Building social capital with interprofessional student teams in rural settings: A service-learning model

Objective: To describe outcomes of a model of service learning in interprofessional learning (IPL) aimed at developing a sustainable model of training that also contributed to service strengthening. Design: A total of 57 semi-structured interviews with key informants and document review exploring the impacts of interprofessional student teams engaged in locally relevant IPL activities. Setting: Six rural towns in South East New South Wales. Participants: Local facilitators, staff of local health and other services, health professionals who supervised the 89 students in 37 IPL teams, and academic and administrative staff. Main outcome measures: Perceived benefits as a consequence of interprofessional, service-learning interventions in these rural towns. Results: Reported outcomes included increased local awareness of a particular issue addressed by the team; improved communication between different health professions; continued use of the team\u27s product or a changed procedure in response to the teams\u27 work; and evidence of improved use of a particular local health service. Conclusions: Given the limited workforce available in rural areas to supervise clinical IPL placements, a service-learning IPL model that aims to build social capital may be a useful educational model

Medicine & Humanities at University of Ottawa’s Faculty of Medicine: Developing a curriculum for our undergraduate medical education program

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Postprandial lipid and vascular responses following consumption of a commercially-relevant interesterified palmitic acid-rich spread in comparison to functionally-equivalent non-interesterified spread and spreadable butter:a randomised controlled trial in healthy adults

Background: Interesterification is an industrial processing technique used widely where hard fats are essential for functionality and consumer acceptability, e.g. margarines and lower fat spreads. Objective: The aim of this study was to compare acute cardiovascular effects of functionally equivalent spreads (similar solid fat content) made with interesterified (IE) or non-IE palm-based fats, or spreadable butter. Methods: A randomised, controlled, 4-armed crossover, double-blind study (25 men, 25 women; 35-75 years; healthy; mean BMI 24.5, SD 3.8), compared effects of mixed nutrient meals containing 50 g fat from functionally equivalent products [IE spread, non-IE spread and spreadable butter (SB), with rapeseed oil (RO) as a reference treatment: with 16.7%, 27.9%, 19.3% and 4% palmitic acid, respectively] on 8 h postprandial changes in plasma triacylglycerol (TAG) and endothelial dysfunction (flow-mediated dilatation; FMD). Circulating reactive oxygen species (estimated using a neutrophil oxidative burst assay), glucose, insulin, NEFA, lipoprotein particle profiles, inflammatory markers (glycoprotein acetylation (Glyc-A) and IL-6), and biomarkers of endotoxemia were measured. Results: Postprandial plasma TAG concentrations after test meals were similar. However following RO versus the 3 spreads, there were significantly higher postprandial apolipoprotein B concentrations, and small HDL and LDL particle concentrations, and lower postprandial extra-large, large, and medium HDL particle concentrations, as well as smaller average HDL and LDL particle sizes. There were no differences following IE compared to the other spreads. Postprandial FMD% did not decrease after high-fat test meals, and there were no differences between treatments. Postprandial serum IL-6 increased similarly after test meals, but RO provoked a greater increase in postprandial concentrations of glycoprotein acetyls (GlycA), as well as 8 h sCD14, an endotoxemia marker. All other postprandial outcomes were not different between treatments. Conclusions: In healthy adults, a commercially-available IE-based spread did not evoke a different postprandial triacylglycerol, lipoprotein subclass, oxidative stress, inflammatory or endotoxemic response to functionally-equivalent, but compositionally-distinct alternative spreads. Clinical trial registry number: NCT03438084 (https://ClinicalTrials.gov).</p

Harnessing Complexity Science for Interprofessional Education Development: A Case Study

Background: Developing learning activities for interprofessional education (IPE) with a group of stakeholders often involves negotiation, collectivity, creativity, innovation, and unpredictable results. Theoretical approaches that can explain and support such emergent processes are needed. This case study explored the applicability of complexity science to explain the experiences of committee members as they developed learning experiences for an IPE placement in a non-acute care hospital.Methods and Findings: Data from a focus group with project steering committee members were re-analyzed through the lens of complexity science&mdash;specifically, three key principles of complex systems and five conditions for nurturing collective learning. Quotes were compared against each of these principles and conditions and, if there was a sufficient match, categorized accordingly into themes. These general themes were then sorted into clusters of sub-themes.Conclusions: Complexity science provides a useful framework for understanding the open-ended, unpredictable, and innovative IPE development process analyzed in this article. It also offers helpful practical guidelines for future learning activity and curriculum development

Knowledge Translation of Interprofessional Collaborative Patient-Centred Practice: The Working Together Project Experience

