Launching into interprofessional education: graduate students learning and growing together.

Interprofessional education (IPE) is vital in university clinical settings to prepare graduate students to engage in today's health care system. However, few university programs have successfully implemented IPE into existing clinical programs. The purpose of this pilot study was to evaluate the effectiveness of an interprofessional (IP) training and clinical experience on graduate students' and caregivers perceptions on quality of care in a pre-existing clinical program. Speech-language pathology (SLP) and Physical Therapy (PT) faculty, worked to coordinate and develop an IP training and clinical experience. Graduate students from both disciplines participated in the IP training and completed a pre-post training questionnaire. Students then participated in an IP clinical experience with three preschool-age children with complex sensory motor needs and completed the questionnaire again following this experience. Students' attitudes and perceptions of readiness for IP engagement following IPE training showed a positive trend but not following an IP clinical experience. Subjective feedback from students and caregivers was highly favorable. The results provide further evidence of the benefits of IP training and clinical experience. More effective qualitative and quantitative tools must be developed to capture the effectiveness of direct IP clinical collaboration.

Unraveling the etiology of ovarian cancer racial disparity in the deep south: Is it nature or nurture?

BACKGROUND: Our objective was to evaluate racial treatment and survival disparities in black women with ovarian cancer in the Deep South and to determine how environmental factors / socioeconomic status (SES) influence survival. METHODS: A retrospective study of ovarian cancer patients from 2007 to 2014 was performed. Socioeconomic status (SES) was obtained though U.S. Census block data and compared using Yost scores. Comparisons were performed using standard statistical approaches. RESULTS: A total of 393 patients were evaluated, 325 (83%) white and 68 (17%) black. Demographic information and surgical approach were similar in each racial group. However, compared to whites, black patients had lower rates of optimal debulking [89% vs. 71%, respectively (p=0.001)] and intraperitoneal chemotherapy (19% vs. 11%, p=0.01). Black women had lower SES parameters including education, income, and poverty. As a result, more black patients had the lowest SES (SES-1) when compared to white patients (17% vs. 41%, p<0.001). When controlling for these factors by cox regression analysis, a survival disadvantage was seen in black women for both progression free survival (16 vs. 27months, p=0.003) and overall survival (42 vs. 88months, p<0.001). CONCLUSIONS: Despite controlling for clinical and environmental factors, a survival disadvantage was still observed in black patients with ovarian cancer in the Deep South. Black women had lower optimal debulking rates and more platinum resistant disease. These data suggest other factors like tumor biology may play a role in racial survival differences, however, more research is needed to determine this causation.

Recovery of an HMWP/hmwBP (pUL48/pUL47) complex from virions of human cytomegalovirus: subunit interactions, oligomer composition, and deubiquitylase activity.

UNLABELLED: We report that the human cytomegalovirus (HCMV) high-molecular-weight tegument protein (HMWP, pUL48; 253 kDa) and the HMWP-binding protein (hmwBP, pUL47; 110 kDa) can be recovered as a complex from virions disrupted by treatment with 50 mM Tris (pH 7.5), 0.5 M NaCl, 0.5% NP-40, and 10 mM dithiothreitol [DTT]. The subunit ratio of the complex approximates 1:1, with a shape and structure consistent with an elongated heterodimer. The HMWP/hmwBP complex was corroborated by reciprocal coimmunoprecipitation experiments using antipeptide antibodies and lysates from both infected cells and disrupted virus particles. An interaction of the amino end of pUL48 (amino acids [aa] 322 to 754) with the carboxyl end of pUL47 (aa 693 to 982) was identified by fragment coimmunoprecipitation experiments, and a head-to-tail self-interaction of hmwBP was also observed. The deubiquitylating activity of pUL48 is retained in the isolated complex, which cleaves K11, K48, and K63 ubiquitin isopeptide linkages. IMPORTANCE: Human cytomegalovirus (HCMV, or human herpesvirus 5 [HHV-5]) is a large DNA-containing virus that belongs to the betaherpesvirus subfamily and is a clinically important pathogen. Defining the constituent elements of its mature form, their organization within the particle, and the assembly process by which it is produced are fundamental to understanding the mechanisms of herpesvirus infection and developing drugs and vaccines against them. In this study, we report isolating a complex of two large proteins encoded by HCMV open reading frames (ORFs) UL47 and UL48 and identifying the binding domains responsible for their interaction with each other and of pUL47 with itself. Our calculations indicate that the complex is a rod-shaped heterodimer. Additionally, we determined that the ubiquitin-specific protease activity of the ORF UL48 protein was functional in the complex, cleaving K11-, K48-, and K63-linked ubiquitin dimers. This information builds on and extends our understanding of the HCMV tegument protein network that is required to interface the HCMV envelope and capsid.

