Broadening Perspectives: A Multidisciplinary Collaborative Teaching and Learning Experience

Following in the wake of Hurricanes Katrina and Rita and conducted when Hurricanes Gustav and Ike struck the coast of Louisiana, a unique service-learning course stretched the boundaries of students and faculty in new ways. First, students and faculty from five distinctive disciplines designed the course collaboratively, infusing different perspectives into every aspect of planning and teaching. Second, the content area—human impacts of disasters and disease—required students (future leaders who will one day make critical decisions in the midst of uncertainty and conflict) to grapple with major human tragedies. Third, the course objective—to encourage critical analysis—required students to examine multifaceted and complex issues as they considered the environmental, political, and social effects of disaster and disease. Finally, this course used a qualitative research project as its service component, and the partner was our own university. The goal of the project was to offer information that would help the administration plan for future disasters. Students directly experienced disaster-related challenges through planned assignments requiring critical analysis and a ropes challenge experience simulating a crisis environment. In the first few weeks of class, proving that in education as in life timing is everything, Hurricane Gustav severely damaged the community and simulation became reality. While this course, entitled Honors 2000: Critical Analysis and Social Responsibility: The Human Response to Disaster and Disease, is not precisely replicable because of unique hurricane occurrences, any team of faculty can replicate the collaboration, flexibility, responsiveness, and authenticity that characterized the experience

Pharmacists' training, experiences and behaviours in managing homeless patients.

Community pharmacists are well-situated to offer proactive and opportunistic support and advice to the homeless. The aim of this research was to investigate pharmacists' training, experiences and behaviours in managing homeless patients. A questionnaire using both open and closed questions was developed, based on existing literature, researcher expertise and the Theoretical Domains Framework (TDF) - a synthesis of behaviour change theory. The TDF outlines fourteen individual domains perceived to influence behaviour, including knowledge, skills, beliefs about capabilities and social influences. The questionnaire was reviewed and piloted with fifty pharmacists, and NHS R&D approval was obtained. The questionnaire was then sent to a random sample of 1,951 community pharmacies in England and Scotland, with two follow-up reminders. Results were analysed using descriptive statistics. 321 responses (response rate 16.5%) were received. The mean (SD) age of respondents was 39 (plus or minus 12) years with a third (n=94, 29.3%) having been qualified as a pharmacist for fewer than five years. Many respondents (n = 187) reported having managed a homeless patient in their pharmacy, with approximately 17% (n=53) saying that this was a daily activity. The majority (n=242, 75.4%) of participants said that homelessness was not included in their undergraduate, postgraduate or continuous professional development (CPD) pharmacy training (n=225, 70.1%). Only a third (n=100, 31.1%) agreed or strongly agreed that they knew to whom they should refer a homeless patient for social support. Approximately 42% (n=137) indicated they would discuss homelessness only if raised by the patient. Only one fifth (n=71, 22.1%) felt comfortable advising homeless patients on how to minimise the impact of homelessness on their medication use, and the vast majority of respondents reported a lack of clear guidelines (n=294, 94.2%). The results of this study suggest lack of appropriate opportunities - at undergraduate, postgraduate and CPD level - for training on how to manage homeless patients. There is a need to develop guidelines that will enable community pharmacists to better support homeless patients in alleviating the impact of homelessness; these guidelines should include advice on the pharmacist's role in supporting homeless medicine management and providing signposting to appropriate social services

Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study.

Background: - The relocation of formerly homeless patients eligible to transfer from a specialist homeless healthcare centre (SHHC) to mainstream general practices is key to patient integration in the local community. Failure to transition patients conferring eligibility for relocation may also negatively impact on SHHC service delivery. Aim: - To explore barriers and facilitators of relocation from the perspectives of formerly homeless patients and healthcare staff involved in their care. Design and setting: - Qualitative semi-structured face-to-face and telephone interviews conducted in the north east of Scotland. Method: - Participants were patients and healthcare staff including GPs, nurses, substance misuse workers, administrative, and local community pharmacy staff recruited from one SHHC, two mainstream general practices, and four community pharmacies. Interview schedules based on the 14 domains of the Theoretical Domains Framework (TDF) were drafted. Transcripts of the interviews were analysed by two independent researchers using a framework approach. Results: - Seventeen patients and 19 staff participated. Key barriers and facilitators aligned to TDF domains included: beliefs about consequences regarding relocation; patient intention to relocate; environmental context and resources in relation to the care of the patients and assessing patient eligibility; patient skills in relation to integration; social and professional role and identity of staff and patients; and emotional attachment to the SHHC. Conclusion: - Implementation of services, which promote relocation and integration, may optimise patient relocation from SHHCs to mainstream general practices. These include peer support networks for patients, better information provision on the relocation process, and supporting patients in the journey of identifying and adjusting to mainstream practices

