Provider Suicide

The purpose of this research and systematic literature review is to determine the risks factors for, the identification of and repercussions of provider suicide. In this review, databases searched included Pubmed, Cochran Database of Systematic Reviews, PsycInfo, National Institute of Health, Medscape and Google Scholar from September 8, 2018 to January 13, 2019. A variety of key terms were used when searching include suicide, provider suicide, suicide, costs of suicide, physician burnout, physician assistant burnout, nurse burnout, doctor suicide, physician assistant suicide, and nurse practitioner suicide. Works chosen for review were published between 1979 and 2018, as the topic has an extended history. Peer reviewed articles including systematic reviews and meta-analysis are included. Editorials were also included for the psychological factors of the topic. The research presented shows evidence that suicide is increased in healthcare providers, especially in women. This is an extremely important topic when considering the number of women entering healthcare. More research still needs to be done to address how suicide also affects all types of providers including nurse practitioners and physician assistants.https://commons.und.edu/pas-grad-posters/1167/thumbnail.jp

Data Services and the Performing Arts

In the academic world, research is primarily seen through the scientific approach of collecting and interpreting scientific or numeric data, or the humanistic approach of comparing and interpreting texts. However, in the performing arts fields, academics see themselves on a spectrum between scholar and artist. Artistic scholarly research activities are often driven by the same requirements as humanities research. However, as artists, research often takes the form of listening to or watching performances. In this approach, performances and recordings are research data to these academics. How can libraries support this method of research? What are the implications for data curation in libraries? These and other questions will be explored in this article

Proposing a Metacurriculum for Occupational Therapy Education in 2025 and Beyond

The American healthcare system has undergone significant changes in the past few years due to government and corporate-level changes. As healthcare requirements continue to shift, occupational therapists must continue to assert their role or risk losing relevancy. Therefore, educational programs must prepare students to meet the populations’ shifting healthcare needs through agile curricula which focus less on isolated skills and more on broad areas of impact. To determine essential content comprising a ‘metacurriculum’ for occupational therapy education of the future, nine articles were analyzed using Bloom’s Taxonomy (revised) to code each document into knowledge, skills, and behaviors. Major themes were identified across all documents. Through the coding analysis eleven themes were identified: population health, developing life-long learners, advocacy (at government and individual level), interprofessional collaboration, generation of evidence and translational science, diversity and inclusion, psychosocial concerns, aging, wellbeing and preventative care, contemporary issues and informatics. The themes can serve as an outline for academic programs to continue to evolve their curricula to ensure that practitioners are fully prepared to address the global issues that will manifest during their careers in occupational therapy

The development and evaluation of novel monoclonal antibodies directed against folate pathway components

Folates are essential in the de novo nucleotide biosynthetic pathway, folate receptor alpha (FR-α) is a folate transporter which is an attractive target for anticancer drug design due to its limited expression in normal tissues. It has great potential to direct therapies toward pathologic cells whilst minimizing toxicity in normal tissues. The enzyme folylpolyglutamate synthetase (FPGS) polyglutamates folates and folate analogues, trapping them within the cell and increasing their affinity as substrates for subsequent enzymatic reactions. Expression of folate biochemical pathway components, such as FR-α and FPGS, may be indicators of malignancy and also determine response to antifolate chemotherapeutics and other folate pathway targeted therapies currently being evaluated. Knowledge of their expression in tumours may enable optimal use by identifying responsive subgroups of patients. In spite of their importance in the diagnosis and treatment of cancer, the lack of monoclonal anti-FR-α and FPGS antibodies suitable for immunohistochemistry (IHC) analysis of formalin fixed, paraffin embedded biopsy samples or Western blot analysis has limited research in this area. The aim of this project was to generate and fully characterize monoclonal antibodies to detect specific expression of these proteins in formalin fixed, paraffin embedded tissues for use on archival tissue and samples collected prospectively in connection with clinical trials of antifolates. Novel monoclonal antibodies with specificity for sensitive detection of FR-α and FPGS in paraffin-embedded tissues were developed. ELISA and Western blot analysis confirmed specific reactivity of both antibodies to the recombinant protein, a single 40kD protein in whole cell lysates from cell lines known to express FR-α, and a single 60kD protein from cells expressing FPGS. Epitope mapping experiments confirmed specificity restricted to a linear epitope present in the protein target sequences. IHC analysis of FR-α in a panel of normal tissues demonstrated predominantly membrane with cytoplasmic staining limited to some ovarian epithelia (inclusion cysts), placental trophoblasts and proximal kidney tubules; FPGS demonstrated a wider pattern of expression. FR-α analysis of a panel of malignant and benign tissues demonstrated limited expression with variable intensities of staining and patterns of membrane and cytoplasmic Development and Evaluation of Novel Monoclonal Antibodies to FR-α and FPGS VI reactivity between cases. In the majority of malignant ovarian tumours, including an archival tissue microarray (TMA) of 167 tumour samples, membrane staining was observed in 89% of cases. FPGS analysis on a panel of benign and malignant tissues demonstrated frequent and high cytoplasmic expression in a range of tumours compared to normal adjacent tissue. The archival ovarian cancer TMA analysis showed a significant association between high expression of FR-α and poor patient survival (p=0.012, Cox regression) indicating a role for FR-α as a prognostic marker and potential therapeutic target for ovarian cancer and other cancers with expression of FR-α, detectable via the use of our antibody on FFPE tumour samples.EThOS - Electronic Theses Online ServiceNewcastle UniversityLeica Biosystems Newcastle (formerly Novocastra Laboratories)GBUnited Kingdo

