A call to uncover the availability, structure, and effects of parental leave policies at academic pharmacy institutions

Parental leave is often an initial barrier to achieving family-career integration, and thus discussing this issue within the broader academic pharmacy community may have important implications for policy development and change. This commentary aims to reveal the implications of inadequate parental leave policies on faculty while highlighting the benefits well-developed policies can have for both parents and their children. Additionally, we put forth a call to action for additional research into the availability and structure of parental leave policies at pharmacy institutions and the effects such policies have on faculty wellbeing, retention, and job satisfaction.

A Multicenter Study Assessing Burnout and Work Engagement in Student Pharmacists and Faculty Members

OBJECTIVE

The objective of this study was to characterize work engagement and burnout as well as potential demographic factors associated with each student and faculty member at 2 pharmacy programs in the US.

METHODS

A survey including the Utrecht Work Engagement Scale-9 (UWES-9) and a single-item burnout measure was conducted from April to May 2020. Demographic data including age range, gender, and other characteristics were also collected. Mean UWES-9 scores, scoring category results, and the proportion of the cohorts reporting symptoms of burnout were reported. Point biserial correlation was used to compare the relationship between UWES-9 mean scores and burnout rates. Regression analyses were also performed to assess variables predictive of work engagement and burnout.

RESULTS

Students (N = 174) reported a mean UWES-9 score of 3.0 (SD = 1.1), while faculty members (N = 35) reported a mean of 4.5 (SD = 0.7). Over half (58.6%) of the students and 40% of faculty members reported symptoms of burnout. Faculty members demonstrated a strong significant negative correlation between work engagement and burnout (r = -0.35), while students did not (r = 0.04). Regression analyses found no significant demographic factors predictive of UWES-9 scores in students or faculty, while first year students were less likely to report burnout symptoms, and no significant factors for burnout were found in faculty.

CONCLUSION

Our study found that work engagement scores and burnout symptoms were inversely correlated in pharmacy faculty members surveyed but lacked correlation in students. Larger, more robust studies should be conducted to further elucidate the relationship between work engagement and burnout.

Empowering Students Who Are Breastfeeding a Child While Enrolled in Pharmacy School

Pharmacy students wishing to maintain their breastfeeding relationship with their child while also excelling within a Doctor of Pharmacy program require important resources and a culture of support. This Commentary examines the challenges that pharmacy students who are breastfeeding face, highlights the importance of pharmacy schools and colleges providing breastfeeding and lactation support, and identifies best practices for implementing support measures for these students. We aim to guide institutions in not only supporting breastfeeding students but empowering them to excel personally, professionally, and academically.

A Call to Action for Lactation Support at Colleges of Pharmacy

Faculty well-being has been promoted and emphasized in recent years, and the Academy has been implored to develop and implement strategies to minimize stress and burnout among its members. Among those at highest risk of succumbing to burnout are female faculty, particularly those with young children. Numerous work-life issues predispose this cohort to stressors. One specific change that could address the needs of this group is providing lactation support in the workplace. Responding to the broader directive to promote faculty well-being, the aim of this commentary is to stimulate conversation regarding providing lactation support at colleges of pharmacy. Establishing such services has the potential to improve the personal and professional well-being of female faculty who are breastfeeding while also creating a more inclusive and supportive workplace. This article discusses the benefits of breastfeeding; highlights the personal, professional, and institutional ramifications of breastfeeding discrimination; and summarizes best practices related to implementing lactation support services.

Radiant Exitance of Old, New, and Damaged LED Light Curing Units

PURPOSE

This study aimed to determine the radiant exitance of new, damaged, and 16-year-old light-curing units (LCUs) with and without infection control barriers, and before and after removal of any debris.

METHODS AND MATERIALS

Old LCUs consisted of 62 SmartLite iQ2 lights (Dentsply Sirona, York, PA). New LCUs consisted of 58 SmartLite Focus (Dentsply Sirona) and 58 Valo Grand (Ultradent, South Jordan, UT, USA) LCUs. Each LCU was examined for damage and debris on its tip. A handheld radiometer (CheckUp with BlueLight Analytics app, Halifax, Nova Scotia, Canada ) was used to measure the radiant exitance using a 10-second exposure time. Measurements were made with and without infection control barriers. If debris was present, the radiant exitance was measured before and after removal of debris with and without the barriers. All measurements were repeated three times. The means of the measurements were used for statistical analyses, which consisted of paired t-tests, analysis of variance (ANOVA), and Tukey post-hoc analyses conducted with a 0.05 level of significance.

