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Examining Sex-Specific Neurobehavioral and Metabolic Effects of Early-Pubertal Stress and Adult Diet Condition
No full textMetabolic syndrome (MetS) and its associated comorbidities has become increasingly prevalent on a global scale. Features of MetS (i.e., insulin resistance and obesity) have been studied in effort to reduce the likelihood of disease onset. Both obesogenic diets and stressful experiences impact metabolic regulation to variable degrees, where sex differences in metabolic programming, alongside environmental exposures, can alter the likelihood of disease progression. Thus, neurobehavioral, and metabolic changes associated with energy homeostasis may be attributed to inherent sex differences in endocrine physiology. Accordingly, our study aimed to further elucidate the sex-specific neurobehavioral and metabolic effects of both chronic obesogenic feeding and age-restricted stress experience. Our findings show that males were more responsive to obesogenic challenge than females, exhibiting increased weight gain, energy intake, fasting hyperglycemia, and insulin resistance. Further, they exhibited altered levels of endocrine hormones, anxiogenic behavior, and hepatic metabolic protein expression. Preliminary data also suggest that adolescent and adult stress exposure altered bodyweight and glycemia to variable degrees. These effects were both diet-dependent and sex-specific. Collectively, our findings implicate inherent sex-differences in adrenal axis physiology in the mediation of diet induced metabolic defects. The current study provides a framework to enable further investigation of the molecular relationships between stress, diet, and sex conditions to identify key factors that may determine the detrimental outcomes associated with MetS
Erector Spinae Plane Block for Postoperative Pain Management After Abdominal Surgery: A Systematic Review
Full text linkA fundamental component of healthcare delivery is providing comfort, including the minimization of pain with as few side effects as possible. Unmanaged postoperative pain continues to be a challenge in healthcare and is a frequently discussed and studied topic. Pain that is not controlled is associated with several negative sequelae involving multiple organ systems and an overall increase in morbidity. Using a multimodal approach to pain management has been emerging as a way of combatting not only unmanaged postoperative pain, but also the use of opioids. Peripheral nerve block administration is effective pain management technique anesthesia professionals are trained to administer. A newer peripheral nerve block, the erector spinae plane block has been shown to be an effective way of lowering postoperative pain scores and opioid consumption in a variety of surgeries. The purpose of this paper is to conduct a systematic review to determine if the administration of the erector spinae plane block (ESPB) will affect postoperative pain and opioid consumption after abdominal surgery when compared to the administration of the long-established transversus abdominus plane (TAP) block. This systematic review was created using both the preferred reporting items for systematic review and meta-analyses (PRISMA) framework and Critical Appraisal Skills Programme (CASP). A literature review was performed, and data was extracted and reported on each study. A cross study analysis was performed using data collection created the author of this review. The ESPB was found to be effective in reducing pain and opioid consumption when compared to receiving no block. The evidence comparing the ESPB to the TAP block suggest the ESPB may have superior pain lowering and opioid sparing abilities than the TAP block but would suggest more studies to confirm
Student Registered Nurse Anesthetists
Full text linkHigh levels of stress have been documented in the student registered nurse anesthetist (SRNA) population and coping skills employed as student have been shown to endure after graduation. Heightened levels of stress, anxiety, and depression have been reported in American adults related to the COVID-19 pandemic. As classes transitioned online and clinical was suspended due to the stay-at-home orders, this stress was predominant for nurse anesthesia students. Research was not available and needed to be conducted to determine how the COVID-19 pandemic affected the stress levels of nurse anesthesia students. Studying how nurse anesthesia students respond to unforeseen events can help us develop additional preparation and coping strategies for future cohorts. The purpose of this study was to explore the effects of the COVID-19 pandemic on stress and wellness and coping mechanisms for student registered nurse anesthetists. A total of n=19 current and prior SRNAs were sent a Qualtrics survey