Minority participation in Gynecologic Oncology Group (GOG) Studies.

OBJECTIVE: Participation of minority populations in clinical trials is paramount to understanding and overcoming cancer racial disparities. The goal of this project is to evaluate minority participation in published GOG clinical trials. METHODS: GOG publications from 1985 to 2013 were reviewed. Minority enrollment was stratified by tumor site, type of study, and year published. Based on Centers of Disease Control and Prevention (CDC) age-adjusted incidence for race, expected and observed ratios of racial participation were calculated. RESULTS: A total of 445 GOG publications involving 67,568 patients were reviewed. Racial breakdown was provided in 170 studies (38%) for a total of 45,259 patients: 83% White (n=37,617); 8% Black (n=3,686), and 9% Other (n=3,956). The majority of studies were Ovarian (n=202) and Phase 2 (n=290). When evaluating the quartiles of publication year, a steady decline in the proportion of Black patients enrolled was seen. Race was not reported in any publication prior to 1994. Compared to years 1994-2002, a 2.8-fold lower proportion of black enrollment was noted in years 2009-2013 (16% and 5.8%, respectively; p<0.01). Utilizing CDC age-adjusted incidence, observed enrollment of Black patients onto GOG clinical trials was significantly less than expected enrollment. Observed Black enrollment was 15-fold lower than expected for ovarian trials, 10-fold lower for endometrial, 4.5-fold for cervix, and 5.2-fold for sarcoma (each p<0.001). CONCLUSIONS: Based on age-adjusted incidence, observed enrollment of Black patients was lower than expected enrollment onto GOG studies. Despite national emphasis on minority enrollment on clinical trials, fewer Black patients were enrolled over time.

Augmentative and alternative communication (AAC) for nursing students; equipping the next generation of nursing professionals.

BACKGROUND: Augmentative and alternative communication (AAC) is often used for patients who are temporarily non-speaking. However, considering AAC for these patients in intensive care units (ICUs) has only recently started to gain the attention of health care providers in the hospital setting. Currently, few nursing programs include content in their curricula as relates to this population. OBJECTIVES: To investigate the feasibility of embedding a brief inservice into an existing undergraduate nursing course, and to determine the feasibility and relevance of AAC use during their clinical ICU rotation. DESIGN: A longitudinal survey study using three time points: pre- and post-inservice, and post implementation following a clinical rotation. SETTING: University nursing program classroom during an Adult Health and Illness course. PARTICIPANTS: Twenty-seven undergraduate nursing students enrolled in the Adult Health and Illness course. METHODS: The participants were given a brief inservice educating them on the use of AAC. The students were given AAC boards to use during their ICU clinical rotation. Survey data was collected before and after the inservice and at the end of the clinical rotation. RESULTS: Pre-service nursing students responded favorably to a brief inservice embedded into an existing nursing course. Survey data indicated an increase in the students' knowledge of AAC (z = 4.52, p < .05) and awareness that AAC can improve communication between patients and staff (z = 2.24, p < .05). CONCLUSION: An interdisciplinary activity between Communication Sciences and Disorders and Nursing departments about AAC could be a new and promising solution to increase communication with non-speaking patients in the ICU.

Heart failure clinical trial enrollment at a rural satellite hospital.

INTRODUCTION: Heart failure is a clinical condition that notably affects the lives of patients in rural areas. Partnering of a rural satellite hospital with an urban academic medical center may provide geographically underrepresented populations with heart failure an opportunity to access to controlled clinical trials (CCTs). METHODS: We report our experience in screening, consenting and enrolling subjects at the VCU Health Community Memorial Hospital (VCU-CMH) in rural South Hill, Virginia, that is part of the larger VCU Health network, with the lead institution being VCU Health Medical College of Virginia Hospitals (VCU-MCV), Richmond, VA. Subjects were enrolled in a clinical trial sponsored by the National Institutes of Health and assigned to treatment with an anti-inflammatory drug for heart failure or placebo. We used the electronic health record and remote guidance and oversight from the VCU-MCV resources using a close-loop communication network to work with local resources at the facility to perform screening, consenting and enrollment. RESULTS: One hundred subjects with recently decompensated heart failure were screened between January 2019 and August 2021, of these 61 are enrolled to date: 52 (85%) at VCU-MCV and 9 (15%) at VCU-CMH. Of the subjects enrolled at VCU-CMH, 33% were female, 77% Black, with a mean age of 52 ± 10 years. CONCLUSION: The use of a combination of virtual/remote monitoring and guidance of local resources in this trial provides an opportunity for decentralization and access of CCTs for potential novel treatment of heart failure to underrepresented individuals from rural areas. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03797001.

