Multi-modal mindfulness training and well-being for healthcare students.

INTRODUCTION: Mindfulness is a mental state attained through focusing awareness on the present with calm acceptance of thoughts, feelings, and bodily sensations. This study evaluated impact of mindfulness activities on well-being of pharmacy and other healthcare students. METHODS: Research participants completed pre- and post-intervention questionnaires evaluating multi-modal mindfulness interventions. Due to the pandemic, sessions led by a certified mindfulness instructor were offered live online and recorded, supplemented by a well-being mobile app and reflective discussion component. Four composite scales were administered to participants. The Brief Resilient Coping Scale (BRCS), Five Facet Mindfulness Questionnaire (FFMQ-15), Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and Depression Anxiety Stress Scales (DASS-21) inventories measured resilient coping skills, awareness, and psychological symptoms, including stress, depression, and anxiety. Exploratory factor analysis and Cronbach's alpha were used to determine scale reliability and validity. RESULTS: Thirty-six participants completed both pre- and post-intervention questionnaires (n = 36). Significant improvement was found in well-being for BRCS, FFMQ-15, and WEMWBS measures (P < .05). Change in DASS-21 was not significant (P = .19). Mobile app use enhanced foundational mindfulness skills. Awareness, connection, and coping themes were identified from written comments. CONCLUSIONS: Evaluation of this multi-modal interprofessional intervention provides further evidence of benefits of mindfulness for pharmacy and other healthcare students. The mobile app and mindful movement with reflection improved all attributes measured by the composite scales. Further research may explore alternative multi-modal mindfulness interventions and incorporation into healthcare education curricula. Interprofessional collaboration is encouraged among faculty to enhance mindfulness while connecting healthcare professionals.

Confucianism and Gender Ratios of Suicide in the World: A WHO Data-Based Study.

This study explores how Confucianism affects suicide rates by gender. Data for the study come from the World Health Organization document "Suicide Worldwide in 2019", which provides frequency and gender ratios for suicide rates in 183 member countries. One-way ANOVA and multiple linear regression analysis were used to examine potential differences in suicide rates and male to female ratio of suicides. Independent variables include region, income level, culture, and Confucian values that may be related to suicide. Suicide rates for Confucian countries do not show significant differences from European countries. However, these countries have lower suicide gender ratios.

The advanced nurse practitioner in context: Systemic processes.

BACKGROUND: Healthcare systems are becoming increasingly complex. Systems thinking can help us to understand this complexity and how to apply that understanding to design and evaluate interventions that improve health outcomes. With the current emphasis on developing advanced nursing practice, it is timely to examine systemic processes that characterize ANP systems and their interactions with wider healthcare systems, and how these processes enable and constrain the role. OBJECTIVE: To make explicit the systemic processes that characterize the Advanced Nurse Practitioner (ANP) system and how they enable and constrain the role. DESIGN: An interpretive descriptive study. SETTING: The study was conducted in a large Hospital Group, consisting of eleven acute hospitals, within the Irish Healthcare System. PARTICIPANTS: Twenty nine participants, including ANPs, nurses, nurse managers, medics and allied health professionals, participated in the study. METHODS: Data were collected through seven in-depth interviews and four focus groups. Data were analyzed using the Organic Systems Framework (OSF), where attention was on language indicative of the processes of individuation, integration, differentiation and homogenization. RESULTS: Participants emphasize how ANP systems exert power by individuating and differentiating; however, restrictive regulations and medical control constrain this power. Integration and homogenization are expressed as ANPs encourage and engage in collaborative practice towards common purposes. When hierarchical structures and professional self-interest dominate, however, these processes are submerged, resulting in unbalanced systems. CONCLUSION: ANP systems realize their power through increased autonomy by individuating and differentiating. Hierarchical structures positioning ANPs in subservient roles should be challenged. Processes of integration and homogenization are expressed in collaborative practices. We recommend that ANPs realize and articulate the value and diversity that they bring to health systems to strengthen their contribution to them. CLINICAL RELEVANCE: Lack of awareness of the systemic processes that enable and constrain the ANP role affects the role's potential contribution to the healthcare system. Systems thinking and employing the OSF as an analysis framework can help us to understand these processes and their implications, and how to apply that understanding to design and evaluate interventions that improve health outcomes.

Revealing how language builds the identity of the advanced nurse practitioner.

