The Health Sciences and Technology Academy: Re-Imagining Programmatic Delivery During the COVID-19 Pandemic

Out-of-school time academic/STEM programs provide educational enrichment to a myriad of student populations with some designed to assist those underrepresented and at-risk who desire to purse post-secondary studies. One such program in West Virginia (WV) is the Health Sciences and Technology Academy (HSTA), which provides hands-on, in person and engaging educational enrichment with the intent to increase the college going rates of Appalachia’s most vulnerable youth. In March 2020, HSTA key personnel encountered the task of redesigning program delivery due to the immediate shutdown of all in person operations resulting from the novel coronavirus, SARS-CoV-19 (COVID-19) pandemic. This paper discusses the programmatic changes of program delivery during HSTA’s key program components—the Summer Institute and the Community Based Programming. This paper also utilizes repeated measures one-way multivariate analysis (MANOVA) and paired t-test analysis to examine participants’ perspectives on learning, enjoyment and satisfaction of the aforementioned components prior to and during the COVID-19 pandemic

High School Students’ Learning During the COVID Pandemic: Perspectives from Health Sciences and Technology Academy Participants

This paper examines the perspectives of Health Sciences and Technology Academy (HSTA) participants as they navigate through their West Virginia (WV) high school learning environments (i.e., in-person, blended/hybrid, complete virtual) during the novel coronavirus, SARS-CoV-19 (COVID-19) pandemic. In March of 2020, the participants in this out-of-school-time (OST) academic enrichment program for exceptionally driven, yet underprivileged, at-risk students, with over 70% living in rural areas, started receiving remote learning instruction through learning management systems or via paper packets. In August of 2020, school systems provided parents and caregivers alternative learning environments for their student(s). In order to understand the learning experiences of HSTA students during these unprecedented times, HSTA released the 2020 Learning Outcomes Survey to participants in December of 2020. We performed chi-square test of independence to test the relationship between participants’ learning environments, their satisfaction with the education they were receiving, their ability to keep up with their school-work, teacher availability to help when needed and teacher feedback supporting them in their learning environment. The results show significant differences between the learning environments and keeping up with school-work as well as teacher feedback supporting them in their learning; however, Phi and Cramer’s V tests for effect size show weak correlations. This study provides a small glimpse into HSTA students’ learning experiences as they attempted to continue to learn in their regular school environment during the COVID-19 pandemic while in HSTA

Optimizing quality and efficiency of respiratory medicines in Scotland

Increasing prevalence of asthma and COPD has increased use of long acting inhalers. Different inhalers with patented delivery systems have kept costs high and inhalers among the highest expenditure items in ambulatory care in Scotland. There was a 136.8% increase in their utilisation between 2001 - 2017 alongside a 195.7% increase in expenditure. This is being addressed with brande

The use of electric pulse training aids (EPTAs) in companion animals

There is currently little regulation of training and behaviour modification processes in the UK (CAWC 2008) besides measures enshrined in the Animal Welfare Act 2006 and a voluntary Code of Practice launched in 2010 (see: http://www.cawc.org.uk/080603.pdf). This Code is consistent with current UK legislation outside of Wales and emphasises the need to safeguard the welfare of all interested parties involved in the “training contract” (animals and people alike) and the importance of adopting sound scientific methods within the skills base of the practitioner. There is much debate and opinion over whether the use of certain training techniques and devices meet these requirements, especially the use of electric pulse training aids (EPTAs). An EPTA is defined for the purposes of this report as a device designed for use in the training of dogs, cats and other companion animal species, which involves the application of an electric current to the skin to aid the training process. In Wales the use of all electronic collars has been banned ostensibly on animal welfare grounds, including those related to boundary fencing (The Animal Welfare (Electronic Collars) (Wales) Regulations 2010). It has been suggested that there are currently around 350000 EPTAs in the UK, although the number in active use is unknown. Nonetheless they clearly represent a significant practice within the sphere of animal training and it is appropriate that careful consideration be given to their use, especially when there appears to be so much contradictory information available and such passionately held convictions (often linked to ethical and animal welfare concerns) by those expressing an opinion. This report critically reviews current evidence and arguments used both for and against the use of such devices and the conclusions drawn. It highlights gaps in our knowledge and awareness of both theory and practice. Recommendations are drawn on this basis