Center for clinical and translational research COVID-19 clinical trial committee: The development of a review and prioritization matrix during a pandemic.

The rate at which the coronavirus disease (COVID-19) spread required a rapid response across many, if not all, industries. Academic medical centers had to rapidly evaluate, prioritize, and coordinate the multiple requests for clinical trial participation. This involved redirecting resources and developing a collaborative system for assessment, decision making, and implementation. Our institution formed a team with diverse representation from multiple stakeholders to review and prioritize all research protocols related to COVID-19. To accomplish this, a prioritization matrix was developed to help determine the order in which the protocols should be placed for consideration by the treating clinician. The purpose of the team was to review the COVID-19 clinical trials in the pipeline, prioritize those trials that best met the needs of our patients, oversee training and resource needs, and lead the formulation of procedures for integration with clinical care. Resources from the Clinical Research Unit were then allocated to support the swift execution of such studies. This manuscript describes that process, the challenges encountered, and the lessons learned on how to make all clinical trials more successful in a complex and dynamic environment.

Clinical trial enrollment at a rural satellite hospital during COVID-19 pandemic.

INTRODUCTION: Controlled clinical trials (CCTs) have traditionally been limited to urban academic clinical centers. Implementation of CCTs in rural setting is challenged by lack of resources, the inexperience of patient care team members in CCT conductance and workflow interruption, and global inexperience with remote data monitoring. METHODS: We report our experience during the coronavirus disease 2019 (COVID-19) pandemic in activating through remote monitoring a multicenter clinical trial (the Study of Efficacy and Safety of Canakinumab Treatment for cytokine release syndrome (CRS) in Participants with COVID-19-induced Pneumonia [CAN-COVID] trial, ClinicalTrials.gov Identifier: NCT04362813) at a rural satellite hospital, the VCU Health Community Memorial Hospital (VCU-CMH) in South Hill, VA, that is part of the larger VCU Health network, with the lead institution being VCU Health Medical College of Virginia Hospital (VCU-MCV), Richmond, VA. We used the local resources at the facility and remote guidance and oversight from the VCU-MCV resources using a closed-loop communication network. Investigational pharmacy, pathology, and nursing were essential to operate the work in coordination with the lead institution. RESULTS: Fifty-one patients with COVID-19 were enrolled from May to August 2020, 35 (69%) at VCU-MCV, and 16 (31%) at VCU-CMH. Among the patients enrolled at VCU-CMH, 37.5% were female, 62.5% Black, and had a median age of 60 (interquartile range 56-68) years. CONCLUSION: Local decentralization of this trial in our experience gave rural patients access to a novel treatment and also accelerated enrollment and more diverse participants' representative of the target population.

The effect of Tier 2 intervention for phonemic awareness in a response-to-intervention model in low-income preschool classrooms.

PURPOSE: This study assessed the effectiveness of a Tier 2 intervention that was designed to increase the phonemic awareness skills of low-income preschoolers who were enrolled in Early Reading First classrooms. METHOD: Thirty-four preschoolers participated in a multiple baseline across participants treatment design. Tier 2 intervention for beginning sound awareness was provided twice weekly in small groups over 6 weeks by trained teachers and speech-language pathologists (SLPs). RESULTS: The intervention was successful for 71% of the children, as indicated by medium to large effect sizes. Comparisons between children who did and did not qualify for intervention suggest that Tier 2 intervention helped narrow the gap in beginning sound awareness that had begun to emerge before treatment. Although children receiving special education and those learning English as a second language were enrolled in the classrooms, they were not overrepresented in the group qualifying for Tier 2 intervention, and most who did qualify demonstrated a positive response to intervention. CONCLUSION: In a relatively short period of time, preschoolers' phonemic awareness skills were increased through small-group Tier 2 intervention provided by teachers and SLPs. Findings indicate the potential of Tier 2 interventions to positively impact the future reading skills of children who are at risk for later reading difficulties.

