Reducing 30-day Heart Failure Readmissions Utilizing Transitional Care

Reducing 30-day Heart Failure Readmissions Utilizing Transitional Care Melissa Beaudry, MSN, APRN, FNP-BC Purpose: Heart failure has a high prevalence and is associated with increased healthcare spending. The cost is driven by the frequency of hospitalizations and high rates of 30-day readmissions. The American Heart Association identified transitional care management (TCM) as effective in reducing hospitalizations. The purpose of this quality improvement (QI) project was to increase outreach to patients being discharged from the hospital with HF over 6 weeks in a rural primary care practice. A secondary aim was to evaluate how this impacted 30-day readmissions and ER utilization. Methods: A retrospective chart review was conducted 12 weeks before implementation to obtain baseline TCM data. A one-hour educational training session was provided to nurses on TCM activities. These included post-discharge phone calls made within 48-72 hours and office visits 5-7 days after discharge. A retrospective chart review was performed during the intervention period and for 12 weeks post-intervention. Results: The number of post-discharge phone calls increased by 26% and office visits decreased by 3% during the intervention period. The number of 30-day readmissions and ER visits were reduced by 29% and 14% respectively. No patients received TCM activities in the post-intervention period. Results were limited by the low number of participants. Conclusion: TCM represents a feasible way to prevent 30-day readmissions and ER utilization, thereby reducing healthcare spending. TCM requires office resources to be successful, notably adequate nursing staff with clear roles/responsibilities and appointment availability. Measuring patient quality of life or understanding of disease self-management is an area of future study. Keywords: heart failure, transitions of care, care transitions, patient readmission, readmissio

Extended Release Buprenorphine (Sublocade) Prescribing in Primary Care

There are many barriers to accessing opioid use disorder (OUD) treatment, especially for rural communities that may be far away from healthcare providers. There is a need for interventions to increase accessibility of OUD treatment. Extended release injectable buprenorphine (Sublocade) provides an option for patients to receive treatment via once a month injections. This could make OUD treatment more accessible to rural and socioeconomically disadvantaged patients by reducing the number of times they would need to travel to the clinic. Our intervention is to create a protocol for prescribing extended release buprenorphine at Family Medicine Hinesburg.https://scholarworks.uvm.edu/fmclerk/2107/thumbnail.jp

Increasing Equitable Cardiovascular Disease Screening and Prevention for Women of Low Socioeconomic Status: You First

Cardiovascular disease (CVD) continues to be the leading cause of death in females of all ages and races. Given the potential reduction in risk of coronary events with modifiable behaviors, primary care physicians are in a unique position to be able to use shared decision making and patient education to help dramatically reduce the potential burden of cardiovascular disease. Consideration for social determinants of health, such SES, should not be forgotten when aiming to provide adequate and accessible healthcare. Furthermore, the incorporation of unique programs, such as You First, into primary care offices can increase equitable care for patients and aid in risk reduction for many diseases, including but not limited to CVD.https://scholarworks.uvm.edu/fmclerk/2102/thumbnail.jp

Exploring Entertainment Media Diets in the Age of Polarization

Objective: With widespread polarization in American partisan news media and culture, entertainment media can play an important role in shaping or changing political attitudes. This project explores whether entertainment TV has the ability to increase partisan crossover within the nation\u27s contemporary partisan divide. Methods: Investigative methods include analyzing 2008 and 2024 surveys for US-based respondents on reasons for watching a particular show or show type, and a content analysis of the shows Parks and Recreation, Modern Family, NCIS, and Duck Dynasty, in which I code for liberal and conservative values each show evokes and compare those to its partisan viewership. Results: Through these two methods of analysis, this research found that entertainment media diets varied on a partisan basis more than previously thought. This variance was seen in the heterogeneous content of shows themselves, as well as the cross-partisan show selection for many individuals surveyed. Conclusions: This research can add to the growing litany of research on the political effects of entertainment media. More specifically, these findings show that entertainment media’s political effects can extend beyond the limitations of self-exposure

Farming and Eating Insects at the University of Vermont

University students in New England match the profile for early adopters of edible insects and increasingly demand diverse options for sustainable protein. This research used focus group sessions to investigate students’ protein consumption motivations, opinions on novel alternative proteins, and sensory perceptions of insect-based foods. Undergraduate students (43) participated in 9 paid focus groups, during which they sampled 5 mealworm-based foods – falafel, granola, hard pretzels, and two types of cookies. The findings suggest that this audience is amenable to entomophagy, and acceptance can be further encouraged by contextualizing insects to align with diet motivations

Change in the Abundance of Coral Across the Hawaiian Archipelago During 2000–2017 in Relation to Thermal Stress

