Development, assessment, and evolution of an interprofessional activity with senior nursing and pharmacy students: application of quality improvement in interprofessional education (IPE)

Purpose: Concurrent development IPE activities and an assessment strategy is essential for informed evolution of such initiatives. This study provides an active example of the progression of IPE at an institution utilizing an active assessment plan. Background: IPE is advocated as a method to develop students who are prepared for interprofessional practice, which is essential for optimal patient outcomes. While IPE has been integrated in many health professional curricula, focus on assessment is needed to ensure obtainment of educational outcomes and truly prepare students for interprofessional collaboration in the work place. Description of Intervention/Program: IPE activities were developed through a multidisciplinary committee consisting of health profession faculty and students. Additionally the committee developed an assessment strategy to evaluate IPE initiatives. One activity implemented over the last three years involves senior nursing and pharmacy students collaboratively addressing a complex patient care simulation. Students complete a pre/post survey evaluating the impact of the activity on their readiness for interprofessional practice, IPE perceptions, and activity impact. Group care plans and group evaluations are also evaluated. Results: Quantitative and qualitative data are reviewed by the committee annually to make informed decisions for future iterations of the activity. Conclusion: Execution of a clear assessment plan is essential to fulfill learning objectives for IPE activities. Feedback from an educational activity allowed for continuous improvement, ensuring impact on student learning, and illustrates the necessity of assessment within IPE. Relevance to IPE or Practice: The study conveys three key points that would be helpful to other institutions implementing IPE. First, the study illustrates the importance of assessment planning when implementing IPE activities. Second, the assessment plan presented serves as an example for others. Lastly, the study provides an active example of applying the assessment plan to iterations of an IPE activity. Seminar Outline/Timeframe of Presentation and Interactive Discussion: Opening discussion on IPE and assessment of IPE activities (10 minutes) Integration of IPE into the University curriculum and details regarding the senior IPE activity (10 minutes) Development of an IPE assessment plan and application to the senior IPE activity (10 minutes) Interprofessional groupwork: 5-6 multidisciplinary group members provided student feedback from an IPE activity and must determine potential adjustments to the activity for future iterations (10 minutes) Interprofessional groupwork: In the same group, discuss potential adjustments to the assessment plan for IPE activities for the activity discussed previously as well as at group members’ own institutions. Large group discussion of group work including information gleaned from student feedback, proposed changes for future activities, and ideas for assessment planning, both for the activity presented and for participants’ own institutions. Two to Three measureable learning objectives relevant to conference goals: To demonstrate successful development and application of assessment strategies in IPE activities. To guide use of student feedback in the improvement of IPE activities To stimulate discussion regarding assessment planning within IP

Interprofessional Education for Freshman Nursing and Pharmacy Students: An Application of Ethics

Purpose: The purpose is to encourage students in the health care professions to work interprofessionally to better enable them to enter the workplace as a member of the collaborative practice team. Background: In 2009, six national education associations of schools of the health professions formed a collaborative to promote and encourage constituent efforts that would advance substantive interprofessional learning experiences (IPE) to help prepare future health professionals for enhanced team-based care of patients and improved population health outcomes. By 2016, this initiative has grown significantly, even being mandated by some professions. Description of Intervention/Program: IPE activities were developed through a committee consisting of faculty and students from nursing and pharmacy programs at the institution. An activity for freshman students (N=152) was developed, focusing on each profession’s code of ethics and application to ethical situations. Students completed a pre/post survey evaluating their readiness and perceptions of IPE, as well as evaluating the activities’ effectiveness in effective collaboration using qualitative and quantitative techniques. Results: The data was evaluated by the IPE committee to determine future iterations of the activity. Conclusion: Based on both quantitative and qualitative feedback from the students, the freshman IPE activity assisted both pharmacy and nursing students to become a more effective member of the health care team, bringing students from different health care programs together to problem-solve while applying a collaboratively devised code of ethics with an application-based activity to produce a robust experience. Relevance to IPE or Practice: The study conveys two key points that would be helpful for others integrating IPE activities into their curriculum. First, the authors illustrated an IPE activity that can be implemented with lower level professional students. Second, the authors outlined a plan for continuous improvement of IPE activity, looking beyond implementation to assessment and optimization of these initiatives. Seminar Outline/Timeframe of Presentation and Interactive Discussion: Opening discussion on IPE and its integration into the university curriculum (10 minutes) Freshman activity initial ideas, design, and feedback: the value of interprofessional ethics in healthcare (10 minutes) Modifications to the freshman activity and student feedback ( 10 minutes) Interprofessional groupwork (5-6 group members made up of participants from different disciplines) to develop a shared code of ethics (10 minutes) Interprofessional groupwork (same group members) using the shared code of ethics to solve a practical, real-world problem (10 minutes) Large group discussion on the overall activity, components of the shared code of ethics, and application of the code to the problem-solving activity, and considerations for the future for this activity (10 minutes) Two to three measureable learning objectives relevant to conference goals: To create a coordinated effort across the nursing and pharmacy health profession curricula to embed essential interprofessional experience and content. To guide professional and institutional curricular development of learning approaches and assessment strategies to achieve productive outcomes for nursing and pharmacy students. To demonstrate a newly developed ethics activity for freshman students in nursing and pharmacy programs to exhibit interprofessional problem-solving

