A Potential Role of GSK-3beta in the Development of Pain Post-Spinal Cord Injury

Chronic neuropathic pain is a very common consequence following spinal cord injury (SCI) and poses significant clinical challenge. Current treatments are largely ineffective and as a result, patients are often left with debilitating pain at and below the level of the spinal cord injury. After spinal injury, a cascade of events occurs within the nervous system. One important aspect of this cascade for investigation is the anatomical changes that occur post-SCI. There is evidence of maladaptive sprouting/growth in sensory nerve fibers that is thought to play a role in the development and amplification of pain signals. Sprouting of primary afferents in the cord, mediated by the dorsal root ganglia (DRG) may contribute to the sensory issues that patients experience after injury. The signaling cascade involving the protein glycogen synthase kinase- 3 beta (GSK-3β) may be important in this maladaptive growth. GSK-3β is highly expressed in the nervous system and is a known regulator of neurite growth through its interactions with cytoskeletal molecules. Recent evidence has shown a potential role for GSK-3β in contributing to pain post-SCI. The purpose of this study was to characterize alterations in GSK-3β in sensory processing regions of the spinal cord dorsal horn and DRG and correlate these expression changes with the presence of pain in a rat model of SCI. Long-Evans rats underwent intramedullary injection of quisqualic acid (QUIS) of saline (sham control) and were allowed to survive for 1 or 22 days. Animals in the 22-day group were examined daily for onset and severity of at-level pain related behaviors termed “overgrooming.” Spinal cord and DRG just below the level of injury were analyzed for alterations in GSK-3β activity. Immunohistochemical staining shows early and persistent changes in GSK-3β expression in the spinal cord dorsal horn and DRG. These findings further support a role for GSK-3β signaling in sensory afferent plasticity and provide insight into a molecular target in SCI-induced pain

Role of GPER in Cadmium-Induced Phosphorylation of ERK1/2 in Ovarian Adenocarcinoma

Cadmium, a carcinogenic heavy metal, is an environmental contaminant found in air, water, and soil. It also exhibits endocrine disruptive properties by mimicking the proliferative effects of the hormone estrogen and is classified as a metalloestrogen. At low concentration levels in some cancer cells, cadmium induces cell proliferation and phosphorylation of ERK1/2, a key protein in the estrogen signaling pathway. While the signaling pathways for cadmium- induced phosphorylation of ERK1/2 have been discovered in breast and lung cancer cells, it has not yet been fully determined in ovarian cancer cells. The fairly recent discovery of a transmembrane receptor found in estrogen responsive tissues, G protein-coupled estrogen receptor (GPER), presents a possible pathway for studying cadmium’s effects in ovarian cancer cells. To determine the role of GPER in cadmium-induced phosphorylation of ERK1/2, two human ovarian adenocarcinoma cell lines, OVCAR3 and SKOV3, were treated for 30 minutes with 10 µM G15, a GPER inhibitor, followed by treatment with 100 nM CdCl2 for 10 minutes. Immunoblot analysis was performed to measure cadmium-induced phosphorylation of ERK1/2. The results indicate that in both cell lines, G-15 decreased cadmium-induced phosphorylation of ERK1/2 suggesting that GPER may be play an important role in cadmium\u27s proliferative effect in ovarian adenocarcinomas

Transcendence: Exploring the Connections between Transgender/Gender Non-Conforming Identities and Experiences of Nature through Art

“Transcendence: Exploring the connections between transgender/gender non-conforming identities and experiences of nature through art” is the written portion of a creative thesis revolving around an immersive art installation and short film. Transcendence, the installation, was created to promote connection by exploring the overlap between transgender and gender non-conforming (GNC) experiences and experiences of nature. Part of this installation is a short film of interviews conducted with transgender and GNC individuals about nature, their gender experiences, and the transcendent nature of the two. The written thesis analyzes existing literature on nature as a restorative, therapeutic, spiritual setting, offers insight into the experiences of gender nonconformity, and reflects on conducting interviews for the short film and the outcomes of presenting the installation to the public

The Routine Use of Tympanometry to Prevent Unnecessary Antibiotics in Patients with Otalgia: An Evidence-Based Practice, Quality Improvement Project

Abstract Background: The use of Tympanometry to diagnosis Otitis Media with Effusion (OME) in adults is not routine practice in primary care, although it is supported by evidence and clinical practice guidelines. The misdiagnosis of OME frequently leads to inappropriate antibiotic prescribing, contributing to the rise in drug resistant infections. Purpose: This evidence-based practice, quality improvement project sought to determine if the use of tympanometry by Family Nurse Practitioners (FNPs), to assess adults visiting primary care clinics, improved the accuracy of otitis media diagnoses and decreased unnecessary antibiotic therapy. The project also evaluated whether experience using the tympanometer was correlated with decreased changes in FNP diagnoses after the review of tympanometer tracings. Methods: A single tympanometer was provided to four FNPs in two primary care clinics. Tympanometry was performed on patients presenting with ear or hearing complaints, without otorrhea, recent ear surgery, or recent trauma to the ear. FNPs performed routine otoscopy exams and made a diagnosis while tympanometry naïve (prior to reviewing tympanometry tracings), and then reviewed tympanometry tracings and either maintained the original diagnosis or changed their diagnosis. Results: A total of 42 patients were seen during the project timeframe and FNPs changed their diagnoses in 45.2% of cases (n =19) after reviewing tymponometry tracings. Most changes in diagnoses resulted in a shift from abnormal to normal (63.2%), potentially preventing the inappropriate prescribing of antibiotics. In addition, FNPs reported a review of tympanometry tracings informed their clinical decision making 69% of the time. Experience using the tympanometer was not significantly correlated with a decrease in changed diagnoses. Discussion: While the number of cases was lower than expected, this project supports the use of tympanometers in primary care settings to diagnosis OME in adults

Enhanced Discharge Preparation to Decrease Discharge Delays: A Quality Improvement Project

Increased length of stay (LOS) is a focus in hospitals as it has implications for decreased quality of care, increased cost of care, and results in care delays for other patients (Rojas-Garcia et al., 2018). LOS is a measure of a hospital’s efficiency and throughput, which is the process of admitting, treating, and discharging patients. Micallef et al. (2020) found a longer LOS can occur from having extra days due to inefficiency in delivering care or from delays in discharge once the patient no longer needs acute care. The longer a patient stays in the hospital, the greater the risk they will develop a healthcare-acquired condition which may lead to a higher mortality rate. These patients also decrease the hospital’s throughput by blocking the admission and treatment of other patients. Additionally, hospitals are generally not reimbursed for providing the additional days of care since hospitals are reimbursed on a prospective payment system (CMS, 2019). A review of the literature confirmed a great interest and genuine need to identify interventions to address hospital LOS and delayed discharges. While the evidence was generally low to moderate for the multiple interventions studied to address the issue, there were strong recommendations to continue work in this area including efforts to improve patient centered discharge planning (Cadel et al., 2021; Feldman et al., 2022; Micallef et al., 2020; Rochester et al., 2018; Rojas-Garcia et al., 2018; Tipton et al., 2021). Incorporating discharge checklists and communication processes with standardized procedures can improve discharge preparations and be helpful in preventing discharge delays