Validation of the Interprofessional Collaborative Competency Attainment Survey (ICCAS) retrospective pre-test measures.

Establishing the effectiveness of IPE experiences is essential, and current assessment measures may be subject to various types of bias. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) is administered after the learning experience as retrospective pretest and posttest measures of perceived collaborative practice skills. Because the ICCAS does not have an actual pretest, there are potential risks of recall bias and social desirability bias. To address these concerns, Jackson (2017) proposed conducting a true ICCAS pretest before the learning experience and examining the differences between the true and retrospective pretest scores and the differences between these pretest and posttest scores. This study design was implemented for two in-person Interprofessional forums conducted in the Fall (N = 745) and following Spring (N = 599) semesters. Students from 11 (Fall) and 12 (Spring) health professions education programs were included. True ICCAS pretest scores did not significantly differ from the retrospective pretest scores in either sample, although the effect sizes for pretest to posttest gains were slightly smaller for the true pretest scores. These results support and provide confidence for using the standard ICCAS administration methodology by demonstrating the administration methodology is not adversely impacted by recall or social desirability biases.

Comparing the Decriminalisation of Assisted Dying in Europe.

Assisted dying is subject to markedly different laws in different European countries, and the legislation is rapidly changing in many of them. This article seeks to enhance our understanding of how public and health-care professionals' opinions shape assisted dying legislation in Europe. To that end, data on the attitudes of the general public as well as health-care professionals was systematically collected, analysed and compared to the legal situation in seven European countries, covering the period from 1990 until 2021.

Knowledge and Practice of Harm Reduction Strategies Among People Who Report Frequent Cannabis Use.

We examined knowledge and practice of harm reduction strategies among people who use cannabis attending an annual public cannabis advocacy event. We also assessed the sources from which they glean information about cannabis. Participants (n = 472) completed a brief survey assessing cannabis use, sources for information on cannabis, and harm reduction strategies. Participants' knowledge of cannabis was based mostly on their own experiments and experiences rather than on information from health professionals. Participants generally had low accuracy in identifying effective harm reduction techniques and low rates of utilizing effective harm reduction techniques, using them at the same rate overall as techniques without empirical support. Results from this survey will be useful to public health professionals developing and implementing harm reduction educational strategies related to cannabis use.

Assessing the assessment: a comparison of the IPASS and ICCAS to measure change in interprofessional competencies following a large-scale interprofessional forum.

Measuring the effectiveness of interprofessional education (IPE) experiences is essential but challenging. Surveying learners before (pretest) and after (posttest) an IPE experience may result in minimal change due to response shift bias. Retrospective pretest/posttest assessment may ameliorate response shift bias but may also result in inflated change scores due to social desirability bias. We studied a cohort of 675 students from 12 health professions who completed the Interprofessional Attitudes Scale (IPAS) within the 4 weeks before (pretest) and the 3 weeks after (posttest) an IPE forum and completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) within the 3 weeks after the forum as a retrospective pretest/posttest. We found higher scores on the pretest IPAS than the retrospective pretest ICCAS and greater change in scores on the ICCAS than the IPAS, indicating potential response shift and social desirability biases. Furthermore, we found few significant correlations between change scores in subscales of the two tests, but a high number of strong and significant correlation among the ICCAS subscale change scores. Our results indicate the timing of pretest administration may impact change scores or that subscales of IPAS may be more unique than those of ICCAS. These findings suggest that educators should consider the potential impact of response shift and social desirability biases when interpreting results of the IPAS and ICCAS in response to an IPE learning experience.

Examining taste testing and point-of-purchase prompting as strategies to promote healthier food selection from food trucks.