Bugs as Features (Part I): Concepts and Foundations for the Compositional Data Analysis of the Microbiome-Gut-Brain Axis

There has been a growing acknowledgement of the involvement of the gut microbiome - the collection of microbes that reside in our gut - in regulating our mood and behaviour. This phenomenon is referred to as the microbiome-gut-brain axis. While our techniques to measure the presence and abundance of these microbes have been steadily improving, the analysis of microbiome data is non-trivial. Here, we present a perspective on the concepts and foundations of data analysis and interpretation of microbiome experiments with a focus on the microbiome-gut-brain axis domain. We give an overview of foundational considerations prior to commencing analysis alongside the core microbiome analysis approaches of alpha diversity, beta diversity, differential feature abundance and functional inference. We emphasize the compositional data analysis (CoDA) paradigm. Further, this perspective features an extensive and heavily annotated microbiome analysis in R in the supplementary materials, as a resource for new and experienced bioinformaticians alike.Comment: For main text: 23 pages, 3 figures; for supplementary demonstration analysis: 31 pages and 12 figures. Supplementary demonstration analysis generated using Rmarkdown by Thomaz F. S. Bastiaanssen. Part I of a two-part piec

Bugs as Features (Part II): A Perspective on Enriching Microbiome-Gut-Brain Axis Analyses with Multidisciplinary Techniques

The microbiome-gut-brain-axis field is multidisciplinary, benefiting from the expertise of microbiology, ecology, psychiatry, computational biology, and epidemiology amongst other disciplines. As the field matures and moves beyond a basic demonstration of its relevance, it is critical that study design and analysis are robust and foster reproducibility. In this companion piece to Bugs as Features (Part 1), we present techniques from adjacent and disparate fields to enrich and inform the analysis of microbiome-gut-brain-axis data. Emerging techniques built specifically for the microbiome-gut-brain axis are also demonstrated. All of these methods are contextualised to inform several common challenges: how do we establish causality? How can we integrate data from multiple 'omics techniques? How might we account for the dynamicism of host-microbiome interactions? This perspective is offered to experienced and emerging microbiome scientists alike, to assist with these questions and others, at the study conception, design, analysis and interpretation stages of research.Comment: For main text: 20 pages, 2 figures; for supplementary analysis: 31 pages and 6 figures. Supplementary analysis generated using Rmarkdown by Thomaz F. S. Bastiaanssen. arXiv admin note: substantial text overlap with arXiv:2207.1247

Blinded patient preference for morphine compared to placebo in the setting of chronic refractory breathlessness – an exploratory study

Context Patients’ preference for morphine therapy has received little attention in the setting of chronic refractory breathlessness. However, this is one important factor in considering longer term therapy. Objectives The aim of this secondary analysis is to explore blinded patient preference of morphine compared to placebo for this indication and to define any predictors of preference. Methods Data were pooled from three randomized, double-blind, crossover, placebo-controlled studies of morphine (four days each) in chronic refractory breathlessness. Blinded patient preferences were chosen at the end of each study. A multivariable regression model was used to establish patient predictors of preference. Results Sixty-five participants provided sufficient data (60 males; median age 74 years; heart failure 55%, chronic obstructive pulmonary disease 45%; median Eastern Cooperative Oncology Group performance status 2). Forty-three percent of participants preferred morphine (32% placebo and 25% no preference). Morphine preference and younger age were strongly associated: odds ratio = 0.85, 95% confidence interval 0.78, 0.93;

