The Big Opportunity: Advancing a Culture of Interprofessionalism

Historically, education has been siloed by disciplines leaving little room for interprofessional education to take place. Culture within an academic organization determines the strategies, modes of operation, goals, values, and terminal student learning outcomes. Using Kotter’s accelerated change management model, as a worksheet for educational cultural change, is an effective method to break complacency, generate ideas, align people, and overcome resistance to change

Interprofessional Education: A Curricular Gap Analysis

The goal of Interprofessional education (IPE) is to create a new health care workforce that is prepared to function as a deliberative culturally competent team, providing patient centered care that optimizes health and quality of life for individuals with multiple chronic conditions. The purpose of an IPE curricular gap analysis is to determine if IPE and key concepts related to chronic disease self-management are integrated into course descriptions, objectives, didactic, activities and evaluated. The baseline results can be an effective tool to initiate an institutional cultural change promoting curricular revision. Key concept terminology, interprofessional, chronic disease self-management, motivational interviewing, and culture and diversity were reviewed in graduate syllabi from the Colleges of Nursing, Medicine, and Allied Health Sciences. The terms were tallied in course content areas (course descriptions, objectives, content didactic, learning activities, and evaluation). Exemplary syllabi included 4 out of the 5 key concept terms listed above. Courses with key concepts in 3 out of 5 content areas were defined as meeting minimum expectations. A total of 457 courses were reviewed across the three graduate colleges. Ten exemplary courses were found with key term concepts threaded throughout the syllabi: 4 with motivational interviewing (MI), 3 with culture and diversity (C&D) and 3 with interprofessional (IP) concepts. Eighteen courses met minimum expectations: 7 courses with MI, 6 with IP and 5 with C&D. The other key concept, chronic disease self-management (CDSM) was notably lacking in all courses from all colleges. A curricular gap analysis is an effective tool to initiate an institutional cultural change to include IPE and related concepts. It can create awareness and commitment from administration, deans, faculty, and students. Champions can be identified from each college, spearheading action plans for changes in syllabi, there by promoting curricular revision in key content areas. Objectives: 1. Discuss the common definition of interprofessional education, chronic disease self-management, motivational interviewing, culture and diversity. 2. Identify a method to examine one’s own curriculum for a gap in IPE. 3. Discuss the use of a curricular gap analysis to create awareness, commitment to facilitate cultural and curricular change within a University

The spectral variability of FSRQs

The optical variability of 29 flat spectrum radio quasars in SDSS Stripe 82 region are investigated by using DR7 released multi-epoch data. All FSRQs show variations with overall amplitude ranging from 0.24 mag to 3.46 mag in different sources. About half of FSRQs show a bluer-when-brighter trend, which is commonly observed for blazars. However, only one source shows a redder-when-brighter trend, which implies it is rare in FSRQs. In this source, the thermal emission may likely be responsible for the spectral behavior.Comment: 4 pages, 1 figure, to be published in Journal of Astrophysics and Astronomy, as a proceeding paper of the conference "Multiwavelength Variability of Blazars", Guangzhou, China, September 22-24, 201

Using Technology to Overcome Interprofessional Education Barriers

Common barriers cited for implementing interprofessional education (IPE) and practices are space constraints, scheduling and time conflicts, full curricula, lack of knowledge and skills related to collaborative practice, and accessibility to other disciplines. Due to these significant barriers, IPE necessitates the development of innovative technological teaching modalities, which provide both didactic and experiential approaches. Using Quality Matters™ standards for designing and evaluating online courses, five interprofessional (IP) online learning activities were developed at a large Midwest academic medical center. The Interprofessional Education Collaborative Expert Panel (IPEC, 2011) rationale for IPE and their four domains for collaborative practice were the framework for the learning activities (LA). Using Blackboard™ as the online platform, LA were inserted in selected courses across programs/disciplines in a timed yet asynchronous event for a period of one week. Each LA time commitment was approximately two hours over a five-day week. Students (n = 187) from six professions (advanced practice nurses, physician assistants, medicine, nutrition, medical lab science, and pharmacy) in nine courses participated. There were 32 interprofessional teams facilitated by six faculty members. Team engagement included viewing videos and short narrated Power Points, and completion of quizzes, case studies, self-reflections or other team assignments and discussions. Feedback from students (n=134) was positive with 70% of students either choosing “agree” or “strongly agree. Participation in the LA increased both their interest (M=2.79/4.0) and knowledge (M=2.78/4.0) of IPE and practice. Twenty-eight students specifically noted strengths of the online format in additional comments. The online learning activities provide foundational knowledge and skill development for interprofessional collaborative practice in a virtual environment. In conclusion, preliminary data supports that these online LAs are a novel approach to teaching IPE. Utilizing existing university resources, LAs are a cost effect method to teach and overcome barriers to IPE. Objective 1: By the end of this presentation, the participants will be able to identify at least three barriers or challenges to interprofessional education and collaborative practice. Objective 2: By the end of this presentation, the participants will be able to describe why online learning activities are an effective strategy to overcome barriers to interprofessional education