OBJECTIVE: To examine the feasibility of taste testing and point-of-purchase prompting to promote healthier food choices at a food truck event. DESIGN: A pre-/post-study was conducted where food trucks provided samples of healthy food items to patrons and implemented point-of-purchase prompting (promotional signage; verbal cues). Implementation fidelity, acceptability and initial effectiveness were assessed via observation, patron surveys and sales data. A linear mixed model with a random effect for subject (food truck) and fixed effect for time point (baseline, intervention and post-intervention) was used to assess changes in relative sales of promoted healthy items as a percentage of food items sold. SETTING: Weekly food truck event in Buffalo, New York. PARTICIPANTS: Seven food trucks; 179 patrons. RESULTS: Implementation fidelity data illustrated that all food trucks complied with manualised procedures. Approximately one-third of surveyed patrons accepted a healthy sample, with the majority rating the sample positively. There was no main effect of time when examining changes in relative sales of promoted healthy items across all periods (P = 0·32); however, effect sizes representing changes between individual time points are consistent with an increase from baseline to intervention (d = 0·51), which was maintained through post-intervention (d = 0·03). The change from baseline to post-intervention corresponded to a medium effect size (d = 0·55). CONCLUSIONS: Findings generally support the feasibility of implementing taste testing and point-of-purchase prompting to increase the selection of healthy food items from food trucks; implications for future research in this novel setting are discussed.

Interprofessional, learner-driven collaboration for innovative solutions to healthcare delivery in student-run clinics.

Student-run clinics are settings in which learners are empowered to design service delivery. Despite shared challenges faced by these clinics in improving clinical and educational programming, information exchange and collaboration between clinics of different institutions and professions are inefficiently facilitated by existing platforms. An abridged, one-hour hackathon event was piloted at the Society of Student-Run Free Clinics' 2018 Annual Conference. During the event, interprofessional teams were guided through defining a problem, ideating and prototyping possible solutions, and sharing them with the larger group. There were 23 participants representing 16 institutions and 5 professions; most had never discussed their clinic's problems with members of other institutions before. Teams generated novel ideas that culminated from a combination of existing local best practices or focused on developing infrastructure between clinics. Feedback of the event was positive; participants felt confident to design and implement solutions and collaborate with other clinics after the event. The abridged hackathon shows promise to facilitate communication and innovation among diverse groups across institutions.

Sulfur polymer composites as controlled-release fertilisers.

Sulfur polymer composites were prepared by the reaction of canola oil and elemental sulfur in the presence of the NPK fertiliser components ammonium sulfate, calcium hydrogen phosphate, and potassium chloride. These composites released nutrients in a controlled fashion, resulting in less wasted fertiliser and better health for potted tomato plants when compared to free NPK.

Using the Elaboration Likelihood Model to Address Drunkorexia among College Students.

BACKGROUND: The many consequences related to alcohol consumption among college students are well documented. Drunkorexia, a relatively new term and area of research, is characterized by skipping meals to reduce caloric intake and/or exercising excessively in attempt to compensate for calories associated with high volume drinking. OBJECTIVE: The objective of this study was to use the Elaboration Likelihood Model to compare the impact of central and peripheral prevention messages on alcohol consumption and drunkorexic behavior. METHODS: Researchers employed a quasi-experimental design, collecting pre- or post-test data from 172 college students living in residence halls at a large Midwestern university, to assess the impact of the prevention messages. Participants in the treatment groups received the message in person (flyer), through email, and via a text message in weekly increments. RESULTS: Results showed that participants exposed to the peripherally framed message decreased the frequency of their alcohol consumption over a 30-day period (p =.003), the number of drinks they consumed the last time they drank (p =.029), the frequency they had more than five drinks over a 30-day period (p =.019), as well as the maximum number of drinks they had on any occasion in the past 30 days (p =.014). Conclusions/Importance: While more research is needed in this area, the findings from this study indicate that researchers and practitioners should design peripheral (short and succinct), rather than central (complex and detailed), messages to prevent drunkorexia and its associated behaviors.

Chitosan microencapsulation of the dispersed phase of an O/W nanoemulsion to hydrochlorothiazide delivery.