A specific group of genes respond to cold dehydration stress in cut Alstroemeria flowers whereas ambient dehydration stress accelerates developmental senescence expression patterns

Petal development and senescence entails a normally irreversible process. It starts with petal expansion and pigment production, and ends with nutrient remobilization and ultimately cell death. In many species this is accompanied by petal abscission. Post-harvest stress is an important factor in limiting petal longevity in cut flowers and accelerates some of the processes of senescence such as petal wilting and abscission. However, some of the effects of moderate stress in young flowers are reversible with appropriate treatments. Transcriptomic studies have shown that distinct gene sets are expressed during petal development and senescence. Despite this, the overlap in gene expression between developmental and stress-induced senescence in petals has not been fully investigated in any species. Here a custom-made cDNA microarray from Alstroemeria petals was used to investigate the overlap in gene expression between developmental changes (bud to first sign of senescence) and typical post-harvest stress treatments. Young flowers were stressed by cold or ambient temperatures without water followed by a recovery and rehydration period. Stressed flowers were still at the bud stage after stress treatments. Microarray analysis showed that ambient dehydration stress accelerates many of the changes in gene expression patterns that would normally occur during developmental senescence. However, a higher proportion of gene expression changes in response to cold stress were specific to this stimulus and not senescence related. The expression of 21 transcription factors was characterized, showing that overlapping sets of regulatory genes are activated during developmental senescence and by different stresses

High-resolution temporal profiling of transcripts during Arabidopsis leaf senescence reveals a distinct chronology of processes and regulation

Leaf senescence is an essential developmental process that impacts dramatically on crop yields and involves altered regulation of thousands of genes and many metabolic and signaling pathways, resulting in major changes in the leaf. The regulation of senescence is complex, and although senescence regulatory genes have been characterized, there is little information on how these function in the global control of the process. We used microarray analysis to obtain a highresolution time-course profile of gene expression during development of a single leaf over a 3-week period to senescence. A complex experimental design approach and a combination of methods were used to extract high-quality replicated data and to identify differentially expressed genes. The multiple time points enable the use of highly informative clustering to reveal distinct time points at which signaling and metabolic pathways change. Analysis of motif enrichment, as well as comparison of transcription factor (TF) families showing altered expression over the time course, identify clear groups of TFs active at different stages of leaf development and senescence. These data enable connection of metabolic processes, signaling pathways, and specific TF activity, which will underpin the development of network models to elucidate the process of senescence

Inhibition of IL-34 Unveils Tissue-Selectivity and Is Sufficient to Reduce Microglial Proliferation in a Model of Chronic Neurodegeneration

The proliferation and activation of microglia, the resident macrophages in the brain, is a hallmark of many neurodegenerative diseases such as Alzheimer´s disease (AD) and prion disease. Colony stimulating factor 1 receptor (CSF1R) is critically involved in regulating microglial proliferation, and CSF1R blocking strategies have been recently used to modulate microglia in neurodegenerative diseases. However, CSF1R is broadly expressed by many cell types and the impact of its inhibition on the innate immune system is still unclear. CSF1R can be activated by two independent ligands, CSF-1 and interleukin 34 (IL-34). Recently, it has been reported that microglia development and maintenance depend on IL-34 signalling. In this study, we evaluate the inhibition of IL-34 as a novel strategy to reduce microglial proliferation in the the ME7 model of prion disease. Selective inhibition of IL-34 showed no effects on peripheral macrophage populations in healthy mice, avoiding the side effects observed after CSF1R inhibition on the systemic compartment. However, we observed a reduction in microglial proliferation after IL-34 inhibition in prion-diseased mice, indicating that microglia could be more specifically targeted by reducing IL-34. Overall, our results highlight the challenges of targeting the CSF1R/IL34 axis in the systemic and central compartments, important for framing any therapeutic effort to tackle microglia/macrophage numbers during brain disease

Indicators of injury recovery identified by patients, family members and clinicians

