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Sanchez-Lechuga B, Salvucci M, Ng N, Kinsley B, Hatunic M, Kennelly M, Edwards J, Fleming A, Byrne B, Byrne MM. A retrospective cohort study evaluating pregnancy outcomes in women with MIDD. Acta Diabetol 2024; 61:323-331. [PMID: 37907768 DOI: 10.1007/s00592-023-02202-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
AIMS The most common pathogenic mitochondrial mutation associated with mitochondrial disease is m.3243A>G. Increased obstetric complications, such as spontaneous abortion, gestational diabetes (GDM), preterm delivery, and preeclampsia, have been reported in women carrying this mutation. We aimed to determine the fetal and maternal outcomes in pregnant women with mitochondrial disease. METHODS We retrospectively studied the obstetric and perinatal outcomes in 88 pregnancies of 26 women with genetically confirmed mitochondrial disease (m.3243A>G in the MTTL1 gene (n = 25); m.12258C>A in the MT-TS2 gene (n = 1)). Outcomes included pregnancy related complications, mode of delivery, gestational age at delivery and birthweight. RESULTS Mean heteroplasmy rate was 18%. The miscarriage rate was higher than background at 25%. 21 pregnancies (24%) were complicated by GDM; 9 pregnancies (13.6%) had a preterm delivery and 2 of them (3%) an extreme premature delivery < 32 weeks. One woman had preeclampsia and one had a postpartum hemorrhage. The caesarean section (CS) rate was 20%. For every unit increase in maternal heteroplasmy levels there was a 26% increased risk of undergoing an assisted operative vaginal delivery (OR 1.26, 95% CI 1.04-1.53, P = 0.002, Bonferroni corrected P = 0.005) and an 18% increased risk of undergoing a CS (OR 1.18, 95% CI 1.01-1.39, P = 0.01, Bonferroni corrected P = 0.03) compared to a spontaneous vaginal delivery. There was a statistical significant correlation between maternal and offspring heteroplasmy levels. Spearman correlation rho = 0.96, 95% CI 0.78-0.99, P = 0.0002. CONCLUSION Women with mitochondrial disease appear to have more frequent obstetric complications including miscarriage and GDM. Pre-pregnancy diagnosis of m.3243A>G will enable the counseling of women and increase awareness of possible obstetric complications.
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Affiliation(s)
- B Sanchez-Lechuga
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland.
- Rotunda Maternity Hospital, Dublin, Ireland.
| | - M Salvucci
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - N Ng
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
- Rotunda Maternity Hospital, Dublin, Ireland
| | - B Kinsley
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M Hatunic
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
- National Maternity Hospital, Dublin, Ireland
| | - M Kennelly
- Rotunda Maternity Hospital, Dublin, Ireland
| | - J Edwards
- Rotunda Maternity Hospital, Dublin, Ireland
| | - A Fleming
- Rotunda Maternity Hospital, Dublin, Ireland
| | - B Byrne
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M M Byrne
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
- Rotunda Maternity Hospital, Dublin, Ireland
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2
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Bonavita R, Scerra G, Di Martino R, Nuzzo S, Polishchuk E, Di Gennaro M, Williams SV, Caporaso MG, Caiazza C, Polishchuk R, D’Agostino M, Fleming A, Renna M. The HSPB1-p62/SQSTM1 functional complex regulates the unconventional secretion and transcellular spreading of the HD-associated mutant huntingtin protein. Hum Mol Genet 2023; 32:2269-2291. [PMID: 36971475 PMCID: PMC10321397 DOI: 10.1093/hmg/ddad047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 07/20/2023] Open
Abstract
Conformational diseases, such as Alzheimer, Parkinson and Huntington diseases, are part of a common class of neurological disorders characterized by the aggregation and progressive accumulation of proteins bearing aberrant conformations. Huntington disease (HD) has autosomal dominant inheritance and is caused by mutations leading to an abnormal expansion in the polyglutamine (polyQ) tract of the huntingtin (HTT) protein, leading to the formation of HTT inclusion bodies in neurons of affected patients. Interestingly, recent experimental evidence is challenging the conventional view by which the disease pathogenesis is solely a consequence of the intracellular accumulation of mutant protein aggregates. These studies reveal that transcellular transfer of mutated huntingtin protein is able to seed oligomers involving even the wild-type (WT) forms of the protein. To date, there is still no successful strategy to treat HD. Here, we describe a novel functional role for the HSPB1-p62/SQSTM1 complex, which acts as a cargo loading platform, allowing the unconventional secretion of mutant HTT by extracellular vesicles. HSPB1 interacts preferentially with polyQ-expanded HTT compared with the WT protein and affects its aggregation. Furthermore, HSPB1 levels correlate with the rate of mutant HTT secretion, which is controlled by the activity of the PI3K/AKT/mTOR signalling pathway. Finally, we show that these HTT-containing vesicular structures are biologically active and able to be internalized by recipient cells, therefore providing an additional mechanism to explain the prion-like spreading properties of mutant HTT. These findings might also have implications for the turn-over of other disease-associated, aggregation-prone proteins.
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Affiliation(s)
| | | | - R Di Martino
- Institute for Endocrinology and Experimental Oncology “G. Salvatore,” National Research Council, 80131 Naples, Italy
- Institute of Biochemistry and Cell Biology, National Research Council, 80131 Naples, Italy
| | - S Nuzzo
- IRCCS SYNLAB SDN, 80143 Naples, Italy
| | - E Polishchuk
- Telethon Institute of Genetics and Medicine (TIGEM), 80078 Pozzuoli, Italy
| | - M Di Gennaro
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy
| | - S V Williams
- Department of Physiology, Development and Neuroscience, University of Cambridge, CB2 3DY Cambridge, UK
| | - M G Caporaso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy
| | - C Caiazza
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy
| | - R Polishchuk
- Telethon Institute of Genetics and Medicine (TIGEM), 80078 Pozzuoli, Italy
| | - M D’Agostino
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy
| | - A Fleming
- Department of Physiology, Development and Neuroscience, University of Cambridge, CB2 3DY Cambridge, UK
| | - M Renna
- To whom correspondence should be addressed at: Department of Molecular Medicine and Medical Biotechnologies, School of Medicine, University of Naples “Federico II”, Via S. Pansini, 5, Building 19, Corpi Bassi Sud (I floor), 80131 Naples, Italy. Tel: +39 081/7463623, Fax: +39 081-7463205;
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3
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Shah M, Fleming A, Barbosa TM, van der Velden AW, Parveen S, Vellinga A. Point prevalence audit surveys of respiratory tract infection consultations and antibiotic prescribing in primary care before and during the COVID-19 pandemic in Ireland. J Antimicrob Chemother 2023; 78:1270-1277. [PMID: 36974983 PMCID: PMC10154125 DOI: 10.1093/jac/dkad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are the most common reason for prescribing antibiotics in general practice. The COVID-19 pandemic has impacted on antibiotic prescribing and delivery of primary care in Ireland. OBJECTIVES To assess the quality of antibiotic prescribing, the impact of the COVID-19 pandemic and identify opportunities for antimicrobial stewardship (AMS) in Ireland. METHODS Point prevalence audit surveys for RTI consultations were conducted as part of a European study at three time periods: January-February 2020, March-May 2020 and March-May 2021. Antibiotic prescribing was assessed and comparisons made between the three time periods. RESULTS In total, 765 consultations were recorded, which were mainly face to face before the pandemic, but changed to predominantly remote consultations during the pandemic surveys in 2020 and 2021 (82% and 75%). Antibiotics were prescribed in 54% of RTI consultations before the pandemic. During pandemic surveys, this dropped to 23% in 2020 and 21% in 2021. There was a decrease in prescribing of Red (reserve) agents in 2021. Assessment against indication-specific quality indicators showed a high proportion of consultations for bronchitis and tonsillitis resulting in an antibiotic prescription (67% and 85%). Point-of-care testing (POCT) to aid diagnosis of RTIs were utilized in less than 1% of consultations. CONCLUSIONS During the COVID-19 pandemic, there was a reduction in antibiotic prescribing. Opportunities identified to support AMS in primary care in Ireland are targeted initiatives to reduce antibiotic prescribing for bronchitis and tonsillitis and introducing POCT to support appropriate antibiotic prescribing.
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Affiliation(s)
- M Shah
- Chief II Antimicrobial Pharmacist, Health Service Executive, Cork, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - T M Barbosa
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A W van der Velden
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - S Parveen
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - A Vellinga
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
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4
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Lam L, Jackson K, York M, Ufuah S, Zimmerman E, Fleming A, Vinson K, G Russell R. Improving the Clinical Learning Environment as Medical Students Through the Learning Environment Assessment and Feedback Committee. Acad Med 2022; 97:S133. [PMID: 37838866 DOI: 10.1097/acm.0000000000004892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- LeAnn Lam
- Author affiliation: L. Lam, K. Jackson, M. York, S. Ufuah, E. Zimmerman, A. Fleming, K. Vinson, R.G. Russell, Vanderbilt University School of Medicine
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5
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Sutton S, Hayden J, Howlett M, Davies J, Fleming A, Elnazir B, Williamson M, McKone E, Cox D, Linnane B, Quittner A, McNally P. 251 Evaluation of the Medication Electronic Monitoring Systems n adherence measurement in a real-world setting. J Cyst Fibros 2022. [PMCID: PMC9527886 DOI: 10.1016/s1569-1993(22)00941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Sutton S, Hayden J, Howlett M, Davies J, Fleming A, Elnazir B, Williamson M, McKone E, Cox D, Linnane B, Quittner A, McNally P, Lester K. ePS6.10 A real-world study evaluating the impact of elexacaftor/tezacaftor/ivacaftor treatment on medication adherence in cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Mainz J, Fleming A, Elnazir B, Williamson M, McKone E, Cox D, Linnane B, Zagoya C, Davies J, McNally P. P043 Significant reduction in abdominal symptoms assessed with the CFAbd-Score over 6 months of elexacaftor/tezacaftor/ivacaftor (ETI) - follow-up results from Irish and British cystic fibrosis patients (RECOVER study). J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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McNally P, Fleming A, Elnazir B, Williamson M, Cox D, Linnane B, Kirwan L, Saunders C, Tiddens H, Grassemann H, McKone E, Davies J. WS06.02 Impact of one year of treatment with elexacaftor/tezacaftor/ivacaftor on clinical outcomes in people with cystic fibrosis in a real-world setting – the RECOVER study. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Short C, Abkir M, Saunders C, Fleming A, McNally P, Semple T, Davies J. WS19.02 Impact of corrected Multiple Breath nitrogenWashout (MBW) software on assessment of under/unventilated lung units (UVLU) with the MBWShX. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Horgan M, Halleran C, Fleming A. A feasibility study of a pharmacist led proton pump inhibitor deprescribing intervention in older patients in an Irish hospital. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac021.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Proton pump inhibitors (PPIs) are over-prescribed and prescribed inappropriately in the older population and have the potential for long-term adverse effects e.g. increased fracture risk, C. difficile infection, chronic kidney disease and drug interactions (1). Hospitalisation of older patients presents an opportunity for review of the PPI indication and potential for deprescribing.
Aim
The study aimed to assess the feasibility of a pharmacist led intervention to deprescribe inappropriately prescribed PPIs in patients ≥65 years in an Irish teaching hospital.
Methods
A multi-component feasibility intervention consisting of an education session for the medical team, followed by pharmacist-led screening of patients for potential PPI deprescribing, was conducted. The education session was delivered by the pharmacist to a geriatric medical team and the content outlined the prevalence of PPI prescribing, potential long-term effects of PPIs, and implementation of a PPI deprescribing algorithm. Over an eight-week period (May-June 2021), new admissions to the geriatric team were screened daily by the pharmacist and PPI prescribing patterns and indications were recorded. Patients ≥65 years were reviewed for PPI appropriateness based on their medical history and use of a PPI deprescribing algorithm (2). If the PPI was eligible for deprescribing (i.e. dose reduction or discontinuation) this was discussed with the geriatric team and the patient’s primary care general practitioner (GP) and the patient. Patients were counselled and educated on this by the pharmacist. Patients whose PPI was deprescribed were followed up at 4- and 12- weeks post deprescribing to assess their symptoms and satisfaction with deprescribing in the interim period. An online survey was sent to the geriatric team doctors evaluating their views on the study process and implementation of PPI deprescribing in practice; data was analysed descriptively using Microsoft Excel®. Written, informed consent was obtained from all patients and doctors involved.
Results
Of a total of 133 patient charts reviewed over the 8-week period, 94 patients were prescribed a PPI, with esomeprazole 40mg (43/94, 45.7%) being most commonly prescribed PPI, followed by pantoprazole 40mg (17/94, 18.1%). PPIs were inappropriately prescribed as per the indication in 36 cases (36/94, 38.3%). Following GP and Geriatric team discussion, 7/94 (7.4%) of patients were eligible for deprescribing, of which 5 had their PPI dose reduced (5/94, 5.3%). One patient declined the deprescribing, in another case the GP declined the deprescribing recommendation. The 5 patients deprescribed had their esomeprazole 40mg daily dose reduced to 20mg daily. This was sustained at the 12-week follow up and patients reported satisfaction with the change with no negative outcomes reported.
Of the 12 geriatric doctors in the study, 6 completed the online survey. The majority reported barriers to PPI deprescribing being uncertainty regarding the indication (5/6) and being unable to monitor the patient after hospital discharge (5/6). All doctors agreed that pharmacists have a positive role to play in implementing PPI deprescribing.
Conclusion
This study found that esomeprazole 40mg daily was the most commonly prescribing PPI in this hospital cohort, with the majority of PPI prescribing found to be inappropriate according to the indication. The feasibility study resulted in a number of patients having their PPI safely deprescribed with a dose reduction. Despite the limitation of a small sample size and small rates of deprescribing, a strength of the study was that a pharmacist led PPI deprescribing initiative resulted in reducing inappropriate PPI prescribing in older patients, with positive engagement from the geriatric medical team. Further resources and research are required to implement this initiative on a wider scale.
