The Korean art song, Gagok (가곡), a genre rooted in the traditional poetic form Sijo and influenced by Western hymnals, has evolved significantly throughout the 20th and 21st centuries. English hymnals were introduced to late nineteenth-century Korea by the missionaries Horace G. Underwood (1859–1916) from a Northern Presbyterian mission and Henry G. Appenzeller (1858–1902) from a Northern Methodist mission. Throughout the period of Japanese rule over Korea from 1910 to 1945, Changga (창가) emerged as a form of secular song that aimed to promote the ideology of civilization development and independence while fostering a sense of patriotism. Public interest in art songs increased through 1960 with larger concerts, private recitals, recordings, and broadcasts. With the establishment of the Korean Composer Association (대한 음악가 협회) in the early 1960s, art song composition became more prevalent. Composers in the 20th and early 21st centuries started composing songs in their unique style.This study examines the works of four female composers– Hanbyeol Kang (b.1993), Wonju Lee (b.1979), Soon-Ae Kim (1920–2007), and JaeEun Park (b.1956)– to explore how they have used art songs to reflect and challenge the historical and social contexts of Korea. New beliefs, internal strife, and social upheavals in Korean culture influenced their cultural and artistic innovation in music. Through a feminist lens, this study analyzes how these composers’ works have contributed to a broader understanding of Korean women’s experiences and struggles. Drawing inspiration from female poets of various eras, these composers offered a unique perspective on the complexities of gender roles and societal expectations. Female composers in the 20th and 21st centuries have been influenced by Korean female poets, creating music that reflects historical events. Those poetic works are of female poets from the Joseon Dynasty, such as Nanseolheon Huh (1563–1589) and Maechang Yi (1573–1610), as well as modern poets, such as Namjo Kim (1927–2003) and Jeonghee Go (1948–1991). The four composers incorporated Korean cultural elements into their vocal works, inspired by the works of Korean female poets and traditional musical elements. Their poetry frequently delved into the complex issues of female social status in the Joseon Dynasty, and the broader social and political upheavals of the Korean War and the Gwangju Democratization Movement. Furthermore, this study provides an in-depth exploration of selected art songs and overview of Korean Art songs. It explores distinctive textual elements, traditional instrumentation, and cultural influences that shaped Korean art song as a genre. The study delves into the use of unique Korean textual elements, traditional instruments, and cultural influences. It explores distinctive textual elements, traditional instrumentation, and cultural influences that shaped Korean art song as a genre. The study delves into the use of unique Korean textual elements, traditional instruments, and cultural influences.

Background: Technostress poses a significant challenge to the nursing profession, with far-reaching implications for nurses' health, well-being, and patient care. Despite this, little is known about technostress among hospital nurses working in the United States (US). Purpose/Aims: The purpose of this study was to examine technostress among hospital nurses and its relationships with hospital characteristics (magnet status, type of EHR used, and if the location is a teaching hospital), current work characteristics (hospital department, weekly hours worked, frequency of floating departments, and years of experience at current hospital), cumulative work experience (years of experience as a nurse and years of experience using EHRs), EHR usability, cognitive workload, and EHR unintended consequences (EHR-UC). Methods: This study used a cross-sectional descriptive design. Participants (n=153) were recruited online via social media and recruitment platforms over a period of 10 weeks. Data were collected using an online Qualtrics survey containing a demographic questionnaire and validated instruments to measure technostress, EHR usability, cognitive workload, and EHR-UC. Data analysis was conducted in Stata 16.1 using one-way analysis of variance, Spearman correlations, and multiple linear regression. Findings: The average level of overall technostress was moderate (M= 2.54; SD = 0.61), on a scale of 1 to 5. Only one technostress inhibitor (technical support provision) showed a significant, small negative correlation with technostress, r (153) = -.21, p = .01. The frequency of floating between departments was the only work characteristic significantly associated with technostress (F= 3.41, p= .04). No significant relationships were found between technostress and other hospital characteristics or cumulative work experience. Significant predictors of technostress included EHR usability, cognitive workload, and EHR-UC. The final regression model showed that EHR usability, cognitive workload, and EHR-UC collectively explained 41% of the variance in technostress, F (3,128) = 31.84, p <.001, Adjusted R²=0.41. Conclusions/Implications: These findings highlight the complex relationships between technostress and various organizational and technological factors in hospital environments. By understanding the factors contributing to technostress and implementing strategies to mitigate its effects, nursing organizations and individuals can create healthier and more supportive work environments for nurses. Future research is needed to explore this important issue.

