Amino acid solution mitigates hypothermia response and intestinal damage following exertional heat stroke in male mice.

Increased gut permeability is implicated in the initiation and extent of the cytokine inflammatory response associated with exertional heat stroke (EHS). The primary objective of this study was to determine if a five amino acid oral rehydration solution (5AAS), specifically designed for the protection of the gastrointestinal lining, would prolong time to EHS, maintain gut function and dampen the systemic inflammatory response (SIR) measured during EHS recovery. Male C57/BL6J mice instrumented with radiotelemetry were gavaged with 150 µL of 5AAS or H2 O, and ≈12 h later were either exposed to an EHS protocol where mice exercised in a 37.5°C environmental chamber to a self-limiting maximum core temperature (Tc,max) or performed the exercise control (EXC) protocol (25°C). 5AAS pretreatment attenuated hypothermia depth and length (p < 0.005), which are indicators of EHS severity during recovery, without any effect on physical performance or thermoregulatory responses in the heat as determined by percent body weight lost (≈9%), max speed (≈6 m/min), distance (≈700 m), time to Tc,max (≈160 min), thermal area (≈550°C∙min), and Tc,max (42.2°C). EHS groups treated with 5AAS showed a significant decrease in gut transepithelial conductance, decreased paracellular permeability, increased villus height, increased electrolyte absorption and changes in tight junction protein expression pattern suggestive of improved barrier integrity (p < 0.05). No differences were witnessed between EHS groups in acute phase response markers of liver, circulating SIR markers, or indicators of organ damage during recovery. These results suggest that a 5AAS improves Tc regulation during EHS recovery through maintaining mucosal function and integrity.

Regional and time course differences in sweat cortisol, glucose, and select cytokine concentrations during exercise.

INTRODUCTION: The use of sweat as a biofluid for non-invasive sampling and diagnostics is a popular area of research. However, concentrations of cortisol, glucose, and cytokines have not been described across anatomical regions or as time progresses throughout exercise. PURPOSE: To determine regional and time course differences in sweat cortisol, glucose, and select cytokines (EGF, IFN-γ, IL-1ß, IL-1α, IL-1ra, TNF-α, IL-6, IL-8, and IL-10). METHODS: Sweat was collected with absorbent patches from eight subjects (24-44 y; 80.2 ± 10.2 kg) on the forehead (FH), right dorsal forearm (RDF), right scapula (RS), and right triceps (RT) at 0-25 min, 30-55 min, and 60-85 min during 90 min of cycling (~ 82% HRmax) in a heated chamber (32 °C, 50% rh). ANOVA was used to determine the effect of site and time on outcomes. Data are reported as LS means ± SE. RESULTS: There was a significant effect of location on sweat analyte concentrations with FH having higher values than most other regions for cortisol (FH: 1.15 ± 0.08 ng/mL > RDF: 0.62 ± 0.09 ng/mL and RT: 0.65 ± 0.12 ng/mL, P = 0.02), IL-1ra (P < 0.0001), and IL-8 (P < 0.0001), but lower concentrations for glucose (P = 0.01), IL-1α (P < 0.0001), and IL-10 (P = 0.02). Sweat IL-1ß concentration was higher on the RS than RT (P < 0.0001). Sweat cortisol concentration increased (25 min: 0.34 ± 0.10 ng/mL < 55 min: 0.89 ± 0.07 ng/mL < 85 min: 1.27 ± 0.07 ng/mL; P < 0.0001), while EGF (P < 0.0001), IL-1ra (P < 0.0001), and IL-6 (P = 0.02) concentrations decreased over time. CONCLUSION: Sweat analyte concentrations varied with time of sampling and anatomical region, which is essential information to consider when conducting future work in this area. CLINICAL TRIAL IDENTIFIER: NCT04240951 registered January 27, 2020.

Gamification in pharmacy education: a systematic quantitative literature review.