In view of biopharmaceutical limitations of hydrochlorothiazide (HCTZ), Trojan-type mucoadhesive systems were proposed, aiming to improve HCTZ pharmacological properties by modulating its release. Nanoemulsions were formed spontaneously by combining medium-chain triglycerides (Lipoid® S75 and Pluronic® F68) and high encapsulation efficiency was obtained. The mucoadhesive properties were provided by chitosan and microencapsulation of nanoemulsions in spray-dryer was successfully achieved by using Aerosil® as wall material. The rapid redispersion of nanoemulsion in simulated fluids led to a fast and complete release of HCTZ in gastric medium. The pharmacodynamics of HCTZ was improved, extending the diuretic activity. Once a simple and low-energy method contributed to obtain stable mucoadhesive nanoemulsions, advantages in terms of production could also be achieved, allowing easy scaling up. This novel mucoadhesive Trojan particulate system of HCTZ showed to be a promising approach to overcome limitations in terms of absorption and consequently improve the therapeutic efficacy.

Self-Nanoemulsified Drug Delivery System of Hydrochlorothiazide for Increasing Dissolution Rate and Diuretic Activity.

Hydrochlorothiazide (HCTZ) is a class IV drug according to the Biopharmaceutical Classification System. This study aimed the development of self-nanoemulsifying drug delivery system (SNEDDS) for HCTZ as an approach to overcome the biopharmaceutical limitations. Pre-formulation screening and ternary phase diagrams were carried out to select the oil phase, the surfactant, and the co-surfactant as the amount of each constituent. The optimized formulations, with reduced amount of surfactant, and composed of medium chain triglycerides, Cremophor EL and Transcutol P did not affect the pH or show drug incompatibilities. The SNEDDS were stabilized by the nanoscale globules and high negative zeta potential. All the physicochemical characterization assays were performed in biorelevant media to better predict the in vivo performance. The enhanced dissolution rate of the SNEDDS reflected in the in vivo diuretic activity, presenting a natriuresis, kaliuresis, and chloriuresis at early stages and an increased volume of total urine compared with HCTZ alone. The designed SNEDDS produced an improvement in the pharmacodynamics due to high dissolution and probable inhibition of intestinal efflux protein by Cremophor EL. The use of SNEDDS demonstrated to be an efficient approach to modulate the absorption of HCTZ and drug therapeutics.

Associations Between Daily Activities, Stress, and Sleep Among Adults During the COVID-19 Pandemic.

The COVID-19 pandemic introduced lifestyle changes that appeared to impact adults' engagement in health-promoting activities. Researchers observed increased stress, sleep problems, and sedentary activity, and decreased physical activity during the pandemic. This secondary analysis examined the frequency that adults engaged in different daily activities and links between activity types, stress, and sleep during the pandemic. Fifty-three adults completed a single online survey in January 2021 where they reported demographics, COVID-19 pandemic experiences, daily activities, stress, and sleep. Sum scores were calculated to indicate total frequency of different activity types. Regressions were used to examine whether the frequency of different activity types predicted sleep duration and stress. There was a trend-level relationship between the frequency of activities done outdoors and stress scores, such that doing outdoor activities more often was linked with less stress (P = .098). Higher income also tended to be linked with more stress (P = .053), as did younger age (P = .028). When restricting the outdoor activity variable to physical outdoor activities only, the relationship with stress became significant (P = .013). These results suggest that engaging in physical activity outdoors may reduce stress during the COVID-19 pandemic.

What Predicts Graduate Public Health Student Success? Evidence for Admission Committees in a Post-Affirmative Action Landscape.

OBJECTIVE: A severe staff shortage and a dearth of professionals from underrepresented backgrounds in the public health workforce are contributing to poor health outcomes in the United States. Schools and programs can mitigate these problems by admitting more graduate public health students overall and from underrepresented backgrounds. We identified predictors of foundational graduate public health course grades and graduate grade point average (GPA), sharing evidence to remove application factors that are admission barriers and do not predict student outcomes. METHODS: We conducted a linear regression analysis on demographic and academic factors from 564 graduate public health applications for students at the University at Buffalo who received their degree from January 1, 2016, to February 1, 2021, analyzing age, race and ethnicity, sex, income, undergraduate degree, verbal and quantitative Graduate Record Examination (GRE) percentiles, and undergraduate GPA. Outcomes were grades in foundational public health courses and cumulative graduate GPA. RESULTS: Undergraduate GPA was the best predictor of graduate public health student success, explaining nearly 7% of foundational public health course grades and 29% of graduate GPA. Higher undergraduate GPA contributed to higher course grades and graduate GPA. GRE scores explained <1% of student outcomes. CONCLUSIONS: Our findings add to the growing body of research showing that standardized test scores may not predict graduate student outcomes and provide further evidence for the field of public health to consider removing this admission barrier. By doing so, institutions could admit more students to graduate public health programs who can bring needed skills to the market, further diversifying the workforce and public health faculty, to better meet population health needs.

