CRYSTAL CHU: When women are diagnosed with breast cancer and they're considering surgical options, a lot of them just naturally think, if I'm going to remove one breast, why not the other? That's the first natural thought that comes to mind. It's really important for them to understand that a mastectomy alone is hard to get through, but removing both is a little more complicated.

I'm Crystal Chu, and I'm a PhD student at the School of Nursing here at UVA. I've been an oncology nurse for almost 10 years and was working mostly with patients diagnosed with breast cancer. Hearing them have those "if I had known this" or "if I had thought about that," that maybe things would have been different for them-- just digging deeper to say, what can we do to make sure that they're making the best choices through their care and ensuring that when they enter survivorship, that they have the best quality of life possible.

LYNN DENGEL: So a contralateral prophylactic mastectomy is when a patient comes in with a diagnosis of breast cancer in one breast and is considering having the opposite side removed for prevention of future cancers. When a woman needs breast surgery for primary breast cancer, adding a contralateral or an opposite-side procedure increases the risk. It just increases the time in the operating room and increases the rate of infection, bleeding. All the complications that we see with the primary surgery, we're then seeing almost twice as many because you're doing both sides.

CRYSTAL CHU: My research really focuses on that decision point and creating this decision aid to make sure that they have the clinical background that they need to understand and really bringing forth their own values and goals. First part goes into clinical background. I make sure to just emphasize what they've already heard from the clinical team, pros and cons of this procedure, risk involved, potential complications.

And then we go into, what are your goals? What's influencing you? The second balance sheet talks about benefits to them and consideration of others. We rarely make a decision on our own. Is someone else afraid that I'm going to have a cancer again? Is my partner worried about what I'm going to look like later? Once they've gone through the whole exercise, say what their preference is.

LYNN DENGEL: Many times, there is a choice for the patient to make. And it's not always crystal clear which side they should end up on. And so the decision aids really add a way for this to be more formalized, more thorough, and for the patient, I think, to drive more of the conversation. It gives them time to go away from me and take time with Crystal or another wonderful nurse to think through this and then come back to me with more understanding and probably in a better place to make the best decision for them.

CRYSTAL CHU: When they have the decision aid to really make their points clear and bring that back to the surgeon, it's a more productive conversation. And it doesn't feel like they're arguing. It feels like they can articulate their needs and goals in a way that the surgeon can hear and understand. And this just gave them their voice to say, this is what I want and why.

Going through this doesn't necessarily change their mind, but it makes them feel more solid, more confident in that choice. And to me, that's really the goal. I want people to feel like they're making a choice and that they're not going to look back and regret it, that you know that these are potential complications. And even if those occur, I'm still OK with my choice.

MARIA MCDONALD: So I really started with the broad question, very broad question, of, what does it mean for mental health, particularly depression, to be transgenerational?

We know there are a lot of environmental risk factors there that plays an important role. But I really was interested in this genetic component.

As a family nurse practitioner, I do work with people who do have anxiety, depression. I can hear from women their experiences. And that also sparks the additional question of, if this is transgenerational, really understanding what it means if a woman has depression during pregnancy, across pregnancy, what could that mean for mom's mental health in the postpartum period as well as the child's mental health?

A mother having depression during pregnancy-- we think about her ability to bond with her-- with being pregnant and then with her child as a newborn. We know that's a really crucial developmental period for children as they're growing. And having that bonding is very important for both mom and for baby.

So oxytocin is the love hormone or social interaction hormone across pregnancy. It has important implications. It has important functions for delivery. But it's also doing these things in the brain, as well, and be important in regulating emotion in that social interaction.

Each of us have our own endogenous oxytocin, which means that our bodies are already producing it. The way to understand how oxytocin is being used is to assess its receptor. So if there are changes in the gene receptor, that may have implications for how oxytocin is being used and could have important implications for that social interaction.

When we're already producing it, how does adding in oxytocin in the form of synthetic oxytocin in humans-- we use Pitocin-- what does that mean? And how does it change the brain and the blood?