RESULTS

Infection control barriers significantly reduced the radiant exitance of all LCUs, ranging from 4.35% to 6.91% depending upon the LCU and the presence of debris or damage. Clean undamaged SmartLite Focus (907 mW/cm2) and Valo Grand (Ultradent) LCUs (883 mW/cm2) with barriers had statistically higher radiant exitance than older clean undamaged SmartLite iQ2 (Dentsply Sirona) LCUs (719 mW/cm2) with barriers. All LCUs exceeded the recommended 400 mW/cm2 radiant power to cure 2 mm of Filtek Supreme Ultra shade A2 composite resin (3M ESPE, St Paul MN, USA).

CONCLUSION

Infection control barriers, debris, damage, and age all significantly reduced radiant exitance of the lights.

Overcoming Past Perceptions and a Profession-Wide Identity Crisis to Reflect Pharmacy's Future

The profession of pharmacy has come to encompass myriad identities, including apothecary, dispenser, merchandiser, expert advisor, and health care provider. While these identities have changed over time, the responsibilities and scope of practice have not evolved to keep up with the goals of the profession and the level of education of practicing pharmacists in the United States. By assuming that the roles of the aforementioned identities involve both product-centric and patient-centric responsibilities, our true professional identity is unclear, which can be linked to the prevalence of the impostor phenomenon within the profession. For pharmacy to truly move forward, a unified definition for the profession is needed by either letting go of past identities or separating these identities from each other by altering standards within professional degree programs and practice models. Without substantial changes to the way we approach this challenge as a profession, the problems described will only persist and deepen.

Assessment of Impostor Phenomenon in Student Pharmacists and Faculty at Two Doctor of Pharmacy Programs

Objective. To evaluate the prevalence of impostor phenomenon in student pharmacists and faculty members at two educational institutions in the United States.Methods. Participants anonymously completed an electronic self-report survey instrument that included the validated Clance Impostor Phenomenon Scale (CIPS) from April 2020 to May 2020. Demographic data including age range, gender, and other characteristics were collected. The Clance Impostor Phenomenon Scale scores were reported as means (SDs), and data were compared between institutions and demographic groups using t tests.Results. The overall mean CIPS survey score (N=209, 35.5% response rate) was 63.8 (SD=15.1). The mean student pharmacist CIPS score for Northeast Ohio Medical University (NEOMED) was 64.7 (SD=14.4) vs 63.8 (SD=16.1) for Sullivan University College of Pharmacy and Health Sciences (SUCOPHS), which was statistically similar. Mean faculty CIPS score for NEOMED was 59.2 (SD=14.0) vs 64.7 (SD=16.8) for SUCOPHS, which was statistically similar. Mean CIPS score for the combined student pharmacist group (NEOMED and SUCOPHS) was 64.3 (SD=15.1) vs 61.2 (SD=15.1) for the combined group of faculty members, which was statistically similar. Overall, most respondents fell in the "moderate" to "frequent" CIPS score classification range (36.4% and 44%, respectively).Conclusion. Impostor phenomenon feelings were common among responding student pharmacists and faculty members at the institutions surveyed; however, little is known about the implications of these findings. Future research should seek to elucidate factors predictive of or associated with impostor phenomenon as well as assess the impact of strategies to prevent or manage impostor phenomenon.

Evaluation of a lateral-flow nanoparticle fluorescence assay for TB infection diagnosis

BACKGROUND:

Programmatic management of TB infection is a critical component of the WHO End TB Strategy. Interferon-gamma release assays (IGRAs) overcome some limitations of the tuberculin skin test, but implementation of IGRA testing in low-resource settings is challenging.

METHODS:

In this feasibility study, we evaluated performance of a novel digital lateral-flow assay, the QIAreach® QuantiFERON® TB (QIAreach-QFT) test, against the QuantiFERON®-TB Gold Plus (QFT-Plus) assay. A population with a mix of risk factors for TB infection (111 donors) were sampled over multiple days. A total of 207 individual blood samples were tested according to the manufacturer’s instructions.