Introduction A focus on what is important to patients has been recognized as an essential pillar in care to ensure safe patient care that focuses on outcomes identified as important by patients. Despite this, asking trauma patients and their families what they consider should be the priorities of care and recovery has been neglected. Methods Adult trauma patients admitted to two centers in Australia for ≥24 h for the treatment of physical injury, and family members of injured patients and clinicians caring for injured patients were invited to participate. Individual interviews were conducted with the patient and family members prior to hospital discharge, and again one and three months post discharge. Individual interviews or focus groups were conducted with clinicians at one point in time. Content analysis of all transcripts was undertaken to determine the indicators of successful recovery over time. Results Participants in the three stakeholder groups were enrolled (patients − 33; family members—22; clinicians—40). Indicators of recovery focused on five main categories including returning to work, resuming family roles, achieving independence, recapturing normality and achieving comfort. Other categories that were less frequently identified included maintaining one’s household, restoring emotional stability, cosmetic considerations and appearance, realignment of life goals, psychological recovery and development of self. Indicators of recovery after physical injury were similar across the three stakeholder groups, although with greater detail identified by patients. In addition, indicators evolved over time with increasing recognition of the importance of the overall impact of the injury in general and on activities of daily living and an unfolding appreciation that life could not be taken for granted. Conclusions Description of the indicators of recovery after traumatic injury that matter to patients, family members and clinicians enable an understanding of similarities and differences. Further testing in a broader cohort of participants is essential to identify patient reported outcome measures that might be used in trauma care and associated research

Protocol for implementation of family health history collection and decision support into primary care using a computerized family health history system

<p>Abstract</p> <p>Background</p> <p>The CDC's Family History Public Health Initiative encourages adoption and increase awareness of family health history. To meet these goals and develop a personalized medicine implementation science research agenda, the Genomedical Connection is using an implementation research (T3 research) framework to develop and integrate a self-administered computerized family history system with built-in decision support into 2 primary care clinics in North Carolina.</p> <p>Methods/Design</p> <p>The family health history system collects a three generation family history on 48 conditions and provides decision support (pedigree and tabular family history, provider recommendation report and patient summary report) for 4 pilot conditions: breast cancer, ovarian cancer, colon cancer, and thrombosis. All adult English-speaking, non-adopted, patients scheduled for well-visits are invited to complete the family health system prior to their appointment. Decision support documents are entered into the medical record and available to provider's prior to the appointment. In order to optimize integration, components were piloted by stakeholders prior to and during implementation. Primary outcomes are change in appropriate testing for hereditary thrombophilia and screening for breast cancer, colon cancer, and ovarian cancer one year after study enrollment. Secondary outcomes include implementation measures related to the benefits and burdens of the family health system and its impact on clinic workflow, patients' risk perception, and intention to change health related behaviors. Outcomes are assessed through chart review, patient surveys at baseline and follow-up, and provider surveys. Clinical validity of the decision support is calculated by comparing its recommendations to those made by a genetic counselor reviewing the same pedigree; and clinical utility is demonstrated through reclassification rates and changes in appropriate screening (the primary outcome).</p> <p>Discussion</p> <p>This study integrates a computerized family health history system within the context of a routine well-visit appointment to overcome many of the existing barriers to collection and use of family history information by primary care providers. Results of the implementation process, its acceptability to patients and providers, modifications necessary to optimize the system, and impact on clinical care can serve to guide future implementation projects for both family history and other tools of personalized medicine, such as health risk assessments.</p

Changes in rocket salad phytochemicals within the commercial supply chain: glucosinolates, isothiocyanates, amino acids and bacterial load increase significantly after processing

Five cultivars of Eruca sativa and a commercial variety of Diplotaxis tenuifolia were grown in the UK (summer) and subjected to commercial growth, harvesting and processing, with subsequent shelf life storage. Glucosinolates (GSL), isothiocyanates (ITC), amino acids (AA), free sugars, and bacterial loads were analysed throughout the supply chain to determine the effects on phytochemical compositions. Bacterial load of leaves increased significantly over time and peaked during shelf life storage. Significant correlations were observed with GSL and AA concentrations, suggesting a previously unknown relationship between plants and endemic leaf bacteria. GSLs, ITCs and AAs increased significantly after processing and during shelf life. The supply chain did not significantly affect glucoraphanin concentrations, and its ITC sulforaphane significantly increased during shelf life in E. sativa cultivars. We hypothesise that commercial processing may increase the nutritional value of the crop, and have added health benefits for the consumer