OBJECTIVES: Gamification involves applying game attributes to non-game contexts and its educational use is increasing. It is essential to review the outcomes and the efficacy of gamification to identify evidence to support its use in pharmacy education. THIS ARTICLE: systematically and quantitatively reviews and evaluates the alignment of learning outcomes and the quality of peer-reviewed literature reporting gamification in pharmacy education. KEY FINDINGS: A literature search was undertaken in February 2022 using CINAHL Complete, MEDLINE, Science Direct, Scopus and ERIC databases, via keywords (game* OR gaming OR gamif*) AND pharmac* AND education. Google Scholar was searched using 'gamification of pharmacy education' and 'serious games in pharmacy education'. Data extracted included type of gamified intervention, mode of delivery, game fidelity, intended learning outcomes and outcomes reported. Quality assessments aligned with key aspects of the SQUIRE-EDU Reporting Guidelines. Of 759 abstracts and 95 full-text papers assessed, 66 articles met the inclusion criteria. They described gamification from 12 countries in the education of 8272 pharmacy and health professional students. Gamified interventions ranged from board games to immersive simulations, with escape rooms most frequently reported. Reporting quality was inconsistent, with observed misalignment between intended learning outcomes and outcomes reported, an apparent overreliance on student perceptions as primary data and a lack of reference to reporting guidelines. SUMMARY: Gamification is included in the curricula of many pharmacy degrees, across multiple subject areas. This review identified evidence gaps and reinforces the need for improved quality of gamification research, critical alignment of learning outcomes with evaluation, and use of reporting guidelines.

Optimising database searching in pharmacy education.

OBJECTIVES: To determine the effectiveness of databases in a pharmacy education literature search. METHODS: Six databases (CINAHL, ERIC, Google Scholar, Ovid MEDLINE, Science Direct and Scopus) were compared for effectiveness in identifying pharmacy education literature. Articles were coded for database of retrieval and results cross-referenced. Sensitivity, precision and number of unique retrievals were calculated. KEY FINDINGS: Scopus yielded the highest sensitivity (65%) and precision (47%). The combination of three databases (Scopus, Science Direct and Google Scholar) identified 97% (n = 64) of 66 relevant articles. CONCLUSIONS: Pharmacy education literature searches require more than one database, ideally Scopus, Science Direct and Google Scholar.

Hospital Pharmacists' Experiences with Medical Assistance in Dying: A Qualitative Study.

Background: Pharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists' involvement, little is known about how they experience MAiD practice. Objective: To study how pharmacists experience the practice of caring for patients who seek MAiD. Methods: This qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison. Results: Nineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists' experiences were personal, relational, emotional, and dynamic. Conclusions: Each of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists' roles in MAiD.

Contexte: Les pharmaciens de nombreux pays participent depuis longtemps à certains aspects de l'aide médicale à mourir (AMM). Depuis que le Canada a adopté une loi l'autorisant en 2016, le nombre de patients qui demandent l'intervention a augmenté chaque année. Malgré la nature mondiale de l'implication des pharmaciens, on sait peu de choses sur la façon dont ils vivent la pratique de l'AMM. Objectif: Étudier comment les pharmaciens vivent la pratique de la prise en charge des patients qui sollicitent l'AMM. Méthodes: Cette étude qualitative a utilisé des entretiens semi-structurés avec des pharmaciens qui avaient pris en charge des patients ayant fait une demande d'AMM. Un enregistrement sonore des entretiens, menés entre juin 2019 et octobre 2020, a été effectué et ils ont été transcrits mot à mot. Les données ont été examinées en adoptant une approche d'analyse du cadre modifié. Les données ont été codées et triées à l'aide des logiciels Quirkos et Microsoft Excel. Les thèmes ont été définis par un processus itératif impliquant une comparaison constante. Résultats: Dix-neuf pharmaciens d'hôpitaux représentant un éventail de milieux de pratique en Alberta ont participé à l'étude. L'expérience de la prise en charge de patients cherchant à recevoir l'aide médicale à mourir a mis en lumière 3 thèmes : trouver sa place dans le processus; jouer un rôle de proche aidant; et supporter des charges émotionnelles. Les expériences des pharmaciens étaient personnelles, relationnelles, émotionnelles et dynamiques. Conclusions: Chaque pharmacien a vécu la pratique de l'AMM d'une manière unique. Bien que leurs rôles dans l'AMM étaient principalement axés sur la médication, leurs expériences ont mis en évidence la centralité des choix, de l'autonomie et des besoins des patients. Les résultats de cette étude informeront les pharmaciens (y compris ceux qui ne sont pas encore engagés dans la pratique de l'AMM) sur le rôle. Ils seront également précieux pour les organismes pharmaceutiques et les éducateurs cherchant à soutenir les pharmaciens et la profession, ainsi que pour les décideurs politiques qui cherchent à élargir les rôles de pharmaciens dans l'AMM.

