this dissertation focuses on the intrinsic role of AIM2 in CD4 T cells during antigen-specific activation and differentiation. Studies have revealed conflicting data on AIM2’s role in Th17 and regulatory T cell differentiation. Also, these studies that explored AIM2’s role in T cell differentiation failed to use antigen-specific model. To address this, we crossed AIM2 deficient mice with animals expressing an ovalbumin specific T cell receptor in CD4 T cells (OT-II). We found that AIM2 does not regulate thymic selection but found fewer recent thymic emigrants to the spleen and fewer CD4 T cells in the spleen of AIM2 deficient OT-II mice. This suggests AIM2 impacts either CD4 T cell migration, retention or homeostasis in secondary lymphoid organs of mice. I further investigated if AIM2 plays a role during antigen-specific activation of CD4 T cells in vitro and found that Aim2-/- OT-II CD4 T cells produce less IL-2 than wild type OT-II CD4 T cells when co-cultured with ovalbumin-incubated dendritic cells. However, we assessed Aim2-/- OT-II CD4 T cell proliferative capacity and differentiation ability in response to OVA immunization in vivo and found no difference between WT OT-II CD4 T cells. Finally, we assessed Aim2-/- OT-II CD4 T cell functional ability utilizing an in vivo syngeneic tumor injection model where B16-OVA melanoma or NOOC2-OVA cancer cells were injected into the flanks of mice and WT or Aim2-/- OT-II cells were transferred into the mice and the tumors were measured over one month. We found no difference in tumor growth between mice that received WT or Aim2-/- OT-II cells. Thus, this deficiency in IL-2 production in Aim2-/- OT-II cells does not result in differentiation differences or functional differences. Further studies are needed to determine how AIM2 regulates CD4 T cell homeostasis and IL-2 production. Taken together, my results and others indicate that AIM2 plays a complex role during head and neck cancer development and T cell biology
Standardizing the Transition to Practice for Advanced Practice Providers in Critical Care
No full textBackground: There is a lack of transitional support for new hire advanced practice providers (APPs), especially within the critical care sector of healthcare which is leading to increased burnout, anxiety, feelings of inadequacy, and a lack of confidence as a new provider. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project way to development and implement curriculum- and resource-based educational onboarding and orientation materials to provide transitional support for new hire APPs in the medical intensive care unit (MICU) within a large academic teaching hospital. Methods: Utilizing an online platform named Brightspace, old onboarding and orientation materials were removed and updated content was either created or virtually sourced to create a structured and sustainable onboarding and orientation experience for future MICU new hires. Pre- and post-implementation surveys were utilized to evaluate whether the updates of Brightspace information were positive or negative for upcoming new hires.
Results: A total of 12 participants from the current MICU practice participated in the project. There was a noted 92% significant improvement in content provided in Brightspace with 75% reporting the new content being more applicable to the APP transition to practice specifically for transition into the MICU group. Conclusions: Creation of a curriculum- and resource-based educational onboarding and orientation materials resulted in a reported improvement in content included and advancements in potential new hire readiness for practicing as a MICU APP following onboarding and orientation. Development of a structured onboarding and orientation process could lead to decreases in new hire anxiety and could provide a standardized approach to the APP transition to practice for other MICUs across the nation
Improving Provider Knowledge and Screening of Cardiac Anxiety Through an Educational Module
No full textBackground: Cardiac-specific anxiety (CSA) is often underrecognized and affects patients after events like myocardial infarction (MI), coronary artery bypass grafting (CABG), heart failure (HF), or implantable cardioverter defibrillator (ICD) placement. Higher CSA levels are associated with worse cardiac outcomes, lower quality of life, poor treatment adherence, and increased healthcare use (Schmitz et al., 2022; Van Beek et al., 2016). Although organizations like the American Heart Association (AHA) and the American Psychiatric Association (APA) recommend routine psychosocial screening, real-world adoption is inconsistent. Evidence shows that only about 60% of patients in cardiac rehab are screened for anxiety or depression, with significant variation in screening methods across different groups (Helmark et al., 2022). The
Cardiac Anxiety Questionnaire (CAQ), a validated screening tool for CSA, is underused in clinical practice due to gaps in provider knowledge and workflow challenges. Purpose: This quality improvement (QI) project aimed to enhance advanced practice providers’ (APPs) knowledge, confidence, and intention to screen for cardiac-specific anxiety with the CAQ via a brief, self-paced educational module at HonorHealth. Methods: A 15-minute online module was created to educate APPs about CSA prevalence, risk factors, and CAQ administration and interpretation. Participants completed pre- and post-module surveys assessing knowledge, confidence, and screening intent, which were distributed through Qualtrics. Data were analyzed using descriptive statistics to evaluate participant knowledge and attitude changes, and open-ended responses offered qualitative feedback on the module's usability. Results: Six APPs completed the pre-survey, while four completed both pre- and post-surveys. The average knowledge quiz scores rose from 6.25 to 8.0, showing a positive trend in learning. Participants also reported increased familiarity with CSA and the CAQ after the intervention, higher confidence in recognizing CSA, and a stronger willingness to include screening in their clinical work. Conclusions: This project showed that a short, targeted educational intervention can improve provider awareness and preparedness to carry out CSA screening in a busy cardiology setting.