References
(1) Wilsdon TD, Hendrix I, Thynne TR, Mangoni AA. Effectiveness of Interventions to Deprescribe Inappropriate Proton Pump Inhibitors in Older Adults. Drugs Aging. 2017 Apr;34(4):265-287. doi: 10.1007/s40266-017-0442-1. PMID: 28220380.
(2) National Health Service. Proton Pump Inhibitor (PPI): Deprescribing algorithm (adult) [Internet]. [cited 2021 Aug 6]. Available from: https://www.dorsetccg.nhs.uk/Downloads/aboutus/medicines-management/Other Guidelines/prescqipp proton-pump-inhibitor-desprescribing-algorithm.pdf
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Affiliation(s)
- M Horgan
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - C Halleran
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork
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11
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Balchaites A, McCarthy S, Fleming A. Exploring the human factors of medication errors in community pharmacy: a mixed methods study. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac019.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Medication errors and near misses in the community pharmacy dispensing process have the potential to adversely impact patient safety. The World Health Organisation has identified the importance of Human factors (HF) in the Patient Safety Curriculum guide (1). However, there is a lack of knowledge on how HF principles have or could be applied in the community pharmacy setting. Adopting a HF approach and using qualitative methods can provide in-depth understanding of factors that contribute to these errors, and contribute to intervention development that may improve patient safety.
Aim
The study aims to investigate the factors contributing to medication dispensing errors and near misses in community pharmacy, and to gather pharmacists’ views of these factors and how these could be mitigated.
Methods
Three Irish community pharmacies were recruited and provided details of the last ten dispensing errors or near misses which occurred. Each error was mapped to the Hierarchical Task Analysis (HTA) steps developed for this study, and mapped to the Systematic Human Error Reduction and Prediction Approach (SHERPA) framework (2). A detailed report was prepared for each pharmacy outlining the error analysis, with recommendations to prevent the errors in future. A qualitative semi-structured interview was conducted with the three pharmacists in the recruited pharmacies to discuss the report, and analysed by thematic analysis.
Results
A total of 30 medication errors/near misses were analysed (10 errors reached the patients and were not administered). The HTA developed outlines 185 subtasks potentially involved in dispensing a prescribed medication. On mapping to the SHERPA framework, selection-based errors were the most frequently reported error category (21/30, 70%); this included incorrect product selection from the shelf (17/30, 56.7%) and incorrect product selection at the point of computer entry (4/30, 13.3%). Of the 75 HTA steps involved across the 30 errors, the most frequent point of error was in the gathering medication steps (47/75, 62.7%), followed by the pharmacist accuracy check steps (16/75, 21.3%) and patient mix up errors (5/30, 16.7%). The pharmacist interview themes found that cognitive burden, fatigue, distraction and staffing deficiencies were reported as increasing the risk of error and near miss. Knowledge gaps and inexperience with certain medications were also reported as contributing to errors. Recommendations to prevent errors included changes to the physical environment (e.g. using product shelf alerts), improved checking processes and taking short mental breaks.
Conclusion
This study found that the most common errors/near misses were at the product selection stage of dispensing, with pharmacy accuracy checks sometimes, but not always, detecting these before they reached the patient. Medication errors occur due to several varying and often interacting factors; cognitive burden and lack of standardised medication checking processes. Despite the small sample size and potential for social desirability bias in the interviews, this study has demonstrated how HF techniques can be applied to the dispensing process as a means of understanding and preventing error occurrence in the community pharmacy.
References
(1) Vosper H, Hignett S. A UK perspective on human factors and patient safety education in pharmacy Curricula. Am J Pharm Educ. 2017;82:6184.
(2) Sutherland A, Ashcroft DM, Phipps DL. Exploring the human factors of prescribing errors in paediatric intensive care units. Arch Dis Child 2019;104:588-595.
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Affiliation(s)
- A Balchaites
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - S McCarthy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - A Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
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Barbosa TM, Fleming A, Crowley E, O’Connor A, Costello L, McCarthy S. P04 An evaluation of antimicrobial stewardship education in the School of Pharmacy of an Irish university—a mixed methods study. JAC Antimicrob Resist 2022. [PMCID: PMC8849434 DOI: 10.1093/jacamr/dlac004.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Antimicrobial stewardship (AMS) is essential to control the emergence of antimicrobial resistance (AMR) which has become an international health priority. Education of undergraduate students on AMS and AMR is a strategic objective in the WHO Global Action Plan on AMR and Ireland's National Action Plan.1,2 Research on AMS/AMR education has focused primarily on medical students with less emphasis on those from other healthcare profession including pharmacy students. Objectives To investigate AMS and AMR education in the Pharmacy undergraduate programme in the School of Pharmacy of an Irish University. Methods A mixed methods study was conducted. Ten semi-structured interviews were conducted in October 2019 with academic staff to capture their views on AMS education. Participants included staff members from different disciplines, those identified as involved in teaching elements of infectious disease, antibiotics, AMS and related topics, and those involved in curriculum design and approval within the School of Pharmacy. Interview transcripts were analysed by thematic analysis. An electronic survey of 17 questions was emailed to all second to fifth year UCC Pharmacy students in October 2019 to gather students’ views and experiences of AMS education. The survey contained four sections which addressed demographics, AMS, resources and education using open-ended, closed-ended or Likert-scale questions. Ethical approval was obtained. Results Six key themes were identified from the ten interviews: (i) curriculum priorities and capacity; (ii) housing of the subject, fragmentation and cohesion; (iii) integration; (iv) communication; (v) teaching methods; and (vi) assessment methods. 113 students participated in the survey (32.3% response rate). 96% agree that a strong knowledge of antimicrobials for their future careers is important, and over 89% of students desire more education on AMR and AMS. Only 43% of students found their AMS education provided sufficient preparation for practice. Students felt most prepared to recognize clinical signs of infection and least prepared for IV to oral switching, interpreting biological marker and de-escalation of antimicrobials. Over 50% of students never used or were not familiar with the national primary care antimicrobial guidelines: www.antibioticprescribing.ie. Conclusions Pharmacy students and staff agree that AMS and AMR are important and need enhanced educational focus. Students feel there are gaps in their AMS education and expressed a desire for more education in this area. Improved communication and identification of curriculum priorities by staff could help to establish a more cohesive and comprehensive educational approach to this area.
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Affiliation(s)
- T. M. Barbosa
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - A. Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - E. Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - A. O’Connor
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - L. Costello
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - S. McCarthy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
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13
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Burton E, O’Driscoll M, Fleming A. The protected antimicrobial process in a University Teaching Hospital: a qualitative interview study exploring the knowledge, attitudes, and experiences of healthcare professionals. Int J Clin Pharm 2022; 44:630-640. [PMID: 35124762 PMCID: PMC9200682 DOI: 10.1007/s11096-022-01381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/21/2022] [Indexed: 11/05/2022]
Abstract
AbstractBackground The protected or restricted supply of certain antimicrobials such as linezolid, caspofungin, aztreonam, in the acute hospital setting is an important element of Antimicrobial Stewardship (AMS) programmes to address the growing problem of antimicrobial resistance. This process involves submitting an application for use to be reviewed typically by a Consultant Microbiologist, Infectious Disease Consultant or Antimicrobial Pharmacist. Aim To investigate healthcare professionals’ knowledge, experiences, and attitudes towards the protected/restricted antimicrobials process in order to identify possible methods of optimisation and improvement. Method Semi-structured interviews with stakeholders involved in the protected/restricted antimicrobial prescribing, dispensing and administration process were conducted in September–October 2019 in a 350-bed voluntary, general, acute hospital in Ireland. Interviews were analysed by the Framework method and mapped to the Theoretical Domains Framework (TDF). Results Interviews were conducted with 8 Doctors, 4 Pharmacists and 3 Nurses. TDF domains identified included: ‘Knowledge’; ‘Social/professional role and identity’; ‘Social influences’; ‘Memory, attention and decision processes’; ‘Beliefs about consequences’; ‘Environmental contexts and resources’. The relationship between prescribers and the AMS Team was reported as a facilitator of the process, whereas the inconsistency of the filing and versions of forms on the wards were seen as challenges. Conclusion The results of this study have shown that the existing protected/restricted antimicrobial process is a multi-disciplinary effort with barriers that require attention in order to make future improvements. Standardization of the form across all wards, an electronic version of the form, and structured education around AMS were suggested to optimize the process.
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Farmery AK, Alexander K, Anderson K, Blanchard JL, Carter CG, Evans K, Fischer M, Fleming A, Frusher S, Fulton EA, Haas B, MacLeod CK, Murray L, Nash KL, Pecl GT, Rousseau Y, Trebilco R, van Putten IE, Mauli S, Dutra L, Greeno D, Kaltavara J, Watson R, Nowak B. Food for all: designing sustainable and secure future seafood systems. Rev Fish Biol Fish 2022; 32:101-121. [PMID: 34092936 PMCID: PMC8164055 DOI: 10.1007/s11160-021-09663-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2021] [Indexed: 05/19/2023]
Abstract
UNLABELLED Food from the sea can make a larger contribution to healthy and sustainable diets, and to addressing hunger and malnutrition, through improvements in production, distribution and equitable access to wild harvest and mariculture resources and products. The supply and consumption of seafood is influenced by a range of 'drivers' including ecosystem change and ocean regulation, the influence of corporations and evolving consumer demand, as well as the growing focus on the importance of seafood for meeting nutritional needs. These drivers need to be examined in a holistic way to develop an informed understanding of the needs, potential impacts and solutions that align seafood production and consumption with relevant 2030 Sustainable Development Goals (SDGs). This paper uses an evidence-based narrative approach to examine how the anticipated global trends for seafood might be experienced by people in different social, geographical and economic situations over the next ten years. Key drivers influencing seafood within the global food system are identified and used to construct a future scenario based on our current trajectory (Business-as-usual 2030). Descriptive pathways and actions are then presented for a more sustainable future scenario that strives towards achieving the SDGs as far as technically possible (More sustainable 2030). Prioritising actions that not only sustainably produce more seafood, but consider aspects of access and utilisation, particularly for people affected by food insecurity and malnutrition, is an essential part of designing sustainable and secure future seafood systems. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11160-021-09663-x.
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Affiliation(s)
- A. K. Farmery
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
| | - K. Alexander
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K. Anderson
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
| | - J. L. Blanchard
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C. G. Carter
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K. Evans
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - M. Fischer
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - A. Fleming
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Land and Water, Hobart, TAS Australia
| | - S. Frusher
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - E. A. Fulton
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - B. Haas
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C. K. MacLeod
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - L. Murray
- College of Health, Massey University, Massey, New Zealand
| | - K. L. Nash
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - G. T. Pecl
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - Y. Rousseau
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - R. Trebilco
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - I. E. van Putten
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - S. Mauli
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - L. Dutra
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - D. Greeno
- College of Arts, Law and Education, University of Tasmania, Hobart, TAS Australia
| | - J. Kaltavara
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - R. Watson
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - B. Nowak
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
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Farmery AK, Alexander K, Anderson K, Blanchard JL, Carter CG, Evans K, Fischer M, Fleming A, Frusher S, Fulton EA, Haas B, MacLeod CK, Murray L, Nash KL, Pecl GT, Rousseau Y, Trebilco R, van Putten IE, Mauli S, Dutra L, Greeno D, Kaltavara J, Watson R, Nowak B. Food for all: designing sustainable and secure future seafood systems. Rev Fish Biol Fish 2022; 32:101-121. [PMID: 34092936 DOI: 10.22541/au.160322471.16891119/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2021] [Indexed: 05/23/2023]
Abstract
UNLABELLED Food from the sea can make a larger contribution to healthy and sustainable diets, and to addressing hunger and malnutrition, through improvements in production, distribution and equitable access to wild harvest and mariculture resources and products. The supply and consumption of seafood is influenced by a range of 'drivers' including ecosystem change and ocean regulation, the influence of corporations and evolving consumer demand, as well as the growing focus on the importance of seafood for meeting nutritional needs. These drivers need to be examined in a holistic way to develop an informed understanding of the needs, potential impacts and solutions that align seafood production and consumption with relevant 2030 Sustainable Development Goals (SDGs). This paper uses an evidence-based narrative approach to examine how the anticipated global trends for seafood might be experienced by people in different social, geographical and economic situations over the next ten years. Key drivers influencing seafood within the global food system are identified and used to construct a future scenario based on our current trajectory (Business-as-usual 2030). Descriptive pathways and actions are then presented for a more sustainable future scenario that strives towards achieving the SDGs as far as technically possible (More sustainable 2030). Prioritising actions that not only sustainably produce more seafood, but consider aspects of access and utilisation, particularly for people affected by food insecurity and malnutrition, is an essential part of designing sustainable and secure future seafood systems. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11160-021-09663-x.
