The Common Cold: What Pharmacists Need to Know

A primer on the common cold for pharmacists, including its causes and pathophysiology and how to assess and treat patients

Proceedings of the 8th Annual Conference on the Science of Dissemination and Implementation

A1 Introduction to the 8(th) Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers, Lisa Simpson D1 Discussion forum: Population health D&I research Felicia Hill-Briggs D2 Discussion forum: Global health D&I research Gila Neta, Cynthia Vinson D3 Discussion forum: Precision medicine and D&I research David Chambers S1 Predictors of community therapists’ use of therapy techniques in a large public mental health system Rinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, Danielle Adams, David Mandell S2 Implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the field Lindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey Cully S3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomes Alan McGuire, Dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle Salyers S4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approach Brittany Cooper, Angie Funaiole S5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessment Julie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine Bradley S6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation study Tonya VanDeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary Cuddeback S7 Personalizing evidence-based child mental health care within a fiscally mandated policy reform Miya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna Lau S8 Leveraging an existing resource for technical assistance: Community-based supervisors in public mental health Shannon Dorsey, Michael Pullmann S9 SBIRT implementation for adolescents in urban federally qualified health centers: Implementation outcomes Shannon Mitchell, Robert Schwartz, Arethusa Kirk, Kristi Dusek, Marla Oros, Colleen Hosler, Jan Gryczynski, Carolina Barbosa, Laura Dunlap, David Lounsbury, Kevin O'Grady, Barry Brown S10 PANEL: Tailoring Implementation Strategies to Context - Expert recommendations for tailoring strategies to context Laura Damschroder, Thomas Waltz, Byron Powell S11 PANEL: Tailoring Implementation Strategies to Context - Extreme facilitation: Helping challenged healthcare settings implement complex programs Mona Ritchie S12 PANEL: Tailoring Implementation Strategies to Context - Using menu-based choice tasks to obtain expert recommendations for implementing three high-priority practices in the VA Thomas Waltz S13 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Siri, rate my therapist: Using technology to automate fidelity ratings of motivational interviewing David Atkins, Zac E. Imel, Bo Xiao, Doğan Can, Panayiotis Georgiou, Shrikanth Narayanan S14 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Identifying indicators of implementation quality for computer-based ratings Cady Berkel, Carlos Gallo, Irwin Sandler, C. Hendricks Brown, Sharlene Wolchik, Anne Marie Mauricio S15 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Improving implementation of behavioral interventions by monitoring emotion in spoken speech Carlos Gallo, C. Hendricks Brown, Sanjay Mehrotra S16 Scorecards and dashboards to assure data quality of health management information system (HMIS) using R Dharmendra Chandurkar, Siddhartha Bora, Arup Das, Anand Tripathi, Niranjan Saggurti, Anita Raj S17 A big data approach for discovering and implementing patient safety insights Eric Hughes, Brian Jacobs, Eric Kirkendall S18 Improving the efficacy of a depression registry for use in a collaborative care model Danielle Loeb, Katy Trinkley, Michael Yang, Andrew Sprowell, Donald Nease S19 Measurement feedback systems as a strategy to support implementation of measurement-based care in behavioral health Aaron Lyon, Cara Lewis, Meredith Boyd, Abigail Melvin, Semret Nicodimos, Freda Liu, Nathanial Jungbluth S20 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Common loop assay: Methods of supporting learning collaboratives Allen Flynn S21 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Innovating audit and feedback using message tailoring models for learning health systems Zach Landis-Lewis S22 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Implementation science and learning health systems: Connecting the dots Anne Sales S23 Facilitation activities of Critical Access Hospitals during TeamSTEPPS implementation Jure Baloh, Marcia Ward, Xi Zhu S24 Organizational and social context of federally qualified health centers and variation in maternal depression outcomes Ian Bennett, Jurgen Unutzer, Johnny Mao, Enola Proctor, Mindy Vredevoogd, Ya-Fen Chan, Nathaniel Williams, Phillip Green S25 Decision support to enhance treatment of hospitalized smokers: A randomized trial Steven Bernstein, June-Marie Rosner, Michelle DeWitt, Jeanette Tetrault, James Dziura, Allen Hsiao, Scott Sussman, Patrick O’Connor, Benjamin Toll S26 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A patient-centered approach to successful community transition after catastrophic injury Michael Jones, Julie Gassaway S27 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - Conducting