• PEDIATRIC HOSPITAL PASTORAL CARE IN A TIME OF COVID

      Weatherspoon, David Mark; McAfee School of Theology
      ABSTRACT DAVID MARK WEATHERSPOON PEDIATRIC HOSPITAL PASTORAL CARE IN A TIME OF COVID Under the direction of Graham B. Walker Jr. Spiritual care providers encountered the challenge of trying to provide pastoral care in a time of COVID. The context for this project involved a collection of pediatric hospitals within the United States where pediatric chaplains adjusted the way they serve patients, families, and staff following the onset of COVID-19. Having served as an ordained chaplain for eighteen years and a pediatric hospital chaplain for seven of those years, I interviewed pediatric hospital chaplains to learn what best practices were being cultivated among spiritual care providers in order to provide quality pastoral care rituals for patients, families, and staff. It was a primary goal of this project to identify the main ways pediatric chaplains altered their best practices of pastoral care rituals to comply with safety protocols through interviews from a cross section of 5-8 pediatric chaplains. From these conversations, I hoped to provide a summary of the innovative ways chaplains created structured experiences, from here forward known as “pastoral care rituals,” that established a focused sense of presence, security, safety, and at times, a self-identifiable change by patients, families, and/or staff. I looked for ways technological changes were effectively utilized by pediatric chaplains in being able to provide a professional standard of care. I assessed the ways pastoral care rituals were adapted to meet the challenges of social distancing and other safety protocols. Pediatric hospital chaplaincy distinguishes itself in the ways pastoral care rituals are provided to meet the scope of needs of children who are patients in need of care; their families who are assisting in the care of their children while in the hospital; and the staff who are uniquely trained to handle the nuances of caring for the health of children while also being sensitive to the needs of family members. This project utilized semi-structured interviews to capture the experiences of pediatric chaplains and how they adjusted their pastoral care ritual best practices during the pandemic. The project narrowed further as it focused specifically upon the positive developments realized by pediatric chaplains in their practice of pediatric pastoral care rituals during the pandemic. The primary themes concerning the innovations in pastoral care rituals that developed following the interviews with the pediatric chaplains were the following: 1. A marked increase and usage of technology: Pediatric chaplains confirmed their increase in technology to provide pastoral care rituals. 2. Creative innovations to pastoral care rituals: Pediatric chaplains were very innovative in how they provided pastoral care rituals post-pandemic. 3. Intensified focus on staff: Interviewed pediatric chaplains shared that staff had heightened spiritual care needs due to the pandemic. 4. Collaborative efforts increased: pediatric chaplains worked much more closely with other departments and outside clergy. 5. Advocacy for needs of self, profession, patients, families and staff: Participants sensed a heightened need to advocate and voice concerns for all layers of their hospital interactions. 6. Pediatric chaplains confronted systemic racism: Participants demonstrated a focused awareness of issues of race and the need and willingness to speak openly about racism and systemic racism within the hospital work environment.
    • Perceptions Of Immediate Family Members On Current Curricular Expectations For Individuals With Severe And Profound Intellectual Disabilities