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Affiliation(s)
- A K Farmery
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
| | - K Alexander
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K Anderson
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
| | - J L Blanchard
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C G Carter
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K Evans
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - M Fischer
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - A Fleming
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Land and Water, Hobart, TAS Australia
| | - S Frusher
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - E A Fulton
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - B Haas
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C K MacLeod
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - L Murray
- College of Health, Massey University, Massey, New Zealand
| | - K L Nash
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - G T Pecl
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - Y Rousseau
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - R Trebilco
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - I E van Putten
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - S Mauli
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - L Dutra
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - D Greeno
- College of Arts, Law and Education, University of Tasmania, Hobart, TAS Australia
| | - J Kaltavara
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - R Watson
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - B Nowak
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
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O'Riordan F, Shiely F, Byrne S, O'Brien D, Ronayne A, Fleming A. Antimicrobial use and antimicrobial resistance in Enterobacterales and Enterococcus faecium: a time series analysis. J Hosp Infect 2021; 120:57-64. [PMID: 34780809 DOI: 10.1016/j.jhin.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Irish and European antimicrobial resistance (AMR) surveillance data have highlighted increasing AMR in Enterobacterales and vancomycin resistance in Enterococcus faecium (VRE). Antimicrobial consumption (AC) in Irish hospital settings is also increasing. METHODS A retrospective time series analysis (TSA) was conducted to evaluate the trends and possible relationship between AC of selected antimicrobials and AMR in Enterobacterales and vancomycin resistance in E. faecium, from January 2017 to December 2020. RESULTS Increased AC was seen with ceftriaxone (p= 0.0006), piperacillin/tazobactam (p = 0.03) and meropenem (p = 0.05), while ciprofloxacin and gentamicin use trended downwards. AMR rates in E. coli, K. pneumoniae and other Enterobacterales were largely stable, an increase in ertapenem resistance in the latter from 0.58% in 2017 to 5.19% in 2020 (p= 0.003) being the main concern. The proportion of E. faecium that was VRE did not changed significantly (64% in 2017; 53% in 2020, p = 0.1). TSA identified a correlation between piperacillin/tazobactam use and the decreasing rate of ceftriaxone resistance in E. coli. CONCLUSION Our data suggest that hospital antimicrobial stewardship programme is largely containing, but not reducing AMR in key nosocomial pathogens. An increase in AC following the COVID-19 pandemic appears as yet to have had no impact on AMR rates.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Ronayne
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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17
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McNally P, Fleming A, Elnazir B, Williamson M, Cox D, Linnane B, Kirwan L, Saunders C, Tiddens H, Grassemann H, McKone E, Davies J. 564: Impact of elexacaftor/tezacaftor/ivacaftor treatment on clinical outcomes in people with CF in a real-world setting—The RECOVER trial. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01987-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Mainz J, Davies J, Fleming A, Elnazir B, Williamson M, McKone E, Cox D, Linnane B, Zagoya C, McNally P. 565: Significant reduction in abdominal symptoms assessed with CFAbd score over 4 weeks of treatment with elexacaftor/tezacaftor/ivacaftor—First results from the RECOVER study. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01988-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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York M, Langford K, Davidson M, Hemingway C, Russell R, Neeley M, Fleming A. Becoming Active Bystanders and Advocates: Teaching Medical Students to Respond to Bias in the Clinical Setting. MedEdPORTAL 2021; 17:11175. [PMID: 34485695 PMCID: PMC8374028 DOI: 10.15766/mep_2374-8265.11175] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/20/2021] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Incidents of bias and microaggressions are prevalent in the clinical setting and are disproportionately experienced by racial minorities, women, and medical students. These incidents contribute to burnout. Published efforts to address these incidents are growing, but gaps remain regarding the long-term efficacy of these curricular models. We developed and longitudinally evaluated a workshop that taught medical students a framework to respond to incidents of bias or microaggressions. METHODS In October 2019, 102 Vanderbilt core clerkship medical students participated in an hour-long, interactive, case-based workshop centered around the 3 D's response behavior framework: (1) direct, (2) distract, and (3) delegate. Participants were surveyed before and after the training, and both qualitative and quantitative data were collected. A refresher workshop was offered 8 months later, which added two additional D's: delay and display discomfort. RESULTS After the workshop, respondents' knowledge of the assessed topics improved significantly, as did their confidence in addressing both personally experienced and witnessed incidents. Respondents initially indicated a high likelihood of using response behaviors to address incidents. The workshop did not consistently modify behavioral responses to experienced or witnessed incidents. Ninety-one percent of respondents agreed the workshop was effective. DISCUSSION This workshop provided an effective curriculum to sustainably improve participant knowledge and confidence in responding to incidents of bias and microaggressions. This resource can be adopted by educators at other institutions.
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Affiliation(s)
- Michelle York
- Medical Student, Vanderbilt University School of Medicine
| | - Kyle Langford
- Medical Student, Vanderbilt University School of Medicine
| | - Mario Davidson
- Assistant Professor, Department of Biostatistics, Vanderbilt University Medical Center
| | - Celeste Hemingway
- Assistant Professor, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
| | - Regina Russell
- Assistant Professor, Department of Medical Education and Administration, Vanderbilt University
| | - Maya Neeley
- Assistant Professor, Department of Pediatrics, Vanderbilt University Medical Center
| | - Amy Fleming
- Associate Dean of Student Affairs, Vanderbilt University School of Medicine
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20
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Jurich D, Daniel M, Hauer KE, Seibert C, Chandran L, Pock AR, Fazio SB, Fleming A, Santen SA. Does Delaying the United States Medical Licensing Examination Step 1 to After Clerkships Affect Student Performance on Clerkship Subject Examinations? Teach Learn Med 2021; 33:366-381. [PMID: 33356583 DOI: 10.1080/10401334.2020.1860063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Phenomenon: Schools are considering the optimal timing of Step 1 of the United States Medical Licensing Examination (USMLE). Two primary reasons for moving Step 1 after the core clerkships are to promote deeper, more integrated basic science learning in clinical contexts and to better prepare students for the increasingly clinical focus of Step 1. Positioning Step 1 after the core clerkships leverages a major national assessment to drive learning, encouraging students to deepen their basic science knowledge while in the clinical setting. Previous studies demonstrated small increases in Step 1 scores, reductions in failure rates, and similar Step 2 Clinical Knowledge scores when Step 1 was after the clerkships. Some schools that have moved Step 1 reported declines in clinical subject examination (CSE) performance. This may be due to shortened pre-clerkship curricula, the absence of the Step 1 study period for knowledge consolidation, or exposure to fewer National Board of Medical Examiners type questions prior to taking CSEs. This multi-institutional study aimed to determine whether student performance on CSEs was affected by moving Step 1 after the core clerkships. Approach: CSE scores for students from eight schools that moved Step 1 after core clerkships between 2012 and 2016 were analyzed in a pre-post format. Hierarchical linear modeling was used to quantify the effect of the curriculum on CSE performance. Additional analysis determined if clerkship order impacted clinical subject exam performance and whether the curriculum change resulted in more students scoring in the lowest percentiles (as defined as below the national fifth percentile) before and after the curricular change. Findings: After moving Step 1 to after the clerkships, collectively these eight schools demonstrated statistically significant lower performance on four CSEs (Medicine, Neurology, Pediatrics, and Surgery) but not Obstetrics/Gynecology or Psychiatry. Comparing performance within the three years pre and post Step 1 change, differences across all clerkships ranged from 0.3 to -2.0 points, with an average difference of -1.1. CSE performance in clerkships taken early in the sequence was more affected by the curricular change, and differences gradually disappeared with subsequent examinations. Medicine and Neurology showed the largest average differences between curricular-group when taken early in the clinical year. Finally, there was a slightly higher chance of scoring below the national fifth percentile in four of the clinical subject exams (Medicine, Neurology, Pediatrics, and Psychiatry) for the cohort with Step 1 after the clerkships. Insights: Moving Step 1 after core clerkships had a small impact on CSE scores overall, with decreased scores for exams early in the clerkship sequence and an increased number of students below the fifth percentile. Score differences have minor effects on clerkship grades, but overall the size of the effect is unlikely to be educationally meaningful. Schools can use a variety of mitigation strategies to address CSE performance and Step 1 preparation in the clerkship phase.
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Affiliation(s)
- Daniel Jurich
- National Board of Medical Examiners, Philadelphia, Pennsylvania, USA
| | - Michelle Daniel
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Karen E Hauer
- Department of Medicine, University of California School of Medicine, San Francisco, California, USA
| | - Christine Seibert
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Latha Chandran
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, New York, New York, USA
| | - Arnyce R Pock
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara B Fazio
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Fleming
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sally A Santen
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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21
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O'Riordan F, Shiely F, Byrne S, Fleming A. Quality indicators for hospital antimicrobial stewardship programmes: a systematic review. J Antimicrob Chemother 2021; 76:1406-1419. [PMID: 33787876 DOI: 10.1093/jac/dkab034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measuring the quality and effectiveness of antimicrobial stewardship (AMS) programmes with quality indicators (QIs) is an area of increasing interest. We conducted a systematic review to identify QIs of AMS programmes in the hospital setting and critically appraise their methodological quality. METHODS We searched the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHL, Scopus/web of science databases and the grey literature for studies that defined and/or described the development process and characteristics of the QIs developed. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument was used to critically appraise the methodological quality of the QI sets. RESULTS We identified 16 studies of QI sets consisting of 229 QIs. The QI sets addressed a broad range of areas of AMS in the hospital setting and consisted of 75% process indicators, 24% structural indicators and 1% outcome indicators. There was a wide variation in the information and level of detail presented describing the methodological characteristics of the QI sets identified. CONCLUSIONS The QIs identified in this study focused on process and structural indicators with few outcome indicators developed-a major deficiency in this area. Future research should focus on the development of outcome indicators or the use of process or structural indicators linked to outcomes to assess AMS. Testing of the QIs in practice is an essential methodological element of the QI development process and should be included in the QI development study or as planned validation work.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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22
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O'Riordan F, Shiely F, Byrne S, Fleming A. A qualitative process evaluation of the introduction of procalcitonin testing as an antimicrobial stewardship intervention. Int J Clin Pharm 2020; 43:532-540. [PMID: 33001314 DOI: 10.1007/s11096-020-01159-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Background Successful antimicrobial stewardship interventions are imperative in today's environment of antimicrobial resistance. New antimicrobial stewardship interventions should include qualitative analysis such as a process evaluation to determine which elements within an intervention are effective and provide insight into the context in which the intervention is introduced. Objective To assess the implementation process and explore the contextual factors which influenced implementation. Setting An academic teaching hospital in Cork, Ireland. Methods A process evaluation was conducted on completion of a feasibility study of the introduction of a procalcitonin antimicrobial stewardship intervention. The process evaluation consisted of semi-structured face-to-face interviews of key stakeholders including participating (senior) doctors (5), medical laboratory scientists (3) and a hospital administrator. The Consolidated Framework for Implementation Research was used to guide data collection, analysis, and interpretation. Main outcome measures Qualitative assessment of the intervention implementation process, the contextual factors which influenced implementation and identification of improvements to the intervention and its implementation and determine if proceeding to a randomised controlled trial would be appropriate. Results Analysis of the interviews identified three main themes. (1) The procalcitonin intervention and implementation process was viewed positively to support prescribing decisions. Participants identified modifications to procalcitonin processing and availability to improve implementation and allow procalcitonin to be "more of a clinical influence". (2) In the antimicrobial stewardship context the concept of fear of missing an infection and risks of potentially serious outcomes for patients emerged. (3) The hospital context consisted of barriers such as available resources and facilitators including the hospital culture of quality improvement. Conclusion This process evaluation provides a detailed analysis of the implementation of procalcitonin testing as an antimicrobial stewardship intervention. The positive findings of this process evaluation and feasibility study should be built upon and a full randomised controlled trial and economic evaluation should be conducted in a variety of hospital settings to confirm the effectiveness of procalcitonin as an antimicrobial stewardship intervention.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland. .,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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23
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O'Riordan F, Shiely F, Byrne S, O'Brien D, Palmer B, Dahly D, O'Connor TM, Curran D, Fleming A. An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: a feasibility study. J Antimicrob Chemother 2020; 74:3352-3361. [PMID: 31325313 DOI: 10.1093/jac/dkz313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/03/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diagnostic uncertainty and a high prevalence of viral infections present unique challenges for antimicrobial prescribing for respiratory tract infections (RTIs). Procalcitonin (PCT) has been shown to support prescribing decisions and reduce antimicrobial use safely in patients with RTIs, but recent study results have been variable. METHODS We conducted a feasibility study of the introduction of PCT testing in patients admitted to hospital with a lower RTI to determine if PCT testing is an effective and worthwhile intervention to introduce to support the existing antimicrobial stewardship (AMS) programme and safely decrease antimicrobial prescribing in patients admitted with RTIs. RESULTS A total of 79 patients were randomized to the intervention PCT-guided treatment group and 40 patients to the standard care respiratory control group. The addition of PCT testing led to a significant decrease in duration of antimicrobial prescriptions (mean 6.8 versus 8.9 days, P = 0.012) and decreased length of hospital stay (median 7 versus 8 days, P = 0.009) between the PCT and respiratory control group. PCT did not demonstrate a significant reduction in antimicrobial consumption when measured as DDDs and days of therapy. CONCLUSIONS PCT testing had a positive effect on antimicrobial prescribing during this feasibility study. The successful implementation of PCT testing in a randomized controlled trial requires an ongoing comprehensive education programme, greater integration into the AMS programme and delivery of PCT results in a timely manner. This feasibility study has shown that a larger randomized controlled trial would be beneficial to further explore the positive aspects of these findings.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - B Palmer
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - D Dahly
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - T M O'Connor
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - D Curran
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Swan Sein A, Daniel M, Fleming A, Morrison G, Christner JG, Esposito K, Pock AR, Grochowski CO, Dalrymple JL, Santen SA. Identifying and Supporting Students to Prevent USMLE Step 1 Failures When Testing Follows Clerkships: Insights From 9 Schools. Acad Med 2020; 95:1338-1345. [PMID: 32134786 DOI: 10.1097/acm.0000000000003272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several schools have moved the United States Medical Licensing Examination Step 1 exam after core clerkships, and others are considering this change. Delaying Step 1 may improve Step 1 performance and lower Step 1 failure rates. Schools considering moving Step 1 are particularly concerned about late identification of struggling students and late Step failures, which can be particularly problematic due to reduced time to remediate and accumulated debt if remediation is ultimately unsuccessful. In the literature published to date, little attention has been given to these students. In this article, authors from 9 medical schools with a postclerkship Step 1 exam share their experiences. The authors describe curricular policies, early warning and identification strategies, and interventions to enhance success for all students and struggling students in particular. Such learners can be identified by understanding challenges that place them "at risk" and by tracking performance outcomes, particularly on other standardized assessments. All learners can benefit from early coaching and advising, mechanisms to ensure early feedback on performance, commercial study tools, learning specialists or resources to enhance learning skills, and wellness programs. Some students may need intensive tutoring, neuropsychological testing and exam accommodations, board preparation courses, deceleration pathways, and options to postpone Step 1. In rare instances, a student may need a compassionate off-ramp from medical school. With the National Board of Medical Examiner's announcement that Step 1 scoring will change to pass/fail as early as January 2022, residency program directors might use failing Step 1 scores to screen out candidates. Institutions altering the timing of Step 1 can benefit from practical guidance by those who have made the change, to both prevent Step 1 failures and minimize adverse effects on those who fail.
