Health Profession Students' Interprofessional Socialization and Values Toward a College-Based Virtual Interprofessional Education Activity.

PURPOSE: The inclusion of interprofessional education (IPE) is essential for the health professions curricula and establishes the expectation of collaborative patient-centered care. The COVID-19 pandemic has required educators to develop innovative methods for IPE student engagement. The purpose of this study was to evaluate a college-based virtual IPE activity for first-year health profession students and measure their interprofessional socialization and values (ISVS) toward IPE teams. The validated interprofessional socialization and valuing scales (ISVS-9A/9B) were used. METHODS: A one-group pre-post-test design examined health profession students' ISVS from seven health programs before and after a virtual IPE activity. The IPE activity was a case-study grounded in the Interprofessional Education Collaborative (IPEC) core competencies that addressed each of the student learners' professional roles. RESULTS: A total of 244 students and 122 students completed the ISVS-9A/9B, respectively. A significant increase in the average total ISVS-9A/9B scores was observed among all student learners for 85 matched pairs (5.27 ± 1.11 vs 5.56 ± 1.02, p=0.01). Participating students generally found the activity valuable to their learning. CONCLUSIONS: The virtual composition of the IPE activity reduced logistical barriers and allowed for collaboration and awareness among students. Virtual IPE activities may be the cornerstone for interdisciplinary student engagement.

The Relationship between Maternal Antibodies to Fetal Brain and Prenatal Stress Exposure in Autism Spectrum Disorder.

Environmental and genetic factors contribute to the etiology of autism spectrum disorder (ASD), but their interaction is less well understood. Mothers that are genetically more stress-susceptible have been found to be at increased risk of having a child with ASD after exposure to stress during pregnancy. Additionally, the presence of maternal antibodies for the fetal brain is associated with a diagnosis of ASD in children. However, the relationship between prenatal stress exposure and maternal antibodies in the mothers of children diagnosed with ASD has not yet been addressed. This exploratory study examined the association of maternal antibody response with prenatal stress and a diagnosis of ASD in children. Blood samples from 53 mothers with at least one child diagnosed with ASD were examined by ELISA. Maternal antibody presence, perceived stress levels during pregnancy (high or low), and maternal 5-HTTLPR polymorphisms were examined for their interrelationship in ASD. While high incidences of prenatal stress and maternal antibodies were found in the sample, they were not associated with each other (p = 0.709, Cramér's V = 0.051). Furthermore, the results revealed no significant association between maternal antibody presence and the interaction between 5-HTTLPR genotype and stress (p = 0.729, Cramér's V = 0.157). Prenatal stress was not found to be associated with the presence of maternal antibodies in the context of ASD, at least in this initial exploratory sample. Despite the known relationship between stress and changes in immune function, these results suggest that prenatal stress and immune dysregulation are independently associated with a diagnosis of ASD in this study population, rather than acting through a convergent mechanism. However, this would need to be confirmed in a larger sample.

Transitioning Professional Development Classes to Virtual Instruction.

The coronavirus disease 2019 (COVID-19) pandemic necessitated shifts in education delivery, forcing professional development specialists toward alternative learning delivery methods. Members of an academic-practice partnership at a Midwestern hospital collaboratively designed virtual evidence-based education modules for staff onboarding. We describe the transition from in-person education to online professional development. [J Contin Educ Nurs. 2021;52(9):404-406.].

Telehealth Education: An Interprofessional Online Immersion Experience in Response to COVID-19.

BACKGROUND: In March 2020, due to the COVID-19 pandemic, universities halted in-person education and health care pivoted to telehealth delivery models. This article describes a nurse-led educational program that transitioned to fully online delivery to prepare interprofessional teams of health care students to use telehealth during the pandemic and beyond. METHOD: Participants included 67 students from seven professions. Researchers developed "the four Ps of telehealth" model to guide the curriculum. The program used pre- and postassessments including the Confidence in Planning for Telehealth Scale, the Telehealth Etiquette Knowledge Scale, and the Confidence in Providing Telehealth Scale. RESULTS: There were significant improvements in scores on all scales following the program (p = .000). CONCLUSION: The results suggest that comprehensive telehealth education should focus on more than just delivering telehealth but also planning and preparing for its delivery. Programs such as this online program can serve as a model for future telehealth programs to prepare providers. [J Nurs Educ. 2020;59(10):570-576.].

4-Methylumbelliferone Inhibits Cancer Stem Cell Activation and Overcomes Chemoresistance in Ovarian Cancer.