      Lowe Windham, Meghan Dianne
      With consideration of current mandated standards-based curricular requirements for students with Intellectual Disabilities, this dissertation sought to examine the perceptions of students and their immediate family on how this curriculum supports students with Severe and Profound Intellectual Disabilities (SID/PID) to realize their post-secondary goals and aspirations. This qualitative case study considered the implementation of a standards-based curriculum versus a life-skills curriculum on the achievement post-secondary goals from the Transition Plans of four individuals with SID/PID. Pre-interview questionnaires, document analysis, semi-structured interviews, and journaling methods were used to answer the research questions. The researcher transcribed each interview utilizing the online software Sonix. Once transcribed, interviews were uploaded to QDA Miner, an online qualitative data analysis software that assists in coding and retrieval. The researcher coded the interviews, creating categories and subcategories. Themes that emerged from the data addressed the following: 1) how standards-based and life-skills curriculum each prepare individuals with SID/PID for post-graduation, and 2) perceptions of immediate family members on the impact of these curriculums post-secondarily. Data showed that all four students passed every part of the Georgia Alternate Assessment (GAA), but none of the former students met 100% of their post-secondary goals. Four themes emerged from the data: 1) these families favored the development of independent life-skills prior to graduation for their loved one with SID/PID, 2) the families did not feel that academic curriculum fostered post-graduation attainment of Transition Plan goals, 3) the families believe that additional teacher training is needed to increase awareness of parents’ rights and options, and 4) the families believe there is a need for a family-centered curriculum. Recommendations for further study include conducting a longitudinal study of families of students with SID/PID from 9th grade to age 25. This type of study could explore the path that families must take and the experience of making life-altering decisions at the beginning of the transition process, the transition immediately following graduation, and for life beyond.
    • Persistence as Resistance: A Phenomenological Narrative Analysis of the Africultural Coping and Motivational Strategies of African American College Students

      Scott, Miraca Joann; Tift College of Education
      Despite decades of institutional efforts to mitigate African American college student first-year attrition, this population continues to have the lowest graduation rates compared to other races and ethnicities (National Center for Education Statistics, 2021). Historically, the collegiate first and fourth years have received more attention from student success researchers due to their direct connection to institutional enrollment and graduation rates (Gahagan & Hunter, 2006); however, more recent research has indicated that the collegiate sophomore year poses the most significant threat to student retention and graduation rates (Perez, 2020). This qualitative study explored how racial-cultural identity salience, culture-specific coping behaviors, and motivation influenced how Afrocentric African American college students avoided college departure to persist to junior year successfully. Framed within an Afrocentric theoretical framework, a phenomenological narrative methodology was employed to assess students’ perceptions of which coping behaviors and motivational factors helped them overcome challenges experienced during their sophomore year at a southern public, four-year predominantly white institution. Six participants were recruited using criterion and snowball sampling techniques. Data analysis revealed 22 subthemes which were consolidated into six emergent themes: 1) Achievement-oriented Motivation, 2) Soundproofing, 3) Centripetal Autonomy, 4) Centripetal Grouping, 5) Self-Care, and 6) Self-Monitoring. Findings suggest an inextricable link between Black sophomores’ need for intraracial connection, the salience of their racial and cultural identity as African American or Black, and their community-centered motivations for persevering during their sophomore year. Implications for practice include establishing wrap-around support for African American sophomore students, championing and amplifying Black sophomore voices, and integrating culturally-aligned theory into higher education policy. For a representative body of literature, researchers are encouraged to abandon using theoretical models that embody Euro-American values when studying Black students. Implications of this study suggest future studies should be positioned using an Afrocentric theoretical framework to illuminate the needs of African American students.
    • Personal, Structural, And Social Characteristics Associated With Newly Licensed Registered Nurses' Confidence In Clinical Decision-making