PCOR to integrate mental health and cancer screening services in primary care Jonathan Tobin S28 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A comparative effectiveness trial of optimal patient-centered care for US trauma care systems Douglas Zatzick S29 Preferences for in-person communication among patients in a multi-center randomized study of in-person versus telephone communication of genetic test results for cancer susceptibility Angela R Bradbury, Linda Patrick-Miller, Brian Egleston, Olufunmilayo I Olopade, Michael J Hall, Mary B Daly, Linda Fleisher, Generosa Grana, Pamela Ganschow, Dominique Fetzer, Amanda Brandt, Dana Farengo-Clark, Andrea Forman, Rikki S Gaber, Cassandra Gulden, Janice Horte, Jessica Long, Rachelle Lorenz Chambers, Terra Lucas, Shreshtha Madaan, Kristin Mattie, Danielle McKenna, Susan Montgomery, Sarah Nielsen, Jacquelyn Powers, Kim Rainey, Christina Rybak, Michelle Savage, Christina Seelaus, Jessica Stoll, Jill Stopfer, Shirley Yao and Susan Domchek S30 Working towards de-implementation: A mixed methods study in breast cancer surveillance care Erin Hahn, Corrine Munoz-Plaza, Jianjin Wang, Jazmine Garcia Delgadillo, Brian Mittman Michael Gould S31Integrating evidence-based practices for increasing cancer screenings in safety-net primary care systems: A multiple case study using the consolidated framework for implementation research Shuting (Lily) Liang, Michelle C. Kegler, Megan Cotter, Emily Phillips, April Hermstad, Rentonia Morton, Derrick Beasley, Jeremy Martinez, Kara Riehman S32 Observations from implementing an mHealth intervention in an FQHC David Gustafson, Lisa Marsch, Louise Mares, Andrew Quanbeck, Fiona McTavish, Helene McDowell, Randall Brown, Chantelle Thomas, Joseph Glass, Joseph Isham, Dhavan Shah S33 A multicomponent intervention to improve primary care provider adherence to chronic opioid therapy guidelines and reduce opioid misuse: A cluster randomized controlled trial protocol Jane Liebschutz, Karen Lasser S34 Implementing collaborative care for substance use disorders in primary care: Preliminary findings from the summit study Katherine Watkins, Allison Ober, Sarah Hunter, Karen Lamp, Brett Ewing S35 Sustaining a task-shifting strategy for blood pressure control in Ghana: A stakeholder analysis Juliet Iwelunmor, Joyce Gyamfi, Sarah Blackstone, Nana Kofi Quakyi, Jacob Plange-Rhule, Gbenga Ogedegbe S36 Contextual adaptation of the consolidated framework for implementation research (CFIR) in a tobacco cessation study in Vietnam Pritika Kumar, Nancy Van Devanter, Nam Nguyen, Linh Nguyen, Trang Nguyen, Nguyet Phuong, Donna Shelley S37 Evidence check: A knowledge brokering approach to systematic reviews for policy Sian Rudge S38 Using Evidence Synthesis to Strengthen Complex Health Systems in Low- and Middle-Income Countries Etienne Langlois S39 Does it matter: timeliness or accuracy of results? The choice of rapid reviews or systematic reviews to inform decision-making Andrea Tricco S40 Evaluation of the veterans choice program using lean six sigma at a VA medical center to identify benefits and overcome obstacles Sherry Ball, Anne Lambert-Kerzner, Christine Sulc, Carol Simmons, Jeneen Shell-Boyd, Taryn Oestreich, Ashley O'Connor, Emily Neely, Marina McCreight, Amy Labebue, Doreen DiFiore, Diana Brostow, P. Michael Ho, David Aron S41 The influence of local context on multi-stakeholder alliance quality improvement activities: A multiple case study Jillian Harvey, Megan McHugh, Dennis Scanlon S42 Increasing physical activity in early care and education: Sustainability via active garden education (SAGE) Rebecca Lee, Erica Soltero, Nathan Parker, Lorna McNeill, Tracey Ledoux S43 Marking a decade of policy implementation: The successes and continuing challenges of a provincial school food and nutrition policy in Canada Jessie-Lee McIsaac, Kate MacLeod, Nicole Ata, Sherry Jarvis, Sara Kirk S44 Use of research evidence among state legislators who prioritize mental health and substance abuse issues Jonathan Purtle, Elizabeth Dodson, Ross Brownson S45 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 1 designs Brian Mittman, Geoffrey Curran S46 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 2 designs Geoffrey Curran S47 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 3 designs Jeffrey Pyne S48 Linking team level implementation leadership and implementation climate to individual level attitudes, behaviors, and implementation outcomes Gregory Aarons, Mark Ehrhart, Elisa Torres S49 Pinpointing the specific elements of local context that matter most to implementation outcomes: Findings from qualitative comparative analysis in the RE-inspire study of VA acute stroke care Edward Miech S50 The GO score: A new context-sensitive instrument to measure group organization level for providing and improving care Edward Miech S51 A research network approach for boosting implementation and improvement Kathleen Stevens, I.S.R.N. Steering Council S52 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - The value of qualitative methods in implementation research Alison Hamilton S53 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Learning