Who Wants To Do Rural Social Work? Student Perceptions of Rural Social Work Practice

In response to growing concerns about the national shortage of rural social workers, the researchers surveyed and interviewed 115 social work students (97 BSW, 18 MSW) to ascertain their career plans and perceptions of rural social work practice. Although more than half reported living in rural communities at the time of their high school graduation, over 70% indicated a preference for practicing social work in or near an urban area. Students articulated multiple incentives that would attract them to rural social work and expressed a clear understanding of how various systems (social service, legislative, community, and educational) could provide these incentives and generally encourage and support rural social work practice

Evaluation of a Technology-Based Survivor Care Plan for Breast Cancer Survivors: Pre-Post Pilot Study.

BACKGROUND: As of 2016, almost 16 million individuals were cancer survivors, including over 3.5 million survivors of breast cancer. Because cancer survivors are living longer and have unique health care needs, the Institute of Medicine proposed a survivor care plan as a way to alleviate the many medical, emotional, and care coordination problems of survivors. OBJECTIVE: This pilot study for breast cancer survivors was undertaken to: (1) examine self-reported changes in knowledge, confidence, and activation from before receipt to after receipt of a survivor care plan; and (2) describe survivor preferences for, and satisfaction with, a technology-based survivor care plan. METHODS: A single group pretest-posttest design was used to study breast cancer survivors in an academic cancer center and a community cancer center during their medical visit after they completed chemotherapy. The intervention was a technology-based survivor care plan. Measures were taken before, immediately after, and 1 month after receipt of the survivor care plan. RESULTS: A total of 38 breast cancer survivors agreed to participate in the study. Compared to baseline levels before receipt of the survivor care plan, participants reported increased knowledge both immediately after its receipt at the academic center (P\u3c.001) and the community center (P\u3c.001) as well as one month later at the academic center (P=.002) and the community center (P\u3c.001). Participants also reported increased confidence immediately following receipt of the survivor care plan at the academic center (P=.63) and the community center (P=.003) and one month later at both the academic center (P=.63) and the community center (P\u3c.001). Activation was increased from baseline to post-survivor care plan at both the academic center (P=.05) and community center (P\u3c.001) as well as from baseline to 1-month follow-up at the academic center (P=.56) and the community center (P\u3c.001). Overall, community center participants had lower knowledge, confidence, and activation at baseline compared with academic center participants. Overall, 22/38 (58%) participants chose the fully functional electronic survivor care plan. However, 12/23 (52%) in the community center group chose the paper version compared to 4/15 (27%) in the academic center group. Satisfaction with the format (38/38 participants) and the content (37/38 participants) of the survivor care plan was high for both groups. CONCLUSIONS: This study provides evidence that knowledge, confidence, and activation of survivors were associated with implementation of the survivor care plan. This research agrees with previous research showing that cancer survivors found the technology-based survivor care plan to be acceptable. More research is needed to determine the optimal approach to survivor care planning to ensure that all cancer survivors can benefit from it

A Point Mutation in HLA-A*0201 Results in Failure to Bind the TAP Complex and to Present Virus-Derived Peptides to CTL

Mutating the HLA-A*0201 heavy chain from threonine to lysine at position 134 (T134K) results in a molecule that presents exogenous peptide, but cannot present endogenously derived antigen. This is reflected in diminished cell surface expression and altered intracellular trafficking of T134K. The failure of T134K to present endogenous antigen can be overcome by using an ER targeting sequence, suggesting that the antigen presentation defect is restricted to TAP-dependent peptide loading. The ability of T134K to load peptide in a TAP-dependent manner is dramatically reduced compared with HLA-A*0201. By coimmunoprecipitation there is no detectable association of the T134K molecule with the TAP complex. Thus, T134K selectively affects TAP association and peptide loading, suggesting a requirement for the direct interaction of MHC class I heavy chain and the TAP complex for efficient presentation of endogenous antigen