      Naguszewski, Tanya L.
      Large numbers of newly licensed nursing graduates are entering the workforce and are immersed into complex care situations requiring high stakes decision-making. These nurses are expected to transition from a student nurse, supported by faculty, to a competent nurse caring independently for high acuity patients with multiple co-morbidities. Employers have reported new graduates are not fully prepared to provide safe, effective patient care. The purpose of this cross sectional, descriptive, correlational study was to examine relationships between demographic, personal, structural, and social characteristics of the work environment and newly licensed registered nurses’ perceived confidence in clinical decision-making in acute care nursing units. A web-based survey was accessed by 421 nurses working in acute care settings resulting in 177 completed surveys. Data were exported into Excel from SurveyMonkey® then imported into Statistical Package for the Social Sciences (SPSS) for data cleaning. The extent of incomplete or missing data was determined and an analytic data set was created. A researcher developed instrument was piloted. Statistical assumptions were tested. Data analysis using descriptive statistics and multiple linear regressions addressed the research questions and results were reported. Results demonstrated nurse-nurse collaboration along with self-confidence and gender were the strongest predictors of newly licensed registered nurses’ perceived confidence in clinical decision-making. Additionally, social characteristics of collaboration, trust, and communication had positive relationships with newly licensed registered nurses perceived confidence in clinical decision-making. Nurse researchers must explore ways to enhance nurse-nurse collaboration by providing reflection and experiential learning activities designed to enhance social characteristics within the work environment. Future research is needed to examine nurse-nurse collaboration to determine if critical thinking competencies are being met and patient outcomes are improving. Researchers must also explore ways to enhance other desired social characteristics in newly licensed registered nurse training programs and promote intellectual collaboration in decision-making. This study offers multiple avenues for future research around newly licensed registered nurses’ desired social characteristics within the workplace related to enhancing clinical decision-making and improving patient outcomes.
    • Perspectives Of Stakeholders Of An Afterschool Program In An At-promise Community

      Rodgers, Angela Faye
      ABSTRACT Afterschool programs provide more than a supervised safe haven for children at the end of the school day and before parents return home from work. They can provide extended academic and enrichment activities for students who are “at-promise�? to succeed in their educational pursuit and human development. Based on the review of the literature on afterschool programs and theorists of human development, the following research question guided the investigation: What are the experiences of parents, teachers, and students of an afterschool program in an at-promise community? The participants in this study completed surveys, interviews, and shared personal stories which determined their perspectives of an afterschool program experience. Analysis of the data gathered demonstrated that the stakeholders in the afterschool program expressed that their lives were transformed in a positive manner since being affiliated with the afterschool program. The participants believe that an afterschool program that addresses participants’ needs in a holistic manner can alter the trajectory of the lives of children, youth, and families. On this basis, it is recommended that additional funding is needed to keep afterschool programs active as well as create more afterschool programs in at-promise communities throughout our nation.
    • Phosphorylation And Signaling Of The Long Splice Isoform Of Free-fatty Acid Receptor 4 (ffa4)

      Senatorov, Ilya S
      PHOSPHORYLATION AND SIGNALING OF THE LONG SPLICE ISOFORM OF FREE FATTY-ACID RECEPTOR 4 (FFA4) Under the direction of Dr. Nader H. Moniri ABSTRACT The G protein-coupled receptor Free-fatty Acid Receptor 4 (FFA4) is expressed ubiquitously throughout the human body where it plays role in modulation of endocrine, inflammatory, and metabolic processes. FFA4 has become a very attractive drug target because it has shown great promise in alleviating systemic inflammation as well as managing malfunctions in diseases resulting from inflammation such as obesity and type 2 diabetes. Humans contain a unique splice variant of FFA4 which has not been found in any other mammals investigated. This variant contains an additional 16 amino acid insert and thereby divides the receptor into FFA4-Short (FFA4-S) and FFA4-Long (FFA4-L) isoforms. Although FFA4-S is found throughout the entire body, FFA4-L has only been found in colorectal tissue, a site where FFA4 expression and signaling has been strongly linked to tumorigenesis. More interestingly, although FFA4-L reacts to the same ligands as FFA4-S, FFA4-L has been demonstrated to possess an intrinsic bias towards β-arrestin signaling rather than coupling to G proteins. Due to the fact that there are currently many efforts to develop therapeutic agonists for FFA4 systemically, it is important to decipher signaling differences between the two receptors to help shed light on what outcomes may result from systemic agonist of both isoforms.   Given that β-arrestin signaling is dependent on receptor phosphorylation, the first objective of this study was to determine whether a difference existed in the kinases which recognize and phosphorylate FFA4-S and FFA4-L, or whether their individual residues composing the “barcode�? of phosphorylation were different. Using siRNA-mediated knockdown, PCR-driven mutagenesis, pharmacological inducers, inhibitors, and autoradiography, we demonstrate that GRK6 mediates homologous phosphorylation of both isoforms, while PKC mediates heterologous phosphorylation of both isoforms. However, their individual sites of phosphorylation proved to be different, although all sites were localized to the same region of their C-terminal tails. The second objective was to see whether the additional 16 amino acid insert differentiating FFA4-L from FFA4-S could rescue β-arrestin signaling in the absence of the C-terminal phosphosensor. Using Bioluminescence Resonance Energy Transfer (BRET) measuring direct β-arrestin recruitment to the receptors in real time, in live cells, we demonstrate that the loss of the C-terminal phosphosensor abolishes β-arrestin signaling in both FFA4-S and FFA4-L The final objective was to determine whether downstream signaling differences could be detected as a result of differential phosphosensors between FFA4-S and FFA4-L. We demonstrate via time-response immunoblotting that ERK1/2 activation via FFA4-L is exclusively mediated through β-arrestin and is sustained over 60 minutes, while ERK1/2 activation through FFA4-S is mediated through both Gαq/11 and β-arrestin resulting in a transient signal, confirming a major functional signaling difference between the isoforms.
    • POLYPHARMACOLOGY OF MITRAGYNA SPECIOSA (“KRATOM”) ALKALOIDS