evaluation: The role of qualitative methods in dissemination and implementation research Deborah Cohen S54 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Qualitative methods in D&I research Deborah Padgett S55 PANEL: Maps & models: The promise of network science for clinical D&I - Hospital network of sharing patients with acute and chronic diseases in California Alexandra Morshed S56 PANEL: Maps & models: The promise of network science for clinical D&I - The use of social network analysis to identify dissemination targets and enhance D&I research study recruitment for pre-exposure prophylaxis for HIV (PrEP) among men who have sex with men Rupa Patel S57 PANEL: Maps & models: The promise of network science for clinical D&I - Network and organizational factors related to the adoption of patient navigation services among rural breast cancer care providers Beth Prusaczyk S58 A theory of de-implementation based on the theory of healthcare professionals’ behavior and intention (THPBI) and the becker model of unlearning David C. Aron, Divya Gupta, Sherry Ball S59 Observation of registered dietitian nutritionist-patient encounters by dietetic interns highlights low awareness and implementation of evidence-based nutrition practice guidelines Rosa Hand, Jenica Abram, Taylor Wolfram S60 Program sustainability action planning: Building capacity for program sustainability using the program sustainability assessment tool Molly Hastings, Sarah Moreland-Russell S61 A review of D&I study designs in published study protocols Rachel Tabak, Alex Ramsey, Ana Baumann, Emily Kryzer, Katherine Montgomery, Ericka Lewis, Margaret Padek, Byron Powell, Ross Brownson S62 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Model simulation techniques to estimate the cost of implementing foundational public health services Cezar Brian Mamaril, Glen Mays, Keith Branham, Lava Timsina S63 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Inter-organizational network effects on the implementation of public health services Glen Mays, Rachel Hogg S64 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Implementation fidelity, coalition functioning, and community prevention system transformation using communities that care Abigail Fagan, Valerie Shapiro, Eric Brown S65 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Expanding capacity for implementation of communities that care at scale using a web-based, video-assisted training system Kevin Haggerty, David Hawkins S66 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Effects of communities that care on reducing youth behavioral health problems Sabrina Oesterle, David Hawkins, Richard Catalano S68 When interventions end: the dynamics of intervention de-adoption and replacement Virginia McKay, M. Margaret Dolcini, Lee Hoffer S69 Results from next-d: can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes? Tannaz Moin, Jinnan Li, O. Kenrik Duru, Susan Ettner, Norman Turk, Charles Chan, Abigail Keckhafer, Robert Luchs, Sam Ho, Carol Mangione S70 Implementing smoking cessation interventions in primary care settings (STOP): using the interactive systems framework Peter Selby, Laurie Zawertailo, Nadia Minian, Dolly Balliunas, Rosa Dragonetti, Sarwar Hussain, Julia Lecce S71 Testing the Getting To Outcomes implementation support intervention in prevention-oriented, community-based settings Matthew Chinman, Joie Acosta, Patricia Ebener, Patrick S Malone, Mary Slaughter S72 Examining the reach of a multi-component farmers’ market implementation approach among low-income consumers in an urban context Darcy Freedman, Susan Flocke, Eunlye Lee, Kristen Matlack, Erika Trapl, Punam Ohri-Vachaspati, Morgan Taggart, Elaine Borawski S73 Increasing implementation of evidence-based health promotion practices at large workplaces: The CEOs Challenge Amanda Parrish, Jeffrey Harris, Marlana Kohn, Kristen Hammerback, Becca McMillan, Peggy Hannon S74 A qualitative assessment of barriers to nutrition promotion and obesity prevention in childcare Taren Swindle, Geoffrey Curran, Leanne Whiteside-Mansell, Wendy Ward S75 Documenting institutionalization of a health communication intervention in African American churches Cheryl Holt, Sheri Lou Santos, Erin Tagai, Mary Ann Scheirer, Roxanne Carter, Janice Bowie, Muhiuddin Haider, Jimmie Slade, Min Qi Wang S76 Reduction in hospital utilization by underserved patients through use of a community-medical home Andrew Masica, Gerald Ogola, Candice Berryman, Kathleen Richter S77 Sustainability of evidence-based lay health advisor programs in African American communities: A mixed methods investigation of the National Witness Project Rachel Shelton, Lina Jandorf, Deborah Erwin S78 Predicting the long-term uninsured population and analyzing their gaps in physical access to healthcare in South Carolina Khoa Truong S79 Using an evidence-based parenting intervention in churches to prevent behavioral problems among Filipino youth: A randomized pilot study Joyce R. Javier, Dean Coffey, Sheree M. Schrager, Lawrence Palinkas, Jeanne Miranda S80 Sustainability of elementary school-based health centers in three health-disparate