Purpose: The purpose of this quality improvement (QI) project was to increase and improve PCPs’ education on the benefits of incorporating a plant-based diet to improve cardiovascular health. The primary care providers were then encouraged to educate their patients that suffer from cardiovascular disease or at risk of cardiovascular disease on the benefits of integrating a plant-based diet in their treatment plan in hopes they will adopt changes to their diet. Background: Cardiovascular disease continues to be the leading cause of mortality remaining a public health crisis. Cardiovascular disease progresses overtime, therefore slowing progression by having appropriate lipid levels is key. Healthy behaviors such as a healthy diet can help in treating and slowing down cardiovascular disease. Healthy plant-based diets have been shown to improve cardiovascular health. Health care professionals need to be prepared to address nutrition to patients as they have a vital role in providing nutritional care. Methods: Guided by the Model for Improvement, healthcare professional participants completed an online educational PowerPoint followed by a pre-post survey to measure a change in participant knowledge and intent to recommend a plant-based to patient with or at risk of cardiovascular disease. Results: All 3 healthcare participants were recruited and agreed to take part in the educational module followed by the pre-post survey. The results of the survey indicated that the educational PowerPoint increased their knowledge on the benefits of a plant-based diet on cardiovascular disease. All participants also agreed to recommend a plant-based diet to their patients. Conclusion: Study findings supported the aim of this quality improvement project. The results indicate that education to providers can help achieve improved knowledge of plant-based nutrition on cardiovascular disease. This encourages providers to recommend a plant-based diet to their patients. Future efforts should include a wider dissemination incorporating more providers and evaluating provider education in hopes they will communicate the benefits of plant-based nutrition to their patients.

Purpose: The purpose of this quality improvement (QI) project was to improve the food insecurity screening process for all adult-primary care patients, by educating providers on food insecurity, assessing for household food quality and sufficiency, identifying the barriers that cause food insecurity, and identifying the interventions needed to increase access to healthy food. Background: Patients living in rural communities throughout the Navajo Nation continue to be negatively impacted by the lack of resources and various social determinants of health. Patients who screen positive for food insecurity are more likely to be diagnosed with chronic illnesses, such as obesity, hypertension, cardiovascular disease, diabetes, non-alcoholic fatty liver disease, and cancer. Educating providers on adequate food insecurity screening tools and the consequences of food insecurity can reveal the challenges that residents of the Navajo Nation face when it comes to accessing healthy and nutritious foods. Methods: The study was comprised of a 22-question pretest, a live educational presentation, and a 14-question posttest. The pretest was distributed to participants, prior to the intervention, to determine the participant’s baseline knowledge of food insecurity screening. Next, a live educational presentation was conducted at the Primary Care Clinic weekly staff meeting on October 17, 2024. Lastly, the participants completed the posttest to evaluate the effectiveness of the educational material. The pre- and posttests included questions about food insecurity, screening, and the readiness of the participant to implement food security screening and provide education to the patient. Results: A total of 44 staff members from the Tséhootsooí Medical Center Primary Care Clinic participated in the project. After attending the educational presentation on food insecurity and decreasing obesity on the Navajo Nation and completing the pre- and post- surveys, all participants (100%) reported an increase in knowledge about food insecurity. Conclusions: This project successfully increased participants’ knowledge of food insecurity and their ability to correctly enter medical nutrition referrals. The interventions introduced the ongoing issues affecting the patients throughout the Navajo Nation. Providers need to utilize evidence-based practice and the knowledge gained from this QI project to improve the food insecurity process and help patients get the resources they need.

Purpose. The purpose of this quality improvement (QI) project was to increase compliance with annual preventative visits in adults ages 18 to 64 with Medicaid by identifying facilitators and barriers. Background. Annual preventative visits increase preventative care uptake and the detection and treatment of chronic disease (Liss et al., 2024). However, completion rates for annual preventative visits have been suboptimal, especially for those with Medicaid or without health insurance and between the age range of 18 to 64. Increasing compliance with annual preventative visits is essential to reduce the burden of chronic disease in the U.S. This also aligns with an objective of Healthy People 2030, which is to “Increase the proportion of adults who get recommended evidence-based preventative health care (U.S. Department of Health and Human Services, n.d.). Methods. Patients at the Ginger Ryan Clinic (GRC) who met inclusion criteria (between the ages of 18 and 64 and having Medicaid insurance) were asked to complete a survey to identify facilitators and barriers to compliance with annual preventative visits. The principal investigator (PI) wrote the ten survey questions based on facilitators and barriers to preventative care identified in the literature review. The patient service representatives (PSRs) distributed surveys to patients who met the inclusion criteria and were willing to participate in the waiting room at check-in for appointments. Surveys were distributed over two weeks. Results. A total of 23 surveys were collected. The surveys successfully identified facilitators and barriers to compliance with annual preventative visits. These included age, gender, having a usual source of care, frequency of visits to the clinic per year, health beliefs, and reminders to schedule. Conclusions. Identifying facilitators and barriers to compliance with annual preventative visits is a vital first step in increasing compliance. While this project did identify some facilitators and barriers, future research and PDSA cycles are needed to strengthen the available evidence and define what facilitators and barriers should be focused on.