AIMS AND OBJECTIVES: To explore how language works to enable and constrain the role of the advanced nurse practitioner (ANP) in the health system. BACKGROUND: Nurses and doctors are produced within historically established disciplinary boundaries. These boundaries are becoming more porous, offering the possibility of a more liberated identity for ANPs that will allow them to reach their full potential. Current uncertainty and confusion about ANPs' identity result in their role being underutilised. DESIGN: A critical discourse analysis design was used to explore participants' language-in-use. Findings are reported according to the COREQ research checklist. METHOD: Data were collected through seven in-depth interviews and four focus groups and analysed using Gee's (2010) Identity Building Tool. Participants included ANPs, nurses (including nurse managers), doctors and allied healthcare professionals. RESULTS: Four discourses were revealed. Participants' language-in-use worked to privilege the ANP's uniquely holistic identity. However, this aspect is also associated with a controlled identity, predominantly constrained by medics and restricted from advancing. The third discourse, the medicalised identity builds an identity that positions ANPs as medical replacements who are assigned trivial medical tasks. The final discourse constructs an independent powerful identity for the ANP that is influential and autonomous. CONCLUSIONS: Circulating discourses and conversations can influence and shape the construction of the ANP identity. Healthcare professionals need to identify and counter discourses and conversations that construct ANPs' ways of knowing and knowledge as inferior and their role as subservient. Otherwise, ANPs' identity will continue to be controlled and their advancement restricted. RELEVANCE TO CLINICAL PRACTICE: Confusion concerning the role and identity of the ANP can limit their contribution to the healthcare system. Healthcare professionals need to be aware of how language-in-use can prevent the role from developing and reaching its full potential in enhancing healthcare provision and delivery. Reporting follows the COREQ criteria.

Constructing the advanced nurse practitioner identity in the healthcare system: A discourse analysis.

AIMS: To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs' identities and how they both enable and constrain their roles. BACKGROUND: Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers. DESIGN: A qualitative discourse analysis using Gee's Tools of Inquiry. METHOD: Data were collected between April 2019 and January 2020 through seven in-depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals. FINDINGS: Five key discourses emerged. Language-in-use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs' identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other. CONCLUSION: This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs' identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals' roles. IMPACT: By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role.

Application of exome sequencing to diagnose a novel presentation of the Cornelia de Lange syndrome in an Afro-Caribbean family.

BACKGROUND: Cornelia de Lange syndrome (CdLS) comprises a recognizable pattern of multiple congenital anomalies caused by variants of the DNA cohesion complex. Affected individuals may display a wide range of phenotypic severity, even within the same family. METHODS: Exome sequencing and confirmatory Sanger sequencing showed the same previously described p.Arg629Ter NIPBL variant in two half-brothers affected with CdLS. Clinical evaluations were obtained in a pro bono genetics clinic. RESULTS: One brother had relatively mild proportionate limb shortening; the other had complete bilateral hypogenesis of the upper arm with absence of lower arm structures, terminal transverse defects, and no digit remnants. His complex lower limb presentation included long bone deficiency and a deviated left foot. The mother had intellectual disability and microcephaly but lacked facial features diagnostic of the CdLS. CONCLUSION: We describe a collaboration between a pediatrics team from a resource-limited nation and USA-based medical geneticists. Reports describing individuals of West Indian ancestry are rarely found in the medical literature. Here, we present a family of Afro-Caribbean ancestry with CdLS presenting with phenotypic variability, including unusual lower limb abnormalities. The observation of this novel family adds to our knowledge of the phenotypic and molecular aspects of CdLS.

Performance of a New Portable Wireless Sleep Monitor.