southern communities Veda Johnson, Valerie Hutcherson, Ruth Ellis S81 Childhood obesity prevention partnership in Louisville: creative opportunities to engage families in a multifaceted approach to obesity prevention Anna Kharmats, Sandra Marshall-King, Monica LaPradd, Fannie Fonseca-Becker S82 Improvements in cervical cancer prevention found after implementation of evidence-based Latina prevention care management program Deanna Kepka, Julia Bodson, Echo Warner, Brynn Fowler S83 The OneFlorida data trust: Achieving health equity through research & training capacity building Elizabeth Shenkman, William Hogan, Folakami Odedina, Jessica De Leon, Monica Hooper, Olveen Carrasquillo, Renee Reams, Myra Hurt, Steven Smith, Jose Szapocznik, David Nelson, Prabir Mandal S84 Disseminating and sustaining medical-legal partnerships: Shared value and social return on investment James Teufe

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Application of Ligninolytic Enzymes in the Production of Biofuels from Cotton Wastes

The application of ligninolytic fungi and enzymes is an option to overcome the issues related with the production of biofuels using cotton wastes. In this dissertation, the ligninolytic fungus and enzymes were evaluated as pretreatment for the biochemical conversion of Cotton Gin Trash (CGT) in ethanol and as a treatment for the transformation of cotton wastes biochar in other substances. In biochemical conversion, seven combinations of three pretreatments (ultrasonication, liquid hot water and ligninolytic enzymes) were evaluated on CGT. The best results were achieved by the sequential combination of ultrasonication, hot water, and ligninolytic enzymes with an improvement of 10% in ethanol yield. To improve these results, alkaline-ultrasonication was evaluated. Additionally, Fourier Transform Infrared (FT-IR) and principal component analysis (PCA) were employed as fast methodology to identify structural differences in the biomass. The combination of ultrasonication-alkali hydrolysis, hot liquid water, and ligninolytic enzymes using 15% of NaOH improved 35% ethanol yield compared with the original treatment. Additionally, FT-IR and PCA identified modifications in the biomass structure after different types of pretreatments and conditions. In thermal conversion, this study evaluated the biodepolymerization of cotton wastes biochar using chemical and biological treatments. The chemical depolymerization evaluated three chemical agents (KMnO4, H2SO4, and NaOH), with three concentrations and two environmental conditions. The sulfuric acid treatments performed the largest transformations of the biochar solid phase; whereas, the KMnO4 treatments achieved the largest depolymerizations. The compounds released into the liquid phase were correlated with fulvic and humic acids and silicon compounds. The biological depolymerization utilized four ligninolytic fungi Phanerochaete chrysosporium, Ceriporiopsis subvermispora, Postia placenta, and Bjerkandera adusta. The greatest depolymerization was obtained by C. subvermispora. The depolymerization kinetics of C. subvermispora evidenced the production of laccase and manganese peroxidase and a correlation between depolymerization and production of ligninolytic enzymes. The modifications obtained in the liquid and solid phases showed the production of humic and fulvic acids from the cultures with C. subvermispora. The results of this research are the initial steps for the development of new processes using the ligninolytic fungus and their enzymes for the production of biofuels from cotton wastes

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Beyond Closed Captioning The other ADA accessibility requirements

Did you know that there is more to making your online course ADA accessible than just closed captioning your videos? Join us as we uncover the ADA accessibility requirements in Sections 508 refresh. In this session, we will discuss how to design your online course space, your materials, and documents to meet the compliance standards. Learn the whys and how’s to formatting your PDFs, PPTs, Canvas content pages, word documents and multimedia to meet standards as well as considerations for colorblindness

A Problem Based Learning, Case Study Approach to Pharmaceutics: Faculty and Student Perspectives

The two-semester PharmD-level I Pharmaceutics course at the University of Southern California School of Pharmacy has been taught using a student-centered, problem-based learning (PBL) approach for the last five years. The most important element of the course is the assignment of two case studies in each semester, and the performance of these case studies by groups of students. The intention of the course is to emphasize group working, cooperation and collective achievement as being equally important to individual effort and grades. The course involves the participation in lectures and discussion groups of faculty, students and teaching assistants, and of student 'mentors' -students who took the course in the previous year. Over a five-year period instructors have designed and then refined the approach within the constraints created by a class size of