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Affiliation(s)
- Aubrie Swan Sein
- A. Swan Sein is director of the Center for Education Research and Evaluation, and assistant professor of educational assessment in pediatrics and dental medicine, Columbia Vagelos College of Physicians and Surgeons, New York City, New York; ORCID: 0000-0002-3139-4626
| | - Michelle Daniel
- M. Daniel is assistant dean for curriculum and associate professor, departments of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119
| | - Amy Fleming
- A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Gail Morrison
- G. Morrison is the William Maul Measey president's distinguished professor in medical education, executive director, Innovation Center for Online Medical Education, and former senior vice dean for education and director of academic programs, Raymond and Ruth Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer G Christner
- J.G. Christner is dean and the Cullen Trust for Higher Education dean's endowed chair, Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Karin Esposito
- K. Esposito is professor of psychiatry and behavioral health and executive associate dean for student affairs, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Arnyce R Pock
- A.R. Pock is associate professor of medicine and associate dean for curriculum, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Colleen O Grochowski
- C.O. Grochowski is associate dean for curricular affairs and associate professor of the practice of medical education, Duke University School of Medicine, Durham, North Carolina
| | - John L Dalrymple
- J.L. Dalrymple is associate dean for medical education quality improvement and associate professor of obstetrics, gynecology and reproductive biology, Harvard Medical School, Boston, Massachusetts
| | - Sally A Santen
- S.A. Santen is senior associate dean of evaluation, assessment and scholarship of learning, and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Freitas P, Oliveira H, Silva F, Fleming A, Miglior F, Schenkel F, Brito L. Genomic analyses for predicted milk fatty acid composition throughout lactation in North American Holstein cattle. J Dairy Sci 2020; 103:6318-6331. [DOI: 10.3168/jds.2019-17628] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
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26
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Harnik V, Santen SA, Fleming A, Sein AS. In Reply to Green et al. Acad Med 2020; 95:665-666. [PMID: 32345873 DOI: 10.1097/acm.0000000000003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vicky Harnik
- Associate dean of curriculum, associate professor of cell biology, New York University Grossman School of Medicine, New York, New York; . Senior associate dean of evaluation, assessment and scholarship of learning, and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia; formerly at University of Michigan Medical School, Ann Arbor, Michigan. Associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. Director, Center for Education Research and Evaluation, and assistant professor of educational assessment in pediatrics and dental medicine, Columbia Vagelos College of Physicians and Surgeons, New York, New York
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Malchiodi F, Jamrozik J, Christen AM, Fleming A, Kistemaker GJ, Richardson C, Daniel V, Kelton DF, Schenkel FS, Miglior F. Symposium review: Multiple-trait single-step genomic evaluation for hoof health. J Dairy Sci 2020; 103:5346-5353. [PMID: 32331881 DOI: 10.3168/jds.2019-17755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/17/2020] [Indexed: 11/19/2022]
Abstract
Hoof lesions represent an important issue in modern dairy herds, with reported prevalence in different countries ranging from 40 to 70%. This high prevalence of hoof lesions has both economic and social consequences, resulting in increased labor expenses and decreasing animal production, longevity, reproduction, health, and welfare. Therefore, a key goal of dairy herds is to reduce the incidence of hoof lesions, which can be achieved both by improving management practices and through genetic selection. The Canadian dairy industry has recently released a hoof health sub-index. This national genetic evaluation program for hoof health was achieved by creating a centralized data collection system that routinely transfers data recorded by hoof trimmers into a coherent and sustainable national database. The 8 most prevalent lesions (digital dermatitis, interdigital dermatitis, interdigital hyperplasia, heel horn erosion, sole hemorrhage, sole ulcer, toe ulcer, and white line lesion) in Canada are analyzed with a multiple-trait model using a single-step genomic BLUP method. Estimated genomic breeding values for each lesion are combined into a sub-index according to their economic value and prevalence. In addition, data recorded within this system were used to create an interactive management report for dairy producers by Canadian DHI, including the prevalence of lesions on farm, their trends over time, and benchmarks with provincial and national averages.
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Affiliation(s)
- F Malchiodi
- Semex Alliance, Guelph, ON, N1H 6J2, Canada; Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 1Y2, Canada.
| | - J Jamrozik
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 1Y2, Canada; Lactanet Canada, Guelph, ON N1K 1E5, Canada
| | - A-M Christen
- Lactanet Canada, Sainte-Anne-de-Bellevue, QC H9X 3R4, Canada
| | - A Fleming
- Lactanet Canada, Guelph, ON N1K 1E5, Canada
| | | | - C Richardson
- School of Applied Systems Biology, La Trobe University, Bundoora, Victoria 3086, Australia
| | - V Daniel
- Vic's Custom Clips, Arva, ON N0M 1C0, Canada
| | - D F Kelton
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 1Y2, Canada
| | - F S Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 1Y2, Canada
| | - F Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 1Y2, Canada
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Freitas PHF, Oliveira HR, Silva FF, Fleming A, Schenkel FS, Miglior F, Brito LF. Short communication: Time-dependent genetic parameters and single-step genome-wide association analyses for predicted milk fatty acid composition in Ayrshire and Jersey dairy cattle. J Dairy Sci 2020; 103:5263-5269. [PMID: 32307163 DOI: 10.3168/jds.2019-17820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/28/2020] [Indexed: 12/27/2022]
Abstract
Milk fat content and fatty acid (FA) composition have great economic value to the dairy industry as they are directly associated with taste and chemical-physical characteristics of milk and dairy products. In addition, consumers' choices are not only based on the nutritional aspects of food, but also on products known to promote better health. Milk FA composition is also related to the metabolic status and physiological stages of cows and thus can also be used as indicator for other novel traits of interest (e.g., metabolic diseases and methane yield). Genetic selection is a promising alternative to manipulate milk FA composition. In this study, we aimed to (1) estimate time-dependent genetic parameters for 5 milk FA groups (i.e., short-chain, medium-chain, long-chain, saturated, and unsaturated) predicted based on milk mid-infrared spectroscopy, for Canadian Ayrshire and Jersey breeds, and (2) conduct a time-dependent, single-step genome-wide association study to identify genomic regions, candidate genes, and metabolic pathways associated with milk FA. We analyzed 31,709 test-day records of 9,648 Ayrshire cows from 268 herds, and 34,341 records of 11,479 Jersey cows from 883 herds. The genomic database contained a total of 2,330 Ayrshire and 1,019 Jersey animals. The average daily heritability ranged from 0.18 (long-chain FA) to 0.34 (medium-chain FA) in Ayrshire, and from 0.25 (long-chain and unsaturated FA) to 0.52 (medium-chain and saturated FA) in Jersey. Important genomic regions were identified in Bos taurus autosomes BTA3, BTA5, BTA12, BTA13, BTA14, BTA16, BTA18, BTA20, and BTA21. The proportion of the variance explained by 20 adjacent SNP ranged from 0.71% (saturated FA) to 1.11% (long-chain FA) in Ayrshire, and from 0.70% (unsaturated FA) to 3.09% (medium-chain FA) in Jersey cattle. Important candidate genes and pathways were also identified, such as the PTK2 and TRAPPC9 genes, associated with milk fat percentage, and HMGCS, FGF10, and C6 genes, associated with fertility traits and immune response. Our findings on the genetic parameters and candidate genes contribute to a better understanding of the genetic architecture of milk FA composition in Ayrshire and Jersey dairy cattle.
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Affiliation(s)
- P H F Freitas
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907; Department of Animal Sciences, Federal University of Viçosa, Viçosa, Minas Gerais, 36570-000, Brazil
| | - H R Oliveira
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907
| | - F F Silva
- Department of Animal Sciences, Federal University of Viçosa, Viçosa, Minas Gerais, 36570-000, Brazil
| | - A Fleming
- Lactanet Canada, Guelph, Ontario, N1K 1E5, Canada
| | - F S Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - F Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - L F Brito
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907.
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Cost KT, Unternaehrer E, Jonas W, Gaudreau H, Bouvette-Tourcot A, Steiner M, Lydon J, Szatmari P, Meaney M, Fleming A. Once and Again: Intergenerational Transmission of Parenting. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionAnimal and human studies suggest that individual differences in maternal parenting behaviour are transmitted from one generation to the next.ObjectiveThis study aimed to examine potential psychosocial mechanisms underlying an intergenerational transmission of conceptualization of parenting, including affect, cognition, and parental support.MethodsIn a subsample of 201 first-time mothers participating in the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project, we assessed maternal childhood rearing experiences, using the Parental Bonding Instrument and the Childhood Trauma Questionnaire. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, internalization of maternal care regulation and current relationship with mother and father.ResultsWe found significant direct associations of maltreatment and rearing by the grandmother with parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: the association of maltreatment on higher parenting stress was fully mediated through more maternal symptoms of depression (z = 2.297; P = 022). The association between sub-optimal rearing provided by the mother and higher parenting stress was mediated through lower internalization of maternal care regulation (z = -2.155; P = 031) and to a lesser degree through more symptoms of depression (z = -1.842; P = 065). Finally, higher quality rearing by the grandfather was indirectly related to lower parenting stress through positive current relationship with the father (z = -2.617; P = 009).ConclusionsThere are distinct pathways by which early experiences manifest in parenting stress. By understanding the structure of dysregulated parenting, clinicians will have practical information to specifically target maternal motivation, social supports, and depressed mood to disrupt maladaptive parenting cognitions and practices.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Jimenez AG, O'Connor ES, Tobin KJ, Anderson KN, Winward JD, Fleming A, Winner C, Chinchilli E, Maya A, Carlson K, Downs CJ. Does Cellular Metabolism from Primary Fibroblasts and Oxidative Stress in Blood Differ between Mammals and Birds? The (Lack-thereof) Scaling of Oxidative Stress. Integr Comp Biol 2020; 59:953-969. [PMID: 30924869 DOI: 10.1093/icb/icz017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As part of mitonuclear communication, retrograde and anterograde signaling helps maintain homeostasis under basal conditions. Basal conditions, however, vary across phylogeny. At the cell-level, some mitonuclear retrograde responses can be quantified by measuring the constitutive components of oxidative stress, the balance between reactive oxygen species (ROS) and antioxidants. ROS are metabolic by-products produced by the mitochondria that can damage macromolecules by structurally altering proteins and inducing mutations in DNA, among other processes. To combat accumulating damage, organisms have evolved endogenous antioxidants and can consume exogenous antioxidants to sequester ROS before they cause cellular damage. ROS are also considered to be regulated through a retrograde signaling cascade from the mitochondria to the nucleus. These cellular pathways may have implications at the whole-animal level as well. For example, birds have higher basal metabolic rates, higher blood glucose concentration, and longer lifespans than similar sized mammals, however, the literature is divergent on whether oxidative stress is higher in birds compared with mammals. Herein, we collected literature values for whole-animal metabolism of birds and mammals. Then, we collected cellular metabolic rate data from primary fibroblast cells isolated from birds and mammals and we collected blood from a phylogenetically diverse group of birds and mammals housed at zoos and measured several parameters of oxidative stress. Additionally, we reviewed the literature on basal-level oxidative stress parameters between mammals and birds. We found that mass-specific metabolic rates were higher in birds compared with mammals. Our laboratory results suggest that cellular basal metabolism, total antioxidant capacity, circulating lipid damage, and catalase activity were significantly lower in birds compared with mammals. We found no body-size correlation on cellular metabolism or oxidative stress. We also found that most oxidative stress parameters significantly correlate with increasing age in mammals, but not in birds; and that correlations with reported maximum lifespans show different results compared with correlations with known aged birds. Our literature review revealed that basal levels of oxidative stress measurements for birds were rare, which made it difficult to draw conclusions.