RESULTS:

The overall percentage agreement was 95.6% (two-sided 95% CI 91.8–98), with a positive percentage agreement (i.e., sensitivity) of 100% (95% CI 94.7–100) and a negative percentage agreement (i.e., specificity) of 95.6% (95% CI 90.6–98.4). All QFT-Plus positive specimens with TB1-Nil and TB2-Nil values less than 1 IU/ml tested positive on QIAreach-QFT.

CONCLUSIONS:

QIAreach QFT is a deployable, accurate testing solution for decentralised testing. It has the potential to overcome key hurdles for TB infection screening in high-burden settings thus helping to achieve the WHO End TB programme goals.

Opportunity cost

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

What is the current practice for managing patients with chronic limb-threatening ischaemia in vascular surgery services? A survey of UK vascular surgeons

INTRODUCTION

The Vascular Society of Great Britain and Ireland (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PAD QIF) stipulates targets for managing patients with chronic limb-threatening ischaemia (CLTI); however, it is unknown whether these are achievable. This survey aims to evaluate contemporary practice for managing CLTI in the UK.

METHODS

A questionnaire was developed in conjunction with the VSGBI to survey the management of CLTI and canvass opinions on the PAD QIF. The survey was distributed to all consultant members of the VSGBI and through a targeted social media campaign.

RESULTS

Forty-seven consultant vascular surgeons based at 36 arterial centres across the UK responded (response rate from arterial centres = 46%). Only 14.3% of centres provided outpatient consultation within the target of seven days from referral, with only one centre providing revascularisation within the target of seven days from consultation. For inpatient management, 31.6% provided surgical and 23.8% endovascular revascularisation within the target of three days from assessment. While 60% of participants believe the PAD QIF's 5-day 'admitted care' pathway is achievable, only 28.6% thought the 14-day 'non-admitted care' pathway was feasible. Challenges to meeting these targets include the availability of theatre space and angiography lists, and availability of outpatient appointments for patient assessment.

CONCLUSIONS

The opinion of UK vascular surgeons indicates that achieving the targets of the PAD QIF represents a major challenge based upon current services. Adapting existing services with a greater focus on providing an 'urgent' model of care may help to potentially overcome these challenges.

535 ELF 2: DEFINING THE DENOMINATOR ELF STUDY GROUP

Introduction

The collaborative UK Emergency Laparotomy and Frailty (ELF) study was one of the first to investigate the older adult population undergoing emergency surgery. Despite accounting for almost half of emergency laparotomies and many considered high-risk, there remains a paucity of research in this population. One undefined area is the older patient who presents with acute abdominal pathology treatable by laparotomy but who do not undergo surgery.

Aims

The primary aim is to estimate the 90-day mortality in older patients presenting with acute abdominal pathology potentially treatable by emergency laparotomy who do not undergo surgery (NoLap). The secondary aims are characterisation of this group, including frailty and sarcopenia with comparison to those older adults that have undergone emergency laparotomy (NELA and ELLSA). In addition, the decision-making process will be explored.

Method

Multicentre prospective cohort study via established research collaboratives (Welsh Barbers, SSRG, OPSOC). ELF 2 requires at least 47 centres, recruiting 700 patients for 3 months prospective data collection via REDCap of NoLap patients with the same NELA inclusion/exclusion criteria. This data will be compared with a matched cohort from NELA and ELLSA. ELF2 data collection includes demographics, co-morbidities, frailty and sarcopenia. Each patient will be followed up for 90-day and 1-year mortality. Heuristics behind the decision will be analysed.

Discussion

This trainee led collaborative project aims to improve understanding of the older adult population being considered for emergency laparotomy. With the ageing population being the dominant health users of the future, defining the denominator is essential for shared decision-making.