The Epidemiology of First-Episode Psychosis in Early Intervention in Psychosis Services: Findings From the Social Epidemiology of Psychoses in East Anglia [SEPEA] Study

OBJECTIVE: Few studies have characterized the epidemiology of first-episode psychoses in rural or urban settings since the introduction of early intervention psychosis services. To address this, the authors conducted a naturalistic cohort study in England, where such services are well established. METHOD: All new first-episode psychosis cases, 16-35 years old, presenting to early intervention psychosis services in the East of England were identified during 2 million person-years follow-up. Presence of ICD-10 F10-33 psychotic disorder was confirmed using OPCRIT [operational criteria for psychotic illness]. Incidence rate ratios were estimated following multivariable Poisson regression, adjusting for age, sex, ethnicity, socioeconomic status, neighborhood-level deprivation, and population density. RESULTS: Of 1,005 referrals, 687 participants (68.4%) fulfilled epidemiological and diagnostic criteria for first-episode psychosis (34.0 new cases per 100,000 person-years; 95% CI=31.5-36.6). Median age at referral was similar for men (22.5 years; interquartile range: 19.5-26.7) and women (23.4 years; interquartile range: 19.5-29.1); incidence rates were highest for men and women before 20 years of age. Rates increased for ethnic minority groups (incidence rate ratio: 1.4; 95% CI=1.1-1.6), as well as with lower socioeconomic status (incidence rate ratio: 1.3; 95% CI=1.2-1.4) and in more urban (incidence rate ratio: 1.4;95%CI=1.0-1.8) and deprived (incidence rate ratio: 2.1; 95% CI=1.3-3.3) neighborhoods, after adjustment for confounders. CONCLUSIONS: Pronounced variation in psychosis incidence, peaking before 20 years old, exists in populations served by early intervention psychosis services. Excess rates were restricted to urban and deprived communities, suggesting that a threshold of socioenvironmental adversity may be necessary to increase incidence. This robust epidemiology can inform service development in various settings about likely population-level need

Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence From the SEPEA Study.

Objective: Several ethnic minority groups experience elevated rates of first-episode psychosis (FEP), but most studies have been conducted in urban settings. We investigated whether incidence varied by ethnicity, generation status, and age-at-immigration in a diverse, mixed rural, and urban setting. Method: We identified 687 people, 16-35 years, with an ICD-10 diagnosis of FEP, presenting to Early Intervention Psychosis services in the East of England over 2 million person-years. We used multilevel Poisson regression to examine incidence variation by ethnicity, rural-urban setting, generation status, and age-at-immigration, adjusting for several confounders including age, sex, socioeconomic status, population density, and deprivation. Results: People of black African (incidence rate ratio: 4.06; 95% confidence interval [CI]: 2.63-6.25), black Caribbean (4.63; 95% CI: 2.38-8.98) and Pakistani (2.31; 95% CI: 1.35-3.94) origins were at greatest FEP risk relative to the white British population, after multivariable adjustment. Non-British white migrants were not at increased FEP risk (1.00; 95% CI: 0.77-1.32). These patterns were independently present in rural and urban settings. For first-generation migrants, migration during childhood conferred greatest risk of psychotic disorders (2.20; 95% CI: 1.33-3.62). Conclusions: Elevated psychosis risk in several visible minority groups could not be explained by differences in postmigratory socioeconomic disadvantage. These patterns were observed across rural and urban areas of our catchment, suggesting that elevated psychosis risk for some ethnic minority groups is not a result of selection processes influencing rural-urban living. Timing of exposure to migration during childhood, an important social and neurodevelopmental window, may also elevate risk

AXR1-ECR1 and AXL1-ECR1 heterodimeric RUB-activating enzymes diverge in function in Arabidopsis thaliana

