The path to leadership: the career journey of academic health sciences library directors

Objective: The authors examined the career journeys of academic health sciences library directors to better understand their leadership development and what led them to their leadership positions in libraries. Methods: A qualitative phenomenological approach was employed due to its focus on exploring and understanding the meaning that individuals ascribe to a particular phenomenon or experience. Eleven library directors from academic health sciences libraries at public universities with very high research activity agreed to participate in the study. The research question guiding this study was: What was the library directors’ career journey that led them into library leadership? Results: A major theme that emerged from the data was “Path to Leadership.” Although each participant’s journey was unique, common elements surfaced as they chronicled their careers that were informative as to how they understood their emergence and development as library leaders. The four categories defining this theme were breadth of experience, focused preparation, mentors, and recognition and development of leadership potential. Conclusions: Previous research suggests that leadership development and preparedness are important contributors to leadership effectiveness. It was encouraging to witness and understand the amount of preparation by participants to ready themselves for their roles as library directors. This study provides a comprehensive view of the path to library leadership that furthers understanding of the value of leadership development and preparedness and provides a model for aspiring library leaders

Visualization of HIV-1 interactions with penile and foreskin epithelia: clues for female-to-male HIV transmission

To gain insight into female-to-male HIV sexual transmission and how male circumcision protects against this mode of transmission, we visualized HIV-1 interactions with foreskin and penile tissues in ex vivo tissue culture and in vivo rhesus macaque models utilizing epifluorescent microscopy. 12 foreskin and 14 cadaveric penile specimens were cultured with R5-tropic photoactivatable (PA)-GFP HIV-1 for 4 or 24 hours. Tissue cryosections were immunofluorescently imaged for epithelial and immune cell markers. Images were analyzed for total virions, proportion of penetrators, depth of virion penetration, as well as immune cell counts and depths in the tissue. We visualized individual PA virions breaching penile epithelial surfaces in the explant and macaque model. Using kernel density estimated probabilities of localizing a virion or immune cell at certain tissue depths revealed that interactions between virions and cells were more likely to occur in the inner foreskin or glans penis (from local or cadaveric donors, respectively). Using statistical models to account for repeated measures and zero-inflated datasets, we found no difference in total virions visualized at 4 hours between inner and outer foreskins from local donors. At 24 hours, there were more virions in inner as compared to outer foreskin (0.0495 +/- 0.0154 and 0.0171 +/- 0.0038 virions/image, p = 0.001). In the cadaveric specimens, we observed more virions in inner foreskin (0.0507 +/- 0.0079 virions/image) than glans tissue (0.0167 +/- 0.0033 virions/image, p<0.001), but a greater proportion was seen penetrating uncircumcised glans tissue (0.0458 +/- 0.0188 vs. 0.0151 +/- 0.0100 virions/image, p = 0.099) and to significantly greater mean depths (29.162 +/- 3.908 vs. 12.466 +/- 2.985 μm). Our in vivo macaque model confirmed that virions can breach penile squamous epithelia in a living model. In summary, these results suggest that the inner foreskin and glans epithelia may be important sites for HIV transmission in uncircumcised men

Accepting the challenge: what academic health sciences library directors do to become effective leaders

Objective: This study sought to better understand effective leadership through the lived experiences of academic health sciences library directors. Methods: Phenomenological interviews were conducted with eight academic health sciences library directors to capture the essence of their shared leadership experiences. The research question that guided the study was: How do academic health sciences library directors understand their leadership effectiveness? The interviews were transcribed and coded, and the data were analyzed thematically. Results: Three main themes emerged from data after analysis: assessment of the environment, strategies and decisions, and critical skills. Assessment of the environment includes awareness not only of trends in libraries and technology, but also the trends in health information, higher education, and current events and politics of their institutions and states. The strategies and decisions theme is about the ability to think both in the long-term and short-term when leading the library. Finally, critical skills are those leadership skills that the research participants identified as most important to their leadership effectiveness. Conclusions: The study identified three main themes capturing the essence of the research participants’ leadership experiences. The three themes constitute a wide array of leadership skills that are important to learn, understand, and develop to increase leadership effectiveness. Effective leadership is fundamental to obtaining long-term strategic goals and is critical to the long-term future of the libraries.  This article has been approved for the Medical Library Association’s Independent Reading Program

Modeling of linear nanopores in a-SiO2 tuning pore surface structure

New strategies are presented for the generation of models for linear nanopores in amorphous silica (a-SiO2) with surface structure tuned to match experimental observations. Specifically, the models successfully target not only the overall density of surface silanol groups, but also the proportion of geminal versus mono silanols for which additional experimental NMR data is reported. The latter quantity has not been appropriately described in previous modeling, and in fact has typically not been considered. Strategies include “pore drilling” of bulk a-SiO2, and “cylindrical resist” methodology forming a-SiO2 around a cylindrical exclusion region, followed by dehydroxylation and hydroxylation processes, respectively. However, these latter processes must be judiciously tailored in order to tune the proportion of geminals, in addition to the overall silanol density, to achieve experimental values. Such tailoring has not been incorporated into previous modeling. Another approach considered tunes surface structure of pores obtained by “pore drilling” through mild annealing.This is a manuscript of an article published as Fought, Ellie L., Yong Han, Theresa L. Windus, Igor I. Slowing, Takeshi Kobayashi, and James W. Evans. "Modeling of linear nanopores in a-SiO2 tuning pore surface structure." Microporous and Mesoporous Materials 341 (2022): 112077. DOI: 10.1016/j.micromeso.2022.112077. Copyright 2022 Elsevier Inc. Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). Posted with permission. DOE Contract Number(s): AC02-07CH11358

Revisits After Emergency Department Discharge for Conditions with High Disposition-Decision Variability at Hospitals with High and Low Discharge Rates

Introduction: The first proposed emergency care alternative payment model seeks to reduce avoidable admissions from the emergency department (ED), but this initiative may increase risk of adverse events after discharge. Our study objective was to describe variation in ED discharge rates and determine whether higher discharge rates were associated with more ED revisits.Methods:  Using all-payer inpatient and ED administrative data from the California Office of Statewide Health Planning and Development (OSHPD) 2017 database, we performed a retrospective cohort study of hospital-level ED discharge rates and ED revisits using conditions that have been previously described as having variability in discharge rates: abdominal pain; altered mental status; chest pain; chronic obstructive pulmonary disease exacerbation; skin and soft tissue infection; syncope; and urinary tract infection. We categorized hospitals into quartiles for each condition based on a covariate-adjusted discharge rate and compared the rate of ED revisits between hospitals in the highest and lowest quartiles.Results: We found a greater than 10% difference in the between-quartile median adjusted discharge rate for each condition except for abdominal pain. There was no significant association between adjusted discharge rates and ED revisits. Altered mental status had the highest revisit rate, at 34% for hospitals in the quartile with the lowest and 30% in hospitals with the highest adjusted discharge rate, although this was not statistically significant. Syncope had the lowest rate of revisits at 16% for hospitals in both the lowest and highest adjusted discharge rate quartiles.Conclusion: Our findings suggest that there may be opportunity to increase ED discharges for certain conditions without resulting in higher rates of ED revisits, which may be a surrogate for adverse events after discharge