STUDY OBJECTIVES: To determine if signals generated by a new sleep monitor (Prodigy) are comparable to signals generated during in-laboratory polysomnography (PSG). METHODS: Fifty-nine patients with various sleep disorders (25 with moderate/severe sleep apnea) were studied. Full PSG was performed using standard acquisition systems. Prodigy was attached to the forehead with four disposable snap electrodes. Four additional electrodes were attached to monitor eye movements and muscle activity, and to serve as reference (mastoid). One frontal EEG signal was outputted in real time from the monitor and stored in the PSG record along with the other PSG signals. PSG was scored for sleep variables manually, and monitor records were scored by a validated automatic system (MSS) (MSS-Prodigy). MSS-Prodigy was briefly edited following suggestions of an Editing Helper feature of MSS. RESULTS: Technical failures resulted in one study being unusable and another with data for only 3 hours. Prodigy EEG signal stored in the PSG record was visually indistinguishable from the PSG-derived EEG signals. Important differences between manual scores and unedited MSS-Prodigy were seen in a few patients in some sleep variables (notably onset latencies and REM time). Editing Helper issued 2.1 ± 0.8 suggestions/file. Only these suggestions were pursued during editing. Intraclass correlation coefficients for manual vs. edited MSS-Prodigy were > 0.83 for all sleep variables except for stages N1 and N3 (0.57 and 0.58). CONCLUSIONS: When scored with MSS, and with only very minor editing, the monitor's results show excellent agreement with manual scoring of polysomnography data, even in patients with severe sleep disorders.

Utility of Technologist Editing of Polysomnography Scoring Performed by a Validated Automatic System.

RATIONALE: Automatic scoring of polysomnography records offers many advantages, but excessive editing time seriously limits its use. OBJECTIVES: To identify reasons for excessive editing time, and the clinical utility of such editing, and to develop an approach to optimize the editing process. METHODS: Forty-two polysomnograms scored manually were scored months later by an automatic system (Michele Sleep Scoring). Results were edited by the technologist who scored them initially. Editing actions and time were documented. An Editing Helper algorithm was developed on the basis of these results, and its effectiveness was tested in 60 new records. MEASUREMENTS AND MAIN RESULTS: Technologists performed 253 ± 110 actions, consuming 54.5 ± 26.3 minutes, per file. Of the edits, 33% were either subsequently reversed or not considered in the clinical summary. The electroencephalography pattern in 67% of epochs changed from awake to non-REM sleep, and vice versa, represented neither stable wakefulness nor sleep so that assigning a precise stage was arbitrary. Many opposing changes occurred. Ultimately the impact of editing on summary results was limited. In the second set, the Editing Helper algorithm reduced editing time from 59 ± 26 to 6 ± 7 minutes. Average (±SD) intraclass correlation coefficients for 15 reported variables were 0.77 ± 0.14 for manual versus unedited automatic, 0.89 ± 0.09 for manual versus fully edited automatic, and 0.87 ± 0.08 for manual versus automatic edited according to the Editing Helper's suggestions only, and there was no difference between the last two average intraclass correlation coefficients. CONCLUSIONS: Editing time does not reflect unreliable scoring. Comprehensive editing of a well-validated automatic scoring system is highly inefficient. Editing can be substantially optimized.

Anatomy of a new U.S. medical school: The Commonwealth Medical College.

In response to the Association of American Medical Colleges' call for increases in medical school enrollment, several new MD-granting schools have opened in recent years. This article chronicles the development of one of these new schools, The Commonwealth Medical College (TCMC), a private, not-for-profit, independent medical college with a distributive model of education and regional campuses in Scranton, Wilkes-Barre, and Williamsport, Pennsylvania. TCMC is unique among new medical schools because it is not affiliated with a parent university. The authors outline the process of identifying a need for a new regional medical school in northeastern Pennsylvania, the financial planning process, the recruitment of faculty and staff, the educational and research missions of TCMC, and details of the infrastructure of the new school. TCMC's purpose is to increase the number of physicians in northeastern Pennsylvania, and in the next 20 years it is expected to add 425 practicing physicians to this part of the state. TCMC is characterized by autonomy, private and public support, assured resources in good supply, a relatively secure clinical base, strong cultural ties to the northeast, recruiting practices that reflect the dean's convictions, and strong support from its board of directors. TCMC has invested heavily in social and community medicine in its educational programs while still developing a strong research emphasis. Major challenges have centered on TCMC's lack of a parent university in areas of accreditation, infrastructure development, faculty recruitment, and graduate medical education programs. These challenges, as well as solutions and benefits, are discussed.

Low-dose computed tomography for the evaluation of flank pain in the pregnant population.