The Working Together (WT) project involved the design and delivery of an online learning resource for healthcare teams in long-term care (LTC) so that knowledge regarding interprofessional collaborative patient-centred practice (ICPCP) could be readily accessed and then transferred to the workplace. The purpose of this paper is to better understand the process of knowledge translation in continuing education for healthcare professionals by documenting our experiences using Lavis et al.’s (2003) organizing framework for knowledge transfer, and highlighting the impact this approach had on the design, development, delivery, and evaluation of the WT program. Fifty-nine pharmacists, physicians, nurses, and nurse practitioners from 17 LTC homes across Ontario, Canada participated in this project. The effectiveness of the knowledge translation of ICPCP through the WT project was evaluated using the Demand-Driven Learning Model (DDLM) evaluation tool (MacDonald, Breithaupt, Stodel, Farres, & Gabriel, 2002) to assess learners’ reactions to the learning resource. Data from quantitative pre-post surveys and qualitative interviews revealed that learners found using the WT online resource to be a satisfactory learning experience, obtained new knowledge and skills regarding ICPCP, transferred knowledge to the workplace, and reported that learning had a positive effect on the residents they cared for.Le projet Working Together (WT) comprend la conception et la production d’une ressource d’apprentissage en ligne pour les équipes de professionnels prodiguant des soins de santé de longue durée (SLD) afin que les connaissances relatives à la pratique interprofessionnelle en collaboration axée sur le patient (PICAP) puissent être facilement accessibles, puis transférées dans le milieu de travail. L’objectif de cet article est de mieux comprendre le processus d’application des connaissances dans la formation continue des professionnels de la santé en documentant notre expérience à l’aide de Lavis et coll. (2003), en établissant un cadre théorique pour le transfert des connaissances et en mettant en évidence l’incidence de cette approche sur la conception, le développement, la réalisation et l’évaluation du programme WT. Cinquante-neuf pharmaciens, médecins, infirmiers et infirmières, infirmiers et infirmières praticiens de 17 centres de SLD en Ontario, au Canada, ont participé à ce projet. L’efficacité de l’application des connaissances de la PICAP à l’échelle du projet WT a été évaluée à l’aide du modèle d’apprentissage axé sur la demande (DDLM) (MacDonald, Breithaupt, Stodel, Farres et Gabriel, 2002) afin de déterminer les réactions des apprenants à la ressource d’apprentissage. Des données tirées de prétest et de postest quantitatifs ainsi que d’entrevues qualitatives ont révélé que les apprenants étaient satisfaisants de l’expérience d’apprentissage que procure la ressource en ligne WT, qu’ils ont acquis de nouvelles connaissances et aptitudes concernant la PICAP et mis en application ces connaissances dans leur milieu de travail, et que l’apprentissage a eu un effet positif sur les pensionnaires dont ils prennent soin

From ocean sprawl to blue-green infrastructure:A UK perspective on an issue of global significance

Artificial structures are proliferating in the marine environment, resulting in ‘ocean sprawl’. In light of the potential environmental impacts of this, such as habitat loss and alteration, it is becoming increasingly important to incorporate ecologically-sensitive design into artificial marine structures. The principles of eco-engineering and green infrastructure are embedded in urban planning practice for terrestrial and freshwater development projects. In marine planning, however, eco-engineering of blue-green infrastructure remains an emerging concept. This note provides a UK perspective on the progress towards uptake of eco-engineering approaches for enhancing biodiversity on artificial marine structures. We emphasise that, despite a clear ‘policy pull’ to incorporate biodiversity enhancements in marine structures, a range of proof-of-concept evidence that it is possible to achieve, and strong cross-sectoral stakeholder support, there are still few examples of truly and purposefullydesigned blue-green artificial structures in the UK. We discuss the barriers that remain and propose a strategy towards effective implementation. Our strategy outlines a step-wise approach to: (1) strengthening the evidence base for what enhancements can be achieved in different scenarios; (2) improving clarity on the predicted benefits and associated costs of enhancements; (3) packaging the evidence in a useful form to support planning and decision-making; and (4) encouraging implementation as routine practice. Given that ocean sprawl is a growing problem globally, the perspective presented here provides valuable insight and lessons for other nations at their various states of progress towards this same goal

The Impact of an Online Learning Resource Designed to Enhance Interprofessional Collaborative Practice in Palliative Care: Findings from the Caring Together Pilot Project

AbstractBackground: This study assessed the effectiveness of an online learning resourcefor staff in long-term care (LTC) homes. The resource was designed to increasepalliative care and interprofessional patient-centred care (IPC) skills and knowledgeand stimulate the transfer of knowledge to the workplace.Methods and Findings: A mixed methods approach was used. The StagedInnovation Design, which uses an experimental group and a control–replicationgroup, was adopted. The resource was piloted in two not-for-profit LTC homeswith 55 staff. Data were collected from four surveys. Individual interviews wereconducted with 15 participants. Participants stated the resource exposed them torelevant, practical information regarding caring for residents at the end of life; thematerial was presented in an engaging, interactive manner; and e-learning was aconvenient way to learn. The resource allowed learners to learn with, from, andabout each other and increased palliative care and IPC skills and knowledge.Evidence regarding changes in learners’ attitudes toward IPC and transfer ofknowledge was weak. Given the short time-frame from completion of the trainingto evaluation, this is not surprising.Conclusions: Suggestions for improving the resource emerged from the evaluation,and these have been implemented.