about 170 students. Described are experiences to date in the teaching and administration of the course, from a faculty perspective. Provided are a number of suggestions regarding the most effective structure of the course, the appropriate methods of evaluation, the potential pitfalls, and the demands of such a course on both students and faculty. To help the reader understand further the impact of the PBL approach on students, several students, who have both taken the course, and then acted as mentors, provide an independent, student perspective on the teaching approach. Their perspective is presented in the final part of the manuscript. INTRODUCTION The usual basic pharmaceutics courses, taught in the first professional year, have traditionally been given in the lecture-examination format. This approach has been defended by the idea that there exists, for this subject, a body of information and data to be transmitted to the student and, after this has been presented (the lecture), the attainment of this information can then be tested (the examination). This method may not provide the best way of achieving what is actually desired for the student of any college course, i.e., understanding the concepts involved in the course and the ability to use these concepts. However, student-centered methods used in other fields, and in more clinical areas of the pharmacy curriculum(1), have traditionally not been considered suitable for the basic sciences. The practical implementation of student-oriented, case study-based courses varies widely, but all these teaching approaches are generally labeled as Problem-Based Learning (PBL). The attempts that have been made to extend the teaching of the basic sciences in the case study direction usually retain lectures and exams, but perhaps add cases or essay questions to the testing aspect. Discussions, when included, are most often 'demi-lectures' as the students usually do not have their inquisitive-disputative 'center' sufficiently well developed to allow useful discussions. A number of examples of workable models for such courses in Medicinal Chemistry(2,3), Therapeutics(4), Pharmacokinetics(5) and Pharmaceutics(6, 7) have been described, but the comparative advantages of each are still unclear. Some evidence for an improved retention of knowledge obtained through the PBL approach, compared to more didactic approaches, has been presented(8,9), but there is still considerable disagreement over this issue. In 1993, faculty in the Department of Pharmaceutical Sciences of the School of Pharmacy at the University of Southern California were challenged to change to a student-oriented, case-study approach to the teaching of Pharmaceutics to a class of 170 students. The design of the course, and the subsequent modifications that we have made, in response to this challenge, as well as the successes we have achieved and the difficulties we have faced, are described in this paper. An interesting and thoughtful analysis of PBL applied to Pharmaceutics has been presented by Duncan-Hewitt (10) and many similarities emerge between this and our own experiences. In particular, these revolve around the anxiety apparent amongst many students as they try to deal with the PBL approach for the first time, and the difficulty, for such a large class size, of establishing sufficient faculty-student contact to calm these anxieties. Addressing these problems has meant that the course structure has been and is still in some flux, but it has been concretized sufficiently to permit an intelligent presentation of the basic structure and philosophy. More detailed aspects of the course, such as the utilization of computer-based case studies, which is an integral part of the program, have previously been presented in other papers (11,12) GOALS AND OBJECTIVES OF THE COURSE DESIGN There were three fundamental objectives in our original course design. These were: (i) to promote student-led learning; (ii) to give students experience in group functioning; and (iii) to develop meaningful evaluation methods that are responsive to the nature of the course. Our current thoughts on the successes and failures in each of these areas are summarized below. In understanding these thoughts and the following discussion on the course structure, it is important that the reader recognizes that the class size is approximately 170 students, and, given the demands on faculty time, that this leads to a necessity for compromise between ideal and practical approaches. A fourth area, the development of leadership skills amongst the students and student mentors, has emerged as we have proceeded with the class. This is not dealt with in a specific manner, but should be apparent in the description of the activities of the students and the mentors in this and subsequent parts of the paper. Student-Led Learning. To enhance retention of the fundamental concepts involved in pharmaceutics, the main objective was to develop self-motivated learning. While concepts should, and perhaps must, be presented by faculty members who have a clear understanding of the utility of, and reasoning behind, those concepts, it should be the