Utilizing an Ecomap to Visualize the Impact of Social Determinants of Health in an Interprofessional Forum.

INTRODUCTION: Graphical representations of a case study can help learners recognize how systems and institutions impact health. The impact of the social determinants of health (SDoH) on individual and community health is well established, yet it may be challenging for students to visualize the impact of these components within a case study. PURPOSE: This study explored the use of ecomaps in an interprofessional forum and examined the perceptions from students and faculty regarding use of this educational tool. METHODS: This tool was assessed over two semesters, Fall 2021 (n=968) and Fall 2022 (n= 835) to evaluate student and faculty perceptions of the use of the tool along with faculty's assessment of student completion of the tool within a rubric. RESULTS: Nearly all students (99%) came prepared to the forum and presented their ecomaps to others during the small group discussion to facilitate conversation as they explored the role of SDoH related to the case study. Both students and faculty rated the use of this tool favorably. DISCUSSION: In conclusion, ecomaps were viewed favorably by both students and faculty. This visual exploration of SDoH helps students to visualize both positive and negative factors that impact a patient's experience.

Assessing dental student knowledge on cannabis and demonstrating the need for cannabis education.

PURPOSE: The American Dental Association advocates for dentists' education on therapeutic and legal issues related to medical cannabis. It is important to understand current knowledge of cannabis and cannabinoids and to have a practical knowledge assessment instrument. This exploratory study is the first of its kind to assess dental students' knowledge of cannabis and aims to determine if there is a need for more instruction regarding cannabis in a dental school's curriculum. METHODS: Predoctoral dental students at the University at Buffalo School of Dental Medicine were recruited to participate. A validated, anonymous 22-item online survey was adapted and administered to students in all 4 years of the dental program. There was a total of 56 knowledge points. RESULTS: The average knowledge score was 21.6 points (SD = 5.2, range: 7-34), corresponding to 38.5% (SD = 9.2) of the answers correct. There were no overall differences in knowledge by gender, years in dental school, or by any reported source of formal education on cannabis. Those who reported doing their own research had higher knowledge scores. Most participants knew that there is an endogenous cannabinoid system (72.3%) and that Tetrahydrocannabinol (THC) is responsible for the "high" experienced with cannabis (76.6%). Most participants reported that they did not know the effective doses of THC (58.2%) and Cannabidiol (CBD) (66.7%); few provided an answer for THC (34%) or CBD (17%) in the acceptable range of 2-10 mg. CONCLUSION: Dental students did not have adequate knowledge on cannabis and cannabinoids. Given the rapid expansion of cannabis legalization, additional efforts are needed to integrate cannabis topics into coursework and learning experiences.

Capabilities and Limitations of Student-Led Free Vision Screening Programs in the United States.

Purpose: The Consortium of Student-Led Eye Clinics (CSLEC), founded in 2021, administered a comprehensive survey to document the types of services, most common diagnoses, and follow-up care protocols offered by student-led free vision screening programs (SLFVSP) in the United States. Methods: An 81-question institutional review board (IRB)-approved survey was administered to student-led vision screening eye clinics from October 1, 2022 to February 24, 2023. Results: Sixteen SLFVSPs were included in the final analysis, of which 81% (n = 13) conducted variations of fundoscopic examinations and 75% (n = 12) measured intraocular pressure. Cataracts and diabetic retinopathy were reported as the most frequent diagnoses by the majority of SLFVSPs (n = 9, 56%); non-mobile SLFVSPs more commonly reported cataract as a frequent diagnosis (P < 0.05). Most patients screened at participating programs were uninsured or met federal poverty guidelines. Prescription glasses were offered by 56% of the programs (n = 9). SLFVSPs that directly scheduled follow-up appointments reported higher attendance rates (66.5%) than those that only sent referrals (20%). Transportation was the most cited barrier for follow-up appointment attendance. Conclusions: SLFVSPs, one community vision screening initiative subtype, vary significantly in scope and capabilities of identifying vision threatening disease. The follow-up infrastructure is not uniformly robust and represents a key target for improving care delivery to at-risk populations. Translational Relevance: The CSLEC aims to develop a consensus-based standardization for the scope of screening services, offer guidelines for diagnostic criteria, promote real-time data stewardship, and identify means to improve follow-up care mechanisms in member communities.