      Chen, Yiming; College of Pharmacy
      The nation’s persistent opioid epidemic requires innovative treatment interventions. Mitragyna speciosa, or kratom, is a plant native to Southeast Asia that contains dozens of potentially active alkaloids. The most abundant and best characterized of these alkaloids is mitragynine, which accounts for up to 66% of crude alkaloid extracts. Kratom preparations have been traditionally used for their analgesic properties and as a mild stimulant to combat work fatigue. Over the past decade, kratom has become a popular drug in the United States, where pulverized kratom leaves are used for self-medication of pain, mood disorders, and opioid withdrawal symptoms. There are, however, no FDA-approved uses for kratom, and the vast majority of scientific research on kratom alkaloids focuses on their opioid receptor activity. To understand the promise and perils associated with kratom use, it is essential to elucidate the mechanisms underlying kratom’s pharmacology, including activities at other non-opioid targets. Based on kratom’s psychoactive profile, which includes acute antidepressant and anxiolytic effects, analgesic effects, and cardiac adverse effects at high doses, we hypothesized that certain kratom alkaloids have activity at serotonin (5-hydroxytryptamine, 5-HT) and alpha-adrenergic G protein- coupled receptors (GPCRs). The binding affinity and functional activity of selected kratom alkaloids—including mitragynine, speciogynine, and paynantheine—the three most abundant alkaloids were evaluated at 5-HT1ARs, 5-HT1BRs, 5-HT2ARs, 5-HT2BRs, 5-HT2CRs, 5-HT5Rs, 5-HT6Rs, and 5-HT7Rs. Mitragynine has been comprehensively demonstrated to be a mu-opioid receptor (MOR) partial agonist, however, a growing literature suggests an adrenergic component of mitragynine-mediated antinociception. To explore mitragynine's adrenergic action, we examined mitragynine's activity at G protein-dependent signaling pathways mediated by human alpha 1 (α1ARs) and alpha 2 adrenergic receptors (α2ARs). Results from the current study provide a better understanding of the complex polypharmacology of kratom alkaloids that contributes to its unique physiological effects.
    • Potential Mechanisms Of Inorganic Mercury Intoxication In Rat Kidney Cells