Explaining variation in sweat sodium concentration: effect of individual characteristics and exercise, environmental, and dietary factors.

This study determined the relative importance of several individual characteristics and dietary, environmental, and exercise factors in determining sweat [Na+] during exercise. Data from 1944 sweat tests were compiled for a retrospective analysis. Stepwise multiple regression (P < 0.05 threshold for inclusion) and T values were used to express the relative importance of each factor in a model. Three separate models were developed based on available independent variables: model 1 (1,944 sweat tests from 1,304 subjects); model 2 (subset with energy expenditure: 1,003 sweat tests from 607 subjects); model 3 (subset with energy expenditure, dietary sodium, and V̇o2max: n = 48). Whole body sweat [Na+] was predicted from forearm sweat patches in models 1 and 2 and directly measured using whole body washdown in model 3. There were no significant effects of age group, race/ethnicity, relative humidity, exercise duration, pre-exercise urine specific gravity, exercise fluid balance, or dietary or exercise sodium intake on any model. Significant predictors in model 1 (adjusted r2 = 0.17, P < 0.001) were season of the year (warm, T = -6.8), exercise mode (cycling, T = 6.8), sex (male, T = 4.9), whole body sweating rate (T = 4.5), and body mass (T = -3.0). Significant predictors in model 2 (adjusted r2 = 0.19, P < 0.001) were season of the year (warm, T = -5.2), energy expenditure (T = 4.7), exercise mode (cycling, T = 3.6), air temperature (T = 3.0), and sex (male, T = 2.7). The only significant predictor in model 3 (r2 = 0.23, P < 0.001) was energy expenditure (T = 3.8). In summary, the models accounted for 17%-23% of the variation in whole body sweat [Na+] and energy expenditure and season of the year (proxy for heat acclimatization) were the most important factors.NEW & NOTEWORTHY This comprehensive analysis of a large, diverse data set contributes to our overall understanding of the factors that influence whole body sweat [Na+]. The main finding was that energy expenditure was directly associated with whole body sweat [Na+], potentially via the relation between energy expenditure and whole body sweating rate (WBSR). Warmer months (proxy for heat acclimatization) were associated with lower whole body sweat [Na+]. Exercise mode, air temperature, and sex may also have small effects, but other variables (age group, race/ethnicity, fluid balance, sodium intake, relative V̇o2max) had no association with whole body sweat [Na+]. Taken together, the models explained 17%-23% of the variation in whole body sweat [Na+].

Impact of a gamified simulation on pharmacy students' self-assessed competencies.

INTRODUCTION: Competency-based pharmacist education develops robust professional identities and prepares graduates for future practice to ensure optimal patient outcomes. An extended gamified simulation was developed as a capstone activity for a new Australian Bachelor of Pharmacy (BPharm) program. The simulation was designed to consolidate students' knowledge, skills, and behaviors from prior learning. This research aimed to explore whether participation in an extended gamified simulation could influence pharmacy students' perceptions of their professional competencies. METHODS: Data were collected over three years to compare a superseded Master of Pharmacy (MPharm) program with an incoming BPharm program. Final year students were invited to self-assess their professional competencies at the start and end of their final semester of study, using a digital self-assessment tool which replicated Australia's National Competency Standards Framework for Pharmacists. Participants rated their own competency against the 26 competency standards across five domains on a five-point Likert scale (not at all competent to very competent). This provided pre- and post-data to compare the simulation (BPharm intervention) and a traditional semester (MPharm comparison), in addition to final course grades. RESULTS: From 2016 to 2019, 85 (90.4%) of 94 intervention and 50 (83.3%) of 60 comparison students completed the self-assessment of professional competencies. Participation in the gamified simulation significantly improved students' pharmacotherapeutics grades and pre-post change scores for seven of the 26 competency standards, two of the five domains, and all domains combined of the National Competency Standards. CONCLUSIONS: An extended, gamified simulation enhances the development of pharmacy students' self-assessed professional competencies.