The Current Landscape of College-Sponsored Postgraduate Teaching and Learning Curriculum Programs

Objective. To describe the landscape of teaching and learning curriculum (TLC) programs sponsored by US schools and colleges of pharmacy and evaluate their adoption of best practice recommendations. Methods. A 28-item electronic survey instrument was developed based on best practice recommendations published by the American Association of Colleges of Pharmacy (AACP), American Society of Health-System Pharmacists (ASHP), and American College of Clinical Pharmacy (ACCP) for the conduct of TLC programs. The survey instrument was electronically distributed to 137 accredited colleges and schools of pharmacy in the United States. Results. Eighty-eight institutions responded, resulting in a response rate of 64%. Sixty-one TLC programs were included in the final analysis. Seventy-five percent of TLC programs reported using best practice recommendations; however, 10% of respondents indicated they were not aware of the published recommendations. Inconsistencies among programs were noted in required teaching experiences, participant evaluation, and ongoing programmatic assessment. Conclusion. Most institutions offering TLC programs are aware of published best practice guidelines and have adopted a majority of the published best practices. However, considerable variability exists across the country. Development of a formal external validation process for TLC programs is necessary to ensure consistent quality.

0456 Natural History of Insomnia: Sleep Reactivity Predicts New-Onset Acute Insomnia

Introduction

Greater vulnerability to stress-related sleep disturbance (i.e., sleep reactivity) is a risk factor for chronic insomnia (CI). What has not been investigated is whether greater sleep reactivity, as assessed by the Ford Insomnia Response to Stress Test (FIRST), predicts the onset of acute insomnia (AI), and more, whether greater sleep reactivity predicts the transition from AI to CI.

Methods

A national cohort of 1,222 good sleeper subjects (68% female; mean age=53.2 years) were prospectively assessed to estimate the incidence of AI and CI. The FIRST was completed at baseline and sleep diaries were completed on a daily basis for a period of one year. Subjects were categorized based on their FIRST scores (high, FIRST>16; low, FIRST≤16). Subjects were also grouped based on whether they developed AI (two consecutive weeks with a frequency of ≥ 3 nights per week of sleep initiation or maintenance problems) or maintained good sleep (GS; n=896). For those subjects that transitioned to AI (n=326), they were also grouped based on whether or not they developed CI (insomnia ≥ 3 nights/week for at least three months; n=23). Chi-square analyses were performed to determine if higher FIRST scores at baseline predicted the incidence of AI or CI.

Results

32.5% of subjects in the high FIRST group met criteria for AI at some point during the one-year interval, whereas 22.5% of subjects in the low FIRST group experienced AI (χ 2=15.2, p<.001). In contrast, FIRST did not predict CI status (low FIRST, 8.5% CI, high FIRST, 5.6% CI; χ 2=1.1, p=.30).

Conclusion

Greater sleep reactivity predicted incident AI but not the onset of CI. While these findings suggest that sleep reactivity may be a predisposing factor for AI, data are not consistent with previous findings showing FIRST scores are predictive of the development of CI. It’s possible that the present study was underpowered to detect these differences, given that the incidence of CI was low (less than 2% of the total sample). Additional analyses are ongoing to evaluate the temporal association between stressful life events and AI in subjects with high and low FIRST scores.

Support

Perlis: NIH R01AG041783, K24AG055602

Pubic apophysitis in elite Australian Rules football players: MRI findings and the utility of VIBE sequences in evaluating athletes with groin pain

AIM

To confirm that pubic apophysitis is common in Australian Rules footballers with groin pain.

MATERIALS AND METHODS

Thirteen male Australian Football League (AFL) players with groin pain were assessed with volumetric interpolated breath-hold examination (VIBE) MRI over the 2017, 2018, and 2019 AFL seasons. Images were reviewed for pubic maturation, the presence of pubic apophysitis, and associated bone pathology and correlated with side of groin pain.

RESULTS

Pubic apophysitis was seen in 92% of AFL players with groin pain. Delayed maturation of the pubic apophyses was observed in 85%. Pubic bone erosions and cyst-like changes were common (100% and 46%, respectively), but due to delayed maturation of the apophyses and apophysiolysis. Apophysitis associated with adductor brevis-gracilis was more common than adductor longus-associated apophysitis.

CONCLUSION

Pubic apophysitis associated with delayed maturation of the pubic apophyses is common in AFL players and is potentially a significant cause of groin pain in these athletes. Imaging findings in this group are the same as those conventionally describing osteitis pubis. Pubic apophysitis is best visualised with VIBE magnetic resonance imaging (MRI) and may be a more pathologically correct description of early, adductor load-related pubic bone pathology.