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Affiliation(s)
- A G Jimenez
- Department of Biology, Colgate University, 13 Oak Drive, Hamilton, NY 13346, USA
| | - E S O'Connor
- Department of Biology, Colgate University, 13 Oak Drive, Hamilton, NY 13346, USA
| | - K J Tobin
- Department of Biology, Colgate University, 13 Oak Drive, Hamilton, NY 13346, USA
| | - K N Anderson
- Department of Biology, Colgate University, 13 Oak Drive, Hamilton, NY 13346, USA
| | - J D Winward
- Department of Biology, Colgate University, 13 Oak Drive, Hamilton, NY 13346, USA
| | - A Fleming
- Department of Biology, Colgate University, 13 Oak Drive, Hamilton, NY 13346, USA
| | - C Winner
- Department of Biology, Hamilton College, 198 College Hill Road, Clinton, NY 13323, USA
| | - E Chinchilli
- Department of Biology, Hamilton College, 198 College Hill Road, Clinton, NY 13323, USA
| | - A Maya
- Department of Biology, Hamilton College, 198 College Hill Road, Clinton, NY 13323, USA
| | - K Carlson
- Department of Biology, Hamilton College, 198 College Hill Road, Clinton, NY 13323, USA
| | - C J Downs
- Department of Biology, Hamilton College, 198 College Hill Road, Clinton, NY 13323, USA
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Bertsch T, Erbacher G, Corda D, Damstra RJ, van Duinen K, Elwell R, van Esch-Smeenge J, Faerber G, Fetzer S, Fink J, Fleming A, Frambach Y, Gordon K, Hardy D, Hendrickx A, Hirsch T, Koet B, Mallinger P, Miller A, Moffatt C, Torio-Padron N, Ure C, Wagner S, Zähringer T. Lipoedema – myths and facts, Part 5. Phlebologie 2020. [DOI: 10.1055/a-1012-7670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractThe four previous articles in this series addressed the myths and facts surrounding lipoedema. We have shown that there is no scientific evidence at all for the key statements made about lipoedema – which are published time and time again. The main result of this “misunderstanding” of lipoedema is a therapeutic concept that misses the mark. The patient’s real problems are overlooked.The national and especially the international response to the series, which can be read in both German and English, has been immense and has exceeded all our expectations. The numerous reactions to our articles make it clear that in other countries, too, the fallacies regarding lipoedema have led to an increasing discrepancy between the experience of healthcare workers and the perspective of patients and self-help groups, based on misinformation mostly generated by the medical profession.Parts 1 to 4 in this series of articles on the myths surrounding lipoedema have made it clear that we have to radically change the view of lipoedema that has been held for decades. Changing our perspective means getting away from the idea of “oedema in lipoedema” – and hence away from the dogma that decongestion is absolutely necessary – and towards the actual problems faced by our patients with lipoedema. Such a paradigm shift in a disease that has been described in the same way for decades cannot be left to individuals but must be put on a much broader footing. For this reason, the lead author of this series of articles invited renowned lipoedema experts from various European countries to discussions on the subject. Experts from seven different countries took part in the two European Lipoedema Forums, with the goal of establishing a consensus. The consensus reflects the experts’ shared view on the disease, having scrutinized the available literature, and having taken into account the many years of clinical practice with this particular patient group. Appropriate to the clinical complexity of lipoedema, participants from different specialties provided an interdisciplinary approach. Nearly all of the participants in the European Lipoedema Forum had already published work on lipoedema, had been involved in drawing up their national lipoedema guidelines, or were on the executive board of their respective specialty society.In this fifth and final part of our series on lipoedema, we will summarise the relevant findings of this consensus, emphasising the treatment of lipoedema as we now recommend it. As the next step, the actual consensus paper “European Best Practice of Lipoedema” will be issued as an international publication.Instead of looking at the treatment of oedema, the consensus paper will focus on treatment of the soft tissue pain, as well as the psychological vulnerability of patients with lipoedema. The relationship between pain perception and the patient’s mental health is recognised and dealt with specifically. The consensus also addresses the problem of self-acceptance, and this plays a prominent role in the new therapeutic concept. The treatment of obesity provides a further pillar of treatment. Obesity is recognised as being the most common comorbid condition by far and an important trigger of lipoedema. Bariatric surgery should therefore also be considered for patients with lipoedema who are morbidly obese. The expert group upgraded the importance of compression therapy and appropriate physical activity, as the demonstrated anti-inflammatory effects directly improve the patients’ symptoms. Patients will be provided with tools for personalised self-management in order to sustain sucessful treatment. Should conservative therapy fail to improve the symptoms, liposuction may be considered in strictly defined circumstances.The change in the view of lipoedema that we describe here brings the patients’ actual symptoms to the forefront. This approach allows us to focus on more comprehensive treatment that is not only more effective but also more sustainable than focusing on the removal of non-existent oedema.
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Affiliation(s)
- Tobias Bertsch
- Foeldiclinic Hinterzarten – European Center of Lymphology, Germany
| | | | - D. Corda
- Polimedica San Lanfranco, Pavia, Italy
| | - R. J. Damstra
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe, Drachten, The Netherlands
| | - K. van Duinen
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe, Drachten, The Netherlands
| | - R. Elwell
- University-Hospitals of North Midlands, UK
| | - J. van Esch-Smeenge
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe, Drachten, The Netherlands
| | - G. Faerber
- Zentrum für Gefäßmedizin, Vascular Medicine, Hamburg, Germany
| | - S. Fetzer
- Patient self-help organisation Lipoedema UK
| | - J. Fink
- Department of General and Visceral Surgery at the Medical Center – University of Freiburg, Germany
| | - A. Fleming
- Rehabilitation-Centre Reade, Amsterdam, Netherlands
| | - Y. Frambach
- Hanse-Klinik, Clinic for Liposuction, Lübeck, Germany
| | | | | | - A. Hendrickx
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe, Drachten, The Netherlands
| | - T. Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Vascular Medicine, Halle, Germany
| | - B. Koet
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe, Drachten, The Netherlands
| | | | - A. Miller
- Dermatologische Praxis, Berlin, Germany
| | | | | | - C. Ure
- Lymphklinik Wolfsberg, Austria
| | | | - T. Zähringer
- Foeldiclinic Hinterzarten – European Center of Lymphology, Germany
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Jurich D, Santen SA, Paniagua M, Fleming A, Harnik V, Pock A, Swan-Sein A, Barone MA, Daniel M. Effects of Moving the United States Medical Licensing Examination Step 1 After Core Clerkships on Step 2 Clinical Knowledge Performance. Acad Med 2020; 95:111-121. [PMID: 31365399 PMCID: PMC6924934 DOI: 10.1097/acm.0000000000002921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.
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Affiliation(s)
- Daniel Jurich
- D. Jurich is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania
| | - Sally A. Santen
- S.A. Santen is senior associate dean of evaluation, assessment and scholarship of learning and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Miguel Paniagua
- M. Paniagua is medical advisor, Test Development Services, National Board of Medical Examiners, and adjunct associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Fleming
- A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Victoria Harnik
- V. Harnik is associate dean for curriculum and associate professor, Department of Cell Biology, New York University School of Medicine, New York, New York
| | - Arnyce Pock
- A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Aubrie Swan-Sein
- A. Swan-Sein is director, Center for Education Research and Evaluation, and assistant professor of educational assessment, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Michael A. Barone
- M.A. Barone is vice president of licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania
| | - Michelle Daniel
- M. Daniel is assistant dean for curriculum and associate professor, Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119
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Fleming A, Conti C, Vettenburg T, Di Falco A. Nonlinear optical memory effect. Opt Lett 2019; 44:4841-4844. [PMID: 31568456 DOI: 10.1364/ol.44.004841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
Light propagating through random media produces characteristic speckle patterns, directly related to the large multitude of scattering events. These complex dynamics remarkably display robustness to perturbation of the incoming light parameters, maintaining correlation in the scattered wavefront. This behavior is known as the optical memory effect. Here we unveil the properties of the nonlinear optical memory effect, which occurs when an optothermal nonlinearity perturbs the random material. The effect is characterized through a series of pump and probe experiments in silica aerogel, in the visible range. This additional degree of freedom further generalizes the memory effect, opening the road to applications based on the nonlinear response of random media.
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Marshall S, Sahm LJ, Moore AC, Fleming A. A systematic approach to map the adolescent human papillomavirus vaccine decision and identify intervention strategies to address vaccine hesitancy. Public Health 2019; 177:71-79. [PMID: 31539781 DOI: 10.1016/j.puhe.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Unsubstantiated safety concerns with human papillomavirus (HPV) vaccines continue to linger. This study sought to identify factors that influence the adolescent HPV vaccine decision and systematically identify intervention functions and strategies likely to be effective in reducing vaccine hesitancy. STUDY DESIGN This is a qualitative focus group study. METHODS Focus groups were conducted with female adolescents (aged 14-16 years) in Cork and Kerry. During focus groups, the trained facilitator used a semistructured, Theoretical Domains Framework (TDF)-based topic guide to prompt discussion. Transcripts were thematically analysed using the TDF and Behaviour Change Wheel. Behaviour Change Technique Taxonomy version 1 was used to suggest intervention functions and strategies for addressing HPV vaccine hesitancy. RESULTS A total of 50 adolescents (96% vaccinated), participated in 10 focus groups. The key themes were presented by means of the relevant TDF domains. Seven domains were selected as the most relevant: knowledge, social influences, beliefs about capabilities, optimism, beliefs about consequences, emotion and environmental context and resources. Five intervention functions were identified, education, persuasion, enablement, modelling and environmental restructuring, and linked to 11 relevant Behaviour Change Technique (BCTs). Potential intervention strategies were developed. CONCLUSIONS This study provided a detailed insight into behavioural factors influencing the vaccine decision-making process. It was identified that awareness and knowledge about HPV and its health sequelae was low. Lack of information is a well-recognised determinant of vaccine hesitancy. Therefore, education was recommended as a key area to address in future intervention studies.
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Affiliation(s)
- S Marshall
- Pharmaceutical Care Research Group, Cavanagh School of Pharmacy, University College Cork, Cork, Ireland.
| | - L J Sahm
- Pharmaceutical Care Research Group, Cavanagh School of Pharmacy, University College Cork, Cork, Ireland; Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - A C Moore
- Department of Biochemistry, University College Cork, Ireland
| | - A Fleming
- Pharmaceutical Care Research Group, Cavanagh School of Pharmacy, University College Cork, Cork, Ireland; Department of Pharmacy, Mercy University Hospital, Cork, Ireland
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Nayeri S, Schenkel F, Fleming A, Kroezen V, Sargolzaei M, Baes C, Cánovas A, Squires J, Miglior F. Genome-wide association analysis for β-hydroxybutyrate concentration in Milk in Holstein dairy cattle. BMC Genet 2019; 20:58. [PMID: 31311492 PMCID: PMC6636026 DOI: 10.1186/s12863-019-0761-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/28/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Ketosis in dairy cattle has been shown to cause a high morbidity in the farm and substantial financial losses to dairy farmers. Ketosis symptoms, however, are difficult to identify, therefore, the amount of ketone bodies (mainly β-hydroxybutyric acid, BHB) is used as an indicator of subclinical ketosis in cows. It has also been shown that milk BHB concentrations have a strong correlation with ketosis in dairy cattle. Mid-infrared spectroscopy (MIR) has recently became a fast, cheap and high-throughput method for analyzing milk components. The aim of this study was to perform a genome-wide association study (GWAS) on the MIR-predicted milk BHB to identify genomic regions, genes and pathways potentially affecting subclinical ketosis in North American Holstein dairy cattle. RESULTS Several significant regions were identified associated with MIR-predicted milk BHB concentrations (indicator of subclinical ketosis) in the first lactation (SCK1) and second and later lactations (SCK2) in Holstein dairy cows. The strongest association was located on BTA6 for SCK1 and BTA14 on SCK2. Several SNPs on BTA6 were identified in regions and variants reported previously to be associated with susceptibility to ketosis and clinical mastitis in Jersey and Holstein dairy cattle, respectively. One highly significant SNP on BTA14 was found within the DGAT1 gene with known functions on fat metabolism and inflammatory response in dairy cattle. A region on BTA6 and three SNPs on BTA20 were found to overlap between SCK1 and SCK2. However, a novel region on BTA20 (55-63 Mb) for SCK2 was also identified, which was not reported in previous association studies. Enrichment analysis of the list of candidate genes within the identified regions for MIR-predicted milk BHB concentrations yielded molecular functions and biological processes that may be involved in the inflammatory response and lipid metabolism in dairy cattle. CONCLUSIONS The results of this study confirmed several SNPs and genes identified in previous studies as associated with ketosis susceptibility and immune response, and also found a novel region that can be used for further analysis to identify causal variations and key regulatory genes that affect clinical/ subclinical ketosis.
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Affiliation(s)
- S. Nayeri
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - F. Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - A. Fleming
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
- Canadian Dairy Network, Guelph, ON N1K 1E5 Canada
| | - V. Kroezen
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - M. Sargolzaei
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
- Select Sires Inc., Plain City, OH 43064 USA
| | - C. Baes
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - A. Cánovas
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - J. Squires
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - F. Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1 Canada
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Fleming A, Schenkel F, Ali R, Corredig M, Carta S, Gregu C, Malchiodi F, Macciotta N, Miglior F. Phenotypic investigation of fine milk components in bovine milk and their prediction using mid-infrared spectroscopy. Can J Anim Sci 2019. [DOI: 10.1139/cjas-2018-0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to examine the phenotypic variation observed in fine milk components, the use of mid-infrared (MIR) spectroscopy to predict these components, and the correlations with other milk production traits. A total of 4116 milk samples were collected from 414 dairy cows from 44 Canadian herds. Overall 3117 samples were analyzed for casein micelle size, 986 and 937 for total and soluble calcium, respectively, and 2054 for lactoferrin. Individual milk MIR spectra were obtained. Linear mixed models with repeated records were used to test the effects of herd nested within breed, breed, days in milk class, parity, and season on milk components. Lactoferrin content in milk increased with stage of lactation and parity number. Prediction equations were developed by partial least squares regression to predict each milk component using MIR spectroscopy, with the greatest coefficient of determination achieved for lactoferrin (0.55). Pearson correlation coefficients for lactoferrin with somatic cell score and protein percentage were 0.49% and 0.40%, respectively. The estimated correlation increased to 0.53% for predicted lactoferrin and protein percentage. The examined fine milk components exhibited variation, but low accuracies for their MIR prediction may limit the utility of this technology for their phenotyping.
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Affiliation(s)
- A. Fleming
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - F.S. Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - R.A. Ali
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - M. Corredig
- Department of Food Science, University of Guelph, Guelph, ON N1G 2W1, Canada
- Gay Lea Foods Co-operative, Mississauga, ON L4W 5B4, Canada
| | - S. Carta
- Dipartimento di Agraria, Università di Sassari, 07100 Sassari, Italy
| | - C.M. Gregu
- Dipartimento di Agraria, Università di Sassari, 07100 Sassari, Italy
| | - F. Malchiodi
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - N.P.P. Macciotta
- Dipartimento di Agraria, Università di Sassari, 07100 Sassari, Italy
| | - F. Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
- Canadian Dairy Network, Guelph, ON N1K 1E5, Canada
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Pock A, Daniel M, Santen SA, Swan-Sein A, Fleming A, Harnik V. Challenges Associated With Moving the United States Medical Licensing Examination (USMLE) Step 1 to After the Core Clerkships and How to Approach Them. Acad Med 2019; 94:775-780. [PMID: 30768466 DOI: 10.1097/acm.0000000000002651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An increasing number of medical schools have moved away from traditional 2 + 2 curricular structures toward curricula that intentionally integrate basic, clinical, and health systems science, with the goal of graduating physicians who consistently apply their foundational knowledge to clinical practice to improve the care of patients and populations. These curricular reforms often include a shortened preclerkship phase with earlier introduction of learners into clinical environments. This has led schools to reconsider the optimal timing of United States Medical Licensing Examination Step 1. A number of schools have shifted the exam to the period immediately after core clerkships. Although this shift can provide pedagogical advantages, there are potential challenges that must be anticipated and proactively addressed. As more institutions consider making this change, key educational leaders from five schools that repositioned the Step 1 exam after core clerkships share strategies for mitigating some of the potential challenges associated with this approach. The authors describe six possible challenges: lack of readiness without consolidation of basic science knowledge prior to clerkships; risk that weaker students will not be identified and provided academic support early; clerkship or clinical shelf exam performance weaknesses; extension of Step 1 study time; an increase in student anxiety about residency specialty choices; and/or a reduced time frame to take and pass board exams. These potential challenges may be addressed using three main strategies: effective communication with all stakeholders; curricular design and assessments that facilitate integration of basic and clinical sciences; and proactive student coaching and advising.