student's responsibility to seek sources of that information that were both understandable and meaningful for him/her. This approach is designed to develop familiarity with a wide spectrum of the pharmaceutical literature and begin the development of the ancillary, but no less essential, skill of evaluating that literature (e.g., 'don't believe everything you hear or are told,' 'I never understand what author X writes', etc.). Our approach to this has been an attempt to foster the idea that there are actually few 'right answers' to the application problems faced by the pharmacist, including those examples presented while in school and, to an even greater extent, those to be faced after graduating and beginning practice. There are, of course, 'right answers' to specific technical and scientific questions. The students are urged to consider 'correct' applications of their knowledge to be only those that they can logically defend with either literature citation or scientific reasoning. They are encouraged to use information from all current and previous classes for this defense. They are further encouraged to file this information in some retrievable manner for future use. Group Functioning. Both the business and the scientific world function as group efforts, quite in contrast to the lecture/exam, academic world. Group efforts require quite different skills than individual work or study. Although the concepts can be taught in principle, they are best learned by practice. In order to foster group functioning, all recommended reading, homework, and case studies require time far in excess of that available to any one student in the course. Students can only get the work done through group efforts, and, in conjunction, must provide the results of that research effort in a meaningful written and verbal form to the other members of the group. Working as part of a group (and depending, to some extent, on that group's efforts for their grade) has been found to be difficult for many students, whose educational success to this point in their careers has been largely based on their being 'individual' workers and learners. However, students soon learn the benefits of good leadership and 'doing their part'. Leaders develop and 'appear' quickly, as do those that can explain what they have read to the group. The group leader is appointed at the start of the academic year and then changed several times over the year, through an internal group decision. In contrast to other PBL approaches(10), we have largely resisted the temptation to interfere with the workings of each group. At the beginning of the year we provide some basic written instructions (see Appendix A) on the role of the group leader and on group functioning, and additional material on the student-mentor relationship, and on the case study method. This material is supplemented by faculty-led discussions on the same issues in the early part of the year. Meaningful Evaluation. The most difficult goal to accomplish has been to develop meaningful methods of evaluation for the individual efforts of each student. The essential problem is that, while instructors want to encourage group working and cooperative effort for the benefit of all, the same instructors are still faced with the necessity of assigning grades on an individual basis. This leads to a contradiction which has been difficult to resolve. The first efforts included no comprehensive, individual evaluations at all. All student grading was based on the group case study reports (one grade for all group members) modified for each student based on evaluations of their participation by their peers in the group. This proved to be more valuable in concept than in practice. Students were very reluctant to grade their group members; but were quick to complain about those that did not do their share. To address the issue of individual participation in the group effort in completing the case studies and other assigned work, we have since tried to incorporate some faculty evaluation of this part of the course. However, this was felt to be feasible only when done in small groups and, in a large class, insufficient contact with some students or groups made meaningful evaluations extremely difficult. After trying several different approaches, the follow- ing has been found to be an effective, if not ideal, compromise between stressing group effort over individual gain, while still recognizing outstanding students and providing sufficient incentive to contribute fully to the group effort. The breakdown of grading over the semester is summarized in • There are two case studies assigned during each semester and about four weeks allowed for their completion; these are group efforts and are quite sophisticated. A number of these cases have been described previously(11) and a typical case study is shown in Appendix B. A final 'mini-case' is also required, to be done individually and in the final examination room, where conceptual understanding and ability to use these concepts is evaluated. Each case study is worth 30 percent of the course grade in each semester, and the examination is worth 40 percent. • Each