Ongoing initiatives within the Scottish National Health Service to affect the prescribing of selective serotonin reuptake inhibitors and their influence

Aim: Increasing use of selective serotonin-reuptake inhibitors (SSRIs) in Scotland, coupled with safety concerns with some SSRIs, and the increasing availability of generic SSRIs, have resulted in multiple initiatives to improve the quality and efficiency of their prescribing in Scotland. Our aim is to assess their influence to provide future direction. Materials & methods: The prescription costs analysis database was used to document utilization and expenditure on SSRIs between 2001 and 2017 alongside documenting the initiatives. Results: Multiple interventions over the years increased international nonproprietary name prescribing up to 99.9% lowering overall costs. This, coupled with initiatives to limit escitalopram prescribing due to concerns with its value, resulted in a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilization. Safety warnings resulted in a significant reduction in the prescribing of paroxetine, citalopram and escitalopram alongside a significant increase in sertraline Conclusion: Multiple initiatives have increased the quality and efficiency of SSRI prescribing in Scotland providing direction to others

Recent initiatives in Scotland to improve the quality and efficiency of prescribing : findings and implications

Background: Changing demographics with an increase in chronic disease prevalence coupled with more aggressive management targets, and the continued launch of new premium priced products, has put considerable strain on healthcare systems to continue providing universal, high quality healthcare. High appropriate use of generics in a class where care is not compromised by prescribing generics versus patented products, combined with quality measures, can help with providing quality healthcare. Objective: Assess the utilisation and costs of lipid lowering therapies (C10), Proton-Pump Inhibitors (PPIs) (A02BC), and Selective Serotonin Reuptake Inhibitors (SSRIs) (N06AB) in ambulatory care in Scotland between 2001 and 2015 alongside reforms to provide future guidance. Methods: Utilisation measured in the number of items dispensed to assess prescriptions and reimbursed expenditure captured in GB pounds from NHS Scotland national database. National and regional initiatives to improve the quality and efficiency of prescribing were captured using standard methodologies (4Es - education, engineering, economics and enforcement). No time series analyses analysis was conducted as multiple interventions over time. Results: Lipid lowering therapies (statins predominantly): multiple initiatives including identifying patients with CHD, encouraging preferential prescribing of generics, reducing ezetimibe prescribing as little evidence of benefit, and encouraging the prescribing of higher dose statins in line with recommendations, resulted in statin expenditure falling by 56% in 2015 vs. 2001 despite a 4.03 fold increase in utilisation. High dose statins now account for 71.3% of total prescriptions, up from 17.3% in 2001. PPIs: similar multiple initiatives resulted in a 68% reduction in expenditure despite a 2.91 fold increase in utilisation. High dose prescribing reduced to 20.3% of all PPIs in 2015, down from 25.8% in 2009, following concerns. SSRIs: similar initiatives and encouraging citalopram vs. escitalopram resulted in expenditure falling by 60.1% despite a 2.12 fold increase in utilisation. Concerns with citalopram in 2012 saw its prescribing fall in recent years whilst the prescribing of sertraline has grown. The prescribing of paroxetine continually fell from 2002 onwards as a result of concerns. Conclusion: Multiple strategies have been successful with improving the quality and efficiency of prescribing in Scotland. These will continue

Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy : a Scottish population-based study

Aim: To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scotland. Study outcomes comprised adherence, discontinuation and persistence to treatment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to discontinue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persistence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adherence was considerably higher among high-intensity patients (63.7%). Conclusion: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing

Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service : their effect and implications