Is there a gender gap in chemical sciences scholarly communication?

Characterisation of gender differences throughout peer-review publication process as revealed by thorough analysis of Royal Society of Chemistry submissions, publications and citation data.

The Royal Society of Chemistry is committed to investigating and addressing the barriers and biases which face women in the chemical sciences. The cornerstone of this is a thorough analysis of data regarding submissions, review and citations for Royal Society of Chemistry journals from January 2014 until July 2018, since the number and impact of publications and citations are an important factor when seeking research funding and for the progression of academic career. We have applied standard statistical techniques to multiple data sources to perform this analysis, and have investigated whether interactions between variables are significant in affecting various outcomes (author gender; reviewer gender; reviewer recommendations and submission outcome) in addition to considering variables individually. By considering several different data sources, we found that a baseline of approximately a third of chemistry researchers are female overall, although this differs considerably with Chemistry sub-discipline. Rather than one dominant bias effect, we observe complex interactions and a gradual trickle-down decrease in this female percentage through the publishing process and each of these female percentages is less than the last: authors of submissions; authors of RSC submissions which are not rejected without peer review; authors of accepted RSC publications; authors of cited articles. The success rate for female authors to progress through each of these publishing stages is lower than that for male authors. There is a decreasing female percentage when progressing through from first authors to corresponding authors to reviewers, reflecting the decreasing female percentage with seniority in Chemistry research observed in the “Diversity landscape of the chemical sciences” report. Highlights and actions from this analysis form the basis of an accompanying report to be released from the Royal Society of Chemistry.

Progress in High-Speed Spin Testing of Superconducting Wire and Tapes for High-Field NMR Magnet Qualification

This paper summarizes the status of a 3-year, NIH-funded research project to study the strength of high temperature superconductors under high circumferential hoop stress, in order to qualify these materials for high-field (> 1 GHz-class NMR magnets. The unique approach presented here is to spin test coils at high rotational speeds, approaching 100,000 rpm, in order to induce the necessary hoop stress. Thermal strain compatibility between the Bi-2212 wire and Inconel wire has been qualified, including thermal cycling. Assembly and testing of the first low-speed (< 30,000 rpm) rotor is now in process, and the design of second, higher speed (> 60,000 rpm) rotor, is also underway.

Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility

STUDY QUESTION

What is the recommended assessment and management of infertile women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertize and consumer preference?

SUMMARY ANSWER

International evidence-based guidelines, including 44 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of infertile women with PCOS.

WHAT IS KNOWN ALREADY

Previous guidelines on PCOS lacked rigorous evidence-based processes, failed to engage consumer and multidisciplinary perspectives or were outdated. The assessment and management of infertile women with PCOS are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Governance included a six continent international advisory and a project board, a multidisciplinary international guideline development group (GDG), consumer and translation committees. Extensive health professional and consumer engagement informed the guideline scope and priorities. The engaged international society-nominated panel included endocrinology, gynaecology, reproductive endocrinology, obstetrics, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Extensive online communication and two face-to-face meetings over 15 months addressed 19 prioritized clinical questions involving nine evidence-based reviews and 10 narrative reviews. Evidence-based recommendations (EBRs) were formulated prior to consensus voting within the guideline panel.

STUDY DESIGN, SIZE, DURATION

International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. A (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation and ultimately recommendation strength. The guideline was peer-reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE II criteria and underwent methodological review. This guideline was approved by all members of the GDG and has been approved by the NHMRC.

MAIN RESULTS AND THE ROLE OF CHANCE

The quality of evidence (QOE) for the EBRs in the assessment and management of infertility in PCOS included very low (n = 1), low (n = 9) and moderate (n = 4) quality with no EBRs based on high-quality evidence. The guideline provides 14 EBRs, 10 clinical consensus recommendations (CCRs) and 20 clinical practice points on the assessment and management of infertility in PCOS. Key changes in this guideline include emphasizing evidence-based fertility therapy, including cheaper and safer fertility management.

LIMITATIONS, REASONS FOR CAUTION

Overall evidence is generally of low to moderate quality, requiring significantly greater research in this neglected, yet common condition. Regional health systems vary and a process for adaptation of this guideline is provided.