group is graded jointly on their case report and the same grade is received by all group members for this part of their grade, which represents about 53 percent of the case grade (and 16 percent of the final class grade) for each case. • Each group member is graded by the faculty (who see the group several times during each case study in formal discussion sessions, with rotation of faculty amongst the groups), the group's mentor (a Level II student, who also meets with the group at least once each week -see below), and by each of the other members of the group (the peer grade, with the grade for each student being determined as an average of all the grades from their group peers). The basis for these grades are attendance, participation, effort, contribution to group discussions and the ability to function within the group. The faculty, mentor and peer grades are, of themselves, only a small percentage of the overall grade (each is 10 percent of the case study grade), but collectively they provide a general, albeit limited and not always entirely accurate, picture of the efforts of each student. We stress that, while this approach is used as part of the determination of the final letter grade, it also provides us with a means of identifying students who may be having some problems in the course. This is particularly important, given that the course is offered to Level I students, and that the absence of the 'traditional' mid-term examination gives us no other means of assessing student progress. • Group interviews by a faculty member are held immediately after the reports are completed. Evaluation of each student's contribution to the case report and their understanding of the other parts of the group's report has been found to be quite straightforward using this procedure. This grade accounts for about 17 percent of each case study grade. COURSE STRUCTURE The course is structured in the following manner. The traditional transfer of information through the lecture addressed to the whole class is largely replaced by concept presentations which are still in a lecture-format, although with a somewhat different purpose and by discussions with faculty and with mentors. Attendance is required at the presentations and discussions. Overlaying this structure is the assignment of case studies, which provide a basis for the full integration of the presented concepts. Two such cases are given in each semester. Because group operation is required, both for the case studies and in the discussion sections, the student groups also meet informally several times each week to distribute work assignments, collect results and discuss problems. The frequency, places and times for these are worked out by the students themselves and implementation is the responsibility of the student group leader (see below). Appendix C shows a typical schedule for the year. The development of the course structure is described in detail in the following sections. Weekly Course Structure. We have experimented with two different course structures. Initially, we devoted each week to a different concept. On the first meeting day of the week, the concept was presented by a faculty member to the whole class. This presentation is, in actuality, a lecture, but its structure and purpose is quite different from the usual course lecture. The concept presentation is intended not so much to teach, develop, or derive the concept for the week, as it is to introduce that topic and define the scope the students are intended to cover in their readings. The reading assignments, key objectives and several illuminating questions for each concept are all in the student's hands from the beginning of the semester. These reading assignments include papers, chapters and/or whole sections of texts. On the next meeting day the students meet with their mentor to discuss the questions and assign reading based on the suggested sources. The mentor serves to clarify and discuss the concepts introduced that week. On the third day the group meet with their faculty discussion leader for a further discussion of the concepts of the week. In these meetings it is assumed that the key questions are answered (a group answer for this is required) and that the reading has been done, so the discussion begins from that standpoint. The discussion is intended to develop understanding of the meaning and the use of each concept in pharmaceutical situations. Although the above schedule worked reasonably well, and the components within it have largely been retained in the new schedule, it was also found that the concepts were learned and retained in a somewhat fragmentary manner. To address this issue, we have now moved to a schedule (see Appendix C) in which six concepts are presented in successive lectures over three weeks, and then six facultyled discussion sessions are held over the next three weeks, in which a more broad-based discussion is possible, and in which the integration of a significant amount of material can occur. This sequence of three weeks of lectures and three weeks of discussions occurs twice through the semester, and four times over the entire year. A further advantage of this approach is that the three weeks of discussion coincide with the period devoted to performance of the case studies, and the due date for each case study is set for the end of the three week discussion period. This has allowed us to much more effectively discuss the case with the students, and to guide them in their problem-solving, thus addressing one of the concerns regarding student anxiety and problem-based learning. In this schedule the mentor sessions retain the same character as that described above, and are still used to explore more specific concepts on a weekly basis, and to discuss assigned weekly questions. 