Barriers and Facilitators to Enhance Interprofessional Education for Rehabilitation Science Graduate Students

Interprofessional education (IPE) aims to develop healthcare practitioners who work effectively in teams, demonstrate strong communication skills, respect others, and have a working knowledge of the roles and responsibilities of other professionals. Of identified research to date, it is unclear what students perceive as important for effective IPE delivery and learning. The purpose of this study was to identify graduate students\u27 perceptions of facilitators and barriers to learning interprofessional practice using phenomenology. Three semi-structured focus groups were conducted including athletic training, occupational therapy, or speech-language pathology students and the transcripts were analyzed using thematic analysis. Four themes emerged about IPE teaching methods and delivery: (1) addressing roles and responsibilities (2) student collaboration and communication (3) engaging with faculty and (4) enhancing realism and diversity of experiences. The themes suggested that IPE can either facilitate or create barriers for students when learning roles and responsibilities, collaborating, and communicating with fellow students, and engaging with faculty. Enhancing the realism and diversity of represented professionals were perceived as potential facilitators for future IPE sessions

The Clinical Reasoning Assessment Tool for Learning from Standardized Patient Experiences: A Pilot Study

Purpose: Clinical reasoning (CR) is the ability to integrate the knowledge of diagnoses with the use of supporting theories to create effective, client-centered interventions. One means of teaching CR to rehabilitation students is using standardized patient (SP) experiences. The relationship between faculty and student CR ratings after SP experiences has not been researched. The purpose of the study was to determine if there would be correlations between physical therapy (PT) and occupational therapy (OT) student and faculty ratings of CR skills after an SP experience. Method: The Clinical Reasoning Assessment Tool (CRAT) was used by students to self-reflect on their CR performance after an SP experience and compared to their respective faculty ratings. The CRAT includes three subsections: content knowledge, procedural knowledge, and conceptual reasoning, each with a visual analog scale. Correlations between students’ self-assessment of CR and faculty reviews were analyzed using Spearman’s rho correlations. Results: Seventeen PT and seventeen OT students participated. Spearman’s rho correlation coefficients for the PT students and their faculty were: content knowledge (r=.180; p=.488), procedural knowledge (r=.697; p=.002), and conceptual reasoning (r=.258; p=.317). Spearman’s rho correlation coefficients for the OT students and their faculty were: content knowledge (r=.103; p=.693), procedural knowledge (r=.676; p=.003), and conceptual reasoning (r=.505; p=.039). Conclusions: Neither PT nor OT student ratings was a statistically significant correlation in content knowledge ratings in relation to respective faculty ratings. Both PT and OT student procedural knowledge rating correlations with faculty were strong and statistically significant. PT student and faculty ratings were not significantly correlated in conceptual reasoning compared to faculty; however, OT students and faculty ratings were strong, had positive correlations, and were statistically significant. Further research is needed to assess students’ CR development longitudinally across curricula

TRIDENT: an Infrared Differential Imaging Camera Optimized for the Detection of Methanated Substellar Companions

A near-infrared camera in use at the Canada-France-Hawaii Telescope (CFHT) and at the 1.6-m telescope of the Observatoire du Mont-Megantic is described. The camera is based on a Hawaii-1 1024x1024 HgCdTe array detector. Its main feature is to acquire three simultaneous images at three wavelengths across the methane absorption bandhead at 1.6 microns, enabling, in theory, an accurate subtraction of the stellar point spread function (PSF) and the detection of faint close methanated companions. The instrument has no coronagraph and features fast data acquisition, yielding high observing efficiency on bright stars. The performance of the instrument is described, and it is illustrated by laboratory tests and CFHT observations of the nearby stars GL526, Ups And and Chi And. TRIDENT can detect (6 sigma) a methanated companion with delta H = 9.5 at 0.5" separation from the star in one hour of observing time. Non-common path aberrations and amplitude modulation differences between the three optical paths are likely to be the limiting factors preventing further PSF attenuation. Instrument rotation and reference star subtraction improve the detection limit by a factor of 2 and 4 respectively. A PSF noise attenuation model is presented to estimate the non-common path wavefront difference effect on PSF subtraction performance.Comment: 41 pages, 16 figures, accepted for publication in PAS

Microbiota-Produced N-Formyl Peptide fMLF Promotes Obesity-Induced Glucose Intolerance.