Despite a small sample size, the findings indicate the practicality and clinical importance of integrating standardized anxiety screening into cardiac care to support holistic, patient-focused outcomes
Cultivo de hierbas en Tucson
No full textEn el sur de Arizona tenemos la suerte de poder cultivar una amplia variedad de hierbas durante todo el año. A diferencia de algunas partes del país donde el otoño marca el final de la temporada de crecimiento, aquí en el desierto de Sonora, tenemos dos principales zonas de crecimiento. Estaciones, son una temporada de crecimiento fresco que dura aproximadamente desde octubre hasta mayo y una temporada de crecimiento cálido que dura desde mayo hasta mediados de septiembre. En cada una crecen diferentes hierbas. Temporada, y algunos, con un poco de ayuda, crecerán felizmente todos los años de duración
Inventory of mine waste features in northwestern Arizona
No full textIn August 2023, the Arizona Geological Survey (AZGS) was awarded federal funding through the United States Geological Survey Earth Mapping Resources Initiative to inventory and catalog 25 mine waste features in northwestern Arizona using ArcGIS Pro. In total, 34 features were inventoried at 18 different sites in Mohave, Yavapai, and Coconino Counties. Subsequent inventory projects will target other parts of the state in order to build a robust catalog of waste features in Arizona. Ultimately, these records will contribute to a growing national mine waste database that will help guide future waste reprocessing and mineral extraction efforts.Documents in the AZGS Documents Repository collection are made available by the Arizona Geological Survey (AZGS) and the University Libraries at the University of Arizona. For more information about items in this collection, please contact [email protected]
Design and Experimental Demonstration of a Scalable Acoustic Analogue of Quantum Computers
No full textComputers have transformed the way we live, work, and innovate. While Quantum computers based on quantum bits (qubits) exploit principles such as superposition and entanglement to offer unprecedented computational power compared to conventional computers. However, their scalability and practical realization are limited by challenges associated with wavefunction decoherence, the need for cryogenic temperatures, and extreme sensitivity to noise and environmental disturbances. The analogy between topological acoustic waves and quantum mechanics offers a path toward the design and operation of an acoustic quantum-analogue computer which does not suffer from the fragility of qubits. In this work, we present the demonstration and characterization of such a scalable, cost-effective, room-temperature acoustic analogue quantum computing platform. This platform harnesses the intrinsic nonlinearity of physical systems to generate wave superposition. We demonstrate several scalable quantum operations, including the realization of quantum permutation gates and quantum-inspired cryptography, using experimental results from this system. In addition, we discuss the underlying concepts and characterization of the platform, along with the ongoing efforts both through analytical simulation in ANSYS mechanical and experimental validation to develop a model of the acoustic quantum analogue computer. Finally, the dissertation concludes with an assessment of the platform’s reliability and robustness, highlighting its promise as a practical alternative for quantum-inspired computation.Release after 05/04/202
Grounding Techniques for Adolescent Anxiety: A Provider Education Quality Improvement Project
No full textBackground: Adolescent anxiety is increasing annually. Contributing factors include increased stress, poor sleeping habits, social media and technology use, along with the significant negative impact COVID-19 has left on this population's mental health. Increased and uncontrolled anxiety can increase the risk of further issues for adolescents, including dropping out of school, unemployment, and additional mental health issues such as depression, substance abuse, and suicide. Purpose Statement: This DNP project aims to equip healthcare providers at an outpatient federally qualified clinic with evidence-based grounding techniques to help patients experiencing stress and anxiety, reduce negative symptoms, and ultimately optimize their overall health, development, and well-being. Methods: Providers were recruited at an integrated, federally qualified health center, United Community Health Center (UCHC). Distribution of an online education module, with completion of a pre- and post-survey to analyze the impact the intervention has made, evaluating four domains- knowledge, confidence, perception, and attitude regarding grounding techniques. Results: A total of 9 participants completed the 3-step intervention process between the primary care and behavioral health providers. The results gathered indicated that the intervention enhanced all four domains evaluated for participants. Conclusions: Grounding techniques are practical and straightforward to educate providers about, and can be provided to patients as a tool to help them gain control of their anxiety and self-regulate
Supraphysiologic Shear Stress Induces Apoptotic Behavior in Platelets
No full textThe rise of cardiovascular disease (CVD) on the global scale, including late-stage heart failure in particular, has led to an increased reliance on mechanical circulatory support (MCS). However, use of MCS has been associated with platelet dysfunction and thrombocytopenia. Previous studies have found that high shear stress exposure promotes phosphatidylserine exposure (PSE), which is associated with late-stage intrinsic apoptosis of platelets (Roka-Moiia et al. 2020). This study examined whether high shear stress at increasing exposure times promotes activation and an orderly regulation of intrinsic apoptosis in platelets by measuring expression of associated biomarkers, including mitochondrial dysfunction, caspases 3/7 activation, and PSE. The study was also interested in whether inhibitors of mitochondrial fission and caspases 3/7 activation alter expression of these associated biomarkers indicative of shear stress-induced activation of platelet apoptosis. The findings of the study demonstrated that high shear stress exposure alters expression of biomarkers associated with intrinsic apoptosis of platelets, including mitochondrial dysfunction, caspase activation, and PSE, and suggested that the known inhibitor of caspases 3/7 activation, Z-VAD-FMK, is the most efficient at targeting this cascade, and with potential combination with other inhibitors, could potentially be utilized to treat the shear stress-induced thrombocytopenia associated with device supported circulation