Purpose: The objective of this project was to increase provider knowledge and awareness of the Patient Health Questionnaire modified for Adolescents (PHQ-A) which is a validated but more age-appropriate depression screening tool for adolescents in a pediatric primary care setting. Background: The rates of adolescent mental health disorders, including depression and suicide, are increasing at an alarming rate. Although there are screening methods in place, many patients continue to go undiagnosed and untreated. One issue might be the tool used to screen for depression. If a depression screening tool was developed and validated on adults, then it is not the best tool for the pediatric populations. An age-appropriate screening tool, like the PHQ-A, can be used to screen for mental health related symptoms. Methods: A literature synthesis was utilized in planning the intervention. Methods include a 10-15 minute in person educational session in which the DNP student presented on the benefits of using the PHQ-A over the Patient Health Questionnaire-2 (PHQ-2) and Patient Health Questionnaire-9 (PHQ-9), which are already being utilized at Arbor Medical Partners Pediatrics. An educational based handout was used to guide the presentation. A survey was provided to the participants afterwards that addressed if knowledge and awareness was gained on the topic in addition to feedback about the educational offering itself. Results: Surveys from eight participants were obtained. Medical assistants and providers felt as though the education was helpful because the statistics provided justified the use of the PHQ-A, the information gained could be used to inform families, and the important role that healthcare providers play in depression screening in adolescents was emphasized. All participants agreed that they would be likely to adopt the PHQ-A into their future practice as well as be supportive of the clinic adopting it. Suggestions on how to improve the educational offering and how it was presented were minimal. Conclusions: The results demonstrated a positive response to the educational offering and the PHQ-A itself. Further PDSA cycles need to be completed to work on ways to accomplish adopting the PHQ-A into practice at Arbor Medical Partners Pediatrics.

Purpose: This quality improvement (QI) project assessed the impact of a 30-minute educational session for primary care providers (PCPs) on their readiness, willingness, and confidence to conduct mental health screenings using the Patient Health Questionnaire- 2 (PHQ-2) tool in overweight and obese patients during weight management consultations. Background: Obesity and depression often co-occur, with obesity increasing the risk of developing depression and vice versa. Mental health screenings are not consistently integrated into obesity management in clinical settings. Early identification of depression through validated tools like the PHQ-2 could lead to more comprehensive care and better health outcomes for obese patients. Methods: The QI project involved a 30-minute educational session for providers at a concierge medicine clinic in Surprise, Arizona. Post-pre surveys were administered to assess changes in confidence, knowledge, and willingness to screen for depression. PHQ-2 screening utilization were tracked for 14 days post-intervention and compared to six months of baseline data. Results: Findings found PHQ-2 screenings increased by 80%, over a similar 14-day period. All of the participants reported improved confidence in conducting mental health assessments. Chart reviews indicated that 90% of the PHQ-2 screenings were completed and documented in the electronic health records. Conclusions: Provider confidence and the frequency of PHQ-2 utilization improved during weight management consultations. Brief, targeted educational interventions can effectively enhance the integration of mental health screenings into caring for obese patients, addressing the interconnected issues of obesity and depression. The project supports the need for continued education and integration of mental health tools to improve comprehensive care delivery.