Increase of the methyl group that's added to the gene will actually suppress the expression of the gene. And that can have implications for, again, continuing on with symptoms that we would say might be related to postpartum depression or depression, anxiety.

My work in clinical practice is working with humans. However, we can't do some of these invasive procedures and take brain samples and see what-- if there are correlations between the brain and the blood. So is how the genes are expressed in the brain the same as what they are in the blood? And we want to do that because then we don't have to take brain samples. We can draw blood from people. And that can be used in a clinical practice setting.

For this particular study, we will be using the [INAUDIBLE] and examining both brain and blood samples to see those relationships between the brain and the blood. If there are correlations, that can be a very good indication that we can use that as a proxy in humans as well. We can draw blood samples. And that can give us an idea of what the brain is doing, as well, the oxytocin in the brain is doing as well.

There are studies that are showing long-term consequences of using exogenous oxytocin for outcomes of postpartum depression. Oftentimes, we will use medications in practice for an important reason. We definitely want to reduce and eliminate this postpartum hemorrhage. It can be a very serious complication. And so this has lifesaving effects. However, use of Pitocin-- yes, though it's important, there are also risk factors associated with it. So all medications have side effects and have consequences. And so if we are able to recognize that it's good to use, it's-- has been helpful-- but, at the same time, how do we individualize it so we can reduce those potential negative effects that we don't want down the line?

SIMONE JAECKL: Kids are primarily victimized between the ages of 11 and 15. The largest group of child victims today in the United States are girls. It's about almost 90%. Children who are trafficked by their parents or by close to relatives, which also happen, especially in the context of the opioid crisis, they have been found to be as young as five years old.

CYNTHIA HURST: We know that children who have been trafficked are more likely to become ill. They're also more likely to die younger.

SERWA ERTL: Sex trafficking is not child prostitution. There is no such thing as child prostitution. It's child abuse.

GERI GREENSPAN: It's not just some stranger that comes and kidnaps a child and then sells them on the street. It's very often somebody that's already in that child's life in a position of trust.

GEQUETTA MURRAY-KEY: Some people don't see it as an issue because they don't see the issue. They're expecting this problem to look a certain way, to be in another country, to be somebody that has ripped clothes and their hair is not combed and they have dirt on their face. And whatever the movies present, they don't recognize that right there in their son's classroom, right there in their daughter's classroom, there's a possibility that someone this could be happening to.

SIMONE JAECKL: I am setting out to explore the risk factors for sex trafficking, the context, the root causes, and hopefully develop intervention and prevention strategies that are effective once I find out what the causes are. The Institute of Medicine and National Research Council pointed out that schools were emerging as promising environments for these prevention and intervention strategies for the kids they serve.

School nurses are just like nurses in general in society. They are the trusted health care professionals. They are uniquely positioned because they easily gain children's trust we have found out, I have found out, and research supports that because they have what they call an open door policy, meaning kids just-- they don't just come to be assessed when they are sick or to pick up meds. But they also come just to chat.

CYNTHIA HURST: Nurses see things that teachers and others may not, and they may notice things-- tattoos or bruises, things that don't make sense.

SERWA ERTL: They're on the front lines right now, so they are seeing children in adolescents day in and day out. They might also hear things from students because they may share information.

GERI GREENSPAN: To have somebody like a school nurse who has access to those children who's already talking to them about intimate health issues, who's there in the school and can see them every day, I think it's very important and can be a great resource.

SIMONE JAECKL: I am interviewing school nurses throughout the Commonwealth, and I see quite a range of preparedness. Some are very prepared, and others are not really prepared at all. They don't really know more than what you and what people in general may know from just from the lay press.

SERWA ERTL: Being aware of what to look for and recognizing that it's child abuse and that this adolescent needs more help I think is the most important thing for a nurse. And so that's why I think nurses are in such a unique position to help with this.