Multiple regression analyses to determine the effect of sweating rate and tattoo characteristics on sweat outcome measures during exercise.

PURPOSE: To compare local sweating rate (LSR) and local sweat sodium ([Na+]), chloride ([Cl-]), and potassium ([K+]) concentrations of tattooed skin and contralateral non-tattooed skin during exercise. METHODS: Thirty-three recreational exercisers (17 men, 16 women) with ≥ 1 unilateral permanent tattoo on the torso/arms were tested during cycling, running, or fitness sessions (26 ± 4 °C and 54 ± 13% relative humidity). Forty-eight tattoos with a range of ink colors, ages (3 weeks to 20 years), and densities (10-100%) were included. Before exercise, the skin was cleaned with alcohol and patches (3 M Tegaderm + Pad) were placed on the tattooed and contralateral non-tattooed skin. LSR was calculated from sweat mass (0.80 ± 0.31 g), patch surface area (11.9 cm2), and duration (62 ± 14 min). Sweat [Na+], [Cl-], and [K+] were measured via ion chromatography. RESULTS: Based on the analysis of variance results, there were no differences between tattooed and non-tattooed skin for LSR (1.16 ± 0.52 vs. 1.12 ± 0.53 mg/cm2/min; p = 0.51), sweat [Na+] (60.2 ± 23.5 vs. 58.5 ± 22.7 mmol/L; p = 0.27), sweat [Cl-] (52.1 ± 22.4 vs. 50.6 ± 22.0 mmol/L; p = 0.31), or sweat [K+] (5.8 ± 1.6 vs. 5.9 ± 1.4 mmol/L; p = 0.31). Multiple regression analyses suggested that younger tattoos were associated with higher sweat [Na+] (p = 0.045) and colorful tattoos were associated with higher sweat [Cl-] (p = 0.04) compared with contralateral non-tattooed skin. Otherwise, there were no effects of LSR or tattoo characteristics on regression models for LSR or sweat electrolyte concentrations. CONCLUSION: There were no effects of tattoos on LSR and sweat [K+] during exercise-induced sweating, but tattoo age and color had small effects on sweat [Na+] and sweat [Cl-], respectively. CLINICAL TRIAL IDENTIFIERS: NCT04240951 was registered on January 27, 2020 and NCT04920266 was registered on June 9, 2021.

Sweating Rate and Sweat Chloride Concentration of Elite Male Basketball Players Measured With a Wearable Microfluidic Device Versus the Standard Absorbent Patch Method.

The purpose of this study was to compare a wearable microfluidic device and standard absorbent patch in measuring local sweating rate (LSR) and sweat chloride concentration ([Cl-]) in elite basketball players. Participants were 53 male basketball players (25 ± 3 years, 92.2 ± 10.4 kg) in the National Basketball Association's development league. Players were tested during a moderate-intensity, coach-led practice (98 ± 30 min, 21.0 ± 1.2 °C). From the right ventral forearm, sweat was collected using an absorbent patch (3M Tegaderm™ + Pad). Subsequently, LSR and local sweat [Cl-] were determined via gravimetry and ion chromatography. From the left ventral forearm, LSR and local sweat [Cl-] were measured using a wearable microfluidic device and associated smartphone application-based algorithms. Whole-body sweating rate (WBSR) was determined from pre- to postexercise change in body mass corrected for fluid/food intake (ad libitum), urine loss, and estimated respiratory water and metabolic mass loss. The WBSR values predicted by the algorithms in the smartphone application were also recorded. There were no differences between the absorbent patch and microfluidic patch for LSR (1.25 ± 0.91 mg·cm-2·min-1 vs. 1.14 ±0.78 mg·cm-2·min-1, p = .34) or local sweat [Cl-] (30.6 ± 17.3 mmol/L vs. 29.6 ± 19.4 mmol/L, p = .55). There was no difference between measured and predicted WBSR (0.97 ± 0.41 L/hr vs. 0.89 ± 0.35 L/hr, p = .22; 95% limits of agreement = 0.61 L/hr). The wearable microfluidic device provides similar LSR, local sweat [Cl-], and WBSR results compared with standard field-based methods in elite male basketball players during moderate-intensity practices.