Quantum resource estimates for computing elliptic curve discrete logarithms

We give precise quantum resource estimates for Shor's algorithm to compute discrete logarithms on elliptic curves over prime fields. The estimates are derived from a simulation of a Toffoli gate network for controlled elliptic curve point addition, implemented within the framework of the quantum computing software tool suite LIQ$Ui|\rangle$. We determine circuit implementations for reversible modular arithmetic, including modular addition, multiplication and inversion, as well as reversible elliptic curve point addition. We conclude that elliptic curve discrete logarithms on an elliptic curve defined over an $n$-bit prime field can be computed on a quantum computer with at most $9n + 2\lceil\log_2(n)\rceil+10$ qubits using a quantum circuit of at most $448 n^3 \log_2(n) + 4090 n^3$ Toffoli gates. We are able to classically simulate the Toffoli networks corresponding to the controlled elliptic curve point addition as the core piece of Shor's algorithm for the NIST standard curves P-192, P-224, P-256, P-384 and P-521. Our approach allows gate-level comparisons to recent resource estimates for Shor's factoring algorithm. The results also support estimates given earlier by Proos and Zalka and indicate that, for current parameters at comparable classical security levels, the number of qubits required to tackle elliptic curves is less than for attacking RSA, suggesting that indeed ECC is an easier target than RSA.Comment: 24 pages, 2 tables, 11 figures. v2: typos fixed and reference added. ASIACRYPT 201

Anastrozole (‘Arimidex’) blocks oestrogen synthesis both peripherally and within the breast in postmenopausal women with large operable breast cancer

The effect of anastrozole on peripheral and tumour aromatase activity and oestrogen levels in postmenopausal patients with oestrogen receptor-rich breast tumours was investigated. Twenty-six patients were randomly allocated to treatment with anastrozole 1 mg (n=13) or 10 mg (n=13), once daily. Before and after 12 weeks' treatment, patients were infused with 3H-Δ4 androstenedione (20 MBq) and 14C-oestrone (E1) (1 MBq) for 18 h. Oestrogens were purified from excised tumours and plasma samples taken after each infusion. Peripheral and tumour aromatase activity and tumour E1 uptake were calculated from levels of 3H and 14C in purified E1 fractions from tumour and plasma. Endogenous tumour oestrogens were measured by radioimmunoassay. Twenty-three patients were available for analysis (1 mg group, n=12; 10 mg group, n=11). Following treatment, anastrozole (1 and 10 mg) markedly inhibited peripheral aromatase in all patients (the difference between pre- and on-treatment values being highly significant P<0.0001). In situ aromatase activity was also profoundly decreased by anastrozole treatment in 16 of 19 tumours (the difference with treatment also being highly significant P=0.0009). Most tumours were able to concentrate E1 beyond levels in the circulation; anastrozole treatment had no consistent effect on uptake of E1. Endogenous tumour levels of both E1 and oestradiol (E2) were significantly reduced with therapy (P=0.028 for E1 and P=0.0019 for E2). Anastrozole (1 and 10 mg daily) effectively suppresses aromatase activity, and subsequently oestrogen levels, within the breast tissue of postmenopausal women with large or locally advanced, operable, oestrogen receptor-rich breast cancers

Formative Debriefing in Team Observed Simulation Encounters to Promote Team Performance

To bridge the gap between interprofessional education (IPE) and interprofessional collaborative practice (IPCP), educators need to foster innovation in healthcare education. Students need opportunities and experiences to practice team skills prior to patient encounters. One innovation includes the use of high-fidelity interprofessional simulation in the form of Team Observed Structured Clinical Encounters (TOSCEs) with standardized patients (SP) and realistic case scenarios. The primary objective of this study was to demonstrate the impact of formative debriefing on team-based performance during TOSCEs. At a large academic medical center, 49 health profession students from the College of Medicine, College of Nursing, College of Health Sciences, and Graduate College volunteered to participate in an interprofessional education program. Prior to participating in TOSCEs students completed two interactive student workshops on: 1) Interprofessional Education and Collaborative Practice (IPEC) domains and 2) chronic disease self-management with motivational interviewing. Fourteen interprofessional student teams (IPST) were formed. Teams consisted of 2-3 students representing a minimum of two disciplines. They were assigned to participate in two separate TOSCEs. The IPST evaluated their individual and team’s performance using the McMaster-Ottawa and the Jefferson Teamwork Observation Guide (JTOG), respectively. Facilitators with established inter-rater reliability guided a formative debriefing session and evaluated the teams’ performance after both TOSCE 1 and 2. Paired t-tests documented improvement in pre-post McMaster-Ottawa and JTOG scores for participants across all four IPEC domains. A comparison between mean ratings of TOSCE 1 and 2, given by students and facilitators, showed a significant difference (p Learning objectives: The learners will be able to define the IPEC domains The learners will be able to list tools for evaluating interprofessional team members and team functionality. The learners will be able discuss the debriefing process as a formative learning experience to increase competencies in the IPEC domains

Screening for breast cancer : medicalization, visualization and the embodied experience

Women’s perspectives on breast screening (mammography and breast awareness) were explored in interviews with midlife women sampled for diversity of background and health experience. Attending mammography screening was considered a social obligation despite women’s fears and experiences of discomfort. Women gave considerable legitimacy to mammography visualizations of the breast, and the expert interpretation of these. In comparison, women lacked confidence in breast awareness practices, directly comparing their sensory capabilities with those of the mammogram, although mammography screening did not substitute breast awareness in a straightforward way. The authors argue that reliance on visualizing technology may create a fragmented sense of the body, separating the at risk breast from embodied experience