WIDER IMPLICATIONS OF THE FINDINGS

The international guideline for the assessment and management of infertility in PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program.

STUDY FUNDING/COMPETING INTEREST(S)

The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine (ASRM). GDG members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Norman has declared a minor shareholder interest in the IVF unit Fertility SA, travel support from Merck and grants from Ferring. Prof. Norman also has scientific advisory board duties for Ferring. The remaining authors have no conflicts of interest to declare.

This article was not externally peer-reviewed by Human Reproduction Open.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Assessment of a structured longitudinal professional identity development curriculum for pharmacy students

BACKGROUND AND PURPOSE

To describe and assess a longitudinal Professional Identity Development (PID) curriculum at Northeast Ohio Medical Universities (NEOMED) College of Pharmacy.

EDUCATIONAL ACTIVITY AND SETTING

Northeast Ohio Medical University, a four-year professional program, has assimilated its career development and advising program into the curriculum as a primary element of the Pharmacist Patient Care Experience (PPCE) course. The concept of PID focuses on student pharmacist career development. The goals for the PID module include guided self-assessment and goal-setting related to career choice with attention to work-life balance, community engagement and leadership. Students also work in small groups, called Professional Development Advising Teams (PDAT), led by a PDAT clinical advisor who is a practicing pharmacist. These meetings provide a forum to debrief self-assessment work and clinical experiences and make connections between the two.

FINDINGS

A voluntary survey was administered to six classes of NEOMED alumni (2011-2016) to evaluate the longitudinal PID curriculum. Respondents found many aspects of the PID curriculum to be beneficial in the development of their professional identity and career planning journey. Most felt that PID sessions enabled them to effectively prepare for a career in pharmacy, with goal setting, Curriculum Vitae (CV) review, and career exploration most helpful in planning for their future careers.

DISCUSSION

PID curricula are resource-intensive and require a firm commitment from administration and the faculty. Elements of the program can be adapted and utilized in a variety of different ways, making this model accessible to all pharmacy schools.

Improving the learning of chemical-protein interactions from literature using transfer learning and specialized word embeddings

In this paper, we explore the application of artificial neural network ('deep learning') methods to the problem of detecting chemical-protein interactions in PubMed abstracts. We present here a system using multiple Long Short Term Memory layers to analyse candidate interactions, to determine whether there is a relation and which type. A particular feature of our system is the use of unlabelled data, both to pre-train word embeddings and also pre-train LSTM layers in the neural network. On the BioCreative VI CHEMPROT test corpus, our system achieves an F score of 61.51% (56.10% precision, 67.84% recall).

X-exome sequencing of 405 unresolved families identifies seven novel intellectual disability genes

X-linked intellectual disability (XLID) is a clinically and genetically heterogeneous disorder. During the past two decades in excess of 100 X-chromosome ID genes have been identified. Yet, a large number of families mapping to the X-chromosome remained unresolved suggesting that more XLID genes or loci are yet to be identified. Here, we have investigated 405 unresolved families with XLID. We employed massively parallel sequencing of all X-chromosome exons in the index males. The majority of these males were previously tested negative for copy number variations and for mutations in a subset of known XLID genes by Sanger sequencing. In total, 745 X-chromosomal genes were screened. After stringent filtering, a total of 1297 non-recurrent exonic variants remained for prioritization. Co-segregation analysis of potential clinically relevant changes revealed that 80 families (20%) carried pathogenic variants in established XLID genes. In 19 families, we detected likely causative protein truncating and missense variants in 7 novel and validated XLID genes (CLCN4, CNKSR2, FRMPD4, KLHL15, LAS1L, RLIM and USP27X) and potentially deleterious variants in 2 novel candidate XLID genes (CDK16 and TAF1). We show that the CLCN4 and CNKSR2 variants impair protein functions as indicated by electrophysiological studies and altered differentiation of cultured primary neurons from Clcn4(-/-) mice or after mRNA knock-down. The newly identified and candidate XLID proteins belong to pathways and networks with established roles in cognitive function and intellectual disability in particular. We suggest that systematic sequencing of all X-chromosomal genes in a cohort of patients with genetic evidence for X-chromosome locus involvement may resolve up to 58% of Fragile X-negative cases.