400 American Journal of Pharmaceutical Education Vol. 62, Winter 1998 Case Studies. Case studies are assigned in approximately the third and eighth week of a 14 week semester, and each group (of six or seven students) is given about four weeks to complete their report. As exemplified in Appendix B, and also in related papers dealing with computer-based case studies in the course (11,12), the case studies are complex problems which require considerable sophistication and background reading in order to arrive at an appropriate answer. Much of the material required for answering the case study has not formally been covered in the lecture presentations, and this forms the basis of the faculty-led discussions during the case study period. This has been found to be particularly effective, because the students then have a reason to engage in these discussions (since they are having to address problems within their case study) and, when the system works most effectively, they are already formulating questions from the background case study reading which might be answered in the discussion periods. For example, the question might arise 'How can I know the ionization state of my drug at my formulation pH when I cannot find its pKa anywhere in the literature?', which might be effectively answered by a discussion of the empirical Hammett-Taft approach to pKa calculation(13). Based on informal conversations with faculty in other pharmacy schools, this version of problem-based learning and of case-study implementation varies somewhat with that used elsewhere. Typically, relatively discrete case studies are given which can be answered in a formal scheduled class period, and cover a relatively specific concept each week. Rather than taking this approach, our case studies are complex, require several weeks of group effort to answer, and involve the understanding and integration of a number of different concepts. For the range of concepts covered over the year, see Appendix C. The complexity of the case studies increases as the year progresses, as each case incorporates material from earlier in the year. This approach has advantages with respect to integration of material, but also places considerable demands on both students and faculty. It probably also requires more extensive faculty-student contact, because the potential for students to go astray in answering the case is considerable. ROLES OF INDIVIDUALS AND GROUPS IN THE COURSE The course is based on the activities of a number of different groups and individuals, in addition to the faculty, as described above. Student Groups. Case studies are performed by groups of six or seven students, giving a total of 26 groups (and hence the requirement for the writing of two sets of 26 similar, but substantively different, case studies each semester -see Appendix B for a typical approach). The groups do not change over the whole year, and only in certain circumstances are students allowed to transfer between groups. In insisting upon this, we wanted to stress that the professional environment may not be filled with colleagues whose views always coincide with your own, and that compromise and the development of working relationships is an essential element in any successful professional enterprise. This insistence can lead to conflicts, but we believe that, for certain individuals, it can provide invaluable insights into their personalities which will serve them well in their professional lives. Student Group Discussion Leaders. Each group is requested to select a leader to serve as the guide for research assignments, resulting reports, case work, and meetings. At the beginning of the first semester (as the students are unfamiliar with their cohorts) the leader is selected by the faculty. A different leader is selected after each case is completed; giving four students experience of leadership for each group of six or seven students over the two semesters. Some minimal guidance is provided to these leaders (Appendix A) and their skills improve visibly with each case study

Videoscape : An Exhibition of Video Art

Dunn describes the conceptual, performance, synaesthetic and experiential elements of video while Gale highlights the differences between television and video, traditional art forms and video and various centres for video production within Canada. Kennedy defines cybernetic, synaesthetic and synergistic aspects of video. Brief biographical notes on over 60 participating artists. Statements by some of the artists. 77 bibl. ref