RELATED TO UBIQUITIN (RUB) modification of CULLIN (CUL) subunits of the CUL-RING ubiquitin E3 ligase (CRL) superfamily regulates CRL ubiquitylation activity. RUB modification requires E1 and E2 enzymes that are analogous to, but distinct from, those activities required for UBIQUITIN (UBQ) attachment. Gene duplications are widespread in angiosperms, and in line with this observation, components of the RUB conjugation pathway are found in multiples in Arabidopsis. To further examine the extent of redundancy within the RUB pathway, we undertook biochemical and genetic characterizations of one such duplication event- the duplication of the genes encoding a subunit of the RUB E1 into AUXIN RESISTANT1 (AXR1) and AXR1-LIKE1 (AXL1). In vitro, the two proteins have similar abilities to function with E1 C-TERMINAL-RELATED1 (ECR1) in catalyzing RUB1 activation and RUB1-ECR1 thioester formation. Using mass spectrometry, endogenous AXR1 and AXL1 proteins were found in complex with 3HA-RUB1, suggesting that AXR1 and AXL1 exist in parallel RUB E1 complexes in Arabidopsis. In contrast, AXR1 and AXL1 differ in ability to correct phenotypic defects in axr1-30, a severe loss-of-function AXR1 mutant, when the respective coding sequences are expressed from the same promoter, suggesting differential in vivo functions. These results suggest that while both proteins function in the RUB pathway and are biochemically similar in RUB-ECR1 thioester formation, they are not functionally equivalent

Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence From the SEPEA Study

$\textbf{Objective}$: Several ethnic minority groups experience elevated rates of first-episode psychosis (FEP), but most studies have been conducted in urban settings. We investigated whether incidence varied by ethnicity, generation status, and age-at-immigration in a diverse, mixed rural, and urban setting. $\textbf{Method}$: We identified 687 people, 16-35 years, with an ICD-10 diagnosis of FEP, presenting to Early Intervention Psychosis services in the East of England over 2 million person-years. We used multilevel Poisson regression to examine incidence variation by ethnicity, rural-urban setting, generation status, and age-at-immigration, adjusting for several confounders including age, sex, socioeconomic status, population density, and deprivation. $\textbf{Results}$: People of black African (incidence rate ratio: 4.06; 95% confidence interval [CI]: 2.63-6.25), black Caribbean (4.63; 95% CI: 2.38-8.98) and Pakistani (2.31; 95% CI: 1.35-3.94) origins were at greatest FEP risk relative to the white British population, after multivariable adjustment. Non-British white migrants were not at increased FEP risk (1.00; 95% CI: 0.77-1.32). These patterns were independently present in rural and urban settings. For first-generation migrants, migration during childhood conferred greatest risk of psychotic disorders (2.20; 95% CI: 1.33-3.62). $\textbf{Conclusions}$: Elevated psychosis risk in several visible minority groups could not be explained by differences in postmigratory socioeconomic disadvantage. These patterns were observed across rural and urban areas of our catchment, suggesting that elevated psychosis risk for some ethnic minority groups is not a result of selection processes influencing rural-urban living. Timing of exposure to migration during childhood, an important social and neurodevelopmental window, may also elevate risk.This work was supported by a Sir Henry Wellcome Research Fellowship from the Wellcome Trust (WT085540 to J.B.K.), a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (101272/Z/13/Z to J.B.K.) and by the National Institute of Health Research (RP-PG-0606-1335 to J.P.). Prof Peter Jones directs the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England

Low back pain status in elite and semi-elite Australian football codes: a cross-sectional survey of football (soccer), Australian rules, rugby league, rugby union and non-athletic controls

<p>Abstract</p> <p>Background</p> <p>Our understanding of the effects of football code participation on low back pain (LBP) is limited. It is unclear whether LBP is more prevalent in athletic populations or differs between levels of competition. Thus it was the aim of this study to document and compare the prevalence, intensity, quality and frequency of LBP between elite and semi-elite male Australian football code participants and a non-athletic group.</p> <p>Methods</p> <p>A cross-sectional survey of elite and semi-elite male Australian football code participants and a non-athletic group was performed. Participants completed a self-reported questionnaire incorporating the Quadruple Visual Analogue Scale (QVAS) and McGill Pain Questionnaire (short form) (MPQ-SF), along with additional questions adapted from an Australian epidemiological study. Respondents were 271 elite players (mean age 23.3, range 17–39), 360 semi-elite players (mean age 23.8, range 16–46) and 148 non-athletic controls (mean age 23.9, range 18–39).</p> <p>Results</p> <p>Groups were matched for age (p = 0.42) and experienced the same age of first onset LBP (p = 0.40). A significant linear increase in LBP from the non-athletic group, to the semi-elite and elite groups for the QVAS and the MPQ-SF was evident (p < 0.001). Elite subjects were more likely to experience more frequent (daily or weekly OR 1.77, 95% CI 1.29–2.42) and severe LBP (discomforting and greater OR 1.75, 95% CI 1.29–2.38).</p> <p>Conclusion</p> <p>Foolers in Australia have significantly more severe and frequent LBP than a non-athletic group and this escalates with level of competition.</p