We have recently shown that the extracellular matrix molecule hyaluronan (HA) plays a role in the development of ovarian cancer chemoresistance. This present study determined if HA production is increased in chemotherapy-resistant ovarian cancers and if the HA inhibitor 4-methylubelliferone (4-MU) can overcome chemoresistance to the chemotherapeutic drug carboplatin (CBP) and inhibit spheroid formation and the expression of cancer stem cell (CSC) markers. We additionally assessed whether 4-MU could inhibit in vivo invasion of chemoresistant primary ovarian cancer cells in the chicken embryo chorioallantoic membrane (CAM) assay. The expression of the HA synthases HAS2 and HAS3 was significantly increased in chemoresistant compared to chemosensitive primary ovarian cancer cells isolated from patient ascites. 4-MU significantly inhibited HA production, cell survival, and spheroid formation of chemoresistant serous ovarian cancer cells. In combination with CBP, 4-MU treatment significantly decreased ovarian cancer cell survival and increased apoptosis of chemoresistant primary cells compared to CBP alone. 4-MU significantly reduced spheroid formation, expression of CSC markers ALDH1A1 and ABCG2 in primary cell spheroid cultures, and ALDH1 immunostaining in patient-derived tissue explant assays following treatment with CBP. Furthermore, 4-MU was very effective at inhibiting in vivo invasion of chemoresistant primary cells in CAM assays. Inhibition of HA is therefore a promising new strategy to overcome chemoresistance and to improve ovarian cancer survival.

Reliability, Validity, and Responsiveness of Clinical Performance-Based Outcome Measures of Walking for Individuals With Lower Limb Amputations: A Systematic Review.

Background: Clinical outcome measures are important to use for individuals with lower limb amputations (LLA) because such individuals require intensive functional gait training before and after being fitted with prostheses. Using standardized instruments throughout the episode of care allows clinicians to objectively monitor patient progress, make evidence-based decisions regarding the plan of care, and communicate results in meaningful ways to patients, payers, and other clinicians. Many clinical outcome measures exist, but not all have been validated and shown to be reliable within this population of interest. Purpose: The aim of this review was to provide a comprehensive overview of the psychometric properties of all current performance-based outcome measures applicable to individuals with lower limb amputations. Data Sources: Reviewers searched for articles using the online databases PubMed/MEDLINE and CINAHL. Reviewers also conducted a manual search of the reference list of 1 of the previously published systematic reviews to identify any additional studies not detected with the online database search. Study Selection: The 2 reviewers screened titles and abstracts for relevance. The same reviewers obtained and read full-text articles of the potentially relevant studies. Reviewers resolved any discrepancies of the inclusion assessment by further discussion. Data Extraction: The reviewers created tables to extract psychometric properties of interest from the included articles. Both reviewers extracted the data from the articles and placed relevant values into a table for each primary outcome measure identified. Data Synthesis: The rigor of study reporting was guided by use of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist. Each reviewer independently read and appraised the included articles, assigning a score to each checklist item. The sum of scores for each item was calculated to appraise the overall quality of reporting of the included articles. Limitations: Review-level limitations included the absence of a third reviewer to settle any disagreements on article inclusion and article appraisal. Additionally, the percentage of reviewer agreement on article appraisal was not determined before disagreements about checklist item satisfaction were resolved. Furthermore, reviewers only extracted data on reliability, validity, and responsiveness; instrument characteristics, such as floor and ceiling effects, are also important. Conclusions: Valid and reliable performance-based clinical measures of ambulation in individuals with LLA were identified. Further research should investigate the minimally clinical, important difference of these clinical measures and address trends in unmet reporting guidelines.

Awareness of Health Outcomes Associated with Insufficient Physical Activity and Associations with Physical Activity Intentions and Behavior.

INTRODUCTION: Little is known about people's awareness of the link between insufficient physical activity and increased risk for multiple health outcomes. METHODS: Of 1161 respondents to an online cross-sectional survey of the US population, we randomly selected 361 and used content analysis to code up to three responses to an open-ended question asking what illnesses are caused by insufficient physical activity. Chi-square and Fisher's exact tests examined relations between disease codes and socio-demographics; t-tests and Mann-Whitney U tests examined relations between codes and physical activity intentions and behavior. RESULTS: Ten codes emerged: cardiovascular (63.5% of participants), metabolic (65.8%), musculoskeletal (10.5%), fatigue (2.0%), psychiatric (8.0%), respiratory (3.4%), gastrointestinal (0.9%), cancer (3.4%), other (2.8%), unexpected interpretation (1.4%). 55.6% of participants named < 3 diseases. Code frequencies were generally similar across demographic groups, ps > .05. Physical activity intentions and behavior were higher among people who either mentioned cardiovascular (pintentions = .001, pbehavior = .001) or metabolic (pintentions = .01, pbehavior = .005) conditions, or who named < 3 diseases (pintentions = .006, pbehavior = .001). CONCLUSION: In our socio-demographically diverse sample, awareness of diseases that are associated with insufficient physical activity was largely related to cardiovascular and metabolic problems. Future health communication efforts should raise awareness of the harms of insufficient physical activity for cancer and other diseases.

Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach.