BACKGROUND: Evaluation of the pregnant patient with suspected renal colic is complex. Fetal irradiation concerns have traditionally prohibited the use of CT in this population. We report our institution's experience using low-dose CT in the evaluation of pregnant patients with refractory flank pain. PATIENTS AND METHODS: A retrospective review of all patients who underwent low-dose CT evaluation of the urinary tract for suspected urinary tract stones was performed. Data obtained included gestational age, urinalysis and ultrasonography results, CT findings, and calculated fetal radiation exposure. RESULTS: Between April 2004 and December 2006, 20 patients with an average gestational age of 26.5 weeks presented to our institution with acute, refractory flank pain consistent with a diagnosis of urolithiasis. All patients underwent renal ultrasonographic evaluation before unenhanced CT of the abdomen and pelvis using a low-dose protocol. The average radiation exposure was 705.75 mrads (range 210-1372; SD +/- 338.66 mrads). Of the 20 patients, CT demonstrated urinary stones (1-12 mm) in 13. Of those patients with documented stones, 4 were treated conservatively, 2 underwent intrapartum stent placement, 5 had ureteroscopy with stone extraction, and 2 were treated postpartum. CONCLUSION: Low-dose CT is highly sensitive and specific for the detection of urinary calculi in the pregnant population. CT confers a low risk of fetal harm and can improve patient care when used judiciously.

CYCLIC SULFONE-3-CARBOXAMIDES AS NOVEL P2-LIGANDS FOR Ro 31-8959 BASED HIV-1 PROTEASE INHIBITORS.

Cyclic sulfone-3-carboxamides are effective P2-1igands for HIV-1 protease inhibitors. Incorporation of 3S-tetrahydro-2H-thiopyrancarboxamide-l, l-dioxide in the hydroxyethylamine series resulted in inhibitor 14 (IC50=9 nM, CIC95=200 nM) with improved potency compared to its corresponding urethane derivative 18 (IC50=2.0 µM).

Potent HIV-1 Protease Inhibitors: Stereoselective Synthesis of a Dipeptide Mimic.

The synthesis of a differentially protected dipeptide mimic 10 in enantiomerically pure form is described. The key step involves the epimerization of the C-2 center of the lactone 4, hydrolysis and protection of the resulting hydroxy acid, followed by Curtius rearrangement to introduce the urethane functionality. The scope and versatility of this isostere has been demonstrated by its conversion to potent HIV-1 protease inhibitors with nanomolar potencies. Also, established through the synthesis of compound 13 and 14, the 3S hydroxyl configuration of the dipeptide isostere 1 is the preferred configuration for its potency. The present synthesis is efficient and provides an access to other dipeptide mimics with a great deal of structural diversity.

3'-Tetrahydrofuranylglycine as a Novel, Unnatural Amino Acid Surrogate for Asparagine in the Design of Inhibitors of the HIV Protease.

The blockade of the HIV protease has become a major target in the search for an effective therapy for AIDS.1 While many reports of potent HIV-1 inhibitors have appeared recently, the compound Ro 31-8959 remains the least selective for the HIV-1 and HIV-2 proteases.2 This property may result in reduced susceptibility to resistance since these represent the genetically most divergent strains of HIV presently known to exist.

An Efficient Synthesis of Functionalized Urethanes from Azides.

Catalytic hydrogenation of various azides in the presence of functionalized mixed carbonates afforded the corresponding urethanes in high yields.

N,N'-Disuccinimidyl Carbonate: A Useful Reagent for Alkoxycarbonylation of Amines.

An efficient and mild method for alkoxycarbonylation of amines is described, utilizing commercially available N,N'-disuccinimidyl carbonate.

A Facile and Enantiospecific Synthesis of 2(S)- and 2(R)-[1'(S)-Azido-2-phenylethyl]oxirane.

The title azidoalkyl oxiranes were synthesized efficiently in an enantiomerically pure form utilizing readily available diethyl d-tartrate.

STEREOCONTROLLED SYNTHESIS OF HIV-l PROTEASE INHIBITORS WITH C2-AXIS OF SYMMETRY.

An efficient and stereocontrolled synthesis of various C2-symmetric HIV-l protease inhibitors is described, starting from commercially available and inexpensive D-mannitol.

An Efficient Synthesis of Hydroxyethylene Dipeptide Isosteres: The Core Unit of Potent HIV-1 Protease Inhibitors.

An efficient and stereocontrolled synthesis of hydroxyethylene dipeptide isosteres 1 from commercially available, optically pure D-mannose is described. This synthesis represents a practical and enantioselective entry to a range of other dipeptide isosteres, which are not limited to amino acid derived substituents.