Introduction: There has been a considerable increase in the use of proton pump inhibitors (PPIs) in recent years due to their effectiveness versus H2 antagonists. This includes reducing GI bleeds in patients at risk. However, there are concerns with their long term use and potential costs. Costs can be reduced with increased prescribing of low cost generic PPIs. Aims: To analyse the influence of multiple demand-side measures in Scotland in recent years to increase the prescribing of low cost generic PPIs as well as encourage the prescribing of lower strength PPIs. Methods: Documenting utilization (mainly items dispensed) and expenditure in Scotland from 2001 to 2017 using health authority databases combined with documenting the multiple initiatives and measures both nationally and regionally. Results: The multiple measures in Scotland ensured high International non-proprietary name prescribing (up to 100% for some PPIs) as well as the prescribing of generic versus patented PPIs, with costs of generic PPIs as low as 8.5% of their pre-patent loss prices. Overall, total expenditure on PPIs in Scotland was 66.7% lower in 2017 at GB£18.83million compared to 2001 levels. This was despite a 3.06-fold increase in PPI utilization during this period. The savings were driven by the increasing use of generic omeprazole and lansoprazole versus patent protected PPIs. There was also a reduction in the prescribing of high strength PPIs during this period. Conclusion: Multiple initiatives in Scotland in recent years have reduced expenditure on PPIs despite appreciably increased utilisation. Multiple initiatives have also helped to reduce the prescribing of higher strength PPIs. This is an exemplar to other countries seeking to enhance their prescribing efficienc

Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service : their effect and implications

Introduction: There has been a considerable increase in the use of proton pump inhibitors (PPIs) in recent years due to their effectiveness versus H2 antagonists. This includes reducing GI bleeds in patients at risk. However, there are concerns with their long term use and potential costs. Costs can be reduced with increased prescribing of low cost generic PPIs. Aims: To analyse the influence of multiple demand-side measures in Scotland in recent years to increase the prescribing of low cost generic PPIs as well as encourage the prescribing of lower strength PPIs. Methods: Documenting utilization (mainly items dispensed) and expenditure in Scotland from 2001 to 2017 using health authority databases combined with documenting the multiple initiatives and measures both nationally and regionally. Results: The multiple measures in Scotland ensured high International non-proprietary name prescribing (up to 100% for some PPIs) as well as the prescribing of generic versus patented PPIs, with costs of generic PPIs as low as 8.5% of their pre-patent loss prices. Overall, total expenditure on PPIs in Scotland was 66.7% lower in 2017 at GB£18.83million compared to 2001 levels. This was despite a 3.06-fold increase in PPI utilization during this period. The savings were driven by the increasing use of generic omeprazole and lansoprazole versus patent protected PPIs. There was also a reduction in the prescribing of high strength PPIs during this period. Conclusion: Multiple initiatives in Scotland in recent years have reduced expenditure on PPIs despite appreciably increased utilisation. Multiple initiatives have also helped to reduce the prescribing of higher strength PPIs. This is an exemplar to other countries seeking to enhance their prescribing efficienc

Intravital FRAP imaging using an E-cadherin-GFP mouse reveals disease- and drug-dependent dynamic regulation of cell-cell junctions in live tissue

E-cadherin-mediated cell-cell junctions play a prominent role in maintaining the epithelial architecture. The disruption or deregulation of these adhesions in cancer can lead to the collapse of tumor epithelia that precedes invasion and subsequent metastasis. Here we generated an E-cadherin-GFP mouse that enables intravital photobleaching and quantification of E-cadherin mobility in live tissue without affecting normal biology. We demonstrate the broad applications of this mouse by examining E-cadherin regulation in multiple tissues, including mammary, brain, liver, and kidney tissue, while specifically monitoring E-cadherin mobility during disease progression in the pancreas. We assess E-cadherin stability in native pancreatic tissue upon genetic manipulation involving Kras and p53 or in response to anti-invasive drug treatment and gain insights into the dynamic remodeling of E-cadherin during in situ cancer progression. FRAP in the E-cadherin-GFP mouse, therefore, promises to be a valuable tool to fundamentally expand our understanding of E-cadherin-mediated events in native microenvironments