GEQUETTA MURRAY-KEY: We're supposed to care for children, protect and provide for them, and so that individual is learning at a young age that they'll have to fend for themselves. They get used to being in a submissive situation and maybe doing things as an adult that they wouldn't normally do but they don't know any other way.

SIMONE JAECKL: These kids are destroyed. To believe in people again, to believe in life, and to get a fair chance of starting a life as an adult, it's very difficult, and I think it is up to us as a society, to health care providers, and to schools to make that happen for these kids. The schools are an excellent place to start because kids are there. If they are watched-- if somebody has an eye on them and because of that, somebody knows what to look for, I think we do have a pretty good chance to at least help more children to safety and health right.

LIZA FOXX I'm with UVA researchers. They have gotten together to study patients on dialysis, to test for things like cognitive function and depression. And they do that through a series of three surveys, which is what I'm here to do with you today, if you accept.

I know, it is. It's very nerve wracking. I definitely stuttered all the time when I first started. I used to tell myself that I'm not good at talking, but I've stopped telling myself that. And that I'm able to speak my mind with ease and grace.

BRESHNA HAIDER: It just made me feel more comfortable with talking to someone, rather than talking at them. And it really-- I just feel like it increased my bedside manner as well.

MAUREEN METZGER: I have found that when I have nursing students involved in research, I often have very high recruitment rates, because they're willing to listen to what the students have to say. And I think it builds a student's confidence, because they are using skills they already have. And they're getting really comfortable conversing with patients, explaining things to patients, collecting information from patients. And so, this just kind of takes it up a notch.

As you know, there's a critical shortage of nursing across the board, but particularly in the area of nursing research. And so, I like to start thinking like get them young and get them to plant that seed about what research is all about.

ALLIE KIM: I actually don't think I had like a very great idea of what nursing research looked like. I was really interested in research, just because I felt like primary prevention is a really big way to really address a lot of issues that are within the community, and I feel like it's not looked at enough.

MEGHAN MATTOS: Nurses do great science, and that they can do great science too. Sometimes it's hard to identify what it means to be a nurse researcher or a neuroscientist, and working one-on-one, meeting every week, seeing exactly what we do, getting a whole idea of the research project, as I said, thinking about it from start to finish, it's such a great opportunity for them, I hope, to be able to see what it's like.

MAUREEN METZGER: We train them how to approach patients. They get city certified. They meet with clinicians when we're explaining the study. They're learning how to do informed consent on patients. We train them in red cap, which is what we use to manage the data. And they learn how to do a chart review, and so, they extract information from the electronic health record.

MEGHAN MATTOS: Learning about literature reviews, moving to databases, how to put data in from Epic, data extraction from different sources, and then that last step of trying to make sense of it and disseminating.

ALLIE KIM: I got to meet some of the engineers that worked on the projects, and that's where I realized, wow, research really does work with all disciplines in ways that you didn't even imagine. There's a civil engineer on our research team and I thought that was really interesting. I could never imagine that both professions would be working together.

ZAHRA ALISA: Looking into someone else's research brings up questions in your own head, which could inspire like a different research project.

MAUREEN METZGER: This is how I got into the kind of nursing that I do. This is how I-- this is how and why I decided to go into academia. This is my research passion. This is why this is my research passion. And just kind of sharing your own journey a little bit, and then sort of helping them see that that can be possible for them too. If someone can't imagine it, then they can't become it.

BRESHNA HAIDER: When Dr. Metzger emailed me, I was like, are you sure? Am I right for this? I've never thought about it, like what do I even do? It was just a lot, but I'm definitely glad that I got out of my comfort zone and reached for it, because it was very meaningful.

ALLIE KIM: It was very fun, and I think, I hope more people consider research in the future, nursing research specifically, because I think it's a vastly growing field. And I think it's very important to not only take research done by physicians, but also by nurses and work together with that.

EMILY WILLIAMS: I am very, very interested in research now. I just told my mom the other day. She just came up. I just went down and did research on my mother. [LAUGHS] So It's definitely changed my mind a lot.