Consumer Experiences with Delta-8-THC: Medical Use, Pharmaceutical Substitution, and Comparisons with Delta-9-THC.

Introduction: Cannabis products containing delta-8-THC became widely available in most of the United States in late 2020 and rapidly became a significant source of revenue for hemp processing companies, especially in states where use of delta-9-THC remains illegal or requires professional authorization for medical use. Scientific research on the use of delta-8-THC is scarce, previous clinical studies included a combined total of 14 participants, leading some state governments to prohibit it until its properties and effects are better understood. Methods: Researchers developed an online survey for delta-8-THC consumers addressing a broad range of issues regarding delta-8-THC, including use for the treatment of health and medical conditions. Previous survey studies on the medical use of cannabis and cannabis products informed survey components. Results: Patterns of delta-8-THC use had both similarities with and differences from the use of delta-9-THC cannabis and products. Administration methods were primarily edibles (64%) and vaping concentrates (48%). About half of the participants (51%) used delta-8-THC to treat a range of health and medical conditions, primarily anxiety or panic attacks (69%), stress (52%), depression or bipolar disorder (46%), and chronic pain (41%). Participants compared delta-8-THC very favorably with both delta-9-THC and pharmaceutical drugs and reported substantial levels of substitution for both. Most participants did not inform their primary care provider of their delta-8-THC use (78%) and were not confident of their primary care provider's ability to integrate medical cannabis into their treatment (70%). Knowledge of effective dosages was low, and participants' knowledge of delta-8-THC was primarily from the Internet and their own experiences. Conclusion: Harm reduction is a central component of public health. Although the legal environment is becoming more restrictive for delta-8-THC in comparison to delta-9-THC, results suggest that delta-8-THC may be equally effective for desired purposes of cannabis use and lower in undesirable or adverse effects. All policies and practices should be informed by empirical evidence. Considerable research will be needed to systematically verify the patterns reported by participants, and collaborations among academic researchers, government, and the cannabis industry may be valuable in developing the knowledge base for delta-8-THC and other cannabinoids.

Cannabis Advertising Policies in the United States: State-Level Variation and Comparison with Canada.

Objective: To assess the regulations on Cannabis advertising across U.S. states for variation and compare with Canadian federal policies, for the purpose of identifying opportunities to protect the public, especially the youth and other vulnerable populations, from health risks. Methods: We reviewed Health Canada's Cannabis Act and Cannabis Regulations to identify prohibited marketing and advertising activities for cannabis products. The Canadian guidelines (where cannabis is legal for both medical and nonmedical use) were compared with regulations in the 36 U.S. states where cannabis is legalized for medical and/or adult (e.g., recreational) use. Results: Cannabis advertising regulations vary greatly and have little consistency across the U.S. states. Most states do not address many of the cannabis advertising activities that are prohibited in Canada. Among the 31 states that do allow some form of cannabis advertising, 74% explicitly prohibit targeting or appealing to minors and 68% prohibit making false or misleading claims. There are 11 illegal advertising tactics in Canada, such as glamorization and testimonials, that were not specifically discussed in any of the U.S. state policies. Conclusion: The lack of consistent marketing guidelines could expose youth and vulnerable populations to cannabis advertisements; more widespread or federal guidance is needed.

An Innovation Sprint to Promote Problem-solving and Interprofessional Skills Among Pharmacy and Public Health Students.