Virtualized Gamified Pharmacy Simulation during COVID-19.

Extended and immersive gamified pharmacy simulation has been demonstrated to provide transformative learning in pharmacy education, preparing graduates for real-world practice. An international consortium of universities has implemented local adaptations of the Pharmacy Game into their curricula. From early 2020, pharmacy academics modified the delivery of gamified simulation in response to the COVID-19 pandemic, while still aiming to deliver the important learning outcomes of enhanced communication, collaboration, confidence and competence. Australian universities went into full lockdown from March 2020, and the critical gamified simulation at Griffith University was delivered entirely virtually in 2020. An array of synchronous and asynchronous approaches and software platforms was employed, including Microsoft Teams, Forms and Stream plus the online interview platform Big Interview. These allowed for the simulation activities, including dispensing, counselling and clinical cases, to be conducted by students online. In 2021, Griffith University conducted hybrid delivery of its Pharmacy Game, balancing student participation both in person and online. Microsoft Power Apps was added to the hosting platform to enhance the simulation interface, and Power Virtual Agent artificial intelligence chatbots, with natural language processing, were used to enable asynchronous clinical interaction. The combination of learning technologies provided the means to deliver successful gamified simulation in the virtual and hybrid environments while still achieving outstanding learning outcomes from the capstone activity. This paper details the technologies used to virtualize the Australian Pharmacy Game and the analytics available to educators to assess student participation, engagement and performance.

The nature of conflict in community pharmacy - A pilot study of pharmacists' experiences during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has caused changes that disrupted the status quo of society. As a result, the level of conflict in community pharmacy has increased significantly. With existing conflict research more focused on the management of conflict, it is important to direct attention towards understanding the nature of conflict. This understanding will allow for informed resources to be developed to guide practice, decreasing the occurrence of and negative effects of conflict. OBJECTIVE: This research explored experiences of pharmacists working in community pharmacies, to identify the occurrence and nature of conflicts which may have been motivated by changes resulting directly or indirectly from the COVID-19 pandemic, to provide directions for future research into the nature of conflict. METHOD: Person-to-person semi-structured telephone interviews were conducted. Transcripts were analysed using inductive reasoning to identify themes. RESULTS: Thirteen pharmacists agreed to participate in this study and 9 were interviewed. Analysis revealed 7 themes that described the causes, contributors, management, outcome, and essence of experienced conflict. A model that incorporated existing theory and themes derived from this study was developed to facilitate understanding of the nature of conflict in community pharmacy during the COVID-19 pandemic. CONCLUSION: Conflict in community pharmacy settings follows a defined model with multiple interrelated themes. Guidance from this model may assist pharmacists in reducing occurrences of dysfunctional conflicts during their practice.

Impact of successive exertional heat injuries on thermoregulatory and systemic inflammatory responses in mice.

