Evaluation of a Longitudinal Institutional Advanced Pharmacy Practice Model

  Objective: To evaluate a longitudinal experiential training model for advanced pharmacy practice experiences (APPEs). Innovation: A six-month longitudinal pilot program named the Focused Institutional Longitudinal Experience (FILE) program was developed at two academic medical centers to maximize active participation of the student and minimize the time spent orienting and onboarding students to each APPE experience.  A unique component of the FILE program is the longitudinal service project, which involved a medication use evaluation, including a review of published literature and drug policy recommendations to medical center quality committees. Analysis: Student ratings regarding the quality and value of the FILE student experience was compared to the traditional APPE model.  Nine quality measures were compared (e.g. amount of opportunity for direct patient care experience, learning, integration into healthcare team, and accountability for patient outcomes) between students from the FILE program to peers completing similar APPEs outside the FILE program. FILE students and APPE preceptors also completed surveys regarding the value of several program aspects. Key Findings: There was no difference between FILE and non-FILE student self-rated measures of APPE quality, and thus the decision to participate in a longitudinal APPE program should be based on the personal preference of the student.  Students in the FILE program agreed or strongly agreed (mean score 4.3) that they felt prepared for post-graduate training at the completion of the program. The potential value that students in a longitudinal program might bring to the site is reinforced by the general agreement by preceptors in the end of year survey  that FILE students take less of their time to orient to their service and the trend toward perception that FILE students are more likely to independently participate in patient care activities.  Next Steps: To address feedback on preceptor-mentor role and the desire for more interaction with pharmacy residents, students are now paired with a pharmacy resident, and the student and resident work together on the service project with a clinical pharmacist as an advisor.  Updated standards of practice clearly delineate the roles and responsibilities of students, residents, and the clinical pharmacist preceptor.  Annual surveys of FILE students and preceptors provide necessary feedback to continuously improve the quality of the program.     Article Type:  Not

Doctor of Education Newsletter 2019

WSU Doctor of Education Inaugural Cohort 2019 Winona State University has an astounding reputation for educational practitioner preparation programs in the College of Education. As the summer of 2019 commences, a new journey begins for the inaugural cohort of doctoral students who embark on their quest to obtain Doctor of Education degrees.https://openriver.winona.edu/educationeddnewsletters/1000/thumbnail.jp

Closing the sea surface mixed layer temperature budget from in situ observations alone: Operation Advection during BoBBLE

Sea surface temperature (SST) is a fundamental driver of tropical weather systems such as monsoon rainfall and tropical cyclones. However, understanding of the factors that control SST variability is lacking, especially during the monsoons when in situ observations are sparse. Here we use a ground-breaking observational approach to determine the controls on the SST variability in the southern Bay of Bengal. We achieve this through the first full closure of the ocean mixed layer energy budget derived entirely from in situ observations during the Bay of Bengal Boundary Layer Experiment (BoBBLE). Locally measured horizontal advection and entrainment contribute more significantly than expected to SST evolution and thus oceanic variability during the observation period. These processes are poorly resolved by state-of-the-art climate models, which may contribute to poor representation of monsoon rainfall variability. The novel techniques presented here provide a blueprint for future observational experiments to quantify the mixed layer heat budget on longer time scales and to evaluate these processes in models

Doctoral Student Perspectives on Motivation and Persistence: Eye-Opening Insights Into the Ideas and Thoughts That Today\u27s Doctoral Students Have About Finishing the Doctoral Degree

It all comes down to this: we have an amazing team of faculty working with us who are present, supportive, intelligent, and motivated to help us succeed. They designed this program with those objectives in mind. We are in good hands, and any questions we have will be answered, so long as we ask them. Having the support system of our faculty, along with the tools we need to be successful, are major parts of the battle, already won. The rest is up to us. - A. Brooke Boultonhttps://openriver.winona.edu/educationeddbooks/1000/thumbnail.jp

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Comparison of in vivo and in vitro HSF1 occupancy uncovers factors influencing binding site determination

189 pagesA transcription factor’s (TF) propensity to bind to any given locus is driven by several influences, including DNA sequence, chromatin environment, surrounding transcription factor binding landscape, and local TF concentration. For many TFs, DNA sequence preference is well characterized, but is insufficient to determine TF binding patterns in vivo. To pinpoint contextual elements beyond DNA sequence that determine TF binding, I compared in vivo and in vitro binding profiles of human heat shock factor 1 (hHSF1), a highly conserved TF that binds to its target elements upon heat stress and regulates the rapid and concerted heat shock response. hHSF1 binds the conserved heat shock element (HSE) motif, which has hundreds of thousands of instances in the human genome, yet only is detected at around 1000 sites by ChIP-seq after heat shock stimuli. I have identified all possible genomic binding sites of hHSF1 in the absence of chromatin with PB-seq, a high-throughput in vitro assay that detects regions of hHSF1-bound naked DNA. Up to 50,000 hHSF1-bound binding sites were identified with PB-seq, a majority of which contained a detectable HSE. Yet, only a small fraction (~2-8%) of these regions are bound in K562 cells by ChIP-seq upon heat shock. I have found that chromatin accessibility is a major determinant of hHSF1 binding, as ATAC-seq and DNase I-hypersensitive regions are depleted at sites where hHSF1 only binds in vitro. To consider the impact of other TFs, chromatin remodelers, and histone marks on hHSF1 binding sitedetermination, I have investigated occupancy and motif prevalence of hundreds of chromatin-associated factors pre- heat shock by using available ENCODE ChIP-seq datasets and motif databases.2023-07-1

Biological Response of Positron Emission Tomography Scan Exposure and Adaptive Response in Humans

The biological effects of exposure to radioactive fluorodeoxyglucose ( 18 F-FDG) were investigated in the lymphocytes of patients undergoing positron emission tomography (PET) procedures. Low-dose, radiation-induced cellular responses were measured using 3 different end points: (1) apoptosis; (2) chromosome aberrations; and (3) γH2AX foci formation. The results showed no significant change in lymphocyte apoptosis, or chromosome aberrations, as a result of in vivo 18 F-FDG exposure, and there was no evidence the PET scan modified the apoptotic response of lymphocytes to a subsequent 2 Gy in vitro challenge irradiation. However, lymphocytes sampled from patients following a PET scan showed an average of 22.86% fewer chromosome breaks and 39.16% fewer dicentrics after a subsequent 2 Gy in vitro challenge irradiation. The effect of 18 F-FDG exposure on phosphorylation of histone H2AX (γH2AX) in lymphocytes of patients showed a varied response between individuals. The relationship between γH2AX foci formation and increasing activity of 18 F-FDG was not directly proportional to dose. This variation is most likely attributed to differences in the factors that combine to constitute an individual’s radiation response. In summary, the results of this study indicate 18 F-FDG PET scans may not be detrimental but can elicit variable responses between individuals and can modify cellular response to subsequent radiation exposures