OBJECTIVES: Suicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents and potential witnesses. To reduce suicides and suicide attempts by rail, it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations. DESIGN AND METHODS: A qualitative thematic approach was used for three parallel studies. Data were gathered from several sources, including interviews with individuals who survived a rail suicide attempt (n=9), CCTV footage of individuals who died by rail suicide (n=16) and qualitative survey data providing views from rail staff (n=79). RESULTS: Our research suggests that there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location, including station hopping and platform switching, limiting contact with others, positioning themselves at the end of the track where the train/tube approaches, allowing trains to pass by and carrying out repetitive behaviours. CONCLUSIONS: There are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways which may present opportunities for intervention. These findings have implications for several stakeholders, including rail providers, transport police and other organisations focused on suicide prevention.

Understanding the individual to implement the ecosystem approach to fisheries management.

Ecosystem-based approaches to fisheries management (EAFMs) have emerged as requisite for sustainable use of fisheries resources. At the same time, however, there is a growing recognition of the degree of variation among individuals within a population, as well as the ecological consequences of this variation. Managing resources at an ecosystem level calls on practitioners to consider evolutionary processes, and ample evidence from the realm of fisheries science indicates that anthropogenic disturbance can drive changes in predominant character traits (e.g. size at maturity). Eco-evolutionary theory suggests that human-induced trait change and the modification of selective regimens might contribute to ecosystem dynamics at a similar magnitude to species extirpation, extinction and ecological dysfunction. Given the dynamic interaction between fisheries and target species via harvest and subsequent ecosystem consequences, we argue that individual diversity in genetic, physiological and behavioural traits are important considerations under EAFMs. Here, we examine the role of individual variation in a number of contexts relevant to fisheries management, including the potential ecological effects of rapid trait change. Using select examples, we highlight the extent of phenotypic diversity of individuals, as well as the ecological constraints on such diversity. We conclude that individual phenotypic diversity is a complex phenomenon that needs to be considered in EAFMs, with the ultimate realization that maintaining or increasing individual trait diversity may afford not only species, but also entire ecosystems, with enhanced resilience to environmental perturbations. Put simply, individuals are the foundation from which population- and ecosystem-level traits emerge and are therefore of central importance for the ecosystem-based approaches to fisheries management.

Widespread Natural Occurrence of Hydroxyurea in Animals.

Here we report the widespread natural occurrence of a known antibiotic and antineoplastic compound, hydroxyurea in animals from many taxonomic groups. Hydroxyurea occurs in all the organisms we have examined including invertebrates (molluscs and crustaceans), fishes from several major groups, amphibians and mammals. The species with highest concentrations was an elasmobranch (sharks, skates and rays), the little skate Leucoraja erinacea with levels up to 250 µM, high enough to have antiviral, antimicrobial and antineoplastic effects based on in vitro studies. Embryos of L. erinacea showed increasing levels of hydroxyurea with development, indicating the capacity for hydroxyurea synthesis. Certain tissues of other organisms (e.g. skin of the frog (64 µM), intestine of lobster (138 µM) gills of the surf clam (100 µM)) had levels high enough to have antiviral effects based on in vitro studies. Hydroxyurea is widely used clinically in the treatment of certain human cancers, sickle cell anemia, psoriasis, myeloproliferative diseases, and has been investigated as a potential treatment of HIV infection and its presence at high levels in tissues of elasmobranchs and other organisms suggests a novel mechanism for fighting disease that may explain the disease resistance of some groups. In light of the known production of nitric oxide from exogenously applied hydroxyurea, endogenous hydoxyurea may play a hitherto unknown role in nitric oxide dynamics.

Effect of construct properties on encapsulated chondrocyte expression of insulin-like growth factor-1.

Hydrogels are a promising type of biomaterial for articular cartilage constructs since they have been shown to enable encapsulated chondrocytes to express their predominant phenotypic marker, type II collagen. Endogenously expressed signaling molecules, such as insulin-like growth factor-1 (IGF-1), are also known to facilitate the retention of this chondrocytic phenotype. Recent investigations have attempted to enhance the ability of encapsulated chondrocytes to regenerate cartilage through delivery of exogenous signaling molecules. However, we hypothesize that by altering construct properties, such as cell density and polymer concentration, we can augment the expression of endogenous IGF-1 in chondrocytes. To this end, bovine articular chondrocytes were encapsulated within alginate hydrogels at two different cell densities (25,000 and 100,000 cells/bead) and various alginate concentrations (0.8%, 1.2%, and 2.0% w/v). These parameters were chosen to simultaneously investigate cell-to-cell distance on paracrine signaling and water content on IGF-1 diffusion by chondrocytes. At 1, 4, and 8d, chondrocytes were analyzed for protein and mRNA expression of IGF-1 as well as type II collagen. Results suggest that cell density and alginate concentration at high cell density can significantly affect the endogenous IGF-1 expression by chondrocytes. Therefore, these results indicate that construct properties can impact chondrocyte gene expression and should be considered in order to create a proper engineered articular cartilage construct.