The purpose of the study was to determine if repeated exertional heat injuries (EHIs) worsen the inflammatory response. We assessed the impact of a single EHI bout (EHI0) or two separate EHI episodes separated by 1 (EHI1), 3 (EHI3), and 7 (EHI7) days in male C57BL/6J mice (n = 236). To induce EHI, mice underwent a forced running protocol until loss of consciousness or core temperature reached ≥ 42.7°C. Blood and tissue samples were obtained 30 min, 3 h, 1 day, or 7 days after the EHI. We observed that mice undergoing repeated EHI (EHI1, EHI3, and EHI7) had longer running distances before collapse (∼528 m), tolerated higher core temperatures (∼0.18°C higher) before collapse, and had higher minimum core temperature (indicative of injury severity) during recovery relative to EHI0 group (∼2.18°C higher; all P < 0.05). Heat resilience was most pronounced when latency was shortest between EHI episodes (i.e., thermal load and running duration highest in EHI1), suggesting the response diminishes with longer recoveries between EHI events. Furthermore, mice experiencing a second EHI exhibited increased serum and liver HSP70, and lower corticosterone, FABP2, MIP-1ß, MIP-2, and IP-10 relative to mice experiencing a single EHI typically at 30 min to 3 h after EHI. Our findings indicate that an EHI event may initiate some adaptive processes that provide acute heat resilience to subsequent EHI conditions. NEW & NOTEWORTHY Mice undergoing repeated exertional heat injuries, within 1 wk of an initial heat injury, appear to have some protective adaptations. During the second exertional heat injury, mice were able to run longer and sustain higher body temperatures before collapse. Despite this, the mice undergoing a second exertional heat injury were more resilient to the heat as evidenced by attenuated minimum body temperature, higher HPS70 (serum and liver), lower corticosterone, and lower FABP2.

A Preclinical Model of Exertional Heat Stroke in Mice.

Heat stroke is the most severe manifestation of heat-related illnesses. Classic heat stroke (CHS), also known as passive heat stroke, occurs at rest, whereas exertional heat stroke (EHS) occurs during physical activity. EHS differs from CHS in etiology, clinical presentation, and sequelae of multi-organ dysfunction. Until recently, only models of CHS have been well established. This protocol aims to provide guidelines for a refined preclinical mouse model of EHS that is free from major limiting factors such as the use of anesthesia, restraint, rectal probes, or electric shock. Male and female C57Bl/6 mice, instrumented with core temperature (Tc) telemetric probes were utilized in this model. For familiarization with the running mode, mice undergo 3 weeks of training using both voluntary and forced running wheels. Thereafter, mice run on a forced wheel inside a climatic chamber set at 37.5 °C and 40%-50% relative humidity (RH) until displaying symptom limitation (e.g., loss of consciousness) at Tc of 42.1-42.5 °C, although suitable results can be obtained at chamber temperatures between 34.5-39.5 °C and humidity between 30%-90%. Depending on the desired severity, mice are removed from the chamber immediately for recovery in ambient temperature or remain in the heated chamber for a longer duration, inducing a more severe exposure and a higher incidence of mortality. Results are compared with sham-matched exercise controls (EXC) and/or naïve controls (NC). The model mirrors many of the pathophysiological outcomes observed in human EHS, including loss of consciousness, severe hyperthermia, multi-organ damage as well as inflammatory cytokine release, and acute phase responses of the immune system. This model is ideal for hypothesis-driven research to test preventative and therapeutic strategies that may delay the onset of EHS or reduce the multi-organ damage that characterizes this manifestation.

Nutritional considerations to counteract gastrointestinal permeability during exertional heat stress.

Intestinal barrier integrity and function are compromised during exertional heat stress (EHS) potentially leading to consequences that range from minor gastrointestinal (GI) disturbances to fatal outcomes in exertional heat stroke or septic shock. This mini-review provides a concise discussion of nutritional interventions that may protect against intestinal permeability during EHS and suggests physiological mechanisms responsible for this protection. Although diverse nutritional interventions have been suggested to be protective against EHS-induced GI permeability, the ingestion of certain amino acids, carbohydrates, and fluid per se is potentially effective strategy, whereas evidence for various polyphenols and pre/probiotics is developing. Plausible physiological mechanisms of protection include increased blood flow, epithelial cell proliferation, upregulation of intracellular heat shock proteins, modulation of inflammatory signaling, alteration of the GI microbiota, and increased expression of tight junction (TJ) proteins. Further clinical research is needed to propose specific nutritional candidates and recommendations for their application to prevent intestinal barrier disruption and elucidate mechanisms during EHS.

Skeletal muscle fibers play a functional role in host defense during sepsis in mice.