Retelling stories: Grammatical and lexical measures for identifying monolingual spanish speaking children with specific language impairment (SLI).

Children with Specific Language Impairment (SLI) have grammatical and lexical difficulties when telling stories. The aim of this work was to explore whether language productivity measures, such as mean length of utterance (MLU), percentage of ungrammatical sentences (%UGS), total number of words (TNW), and number of different words (NDW) produced by young children during a story retell task, can be used to accurately differentiate monolingual Spanish-speaking children with SLI from children with typical language development (TLD). Fifty monolingual Spanish-speaking children between 4; 0 and 6; 11 years were assigned to one of two groups: 25 children with SLI and 25 TLD age-matched peers. A scripted picture book was read to each child and the child was subsequently asked to retell the story using pictures. Story retells were analyzed for MLU, %UGS, TNW, and NDW. Results showed significant differences between groups on all four measures. Children with SLI showed significantly lower MLU, TNW and NDW, and significantly higher%UGS when compared with age-matched peers with TLD. Results suggest that measures of language productivity obtained during story retells may be used to accurately detect differences in language performance and differentiate monolingual Spanish-speaking children with SLI from their typical peers. The findings from this study have clinical implications for assessment and identification of monolingual Spanish-speaking children with language impairments.

The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997.

OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.

Early- and intermediate-stage variants of simian immunodeficiency virus replicate efficiently in cells lacking CCR5.

Primate lentiviruses are thought to use the chemokine receptor CCR5 as the major coreceptor for entry into cells. Here we show that some variants of simian immunodeficiency virus (SIV) replicate efficiently in peripheral blood mononuclear cells (PBMCs) lacking a functional CCR5. There were differences in the replication patterns of sequential variants that evolved during SIVMne infection; the late-stage pathogenic variants were unable to replicate in PBMCs lacking CCR5, whereas the early- and intermediate-stage viruses replicated as well in PBMCs lacking CCR5 as they did in cells with wild-type CCR5. The coreceptor specificities of these sequential variants were compared using indicator cell lines expressing known SIV coreceptors. Among the known SIV coreceptors, there were none that were functional for the early and intermediate variants but not the late-stage variants, suggesting that the coreceptor used for replication in PBMCs may be a coreceptor that has not yet been described. Because some variants replicate with high efficiency in peripheral blood cells using this as yet uncharacterized cellular receptor, this coreceptor may be important for viral entry of some target cell populations in the host.

Thrombocytosis is associated with a significant increase in the cancer specific death rate after radical nephrectomy.

PURPOSE: We have previously reported that patients with advanced renal cell carcinoma and a normal platelet count of 400,000/mm. have a 64% increase in life expectancy compared with those with thrombocytosis. We determined whether thrombocytosis was predictive of death from renal cell carcinoma after radical nephrectomy was performed with curative intent for early stage disease. MATERIALS AND METHODS: We reviewed the records of 204 patients with renal cell carcinoma who underwent radical nephrectomy with curative intent between June 1993 and January 2000 at Emory University Hospital. Survival, pathological grade and stage were recorded from the Emory Winship Cancer Institute tumor registry. Platelet counts were recorded and any patient with at least 1 platelet count of greater than 400,000/mm. was classified with thrombocytosis. Those with a platelet count of 400,000/mm. were classified with a normal platelet count. RESULTS: There were 26 patients with thrombocytosis and 178 patients with persistently normal platelet counts. The overall and cancer specific death rate in the 26 patients with thrombocytosis was 50% and 42%, respectively. The overall mean time between nephrectomy and death was 12.1 months in this group. The overall and cancer specific death rate in the 178 patients with a normal platelet count was 15.2% and 7.3%, respectively. Mean time to death was 22.6 months in this group. Differences in the overall and cancer specific death rates were highly statistically significant as well as clinically significant. These differences remained significant after controlling for grade, stage and histological type of cancer. CONCLUSIONS: This study documents the association of thrombocytosis with decreased survival in patients with renal cell carcinoma. In those who undergo nephrectomy for early stage renal cell carcinoma with a perioperative platelet count of greater than 400,000/mm. the cancer specific death rate from renal cell carcinoma is greater than 5 times the rate in patients with a persistently normal platelet counts after radical nephrectomy. The platelet count appears to be a new and powerful independent prognosticator in patients with renal cell carcinoma who undergo radical nephrectomy for presumed localized disease.