The association between Polycystic Ovary Syndrome (PCOS) and metabolic syndrome: a statistical modelling approach

OBJECTIVE

Polycystic ovary syndrome (PCOS) affects 12-21% of women. Women with PCOS exhibit clustering of metabolic features. We applied rigorous statistical methods to further understand the interplay between PCOS and metabolic features including insulin resistance, obesity and androgen status.

DESIGN

Retrospective cross-sectional analysis.

PATIENTS

Women with PCOS attending reproductive endocrine clinics in South Australia for the treatment of PCOS (n = 172). Women without PCOS (controls) in the same Australian region (n = 335) from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), a national population-based study (age- and BMI-matched within one standard deviation of the PCOS cohort).

MEASUREMENTS

The factor structure for metabolic syndrome for women with PCOS and control groups was examined, specifically, the contribution of individual factors to metabolic syndrome and the association of hyperandrogenism with other metabolic factors.

RESULTS

Women with PCOS demonstrated clustering of metabolic features that was not observed in the control group. Metabolic syndrome in the PCOS cohort was strongly represented by obesity (standardized factor loading = 0·95, P < 0·001) and insulin resistance factors (loading = 0·92, P < 0·001) and moderately by blood pressure (loading = 0·62, P < 0·001) and lipid factors (loading = 0·67, P = 0·002). On further analysis, the insulin resistance factor strongly correlated with the obesity (r = 0·70, P < 0·001) and lipid factors (r = 0·68, P < 0·001) and moderately with the blood pressure factor (loading = 0·43, P = 0·002). The hyperandrogenism factor was moderately correlated with the insulin resistance factor (r = 0·38, P < 0·003), but did not correlate with any other metabolic factors.

CONCLUSIONS

PCOS women are more likely to display metabolic clustering in comparison with age- and BMI-matched control women. Obesity and insulin resistance, but not androgens, are independently and most strongly associated with metabolic syndrome in PCOS.

Obesity and polycystic ovary syndrome

Obesity is now a major international health concern. It is increasingly common in young women with reproductive, metabolic and psychological health impacts. Reproductive health impacts are often poorly appreciated and include polycystic ovary syndrome (PCOS), infertility and pregnancy complications. PCOS is the most common endocrine condition in women and is underpinned by hormonal disturbances including insulin resistance and hyperandrogenism. Obesity exacerbates hormonal and clinical features of PCOS and women with PCOS appear at higher risk of obesity, with multiple underlying mechanisms linking the conditions. Lifestyle intervention is first line in management of PCOS to both prevent weight gain and induce weight loss; however improved engagement and sustainability remain challenges with the need for more research. Medications like metformin, orlistat, GLP1 agonists and bariatric surgery have been used with the need for large scale randomised clinical trials to define their roles.

Risk stratification in early pregnancy for women at increased risk of gestational diabetes

AIM

To evaluate the addition of fasting glucose and lipids to a simple, validated risk prediction tool for gestational diabetes (GDM) applied in early pregnancy.

METHODS

Women at risk of developing GDM on a validated risk prediction tool were recruited in early pregnancy into a large randomised controlled trial. Outcome measures included fasting biochemical markers (glucose, lipids) at 12-15 weeks gestation and GDM diagnosis (28 weeks gestation). Multivariable logistic regression was used to identify additional predictive biochemical variables for GDM, with corresponding receiver operator characteristic (ROC) curves generated. Unadjusted and adjusted models were derived for both the Australasian Diabetes in Pregnancy (ADIPS) and the International Association for Diabetes in Pregnancy Study Group (IADPSG) GDM diagnostic criteria.

RESULTS

51 (23%) Women were diagnosed with GDM based on ADIPS criteria, with 60 (30%) diagnosed based on IADPSG criteria. In all four regression models, fasting glucose was the strongest predictor for GDM development with an odds ratio range of 4.7-6.3 (ADIPS) and 8.8-10 (IADPSG). ROC curves revealed an area under the curve of 0.79 (95% CI: 0.72-0.86) for ADIPS criteria and 0.83 (95% CI: 0.77-0.90) for IADPSG criteria for adjusted models.

CONCLUSIONS

In a two-step approach, when applied with a validated risk prediction tool, fasting glucose in early pregnancy was predictive of GDM and incrementally improved risk identification, presenting potential for an early pregnancy, GDM risk screening strategy for streamlining of pregnancy care and opportunity for preventive intervention.