Objective. Innovation sprints are a novel pedagogy where small groups of students find creative solutions to problems. The purpose of this study was to extend our understanding of innovation sprint pedagogical design by investigating the impact of an innovation sprint on Doctor of Pharmacy (PharmD) students' and Master of Public Health (MPH) students' interprofessional collaboration and problem-solving skills. We hypothesized that the innovation sprint would increase student self-efficacy and that interprofessional collaborative behaviors would be demonstrated by individuals on a team.Methods. MPH and third-year PharmD students were assigned to teams and participated in a required two-hour innovation sprint. Faculty observed student teams and evaluated their interprofessional collaboration skills using a rubric modeled after the Modified McMaster-Ottawa Scale. Students completed a postprogram survey assessing their interprofessional collaborative behaviors and attitudes toward the innovation sprint.Results. Of the 133 students participating in the innovation sprint, 127 completed the postprogram survey (response rate=95%). Faculty determined that 123 students (92%) met the interprofessional collaboration competencies. The mean interprofessional collaborative competencies attainment survey scores increased for both PharmD and MPH students. Qualitative analyses highlighted themes of interprofessional collaboration and problem-solving skills that students valued. Overall, students enjoyed working with each other and engaging in creative problem-solving.Conclusion. An interprofessional innovation sprint involving PharmD and MPH students demonstrated a positive impact on student self-assessed interprofessional collaboration and problem-solving skills. Further, faculty observed a high rate of interprofessional behaviors within student teams. Based on these findings, an innovation sprint may be an effective pedagogical tool to enhance students' skills in these areas.

THC-O-Acetate: Scarce Evidence for a Psychedelic Cannabinoid.

There is a growing interest in semi-synthetic cannabinoids, including THC-O-acetate (THC-Oac). Some cannabis marketers and users have claimed that THC-Oac produces psychedelic effects; the current study is the first to examine this claim. Researchers developed an online survey for THC-Oac consumers based on previous cannabis and psychedelic use surveys and in consultation with the moderator of an online forum. The survey assessed the experiential profile of THC-Oac and included items from the Mystical Experience Questionnaire (MEQ), an instrument for assessing psychedelic experiences. Participants reported a low to moderate level of cognitive distortions (altered sense of time, difficulties concentrating, difficulties with short-term memory) and few visuals or hallucinations. Participants' responses were significantly below the threshold for a complete mystical experience on all four MEQ dimensions. Participants who had used classic (5-HT2A agonist) psychedelics had lower scores on all MEQ dimensions. When asked directly, 79% responded that using THC-Oac is "not at all" or "a little" of a psychedelic experience. Some reports of psychedelic experiences may be due to expectations or contaminants. Those having prior experience with classic psychedelics had lower ratings of mystical experiences.

Reviewing the Risk of Ketene Formation in Dabbing and Vaping Tetrahydrocannabinol-O-Acetate.

Introduction: In the wake of continued consumer demand despite increasing regulatory scrutiny, there is a need to develop systematic methods for identifying the harm profile of new psychoactive substances derived from hemp. Tetrahydrocannabinol-O (THC-O)-acetate, colloquially known as THCO, is the acetate ester of the principal psychoactive compound in cannabis. The heating of THCO can create ketene gas, which is harmful to the lungs. Materials and Methods: The research team used a multidisciplinary, iterative process to develop a survey to incorporate consumers' perspectives of semisynthetic cannabinoids. The survey was then distributed across the social media platform Reddit to learn about delivery device preferences and associated use styles when consuming THCO. Results: Most participants (74.9%) vaped THCO and one-quarter of participants (24.3%) dabbed THCO and tended to report higher temperatures for dabbing than vaping THCO. A small portion (12.0%) of participants reported concerns regarding ketene risk. Conclusion: As there are multiple variables associated with the formation of ketene, and consumer responses indicate temperatures use that might enable ketene formation, more research is needed to understand the risk profile of hemp-derived substances like THCO. Further studies are needed to understand the how various routes of administration and delivery devices used with THCO may exacerbate the risk of ketene formation and other potential harms.