      Orr, Sarah Elizabeth
      Mercury is a ubiquitous toxic metal that is found in the environment. Different forms of mercury can be ingested, inhaled, and/or absorbed dermally. Exposure to mercury occurs typically through the ingestion of organic mercuric compounds in contaminated seafood and/or the inhalation of mercury vapor from mercury-containing dental amalgams, broken mercury-containing thermometers, or industrial sources such as coal-fired power plants. Mercury intoxication occurs in target cells of organs, such as kidneys, following significant exposure to one of the different chemical forms of mercury. Due to the adverse health effects of mercuric ions in humans, a thorough analysis of the mechanisms by which mercury initiates cellular intoxication in target cells is necessary for the development of effective therapeutic strategies. The purpose of this study was to identify the specific intracellular mechanisms that lead to the toxic effects of inorganic mercury (Hg2+) in target cells. Exposure to mercury can lead to significant alterations in cytoskeletal structure, calcium availability, membrane permeability, oxidative stress, and autophagy. These alterations were studied and assessed using a variety of laboratory techniques including cell culture, laser-scanning confocal microscopy, and quantitative PCR. Additionally, the protective properties of alpha lipoic acid were analyzed using similar methods. By experimentally examining each of these aspects, we have established a more complete understanding of intoxication and cellular injury induced by inorganic mercury in proximal tubular cells.
    • PRECLINICAL DEVELOPMENT OF A NOVEL SEROTONIN RECEPTOR MODULATOR FOR FRAGILE X SYNDROME

      Armstrong, Jessica; College of Pharmacy
      Fragile X syndrome (FXS), caused by FMR1 gene silencing and subsequent loss of the RNA-binding protein FMRP, is the leading monogenic cause of intellectual disability and autism spectrum disorder, characterized by social deficits and repetitive behaviors. Currently, there are no approved medications for FXS and only two approved for autism. MMP-9 is an extracellular matrix regulating enzyme and a significant target of FMRP—the loss of FMRP in FXS leads to overexpression of MMP-9. MMP-9 degrades perineuronal nets (PNNs) that stabilize glutamatergic and GABAergic neurotransmission, and imbalance in these neurotransmitter systems is a hallmark of FXS, suggesting correcting MMP-9 overactivity may restore neuronal homeostasis in FXS by normalizing PNNs. For example, we show significantly decreased PNN density in hippocampal CA2 in juvenile Fmr1 knockout mice, a neural system critical for social memory, compared to wild-type mice. In parallel with PNN deficits, we show a trend that juvenile Fmr1 KO mice have increased MMP-9. We showed that acute administration of FPT, a novel medication candidate with potent 5-HT1AR, 5-HT1BR, 5-HT1DR agonist activity, moderate 5-HT2CR activity, and weak agonist/competitive antagonist 5-HT7R activity, increases social interactions, decreases anxiety, and decreases repetitive behaviors in adult Fmr1 KO and WT mice. However, we did not investigate FPT’s effects on social behavior in juvenile mice—focusing on critical neurodevelopmental periods—nor have we explored mechanisms underlying FPT’s therapeutic-like effects. In susceptible juvenile Fmr1 KO mice, FPT eliminated the audiogenic seizure phenotype. We investigated whether FPT would be efficacious after chronic treatment or if tolerance would develop. After four-day repeated treatment followed by a one-day washout period, FPT increased social interactions in juvenile Fmr1 KO mice and WT mice. FPT restored the CA2 PNN deficit in juvenile Fmr1 KO mice to WT levels such that there were significant genotype and interaction effects and a near-significant treatment effect. Additionally, there was a near-significant interaction effect of genotype and treatment for the MMP-9 results. MMP-9 trended towards an increase in vehicle-treated Fmr1 KO mice compared to WT mice (vehicle- or FPT-treated), and FPT restored MMP-9 to WT levels. Modulating distinct 5-HTRs can regulate MMP-9 expression, neuroanatomical plasticity, and social behaviors. We conclude that FPT increases social behavior in juvenile Fmr1 KO mice and works, in part, by decreasing MMP-9 levels and restoring PNN levels in hippocampal CA2 via a 5-HT1AR, 5-HT1BR, 5-HT1DR, 5-HT2CR, and/or 5-HT7R mechanism.