Skeletal muscles secrete a wide variety of immunologically active cytokines, but the functional significance of this response to in vivo innate immunity is not understood. We addressed this by knocking out the toll receptor adapter protein, Myd88, only in skeletal muscle fibers (skmMyd88KO), and followed male and female mice at 6 and 12 h after peritoneal injection of cecal slurry (CS), a model of polymicrobial sepsis. Because of a previously identified increase in mortality to CS injection, males received ~ 30% lower dose. At 12 h, skmMyd88KO caused significant reductions in a wide variety of pro- and anti-inflammatory plasma cytokines, e.g. TNFα, IL-1ß and IL-10, compared to strain-matched controls in both males and females. Similar reductions were observed at 6 h in females. SkmMyd88KO led to ~ 40-50% elevations in peritoneal neutrophils at 6 and 12 h post CS in females. At 12 h post CS, skmMyd88KO increased peritoneal monocytes/macrophages and decreased %eosinophils and %basophils in females. SkmMyd88KO also led to significantly higher rates of mortality in female mice but not in males. In conclusion, the results suggest that skeletal muscle Myd88-dependent signal transduction can play functionally important role in normal whole body, innate immune inflammatory responses to peritoneal sepsis.

Experiential Learning in a Gamified Pharmacy Simulation: A Qualitative Exploration Guided by Semantic Analysis.

Experiential learning is an important component of pharmacist education and is primarily achieved through supervised placement or simulation. This study explored senior pharmacy students' experiential learning in an extended, immersive, gamified simulation, conducted as a capstone learning activity toward the end of their final year of study, consolidating all prior learning and preparing students for intern practice. The simulation aimed to enhance student confidence, competence and collaboration. The three-week activity involved student teams competitively managing simulated pharmacies, assuming the role of pharmacists to complete all scaffolded assessments, including dispensing prescriptions, clinical cases, verbal counselling, simulated patient cases, interprofessional collaboration, and assignments. Assessments were marked continuously, with consequences of practice acknowledged through gain or loss of 'patients' for the pharmacy. From 2016 to 2018, 123 students completed multiple individual reflective journals (n = 733). Reflective journals were analyzed to explore the student experience, using a mixed methods approach. Initial Leximancer® 4.51 semantic analysis guided thematic analysis, conducted in NVivo® 12. The major themes that emerged were teamwork, patient-centeredness, medicines provision, future practice, and the learning experience. Student participants reported an intense and emotional experience in the gamified simulation, with many students revealing transformation in their skills, behaviors and attitudes over its duration.

Hospital pharmacists' ethical exposure and decision-making.

BACKGROUND: Studies have explored community pharmacy ethical dilemmas; however, limited research exists on hospital pharmacy ethical issues and pharmacists' ethical decision-making processes. Research exploring this is timely, considering developments in hospital pharmacy practices, new hospital pharmacist roles, and evolving responsibilities. AIM/OBJECTIVES: To explore hospital pharmacists' ethical decision-making and processes for managing ethical challenges in the context of evolving Australian hospital pharmacy practices. METHODS: Face-to-face semi-structured interviews with 20 purposively-selected hospital pharmacists from four Queensland Health hospitals. An interview guide with 11 open-ended questions and prompts was developed, validated, and trialed. Pharmacists who consented received the guide prior to interviews. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo 12 to facilitate coding and thematic analysis. RESULTS: Participants were interviewed January to April 2019; median interview duration was 17.45 min. Data saturation was reached. Participants' experiences ranged from junior level pharmacists to senior management positions, in clinical and non-clinical roles. Emerging themes were: 1) influences on the development of ethical decision-making skills, 2) ethical decision-making is an integral part of the hospital pharmacist's role, and 3) institutional requirements and settings impact on ethical exposure. A wide range of contemporary ethical issues unique to hospital pharmacy practice, mostly involving complex medication management safety, supply, and cost scenarios, were identified. Junior pharmacists indicated they would benefit from additional training, mentorship, and availability of hospital-specific targeted ethics resources. CONCLUSION: The findings highlighted that hospital pharmacists are regularly faced with ethical issues unique to the hospital pharmacy practice context. Application of sound and structured ethical reasoning and decision-making is, therefore, required in this setting. Participants identified many interrelated factors that impacted their ethical reasoning and behaviour. This study identified gaps that, once addressed, will better support ethical reasoning in hospital pharmacy settings.