Purpose: Medications for opioid use disorder (MOUD) are considered the standard of care for substance use disorder (SUD); however, the literature reveals a significant underutilization of this treatment. The medications work to reduce acute withdrawal symptoms and opioid cravings to prevent hazardous drug use, subsequently resulting in a reduction in overdose and secondary diseases and injuries related to high-risk behavior when under the influence of substances. A quality improvement project was designed to educate staff at a local prison on addiction and treatment involving MOUD in the context of a recently implemented program including buprenorphine. Background: OUD is a prevalent issue amongst those incarcerated, with high rates of return to use and overdose upon reentry to the community. MOUD/MAT programs have increased in correctional settings but still fall short of meeting the current needs of this population. Stigma surrounding addiction can lead to delayed access in treatment and plays a role in an individual’s continued use. Methods: Both clinical and correctional staff were recruited through email with participation occurring over the course of 10 days. Some 23 participants completed the pre- and post-surveys in their entirety and were included in the results analysis. Results: There was evidence of improved knowledge regarding the statistics and neurobiology of addiction as well as influential factors of addiction related to the social determinants of health model. The open-ended questions provided staff the opportunity to share their perceived barriers in administering MOUD to inmates which varied in response, from no concerns or non-applicability to their job function to concerns with the safety of the program related to diversion and subsequent misuse of the medication. Conclusion: The educational intervention provided staff at a local prison with evidence-based information surrounding the use of MOUD. Based on staff feedback, there may be an opportunity for further exploration of potential contributing factors in medication diversion. The literature highlights diversion as a legitimate concern, however, protocols exist in prevention strategies including staff administration process, and route of medication being considered for the uniqueness of the correctional facility needs.

Co-transcriptional R-loops form when nascent RNA transcripts base pairs with the template DNA strand, displacing the non-template DNA strand. Initially considered a transcriptional byproduct with potential implications for genomic integrity, recent studies highlight the regulatory roles of R-loops. The FET family proteins (FUS, EWSR1, and TAF15) have emerged as significant players in R-loop-mediated transcriptional regulation. This study investigates the mechanisms by which FUS and EWSR1 contribute to transcriptional regulation and global R-loop dynamics. Furthermore, we explore the implications of translocation events leading to the expression of the EWS-FLI1 fusion protein, a hallmark of Ewing Sarcoma present in more than 85% of patients. First, we employed electrophoretic mobility shift assays (EMSA) to show that EWSR1 directly interacts with R-loops through DNA fork regions. The specificity of this interaction is mediated by the RGG1-RRM-RGG2 domains, while the RGG2-ZnF-RGG3 domains contribute to its affinity. Second, we found that both wildtype EWSR1 and the fusion EWS-FLI1 protein interact with RNAPII in large membraneless organelles, where they regulate similar transcripts implicated in Ewing Sarcoma pathogenesis. Next, using in vitro transcription assays, we demonstrate that FUS promotes T7 polymerase-mediated transcription by binding to RNA, thereby inhibiting R- loop formation. This finding is further supported by FUS knockdown in HEK293 cells which leads to the accumulation of R-loops. Lastly, through quantitative mass spectrometry proteomics, we found that aberrant R-loop accumulation disrupts mitochondrial, mitotic, and transport processes in A673 Ewing Sarcoma cells.

PURPOSE. This project was designed to strengthen primary care provider (PCP) knowledge and confidence in Valley fever diagnosis, treatment, and specialty-referral requirements at a Southern Arizona rural community health organization.BACKGROUND. Coccidioidomycosis (i.e., Valley fever) is a fungal infection acquired by inhaling spores located in the dust of endemic regions. Southern Arizona has the highest incidence of the disease in the nation, with Maricopa, Pima, and Pinal Counties accounting for over half of all cases in the United States. Despite the fact that Valley fever is responsible for one-third of all pneumonia cases diagnosed in Southern Arizona, only 13% of Arizona PCPs appropriately test for the disease. Patients experience on average a one-month delay for diagnosis, and more than 80% of cases are initially misdiagnosed. This delay to diagnosis leads to increased healthcare costs, increased incidence of complications, and delayed specialist referral for high-risk patients. METHODS. The multilevel intervention design included a 30-minute, synchronous provider education session delivered via Microsoft TEAMS. Education content was developed from Infectious Disease Society of America (IDSA) clinical practice guidelines, a 2017 CDC Valley Fever PCP training video, and the Valley Fever Center for Excellence (VFCE) training manual for PCPs. A pocket-sized handbook and printable flowchart of the educational material was also provided. Evaluation was accomplished with a post-pre survey examining provider knowledge, attitudes, and practices related to Valley fever diagnosis and management. A “Valley Fever Champion” was selected from among participating PCPs to provide quarterly educational emails and attend the annual VFCE meeting. RESULTS. Of the 31 providers in attendance, 19 completed the post-education evaluation survey. Statistically significant improvements were seen in provider confidence in ability to diagnose (p=.001) and treat (p=.011) Valley fever, and knowledge of lab testing options (p=.031). Modest improvements were gained in knowledge of vaccine availability and health department notification requirements. Notably, among providers who obtained their clinical degree in Arizona, only 20% reported receiving prior education on Valley fever. CONCLUSIONS. This project demonstrates an effective model for providing Valley fever training to Arizona PCPs and connecting them with local specialists and resources from organizations such as the VFCE.