The mechanics of PLGA nanofiber scaffolds with biomimetic gradients in mineral for tendon-to-bone repair

Attachment of dissimilar materials is prone to failure due to stress concentrations that can arise their interface. A compositionally or structurally graded transition can dissipate these stress concentrations and thereby toughen an attachment. The interface between compliant tendon and stiff bone utilizes a monotonic change in hydroxylapatite mineral ("mineral") content to produce a gradient in mechanical properties and mitigate stress concentrations. Previous efforts to mimic the natural tendon-to-bone attachment have included electrospun nanofibrous polymer scaffolds with gradients in mineral. Mineralization of the nanofiber scaffolds has typically been achieved using simulated body fluid (SBF). Depending on the specific formulation of SBF, mineral morphologies ranged from densely packed small crystals to platelike crystal florets. Although this mineralization of scaffolds produced increases in modulus, the peak modulus achieved remained significantly below that of bone. Missing from these prior empirical approaches was insight into the effect of mineral morphology on scaffold mechanics and on the potential for the approach to ultimately achieve moduli approaching that of bone. Here, we applied two mineralization methods to generate scaffolds with spatial gradations in mineral content, and developed methods to quantify the stiffening effects and evaluate them in the context of theoretical bounds. We asked whether either of the mineralization methods we developed holds potential to achieve adequate stiffening of the scaffold, and tested the hypothesis that the smoother, denser mineral coating could attain more potent stiffening effects. Testing this hypothesis required development of and comparison to homogenization bounds, and development of techniques to estimate mineral volume fractions and spatial gradations in modulus. For both mineralization strategies, energy dispersive X-ray analysis demonstrated the formation of linear gradients in mineral concentration along the length of the scaffolds, and Raman spectroscopic analysis revealed that the mineral produced was hydroxylapatite. Mechanical testing showed that the stiffness gradient using the new method was significantly steeper. By analyzing the scaffolds using micromechanical modeling techniques and extrapolating from our experimental results, we present evidence that the new mineralization protocol has the potential to achieve levels of stiffness adequate to contribute to enhanced repair of tendon-to-bone attachments.

Can the fetal fibronectin test be used by remote dwelling pregnant women to predict the onset of labour at term and delay transfer for birth in regional settings?

INTRODUCTION

The closure of rural maternity units in Australia means an increasing number of women are transferred into major centres to await birth. Accurately excluding the onset of labour could delay relocation. The fetal fibronectin (fFN) test is used to predict preterm birth; however, the accuracy of this test for determining impending term birth is unclear.

METHODS

75 women were recruited to this study from<strong> </strong>two remote maternity units. Eligibility criteria were: aged &&num;8805;18 years, singleton pregnancy, 37+0-40+3 weeks (37 weeks to 40 weeks and 3 days gestation) and no indication for induction of labour or caesarean section in next 7 days. The Quikcheck fFN® test was performed at 37 weeks and then repeated at 7 day intervals. Time-to-birth from test date was modelled using linear regression. Logistic regression models estimated odds of birth within 7 days. Separate models considered first and last test results and those at 38 weeks; adjusted for use of lubricant and gestational age.

RESULTS

A shorter time-to-birth was found in women with positive compared with negative fFN tests; significant at first fFN test (adjusted mean difference [AMD] 5.4 days, 95% CI 2.0-8.8) and 38 weeks (AMD 5.7 days, 95% CI 2.2-9.2 days). A positive test was also associated with a significant increase in the odds of birthing within 7 days: first fFN test adjusted odds ratio (AOR) 11.0 (95% CI 2.5-48.7), 38 weeks test AOR 14.4 (95% CI 3.4-60.2), last fFN test AOR 8.1 (95% CI 1.6-39.8). However, of women who gave birth within 7 days of testing a significant proportion had a negative fFN result; first fFN test 8/17(47.1%), 38 weeks test 4/14(28.6%) and last fFN test 29/58(50.0%).

CONCLUSION

The presence of fFN in cervical secretions was associated with impending term birth but its absence did not reliably exclude the onset of birth. Delaying transfer based on these findings would result in some women birthing in their home communities.