Iminosugar-Based Inhibitors of Glucosylceramide Synthase Increase Brain Glycosphingolipids and Survival in a Mouse Model of Sandhoff Disease

The neuropathic glycosphingolipidoses are a subgroup of lysosomal storage disorders for which there are no effective therapies. A potential approach is substrate reduction therapy using inhibitors of glucosylceramide synthase (GCS) to decrease the synthesis of glucosylceramide and related glycosphingolipids that accumulate in the lysosomes. Genz-529468, a blood-brain barrier-permeant iminosugar-based GCS inhibitor, was used to evaluate this concept in a mouse model of Sandhoff disease, which accumulates the glycosphingolipid GM2 in the visceral organs and CNS. As expected, oral administration of the drug inhibited hepatic GM2 accumulation. Paradoxically, in the brain, treatment resulted in a slight increase in GM2 levels and a 20-fold increase in glucosylceramide levels. The increase in brain glucosylceramide levels might be due to concurrent inhibition of the non-lysosomal glucosylceramidase, Gba2. Similar results were observed with NB-DNJ, another iminosugar-based GCS inhibitor. Despite these unanticipated increases in glycosphingolipids in the CNS, treatment nevertheless delayed the loss of motor function and coordination and extended the lifespan of the Sandhoff mice. These results suggest that the CNS benefits observed in the Sandhoff mice might not necessarily be due to substrate reduction therapy but rather to off-target effects

Lost opportunities in HIV prevention: programmes miss places where exposures are highest

Background: Efforts at HIV prevention that focus on high risk places might be more effective and less stigmatizing than those targeting high risk groups. The objective of the present study was to assess risk behaviour patterns, signs of current preventive interventions and apparent gaps in places where the risk of HIV transmission is high and in communities with high HIV prevalence. Methods: The PLACE method was used to collect data. Inhabitants of selected communities in Lusaka and Livingstone were interviewed about where people met new sexual partners. Signs of HIV preventive activities in these places were recorded. At selected venues, people were interviewed about their sexual behaviour. Peer educators and staff of NGOs were also interviewed. Results: The places identified were mostly bars, restaurants or sherbeens, and fewer than 20% reported any HIV preventive activity such as meetings, pamphlets or posters. In 43% of places in Livingstone and 26% in Lusaka, condoms were never available. There were few active peer educators. Among the 432 persons in Lusaka and 676 in Livingstone who were invited for interview about sexual behaviour, consistent condom use was relatively high in Lusaka (77%) but low in Livingstone (44% of men and 34% of women). Having no condom available was the most common reason for not using one. Condom use in Livingstone was higher among individuals socializing in places where condoms always were available. Conclusion: In the places studied we found a high prevalence of behaviours with a high potential for HIV transmission but few signs of HIV preventive interventions. Covering the gaps in prevention in these high exposure places should be given the highest priority

Diverse and Active Roles for Adipocytes During Mammary Gland Growth and Function

The mammary gland is unique in its requirement to develop in close association with a depot of adipose tissue that is commonly referred to as the mammary fat pad. As discussed throughout this issue, the mammary fat pad represents a complex stromal microenvironment that includes a variety of cell types. In this article we focus on adipocytes as local regulators of epithelial cell growth and their function during lactation. Several important considerations arise from such a discussion. There is a clear and close interrelationship between different stromal tissue types within the mammary fat pad and its adipocytes. Furthermore, these relationships are both stage- and species-dependent, although many questions remain unanswered regarding their roles in these different states. Several lines of evidence also suggest that adipocytes within the mammary fat pad may function differently from those in other fat depots. Finally, past and future technologies present a variety of opportunities to model these complexities in order to more precisely delineate the many potential functions of adipocytes within the mammary glands. A thorough understanding of the role for this cell type in the mammary glands could present numerous opportunities to modify both breast cancer risk and lactation performance