Coral reefs are declining at unprecedented rates across the world, threatening ecosystem goods, services, and functionality. Previous research suggests thermal stress is a major driving factor of coral decline, however, these studies primarily draw conclusions from small-scale, in situ data collection. This study represents the first effort to quantify large-scale change in coral cover across the Hawaiian Islands over an extended time period using remote sensing. Hyperspectral imagery from the Airborne Visible-Infrared Imaging Spectrometer (AVIRIS) was used to quantify benthic cover of reef ecosystems across the Main and Northwestern Hawaiian Islands in 2000 and 2017. A total of 320.28 km2 of benthic area was mapped and analyzed across Kauaʻi, Oʻahu, Lanaʻi, Maui, and French Frigate Shoals. Average coral cover dropped from approximately 23% to 8% over the 17-year time period, representing a relative decline of more than 65%. Various thermal stress metrics were obtained through NOAA’s Coral Reef Watch bleaching area alert data and compared to the coral cover data. Adjusted R2 values ranged between 0.02 and 0.043, indicating weak correlations between bleaching area alert metrics and absolute change in coral cover. This study offers preliminary evidence that Hawaiian coral reefs are declining not only on a small-scale, but across entire reef ecosystems. However, thermal data alone cannot explain the decline in coral cover observed. Although the question of what causes this decrease in cover remains, hyperspectral remote sensing may be the missing link. Only once we understand coral change at the reef scale can we hope to conserve these ecosystems

Using Top Grafting to Manage Endemic Fire blight Infection in Apple Trees at UVM Horticulture Research and Education Center

Fire blight, an infection that affects apple and pear trees, is caused by the bacteria Erwinia amylovora. It infects trees through any opening, natural or otherwise, and will spread throughout the vasculature of the tree if left untreated. Currently, the management techniques for control of fire blight consist of prevention through heavy sanitation, pruning, or application of sprays, which all are very time-consuming and / or costly endeavors. This study seeks to determine if top grafting, a method only previously used for propagation, decreasing the physiological age or changing of varieties of trees, is an effective and worthwhile option for control of fire blight, as top grafting involves the removal of most of the aboveground biomass. In this study we analyzed a previously untested hypothesis, as there is no published research on the effects of top grafting infected trees compared to common treatments, pruning and application of sprays. This paper outlines the first two years of the study, including disease and harvest data for the treatment groups, as well as a net present value analysis, which predicts what the treatments could look like up to 20 years in the future, comparing the replacement of tree mass through top grafting versus maintaining current conditions

Bringing Personal Identity into our Learning Spaces

Abstract This paper will integrate a personal narrative with published work to examine the journey and thoughts of a South Asian female theatre educator working in theatre education. The paper will discuss stories of identity, the impact it has had, and the intentionality of what should be done with this information. It will illuminate the need for further research to engage more South Asian female voices in theatre education. Keywords: ethnic identity, teacher preparation, South Asian, theatre teacher, autoethnography, female voic

Epigenomic Landscape Profiling and Bioinformatics Application in Breast Cancer Model

Breast cancer, known for its global impact and heterogeneity, involves both geneticand epigenetic alterations that malignantly transform breast epithelial cells. Among these changes, epigenetic modifications, particularly post-translational histone modifications (PTMs), are now recognized as potential therapeutic targets. Despite this, a full understanding of epigenetic regulation, specifically altered landscape of PTMs during breast tumor development, is still evolving. This dissertation aims to elucidate the global patterns of PTMs in the context of breast cancer development, employing molecular datasets integrated with bioinformatic analyses to examine the epigenomic landscape within the MCF10 breast tumor progression model. Graph analysis is also applied to deconstruct histone modification profiles, providing insight into their functions in breast tumor development. The first section details the regulatory PTM enrichment profiles in the MCF10 model, which simulates various stages of breast cancer development. Utilizing the Peaksat package in R, high-quality ChIP-seq data is captured. An integrated analysis of this dataset delineates chromatin states of breast cells, shedding light on the dynamic shifts in cis-regulatory elements during cancer genesis. This segment emphasizes the transformation of heterochromatin and enhancer domains that govern gene expression and pathway modulation in breast cancer cells, with further analysis revealing the regulatory networks and pinpointing key transcription factors as possible targets for therapy. Besides PTM landscape, the role of Bromodomain-containing (BRD) proteins, known acetyllysine ’readers’ and critical to transcriptional machinery, has not been systematically studied in the context of breast cancer. The latter portion of this dissertation provides an in-depth analysis of BRD proteins’ roles in cancer progression and treatment. A thorough examination of protein-protein interaction (PPI) profiles through graph analysis leads to predictions of functions for previously uncharacterized proteins, underscoring the vital role of BRD proteins in chromatin regulation. In essence, this dissertation advances our comprehension of the epigenomic regulation of breast cancer and unveils new avenues for therapeutic interventions