Electronic adherence monitoring identifies severe preschool wheezers who are steroid responsive.

Little is known about adherence to inhaled corticosteroids (ICS) in preschool children with troublesome wheeze. Children with aeroallergen senitization, or those reporting multiple trigger wheeze (MTW), are more likely to respond to ICS. We hypothesized that adherence to ICS and symptom control are only positively related in atopic children, or those reporting MTW. Patients aged 1 to 5 years with recurrent wheeze prescribed ICS were recruited from a tertiary respiratory clinic. Clinical phenotype and aeroallergen senitization were determined, and adherence assessed using an electronic monitoring device (Smartinhaler). Symptom control (test for respiratory and asthma control in kids [TRACK]), quality of life (PACQLQ), airway inflammation (offline exhaled nitric oxide) were assessed at baseline and follow-up. Forty-eight children (mean age 3.7 years; SD, 1.2) were monitored for a median of 112 (interquartile range [IQR], 91-126) days. At baseline n = 29 reported episodic viral wheeze and n = 19 reported MTW. Twenty-four out of 48 (50%) wheezers had suboptimal ICS adherence (<80%). Median adherence was 64% (IQR, 38-84). There was a significant increase in TRACK and PACQLQ in the group as a whole, unrelated to adherence. In subgroup analysis only atopic wheezers with moderate or good adherence ≥ 60% had a significant increase in TRACK. There was no relationship between clinical phenotype, and adherence or TRACK. In this pilot study, overall adherence to ICS was suboptimal and was positively related to symptom control in atopic wheezers only. Assessments of adherence are important in preschool troublesome wheezers before therapy escalation to help identify those with an ICS responsive phenotype

Detection of ctDNA from dried blood spots after DNA size selection

Background: Recent advances in the study and clinical applications of circulating tumor DNA (ctDNA) are limited by practical considerations of sample collection. Whole genome sequencing (WGS) is increasingly used for analysis of ctDNA, identifying copy-number alterations and fragmentation patterns. We hypothesized that low-depth/shallow WGS (sWGS) data may be generated from minute amounts of cell-free DNA, and that fragment-size selection may remove contaminating genomic DNA from small blood volumes. Dried blood spots have practical advantages for sample collection, may facilitate serial sampling, and could support novel study designs in humans and animal models. Methods: We developed a protocol for the isolation and analysis of cell-free DNA from dried blood spots using filter paper cards and bead-based size selection. DNA extracted and size-selected from dried spots was analyzed using sWGS and PCR. Results: Analyzing a 50L dried blood spot from frozen whole blood of a patient with melanoma, we identified ctDNA based on the presence of tumor-specific somatic copy-number alterations, and found a fragment size profile similar to that observed in plasma DNA. We found alterations in different chromosomes in blood-spots from two patients with high-grade serous ovarian carcinoma. Extending this approach to serial dried blood spots from mouse xenograft models, we detect tumor-derived cell-free DNA and identified ctDNA from the originally grafted ascites. Conclusion: Our data suggest that ctDNA can be detected and monitored in dried blood spots from archived and fresh blood samples, enabling new approaches for sample collection and novel study/trial designs for both patients and in vivo models.The University of Cambridge and Cancer Research UK (grant numbers A20240 and A29580). The research leading to these results has received funding from the European Research Council under the European Union’s Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement n.337905. Healthy volunteer samples were provided by the Cambridge Blood and Stem Cell Biobank, which is supported by the Cambridge NIHR Biomedical Research Centre, Wellcome Trust - MRC Stem Cell Institute and the Cambridge Experimental Cancer Medicine Centre, UK

Individual and population-level responses to ocean acidification

Ocean acidification is predicted to have detrimental effects on many marine organisms and ecological processes. Despite growing evidence for direct impacts on specific species, few studies have simultaneously considered the effects of ocean acidification on individuals (e.g. consequences for energy budgets and resource partitioning) and population level demographic processes. Here we show that ocean acidification increases energetic demands on gastropods resulting in altered energy allocation, i.e. reduced shell size but increased body mass. When scaled up to the population level, long-term exposure to ocean acidification altered population demography, with evidence of a reduction in the proportion of females in the population and genetic signatures of increased variance in reproductive success among individuals. Such increased variance enhances levels of short-term genetic drift which is predicted to inhibit adaptation. Our study indicates that even against a background of high gene flow, ocean acidification is driving individual- and population-level changes that will impact eco-evolutionary trajectories