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Affiliation(s)
- Arnyce Pock
- A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. M. Daniel is assistant dean of curriculum and associate professor of emergency medicine and learning health sciences, University of Michigan School of Medicine, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119. S.A. Santen is senior associate dean of evaluation, assessment, and scholarship of learning and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. A. Swan-Sein is director, Center for Educational Research and Evaluation, and assistant professor of educational assessment, Columbia Vagelos College of Physicians and Surgeons, New York, New York. A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. V. Harnik is associate dean of curriculum and associate professor of cell biology, NYU School of Medicine, New York, New York
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Gibbons S, Fleming A, Fairhurst A, Ford C, Barth J. Clinical and analytical evaluation of LC-MS methods for plasma renin activity and aldosterone. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jurich D, Daniel M, Paniagua M, Fleming A, Harnik V, Pock A, Swan-Sein A, Barone MA, Santen SA. Moving the United States Medical Licensing Examination Step 1 After Core Clerkships: An Outcomes Analysis. Acad Med 2019; 94:371-377. [PMID: 30211755 DOI: 10.1097/acm.0000000000002458] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Schools undergoing curricular reform are reconsidering the optimal timing of Step 1. This study provides a psychometric investigation of the impact on United States Medical Licensing Examination Step 1 scores of changing the timing of Step 1 from after completion of the basic science curricula to after core clerkships. METHOD Data from four schools that recently moved the examination were analyzed in a pre-post format using examinee scores from three years before and after the change. The sample included scores from 2008 through 2016. Several confounders were addressed, including rising national scores and potential differences in cohort abilities using deviation scores and analysis of covariance (ANCOVA) controlling for Medical College Admission Test (MCAT) scores. A resampling procedure compared study schools' score changes versus similar schools' in the same time period. RESULTS The ANCOVA indicated postchange Step 1 scores were higher compared with prechange (adjusted difference = 2.67; 95% confidence interval: 1.50-3.83, P < .001; effect size = 0.14) after adjusting for MCAT scores and rising national averages. The average score increase in study schools was larger than changes seen in similar schools. Failure rates also decreased from 2.87% (n = 48) pre change to 0.39% (n = 6) post change (P < .001). CONCLUSIONS Results suggest moving Step 1 after core clerkships yielded a small increase in scores and a reduction in failure rates. Although these small increases are unlikely to represent meaningful knowledge gains, this demonstration of "noninferiority" may allow schools to implement significant curricular reforms.
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Affiliation(s)
- Daniel Jurich
- D. Jurich is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania. M. Daniel is assistant dean for curriculum and associate professor, Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119. M. Paniagua is medical advisor, Test Development Services, National Board of Medical Examiners, and adjunct associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A. Fleming is associate dean for medical student affairs and associate professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. V. Harnik is associate dean for curriculum and associate professor, Department of Cell Biology, New York University School of Medicine, New York, New York. A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. A. Swan-Sein is director, Center for Education Research and Evaluation, and assistant professor of educational assessment, Columbia University Vagelos College of Physicians and Surgeons, New York, New York. M.A. Barone is vice president of licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania. S.A. Santen is senior associate dean of evaluation, assessment and scholarship of learning, and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, and was previously assistant dean for educational research and quality improvement, University of Michigan Medical School, Ann Arbor, Michigan
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Fleming A, Baes CF, Martin AAA, Chud TCS, Malchiodi F, Brito LF, Miglior F. Symposium review: The choice and collection of new relevant phenotypes for fertility selection. J Dairy Sci 2019; 102:3722-3734. [PMID: 30712934 DOI: 10.3168/jds.2018-15470] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/02/2018] [Indexed: 12/17/2022]
Abstract
In dairy production, high fertility contributes to herd profitability by achieving greater production and maintaining short calving intervals. Improved management practices and genetic selection have contributed to reversing negative trends in dairy cow fertility, but further progress is still required. Phenotypes included in current genetic evaluations are largely interval and binary traits calculated from insemination and calving date records. Several indicator traits such as calving, health, variation in body condition score, and longevity traits also apply to genetic improvement of fertility. Several fertility traits are included in the selection indices of many countries, but for improved selection, the development of novel phenotypes that more closely describe the physiology of reproduction and limit management bias could be more effective. Progesterone-based phenotypes can be determined from milk samples to describe the heritable interval from calving to corpus luteum activity, as well as additional measures of cow cyclicity. A fundamental component of artificial insemination practices is the observation of estrus. Novel phenotypes collected on estrous activity could be used to select for cows clearly displaying heat, as those cows are more likely to be inseminated at the right time and therefore have greater fertility performance. On-farm technologies, including in-line milk testing and activity monitors, may allow for phenotyping novel traits on large numbers of animals. Additionally, selection for improved fertility using traditional traits could benefit from refined and accurate recording and implementation of parameters such as pregnancy confirmation and reproductive management strategy, to differentiate embryonic or fetal loss, and to ensure selection for reproductive capability without producer intervention. Opportunities exist to achieve genetic improvement of reproductive efficiency in cattle using novel phenotypes, which is required for long-term sustainability of the dairy cattle population and industry.
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Affiliation(s)
- A Fleming
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada; Canadian Dairy Network, Guelph, ON, N1K 1E5, Canada.
| | - C F Baes
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - A A A Martin
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada; Animal Breeding and Genomics Centre, Wageningen University and Research, Wageningen, 6708PB, the Netherlands
| | - T C S Chud
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - F Malchiodi
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada; Semex Alliance, Guelph, ON, N1H 6J2, Canada
| | - L F Brito
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada; Department of Animal Sciences, Purdue University, West Lafayette, IN 47907
| | - F Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada; Canadian Dairy Network, Guelph, ON, N1K 1E5, Canada
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Dennis M, Mead G, Forbes J, Graham C, Hackett M, Hankey GJ, House A, Lewis S, Lundström E, Sandercock P, Innes K, Williams C, Drever J, Mcgrath A, Deary A, Fraser R, Anderson R, Walker P, Perry D, Mcgill C, Buchanan D, Chun Y, Dinsmore L, Maschauer E, Barugh A, Mikhail S, Blair G, Hoeritzauer I, Scott M, Fraser G, Lawrence K, Shaw A, Williamson J, Burgess D, Macleod M, Morales D, Sullivan F, Brady M, French R, Van Wijck F, Watkins C, Proudfoot F, Skwarski J, Mcgowan D, Murphy R, Burgess S, Rutherford W, Mccormick K, Buchan R, Macraild A, Paulton R, Fazal A, Taylor P, Parakramawansha R, Hunter N, Perry J, Bamford J, Waugh D, Veraque E, Bedford C, Kambafwile M, Idrovo L, Makawa L, Smalley P, Randall M, Thirugnana-Chandran T, Hassan A, Vowden R, Jackson J, Bhalla A, Rudd A, Tam CK, Birns J, Gibbs C, Lee Carbon L, Cattermole E, Marks K, Cape A, Hurley L, Kullane S, Smyth N, Eglinton C, Wilson J, Giallombardo E, Frith A, Reidy P, Pitt M, Sykes L, Dellafera D, Croome V, Kerwood L, Hancevic M, Narh C, Merritt C, Duffy J, Cooke D, Willson J, Ali A, Naqvi A, Kamara C, Bowler H, Bell S, Jackson T, Harkness K, Stocks K, Duty S, Doyle C, Dunn G, Endean K, Claydon F, Richards E, Howe J, Lindert R, Majid A, Dakin K, Maatouk A, Barron L, Meegada M, Rana P, Nair A, Brighouse-Johnson C, Greig J, Kyu M, Prasad S, Robinson M, Alam I, Mclean B, Greenhalgh L, Ahmed Z, Roffe C, Brammer S, Beardmore C, Finney K, Barry A, Hollinshead P, Grocott J, Maguire H, Natarajan I, Chembala J, Sanyal R, Lijko S, Abano N, Remegoso A, Ferdinand P, Stevens S, Varquez R, Causley C, Butler A, Whitmore P, Stephen C, Carpio R, Hiden J, Muddegowda G, Denic H, Sword J, Curwen R, James M, Mudd P, Hall F, Cageao J, Keenan S, Roughan C, Kingwell H, Hemsley A, Lohan C, Davenport S, Bowring A, Chapter T, Hough M, Strain D, Gupwell K, Miller K, Goff A, Cusack E, Todd S, Partridge R, Jennings G, Thorpe K, Stephenson J, Littlewood K, Barber M, Brodie F, Marshall S, Esson D, Coburn I, Mcinnes C, Ross F, Bowie E, Barcroft H, Withers V, Miller L, Willcoxson P, Donninson M, Evans R, Daniel D, Coyle J, Keeling M, Wanklyn P, Elliott M, Wightman J, Iveson E, Dyer N, Porteous AM, Haritakis M, Ward M, Doughty L, Carr L, O Neill M, Anazodo C, Wood P, Cottrell P, Donne C, Rodriguez R, Mir R, Westmoreland J, Bell J, Emms C, Wright L, Clark Brown P, Bamford E, Stanners A, Carpenter M, Datta P, Davey R, Needle A, Eastwood MJ, Razik FZ, Ghouri I, Bateman G, Archer J, Balasubramanian V, Bowers R, Ball J, Benton L, Jackson L, Ellam J, Norton K, Guyler P, Dowling T, Tysoe S, Harman P, Kundu A, Omodunbi O, Loganathan T, Chandler S, Noor S, Siddiqui A, Siddiqui A, Kunhunny S, Sinha D, Sheppard M, Rashmi S, France E, Orath Prabakaran R, Wilson L, Ropun A, Kelavkar S, Ng KX, Kamuriwo L, Shah S, Mangion D, Constantin C, De Michele Hock L, Hardwick A, Borley J, Markova S, Netherton K, Lawrence T, Fletcher J, Spencer R, Palmer H, Cullen C, Hamill D, Durairaj R, Mellor Z, Fluskey T, Wood D, Keeling A, Hankin V, Peters J, Shackcloth D, Hlaing T, Tangney R, Ewing J, Harrison M, Stevenson S, Sutton V, Soliman M, Hindle J, Watson E, Hewitt C, Borley J, Butler S, Wahishi I, Arif S, Fields A, Sharma J, Brown R, Taylor C, Bell S, Leach S, Patterson C, Khan S, Wilson H, Price J, Ramadan H, Maguire S, Bellfield R, Hooley M, Hamid U, Gaba W, Ghulam R, Masters L, Quinn O, Sekaran L, Tate M, Mohammed N, Bharaj K, Justin F, Pattni R, Alwis L, Sethuraman S, Robinson R, Eldridge L, Mintias S, Chauhan M, Tam CK, Palmones J, Holmes C, Guthrie LB, Osborn M, Ball L, Caine S, Steele A, Murphy P, Devitt N, Leonard J, Patel R, Penwarden I, Dodd E, Holloway A, Baker P, Clarke S, Williams S, Dow L, Wynn-Williams R, Kennedy J, Teal R, Schulz U, Ford G, Mathieson P, Reckless I, Deveciana A, Mccann P, Cluckie G, Howell G, Ayer J, Moynihan B, Ghatala R, Clarke B, Cloud G, Patel B, Khan U, Al-Samarrai N, Trippier S, Chopra N, Adedoyin T, Watson F, Jones V, Zhang L, Choy L, Williams R, Clarke N, Blight A, Kennedy K, Dainty A, Selvarajah J, Kalladka D, Cheripelli B, Smith W, Moreton F, Welch A, Huang X, Douglas E, Lush A, Day N, El Tawil S, Montgomery K, Hamilton H, Ritchie D, Ramachandra S, Mcleish K, Thavanesan K, Loganathan S, Roberts J, Cox C, Orr S, Hogan A, Tiwari D, Hann G, Longland B, David O, Bell J, Ovington C, Rogers E, Bower R, Keltos M, Cohen D, Devine J, Alwis L, Southworth L, Burgess L, Lang