The composition of the gastrointestinal microbiota and associated metabolites changes dramatically with diet and the development of obesity. Although many correlations have been described, specific mechanistic links between these changes and glucose homeostasis remain to be defined. Here we show that blood and intestinal levels of the microbiota-produced N-formyl peptide, formyl-methionyl-leucyl-phenylalanine, are elevated in high-fat diet-induced obese mice. Genetic or pharmacological inhibition of the N-formyl peptide receptor Fpr1 leads to increased insulin levels and improved glucose tolerance, dependent upon glucagon-like peptide 1. Obese Fpr1 knockout mice also display an altered microbiome, exemplifying the dynamic relationship between host metabolism and microbiota. Overall, we describe a new mechanism by which the gut microbiota can modulate glucose metabolism, providing a potential approach for the treatment of metabolic disease

Search for residual prostate cancer on pT0 radical prostatectomy after positive biopsy

Reported incidence of no residual prostate cancer (i.e. pathological stage pT0) on radical prostatectomy ranges from 0.07 to 4.2%. The incidence is higher after neoadjuvant endocrine treatment. The aim of this study was to search for residual cancer on radical prostatectomy (RP) specimens when an initial sampling failed to find the cancer in patients with positive biopsy. Our database of 1,328 consecutive patients whose biopsies and RP specimen were both examined at the Polytechnic University-United Hospitals of the Marche Region between March 1995 and June 2006 was reviewed. The radical prostatectomies were grossly completely sampled and examined with the whole mount technique. We identified eight patients (i.e. 0.6%; three untreated and five hormonally treated preoperatively, i.e. 0.3 and 0.8%, respectively, of the total number of RPs included in the study) with positive biopsy and with no residual cancer in the initial routine histological examination of the RP. The RP of this group of eight was subjected to additional sectioning and evaluation of the paraffin blocks of the prostatectomy, also after block-flipping, immunostaining with an antibody against CAM 5.2, p63, PSA, and alpha-methylacyl-CoA racemase, and DNA specimen identity analysis. There were no cases with a false positive biopsy diagnosis, and cancer was not overlooked or missed in the initial routine histological examination of any of the 8 pT0 RPs. A minute focus of cancer (the diameter was always below 2.0 mm) was found on the additional sections in five. In particular, cancer was found after block-flipping in one of them. In an additional case, cancer was eventually discovered after immunostaining tissue sections for cytokeratin CAM 5.2, for p63 and PSA. In the remaining two cases (one untreated and the other hormonally treated), cancer was not found (0.15% of the 1,328 RPs included in the study); the review of the description of the macroscopic appearance of the RP and of its slides revealed that part of the peripheral zone corresponding to the site of the positive biopsy was missing, i.e. not removed from the patient at the time of the operation at least in one of the two. DNA specimen analysis confirmed the identity of the biopsy and prostatectomy in both. An extensive search for residual cancer reduces the number of pT0 RPs after a positive biopsy from 0.6 to 0.15%. It is recommended to have the needle biopsy reviewed, carefully look again at the radical prostatectomy, do deeper sections and then flip certain paraffin blocks. In addition, atypical foci should be stained for basal cell markers and often AMACR, especially in hormone-treated cases. If a block is missing part of the peripheral zone (capsular incision), this should be commented on. DNA analysis for tissue identity should be performed when the other steps have been taken without finding cancer

Endometrial stromal sarcoma: a population-based analysis

To determine independent prognostic factors for the survival of patients with endometrial stromal sarcoma (ESS), data were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute from 1988 to 2003. Kaplan–Meier and Cox proportional hazards models were used for analyses. Of 831 women diagnosed with ESS, the median age was 52 years (range: 17–96 years). In total, 59.9% had stage I, 5.1% stage II, 14.9% stage III, and 20.1% had stage IV disease. Overall, 13.0, 36.1, and 34.7% presented with grades 1, 2, and 3, respectively. Patients with stage I–II vs III–IV disease had 5 years DSS of 89.3% vs 50.3% (P<0.001) and those with grades 1, 2, and 3 cancers had survivals of 91.4, 95.4, and 42.1% (P<0.001). In multivariate analysis, older patients, black race, advanced stage, higher grade, lack of primary surgery, and nodal metastasis were independent prognostic factors for poorer survival. In younger women (<50 years) with stage I–II disease, ovarian-sparing procedures did not adversely impact survival (91.9 vs 96.2%; P=0.1). Age, race, primary surgery, stage, and grade are important prognostic factors for ESS. Excellent survival in patients with grade 1 and 2 disease of all stages supports the concept that these tumors are significantly different from grade 3 tumors. Ovarian-sparing surgeries may be considered in younger patients with early-stage disease