with the COVID-PSS-10, Coronavirus Anxiety Scale, and three qualitative questions. Twelve participants (63%) completed the Qualtrics survey between March-April 2021. High perceived stress was reported in 33% of the participants (n=4). Dysfunctional anxiety symptoms were reported by 33% of SRNAs (n=4). Most responses to the qualitative questions reported uncertainty or stress relief, diminished physical and social wellness, and some form of maladaptive coping. The results display the importance of identifying students at risk for maladaptive coping. Additional stress management training should be provided to students and faculty and tailored according to students\u27 academic progression. Updates to the Graduate Student Handbook, coupled with a dynamic resource toolkit, would guide students navigating the challenging phases of graduate level education
A Systematic Review Comparing Opioid-Free and Opioid-Inclusive Anesthesia for Pain Control in Adults After Laparoscopic Cholecystectomy
Full text linkIn the United States, over 12 months, from June 2019 to May 2020, 81, 230 lives were lost to opioid overdose. As a nation, addressing opioid misuse should take priority (National Safety Council, December 2020). Opioid addiction can occur following routine general surgical admission and as healthcare providers strive to adequately manage perioperative pain, the over-use and over-prescription of opioids have contributed to the opioid epidemic. Utilizing nonopioid analgesics that have a lower addiction potential and fewer side effects can greatly enhance patient recovery and perioperative outcomes (Chia et al., 2020). This systematic review examined the effectiveness of opioid-free anesthesia compared to opioid-inclusive anesthesia in reducing postoperative pain in patients undergoing laparoscopic cholecystectomy.
A thorough literature review was performed focusing on cholecystitis and cholelithiasis, pain, postoperative pain, and management following laparoscopic cholecystectomy, multimodal general anesthesia, opioid-free, and opioid-inclusive anesthetic techniques. The framework that guided this systematic review was Good��s middle-range theory of acute pain management. A total of six randomized controlled trials met the inclusion criteria. This systematic review provides promising evidence that opioid-free anesthesia can be an effective and safer alternative to opioid-inclusive anesthesia in reducing side effects, postoperative pain, and opioid consumption in patients undergoing laparoscopic cholecystectomy
Impact of Structural and Individual Level Traits on Delinquent and Criminal Behavior: Building a Testable Multilevel Model
Full text linkThe creation of a multilevel model to examine the structural and individual level characteristics that contribute to delinquency and criminality, and how the created work can inform future research, counseling and policy strategy changes in the future
#MeToo Movement: A Sociological Analysis of Media Representations
Full text linkThe Me Too or #MeToo movement has come under the spotlight in recent years since more survivors/victims are now speaking out against their abuser. These survivors/victims repressed their abuse for years, ashamed to speak out in fear that they would not be believed or face extreme scrutiny and humiliation. Survivors/victims are now coming together to seek justice and to reform the judicial system and how they handle sexual abuse and violence cases. This movement has become more prominent now than it was when it first was formed in 2006 by Tarana Burke and reintroduced by Alyssa Milano using Twitter in 2017. The movement challenges everyday lifestyles and workplace environments to consider what behaviors constitute as appropriate. Companies and businesses are now implementing compliance workplace harassment training to avoid such incidences of sexual abuse and violence
Motivational Interviewing and Trisomy 21: Resolving Ambivalence
Full text linkThroughout the semester I worked with a 24-year-old, heterosexual, Caucasian male client diagnosed with Down Syndrome and Obesity on a variety of topics including: deaths of loved ones, finding employment, and lying. My approach was based in Motivational Interviewing and this allowed me to build a rapport with my client very quickly. The use of open-ended questions allowed him to tell his perspective and explain how he really feels, coupled with positive affirmation the client felt very comfortable in each session and benefited from the MI approach and the resources that came with it
Put Your Thoughts on Trial: Cognitive Restructuring
Full text linkFor this project, I applied cognitive restructuring techniques to a patient with a substance abuse diagnosis. It incorporates role playing, psychoeducation, and Socratic questions. I describe case overview, method, and results in this PIP