M, Badiani B, Guo F, Oshodi A, Owoyele E, Epie N, David A, Mpelembue M, Bathula R, Abdul-Saheb M, Chamberlain A, Sudkeo V, Rashed K, Wood D, Williams-Yesson B, Board J, De Bruijn S, Buckley C, Board S, Allison J, Keeling E, Duckett T, Donaldson D, Vickers C, Barron C, Balian L, Wilson J, Edwards A, England T, Hedstrom A, Bedford E, Harper M, Melikyan E, Abbott W, Subramanian K, Goldsworthy M, Srinivasan M, Yeomans A, Donaldson D, Hurford F, Chapman R, Shahzad S, David O, Motherwell N, Tonks L, Young R, Ghani U, Mukherjee I, Dutta D, Obaid M, Brown P, Davis F, Ward D, Turfrey J, Cartwright B, Topia B, Spurway J, Collins K, Bakawala R, Hughes C, Oconnell S, Hill L, Chatterjee K, Webster T, Haider S, Rushworth P, Macleod F, Nallasivan A, Perkins C, Burns E, Leason S, Carter T, Seagrave S, Sami E, Armstrong L, Naqvi SN, Hassan M, Parkinson S, Mawer S, Darnbrook G, Booth C, Hairsine B, Smith M, Williamson S, Farquhar F, Esisi B, Cassidy T, Mankin G, Mcclelland B, Bokhari M, Sproates D, Epstein E, Hurdowar S, Blackburn R, Sukhdeep N, Razak S, Osman K, Hashmi A, Upton N, Harrington F, Courtauld G, Schofield C, Lucas L, Adie K, Bond K, Mate A, Skewes J, James A, Brodie C, Johnson M, Allsop L, Driver E, Harris K, Drake M, Ellis S, Maund B, Thomas E, Moore K, Burn M, Hamilton A, Mahalingam S, Misra A, Reid F, Benford A, Hilton D, Hazell L, Ofori K, Thomas AL, Mathew M, Dayal S, Burn I, Fotherby K, Jennings-Preece K, Willberry A, Morgan D, Butler D, Sahota G, Kauldhar K, Ahmad N, Stevens A, Das S, Bruce D, Pai Y, Nyo K, Stephenson L, Nendick R, Rogers G, Dhakal M, Dima S, Brown E, Clayton S, Gamble P, Naeem M, Hayman R, Burnip R, Earnshaw P, Hargroves D, Ransom B, Rudenko H, Balogun I, Griffiths K, Mears K, Webb T, Cowie L, Hammond T, Thomson A, Ceccarelli D, Chattha N, Beranova E, Verrion A, Gillian A, Schumacher N, Bahk A, Walker S, Cvoro V, Mccormick K, Chapman N, Pound S, Cain R, Mcauley S, Couser M, Simpson M, Tachtatzis A, Ullah K, Sims D, Jones R, Smith J, Tongue R, Willmot M, Sutton C, Littleton E, Khaira J, Maiden S, Cunningham J, Green C, Chin YM, Bates M, Ahlquist K, Kane I, Breeds J, Sargent T, Latter L, Pitt Ford A, Gainsborough N, Levett T, Thompson P, Barbon E, Dunne A, Hervey S, Ragab S, Sandell T, Dickson C, Dube J, Power S, Evans N, Wadams B, Elitova S, Aubrey B, Garcia T, Mcilmoyle J, Jeffs C, Dickinson C, Ahmed A, Kumar S, Frudd J, Armer C, Potter A, Donaldson S, Howard J, Jones K, Dhar S, Collas D, Sundayi S, Denham L, Oza D, Walker E, Cunningham J, Bhandari M, Ispoglou S, Evans R, Sharobeem K, Walton E, Shanu S, Hayes A, Howard-Brown J, Billingham S, Weir N, Pressly V, Wood E, Sykes L, Howard G, Burton H, Crawford P, Egerton S, Evans S, Hakkak J, Andrews J, Lampard R, Allen C, Walters A, Said R, Marigold JR, Tsang SM, Creeden R, Cox C, Smith S, Gartrell I, Smith F, Jenkins C, Pryor J, Hedges A, Price F, Moseley L, Mercer L, Hughes C, Mcgowan D, Azim A, White J, Krasinska-Chavez M, Chaplin S, Curtis J, Singh D, Imam J, Nicolson A, Alam S, Whitworth S, Wood L, Warburton E, Kelly S, Mcgee J, Markus H, Chandrasena D, Hayden D, Sesay J, Hayhoe H, Bolton M, Macdonald J, Mitchell J, Farron C, Amis E, Day D, Culbert A, Espanol A, Hannon N, Handley D, Finlay S, Crisp S, Whitehead L, Francis J, Oconnell J, Osborne E, Beard R, Krishnamurthy R, Mokoena L, Sattar N, Myint M, Edwards M, Smith A, Corrigan P, Byrne A, Blackburn J, Mcghee C, Smart A, Macleod M, Donaldson F, Copeland C, Wilson J, Scott R, Fitzsimmons P, Lopez P, Wilkinson M, Manoj A, Cox P, Trainor L, Fletcher G, Denny L, Kavanagh K, Allsop H, Emsley H, Sultan S, Mcloughlin A, Walmsley B, Hough L, Ahmed S, Doyle D, Gregary B, Raj S, Nagaratnam K, Mannava N, Haque N, Shields N, Preston K, Mason G, Short K, Lumsdale G, Uitenbosch G, Sukys U, Valentine S, Jarrett D, Dodsworth K, Wands M, Khan N, Tandy J, Watkinson C, Golding W, Butler R, Williams M, Davies Y, Yip K, James C, Suttling A, Maney A, Gamble GE, Hague A, Charles B, Blane S, Duran B, Lambert C, Stagg K, Whiting R, Homan JE, Brown S, Hussain M, Harvey M, Graham L, Foote L, Lane C, Kemp L(J, Rowe J, Durman H, Foot J, Brotherton L, Hunt N, Pawley C, Whitcher A, Sutton P, Mcdonald S, Pak D, Wiltshire A, Jagger J, Metcalf AK, Healey GL, Balami J, Self CM, Crofts M, Chakrabarti A, Hmu C, Ravenhill G, Grimmer C, Soe T, Keshet-Price J, Langley M, Potter I, Tam PL, Macleod MJ, Cooper P, Christie M, Irvine J, Annison F, Christie D, Meneses C, Johnson A, Joyson A, Nelson S, Taylor V, Reid J, Clarke R, Furnace J, Gow H, Abousleiman Y, Beadling T, Collins S, Jones S, Purcell J, Bloom S, Goshawk S, Landicho M, Sangaralingham S, Begum Y, Mutton S, Munuswamy Vaiyapuri E, Allen J, Lowe J, Hughes M, Wiggam I, Cuddy S, Tauro S, Wells B, Mohd Nor A, Eglinton C, Persad N, Kalita M, Weatherby S, Brown C, Pace A, Lashley D, Marner M, Weinling M, Wilmshurst N, Waugh D, Mucha A, Shah A, Baker J, Westcott J, Cowan R, Vasileiadis E, Mumani S, Parry A, Mason C, Holden M, Petrides K, Nishiyama T, Mehta H, Krishnan M, Lynne D, Thomas L, Lynda C, Hughes C, Clements C, Williams R, Anjum T, Sharon S, Tucker S, Jones P, Colwill D, Thompson Jones H, Chadha D, Fairweather M, Walstow D, Fong R, Johnston S, Almadenboyle C, Ross S, Carson S, Nair P, Tenbruck E, Stirling M, Pusalkar A, Beadle H, Chan K, Dangri P, Asokanathan A, Rana A, Gohil S, Massyn M, Aruldoss P, Cook A, Crabtree K, Dabbagh S, Black T, Clarke C, Mead D, Fennelly R, Anthony A, Nardone L, Dimartino V, Tribbeck M, Broughton D, Tryambake D, Dixon L, Skotnicka A, Thompson J, Whitehouse S, Sigsworth A, Wong J, Annamalai A, Pagan J, Affley B, Sunderland C, Goldenberg L, Khan A, Wilkinson P, Nari R, Abbott L, Young E, Shakhon A, Lock S, Stewart J, Pereira R, Dsouza M, Dunn S, Mckenna AM, Cron N, Kidd M, Hull G, Bunworth K, Drummond G, Mahawish K, Hayes N, Connell L, Simpson J, Penney H, Punekar S, Nevinson J, Wareing W, Ward J, Greenwood R, Austin D, Banaras A, Hogan C, Corbett T, Oji N, Elliott E, Brezitski M, Passeron N, Howaniec L, Watchurst C, Patel K, Erande R, Shah R, Sengupta N, Metiu M, Gonzalez C, Funnell S, Margalef J, Peters G, Chadbourn I, Sivakumar R, Saksena R, Ketley-O'donel J, Needle R, Chinery E, Wright A, Cook S, Ngeh J, Proeschel H, Cook P, Ashcroft P, Sharpe S, Jones S, Jenkinson D, Kelly D, Bray H, Gunathilagan G, Griffiths K, Mears K, Gillian A, Jones S, Tilbey S, Abubakar S, Beranova E, Vassallo J, Leonard D, Orrell L, Hasan A, Khan A, Qamar S, Graham S, Hewitt E, Awolesi J, Haque M, Kent A, Bradshaw E, Cooper M, Wynter I, Rajapakse A, Janbieh J, Nasar AM, Wade L, Otter L, Haigh S, Burgoyne JR, Boulton R, Boulton A, Rayessa R, Clarkson E, Rhian H, Fleming A, Mitchelson K, Lowthorpe V, Abdul-Hamid A, Jones P, Duggan C, Hynes A, Nurse E, Raza SA, Jones S, Pallikona U, Edwards B, Morgan G, Dennett K, Tench H, Loosley R, Trugeon-Smith T, Jones R, Williams R, Robson D, Mavinamane S, Meenakshisundaram S, Ranga L, Dealing S, Hill A, Hargreaves M, Smith T, Bate J, Harrison L, Kirthivasan R, Cannon E, Topliffe J, Keskeys R, Williams S, Mcneela F, Cairns F, James T, Lyle A, Shah S, Zachariah G, Fergey L, Smolen S, Cooper L, Bohannan E, Omer S, Amlani S, Hunter N, Hawkes-Blackburn M, Gulli G, Peacocke A, Amero J, Burova M, Speirs O, Levy S, Francis L, Holland S, Brotheridge S, Lyon H, Hare C, Jackson S, Stephenson L, Al Hussayni S, Featherstone J, Bwalya A, Singh A, Goorah MN, Walford J, Bell A, Kelly C, Rusk D, Sutton D, Patel F, Duberley S, Hayes K, Hunt L, El Nour A, Cottrell P, Westmoreland J, Honour S, Box C, Wood P, Haritakis M, Dyer S, Brown L, Elliott K, Temlett E, Paterson J, Furness R, Young S, Orugun E, Brewer C, Thornthwaite S, Crowther H, Glover R, Sein M, Haque K, Gibson E, Wong S, Rotchell K, Burton K, Brookes L, Bailey L, Leonard D, Lindley C, Murray A, Waltho K, Holland M, Kumar P, Harlekar P, Booth L, Culmsee C, Drew J, Khan M, Mackenzie N, Thomas C, Ritchie J, Barker J, Haley M, Cotterill D, Lane L, Little C, Simmons D, Saunders G, Dymond H, Kidd S, Warinton R, Neves-Silva Y, Nevajda B, Villaruel M, Umasankar U, Patel S, Man A, Christmas N, Rangasamy R, Ladner R, Butt G, Alvares W, Gadi N, Power M, Wroath B, Dynan K, Wilson D, Crothers S, Leonard C, Hagan S, Douris G, Vahidassr D, Thompson A, Gallen B, Mckenna S, Edwards C, Mcgoldrick C, Bhattad M, Kawafi K, Morse D, Jacob P, Turner L, Saravanan N, Johnson L, Humphrey S, Namushi R, Patel R, Mclaughlin J, Omahony P, Osikominu E, Orefo C, Mcdonald C, Jones V, Makanju E, Khan T, Appiatse G, Stone H, Augustin M, Wardale A, Salehin M, Bailey D, Garcia-Alen L, Kalathil L, Tinsley S, Jones T, Amor K, Ritchings A, Margerum E, Horton J, Miller R, Gautam N, Meir J, Jones A, Putteril J, Lepore M, Makanju E, Gallifent R, Arundell LL, Mcredmond C, Goulding A, Nadarajan V, Laurence J, Fung Lo S, Melander S, Nicholas P, Woodford E, Mckenzie G, Le V, Crause J, Luder R, Bhargava M, Shah R, Bhome G, Johnson VV, Chesser D, Bridger H, Murali E, Scott J, Morrison S, Burns A, Graham J, Duffy M, Ali K, Sargent T, Pitcher E, Gaylard J, Newman J, Punnoose S, Besley S, Purohit K, Rees A, Davy M, Chohan O, Khan MF, Walker R, Murray V, Bent C, Oakley S, Blight A, Peixoto C, Jones S, Livingstone G, Butler F, Bradfield S, Gordon L, Schmit J, Wijewardane A, Edmunds T, Wills R, Medcalf C, Argandona L, Cuenoud L, Hassan H, Erumere E, Ocallaghan A, Gompertz P, Redjep O, Auld G, Howaniec L, Song A, Tarkas T, Kabash H, Hungwe R. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet 2019; 393:265-274. [PMID: 30528472 PMCID: PMC6336936 DOI: 10.1016/s0140-6736(18)32823-x] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. METHODS FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. FINDINGS Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839-1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26-6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38-2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. INTERPRETATION Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. FUNDING UK Stroke Association and NIHR Health Technology Assessment Programme.
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Gliatto P, Colbert-Getz JM, Bhutiani M, Cutrer WB, Edwards S, Fleming A, Keeley M, Osterberg L, Pilla MA, Moynahan K. Too Many Hats? Conflicts of Interest in Learning Community Faculty Roles. J Med Educ Curric Dev 2019; 6:2382120519827890. [PMID: 30923748 PMCID: PMC6431764 DOI: 10.1177/2382120519827890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 05/28/2023]
Abstract
PURPOSE Many US medical schools have adopted learning communities to provide a framework for advising and teaching functions. Faculty who participate in learning communities often have additional educator roles. Defining potential conflicts of interest (COIs) among these roles is an important consideration for schools with existing learning communities and those looking to develop them, both for transparency with students and also to comply with regulatory requirements. METHODS A survey was sent to the institutional contact for each of the 42 Learning Communities Institute (LCI) member medical schools to assess faculty opinions about what roles potentially conflict. The survey asked the role of learning community faculty in summative and formative assessment of students and whether schools had existing policies around COIs in medical education. RESULTS In all, 35 (85%) LCI representatives responded; 30 (86%) respondents agreed or strongly agreed that learning community faculty should be permitted to evaluate their students for formative purposes, while 19 (54%) strongly agreed or agreed that learning community faculty should be permitted to evaluate their students in a way that contributes to a grade; 31 (89%) reported awareness of the accreditation standard ensuring "that medical students can obtain academic counseling from individuals who have no role in making assessment or promotion decisions about them," but only 10 (29%) had a school policy about COIs in education. There was a wide range of responses about what roles potentially conflict with being a learning community faculty. CONCLUSION The potential for COIs between learning community faculty and other educator roles concerns faculty at schools with learning communities, but most schools have not formally addressed these concerns.
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Affiliation(s)
- Peter Gliatto
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jorie M Colbert-Getz
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Monica Bhutiani
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - William B Cutrer
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sharon Edwards
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amy Fleming
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Meg Keeley
- Department of Pediatrics. University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lars Osterberg
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael A Pilla
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kevin Moynahan
- Department of Medicine, School of Medicine–Tucson, University of Arizona, Tucson, AZ, USA
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Shochet R, Fleming A, Wagner J, Colbert-Getz J, Bhutiani M, Moynahan K, Keeley M. Defining Learning Communities in Undergraduate Medical Education: A National Study. J Med Educ Curric Dev 2019; 6:2382120519827911. [PMID: 30937385 PMCID: PMC6434432 DOI: 10.1177/2382120519827911] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Learning communities (LCs) are intentionally designed groups that are actively engaged in learning with and from each other. While gaining prominence in US medical schools, LCs show significant variability in their characteristics across institutions, creating uncertainty about how best to measure their effects. OBJECTIVE The aim of this study is to describe the characteristics of medical school LCs by primary purpose, structures, and processes and lay the groundwork for future outcome studies and benchmarking for best practices. METHODS Medical school LC directors from programs affiliated with the Learning Communities Institute (LCI) were sent an online survey of program demographics and activities, and asked to upload a program description or summary of the LC's purpose, goals, and how it functions. Descriptive statistics were computed for survey responses and a qualitative content analysis was performed on program descriptions by 3 authors to identify and categorize emergent themes. RESULTS Of 28 medical school LCs surveyed, 96% (27) responded, and 25 (89%) provided program descriptions for qualitative content analysis. All programs reported longitudinal relationships between students and faculty. Most frequently cited objectives were advising or mentoring (100%), professional development (96%), courses (96%), social activities (85%), and wellness (82%). Primary purpose themes were supporting students' professional development, fostering a sense of community, and creating a sense of wholeness. Structures included a community framework, subdivisions into smaller units, and governance by faculty and students. Process themes included longitudinal relationships, integrating faculty roles, and connecting students across class years. CONCLUSIONS Medical school LCs represent a collection of high-impact educational practices characterized by community and small-group structures, relational continuity, and collaborative learning as a means to guide and holistically support students in their learning and development as physicians. In describing 27 medical school LCs, this study proposes a unifying framework to facilitate future educational outcomes studies across institutions.
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Affiliation(s)
- Robert Shochet
- Colleges Advisory Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy Fleming
- Department of Pediatrics and Medical Student Affairs, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - James Wagner
- Department of Internal Medicine, University of Texas Southwestern School of Medicine, Austin, TX, USA
| | - Jorie Colbert-Getz
- Department of Internal Medicine and Education Quality Improvement, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Monica Bhutiani
- Division of Anesthesia Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kevin Moynahan
- College of Medicine—Tucson, The University of Arizona, Nashville, TN, USA
| | - Meg Keeley
- Department of Pediatrics and Student Affairs, University of Virginia School of Medicine, Charlottesville, VA, USA
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Rovere G, de Los Campos G, Tempelman RJ, Vazquez AI, Miglior F, Schenkel F, Cecchinato A, Bittante G, Toledo-Alvarado H, Fleming A. A landscape of the heritability of Fourier-transform infrared spectral wavelengths of milk samples by parity and lactation stage in Holstein cows. J Dairy Sci 2018; 102:1354-1363. [PMID: 30580946 DOI: 10.3168/jds.2018-15109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/28/2018] [Indexed: 11/19/2022]
Abstract
Fourier-transform near- and mid-infrared (FTIR) milk spectral data are routinely collected in many countries worldwide. Establishing an optimal strategy to use spectral data in genetic evaluations requires knowledge of the heritabilities of individual FTIR wavelength absorbances. Previous FTIR heritability estimates have been based on relatively small sample sizes and have not considered the possibility that heritability may vary across parities and stages of the lactation. We used data from ∼370,000 test-day records of Canadian Holstein cows to produce a landscape of the heritability of FTIR spectra, 1,060 wavelengths in the near- and mid-infrared spectrum (5,011-925 cm-1), by parity and month of the lactation (mo 1 to 3 and mo 1 to 6, respectively). The 2 regions of the spectrum associated with absorption of electromagnetic energy by water molecules were estimated to have very high phenotypic variances, very low heritabilities, and very low proportion of variance explained by herd-year-season (HYS) subclasses. The near- or short-wavelength infrared (SWIR: 5,066-3,672 cm-1) region was also characterized by low heritability estimates, whereas the estimated proportion of the variance explained by HYS was high. The mid-wavelength infrared region (MWIR: 3,000-2,500 cm-1) and the transition between mid and long-wavelength infrared region (MWIR-LWIR: 1,500-925 cm-1) harbor several waves characterized by moderately high (≥0.4) heritabilities. Most of the high-heritability regions contained wavelengths that are reported to be associated with important milk metabolites and components. Interestingly, these 2 same regions tended to show more variability in heritabilities between parity and lactation stage. Second parity showed heritability patterns that were distinctly different from those of the first and third parities, whereas the first 2 mo of the lactation had clearly distinct heritability patterns compared with mo 3 to 6.
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Affiliation(s)
- G Rovere
- Department of Animal Science, Michigan State University, East Lansing 48824; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing 48824; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing 48824.
| | - G de Los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing 48824; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing 48824; Department of Statistics and Probability, Michigan State University, East Lansing 48824
| | - R J Tempelman
- Department of Animal Science, Michigan State University, East Lansing 48824
| | - A I Vazquez
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing 48824; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing 48824
| | - F Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada, N1G 2W1; Canadian Dairy Network, Guelph, Ontario, Canada N1K 1E5
| | - F Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada, N1G 2W1
| | - A Cecchinato
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro, Italy
| | - G Bittante
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro, Italy
| | - H Toledo-Alvarado
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro, Italy
| | - A Fleming
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada, N1G 2W1; Canadian Dairy Network, Guelph, Ontario, Canada N1K 1E5
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Affiliation(s)
- S. H. Mehrtens
- Department of DermatologyMedway NHS Foundation Trust Windmill Rd Gillingham, Kent ME7 5NY UK
| | - A. Fleming
- Department of Histopathology Medway NHS Foundation Trust Windmill Rd Gillingham, Kent ME7 5NY UK
| | - L. Shall
- Department of DermatologyMedway NHS Foundation Trust Windmill Rd Gillingham, Kent ME7 5NY UK
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Parekh K, Benningfield M, Burrows H, Fleming A, Golden WC, Keeley M, Kileny S, Klink TE. Motivational Advising Workshop: Utilizing Motivational Interviewing Theory to Facilitate and Engage Intrinsic Motivation to Change Learners' Behavior. MedEdPORTAL 2018; 14:10751. [PMID: 30800951 PMCID: PMC6342340 DOI: 10.15766/mep_2374-8265.10751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/05/2018] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Motivational interviewing (MI) is a counseling method that utilizes a patient's own motivation to effect personal change. MI has been applied routinely and successfully to managing medical conditions (e.g., substance abuse). Employing MI techniques to engage medical learners (termed motivational advising [MA]) may help them overcome professional and/or personal challenges limiting their career development. METHODS Medical educators from four academic medical centers developed a module focused on teaching fellow educators MI theory and techniques for MA using didactic and interactive components. Participants participated in facilitated role-plays to practice MA delivery techniques and observed videos of a traditional advisor-advisee interaction as well as an MA-focused engagement. A postworkshop survey was used to evaluate the workshop. RESULTS In a survey of 48 educators attending the workshop at two medical conferences, over 80% of respondents demonstrated an interest in learning more about MA. Additionally, over 60% indicated that they would seek opportunities to practice and/or implement MA with their advisees. Knowledge of the technical components of MA also increased significantly in pre- and posttest analysis. DISCUSSION This module introducing the concept of MA was well received by medical educators and was viewed as a valuable tool in advising medical learners. The provided components enable replication of this workshop in other settings with or without an expert in MI techniques. Although the workshop has been conducted with physicians involved in medical education, it would be applicable to other health professionals who advise trainees such as nursing, dentistry, pharmacy, or veterinary medicine.
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Affiliation(s)
- Kendra Parekh
- Assistant Professor, Department of Emergency Medicine, Vanderbilt University School of Medicine
| | - Margaret Benningfield
- Associate Professor, Department of Psychiatry, Vanderbilt University School of Medicine
| | - Heather Burrows
- Director, Pediatric Residency Program, University of Michigan Medical School
| | - Amy Fleming
- Associate Dean, Medical Student Affairs, Vanderbilt University School of Medicine
| | - W. Christopher Golden
- Director, Medical Student Core Clerkship, Johns Hopkins University School of Medicine
- Assistant Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Meg Keeley
- Assistant Dean, Student Affairs, University of Virginia School of Medicine
| | - Sharon Kileny
- Assistant Professor, Department of Pediatrics, University of Michigan Medical School
| | - Thomas E. Klink
- Senior Medical Student, Vanderbilt University School of Medicine
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Allos BM, Yakes EA, Fleming A, Cutrer WB, Pilla M, Clair W, Fowler M, Miller B. Framing Medicine as a Moral Practice: An Introductory Medical School Course. Acad Med 2018; 93:1310-1314. [PMID: 29847324 DOI: 10.1097/acm.0000000000002301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PROBLEM The transition into medical school represents a time of profound professional development for medical students. Many medical schools manage this transition with brief orientations followed by abrupt moves into the anatomy laboratory. Recognizing that early introduction of key humanistic concepts could have a lasting impact on students' attitudes, faculty at the Vanderbilt University School of Medicine created the Foundations of the Profession (FoP) course to frame medicine as a moral practice. APPROACH The FoP course, offered annually since 2012, occurs during the first week of medical school. Using coronary artery disease with a chief complaint of angina as a core example, teams of students create variations of five hypothetical patients and walk them through potential care episodes. This allows students to compare the impact of many factors on a provider's ability to uphold fundamental professional obligations. Students engage in readings, lectures, small-group discussions, clinic visits, and research on insurance plans. Faculty engage with students in small groups and establish a safe environment for discussion of challenging moral dilemmas. OUTCOMES From 2013 to 2016, 356 (97%) of the 368 first-year medical students who took the course submitted summative course evaluations. Of the respondents, 349 (98%) indicated they believed the course contributed to their professional development and supported their learning. NEXT STEPS Future iterations of this course may include increased exposure to key educational faculty to solidify the formation of a moral scaffold on which to build subsequent knowledge.
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Affiliation(s)
- Ban Mishu Allos
- B.M. Allos is associate professor of medicine, Division of Infectious Diseases, and director of the microbiology and immunology course for first-year medical students, Vanderbilt University School of Medicine, Nashville, Tennessee. E.A. Yakes is associate professor of medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. A. Fleming is associate professor of pediatrics and associate dean for medical student affairs, Vanderbilt University School of Medicine, Nashville, Tennessee. W.B. Cutrer is associate professor of pediatrics, director of learning communities, and associate dean for undergraduate medical education, Vanderbilt University School of Medicine, Nashville, Tennessee. M. Pilla is professor of clinical anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee. W. Clair is associate professor of medicine, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee. M. Fowler is associate professor of medicine, Division of Endocrinology, Diabetes and Metabolism, and director of clinical skills development in undergraduate medical education, Vanderbilt University School of Medicine, Nashville, Tennessee. B. Miller is senior associate dean for health sciences education and executive vice president for educational affairs, Vanderbilt University School of Medicine, Nashville, Tennessee
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Fleming A. An exclusive look inside the UK's legal cannabis farm. New Sci 2018. [DOI: 10.1016/s0262-4079(18)31346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fleming A, Schenkel F, Malchiodi F, Ali R, Mallard B, Sargolzaei M, Jamrozik J, Johnston J, Miglior F. Genetic correlations of mid-infrared-predicted milk fatty acid groups with milk production traits. J Dairy Sci 2018; 101:4295-4306. [DOI: 10.3168/jds.2017-14089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
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Wang KW, Fleming A, Johnston DL, Zelcer SM, Rassekh SR, Ladhani S, Socha A, Shinuda J, Jaber S, Burrow S, Singh SK, Banfield L, de Souza RJ, Thabane L, Samaan MC. Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta-analysis. Clin Obes 2018; 8:55-67. [PMID: 29024558 DOI: 10.1111/cob.12224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/22/2022]
Abstract
Survivors of childhood brain tumours (SCBT) have increased cardiometabolic risks, but the determinants of these risks are unclear. This systematic review aims to compare the prevalence of overweight and obesity as well as adiposity measures between SCBT and non-cancer controls. The PubMed, EMBASE, MEDLINE, CINAHL and the Cochrane Library databases were searched. The primary outcomes were the prevalence of overweight and obesity based on body mass index. The secondary outcomes were adiposity measures including percent fat mass, waist-to-hip and waist-to-height ratios. Forty-one studies were included in the meta-analysis. The prevalence of overweight and obesity combined was similar between overall SCBT, SCBT excluding craniopharyngioma and non-cancer controls (42.6%, 95% CI 30.1-55.1 vs. 31.7%, 95% CI 20.4-43.0 vs. 40.4%, 95% CI 34.0-46.8). We also found that SCBT have higher percent fat mass (mean difference 4.1%, 95% CI 2.0-6.1), waist-to-hip ratio (mean difference 0.07, 95% CI 0.02-0.13) and waist-to-height ratio (mean difference 0.06, 95% CI 0.01-0.10) than non-cancer controls. We conclude that SCBT have similar overweight and obesity distribution but higher adiposity than non-cancer controls. More studies were needed to explore the determinants of adiposity and its contribution to cardiometabolic outcomes in SCBT.
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Affiliation(s)
- K-W Wang
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
| | - A Fleming
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Canada
| | - S R Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
| | - S Ladhani
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - A Socha
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - J Shinuda
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Jaber
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Canada
| | - S K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Canada
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Canada
| | - L Banfield
- Health Sciences Library, McMaster University, Hamilton, Canada
| | - R J de Souza
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - L Thabane
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - M C Samaan
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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