University of Tennessee Health Science Center
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A Librarian\u27s Perspective on Manually Tagging Curriculum for LCME Accreditation
Get PDFObjective: The objective of this paper is to discuss and share some of the successes and challenges of manually tagging all first- and second-year (M1/M2) curriculum course sessions over the course of five academic years (2014 - 2019).
Methods: As part of the Liaison Committee on Medical Education (LCME) accreditation process, all US medical schools are required to maintain a curriculum database that tracks the number of course hours spent on a selected set of topics outlined in the LCME Functions and Structures of a Medical School; this is usually achieved by building a controlled vocabulary based on Standard 6 and Standard 7. The created vocabulary is then applied to the corresponding course sessions in a process known as curriculum tagging or curriculum mapping. The health sciences library provides this service for the college in accordance with the requirements outlined by the LCME.
Results: In 2014, the health sciences library began manually tagging all course sessions from the M1/M2 curriculum. This paper describes the challenges and successes encountered manually tagging the curriculum over five academic years. The challenges include taking over the tagging mid-project, not being able to participate in the creation of the controlled vocabulary tags, extremely limited feedback on the completed tagging and overall project, and finally the amount of time required to manually tag all course sessions. Some of the successes discussed are making a case for full access to all course content, a new page layout in the curriculum database to facilitate tagging, and finding, then applying, word frequency analysis software to course content to better determine tag selection.
Conclusions: The curriculum database and course session tagging received a rating of Satisfactory from the LCME Committee after the LCME Site Survey during the accreditation process
Study of Natural Killer Cells and Their Therapeutic Role in Pediatric Cancer
Get PDFNK cells are known to play an important role in the natural defense against viral infections and tumor immune surveillance. Through complex interactions between NK cell receptors and target cell ligands, transformed or unhealthy cells are identified and rapidly eliminated. NK cells have been used for therapeutic purposes in pediatric oncology, for example by harnessing the mechanisms of NK cell surveillance in acute myeloid leukemia (AML) or intervention-augmented antibody-dependent cell-mediated cytotoxicity (ADCC) in neuroblastoma. However, the underlying cellular mechanisms in these processes are not fully understood. In my thesis research, I sought to gain a deeper understanding of the molecular and cellular changes within NK cells that occur in the tumor microenvironment and with immunotherapy. I discovered that NK cells have attenuated natural cytotoxicity in children with neuroblastoma that correlates with clinical tumor response to chemoimmunotherapy. Compared to age-matched reference data in healthy children, the studied patients had higher proportions of CD56bright NK cells, suggestive of immaturity of the NK cell compartment. Although preactivation with cytokines did not entirely overcome the hyporeactivity in patient NK cells, the therapeutic use of interleukin (IL)-2 or -15 significantly enhanced the natural cytotoxicity and ADCC of tested NK cells against neuroblastoma in vitro and in vivo and therefore warrants further investigation. To provide a suitable animal model for future studies of NK cell dysfunction and immunotherapy, I developed a humanize MISTRG neuroblastoma model. Human NK cells that arise in this model after hematopoietic progenitor cell transplantation were functionally intact and capable of suppressing neuroblastoma growth with chemoimmunotherapy in vivo. Despite the discovered molecular differences of NK cell subsets in these mice compared to patient NK cells, the humanized MISTRG neuroblastoma model is a valuable tool to study NK cell biology in neuroblastoma and test whether therapeutic interventions, such as cytokine supplementation, can overcome impaired NK cytotoxicity. Collectively, results from this work are important because they link the cellular capacity of a key effector cell involved in ADCC to antibody-mediated tumor shrinkage in the clinic, revealing potential mechanisms for therapy failure in patients who receive chemoimmunotherapy for neuroblastoma
How One Library\u27s Location Change Impacted Health Information Requests: Comparing Zip Codes and Health Disparities to Shape Library Services
Get PDFObjective In 2014, the Preston Medical Library underwent a radical change, moving from an academic office building to the main floor of a regional medical center. While the library previously served the public, health information requests have substantially increased in volume due to the new location. Each health information request is logged with the subject nature and patron contact information. The objective is: to analyze this data to see if our reach has expanded to counties that previously have not used the service, to see which counties request the most health information, and to ascertain whether more requests are from counties with a higher poverty level.
Methods Consumer health request data was downloaded from the library database. First names and other identifying data were removed. The request forms were sorted by county and zip code. For the largest three counties, researchers further sorted by zip code. GIS will be used to create maps, visually showing where the largest concentrations of patrons are located. Requests were reviewed by zip code and county, comparing number of requests as well as poverty levels.
Results There were 3,141 health information requests from September 21, 2014 to May 31, 2019. Ninety-nine results were omitted because they were from out-of-state. The majority of requests were from Knox county and adjacent counties. Requests were also received from counties not previously reached and counties with elevated poverty levels.
Conclusion Collecting data on patron interactions is not only critical for institutional reporting, but also for community outreach. Understanding that data requires taking additional steps to filter the information, assess local demographics, and customize library services. Researchers anticipate being able to better tailor services to the community based on the results
Safeguarding Against Data Breaches
Get PDFReports of data breaches have seen an increase in the past decade and compared to other businesses; these breaches are estimated to be the most expensive in healthcare and affect millions of patients. One may ask what is a data breach, what causes it, and how can it be prevented? Particularly vulnerable to breaches is Protected Health Information (PHI) collected by the healthcare provider. This information is any part of the patient’s medical record or payment history. Regularly, healthcare organizations utilize business associates and covered entities to deliver patient care. During this process, PHI is produced. This study addresses the obligations that business associates and covered entities have toward protecting patient information, the leading cause of breaches: hacking, medical identity theft, and unauthorized access to records, and what measures we will use to protect against such infringements
The Role of Secretory Phospholipase A2 Group IIA in Obesity and Metabolism
Get PDFSecretory phospholipase A2 group IIA (PLA2G2A) is a member of a family of secretory phospholipases previously implicated in inflammation, atherogenesis, and antibacterial actions. These enzymes hydrolyze glycerophospholipids at the sn-2 position releasing lysophospholipids and fatty acids. Though studies have shown PLA2G2A is pro-inflammatory and promotes atherosclerosis, no research has analyzed the role of this enzyme in obesity and metabolism. Studies in the past 5-10 years utilizing various knock- out or over-expression mouse models have analyzed the role of different secretory phospholipase A2s (sPLA2) in metabolic diseases. From these studies, it is known that at least seven of the 11 sPLA2 isozymes contribute to the prevention or causation of metabolic diseases such as obesity and Type 2 diabetes. Increased energy expenditure, insulin sensitivity, and glucose tolerance are common characteristics of a mouse with a beneficial metabolic phenotype. We studied the impact of a high-fat diet on wild-type C57BL/6 and C57BL/6 mice over-expressing the human PLA2G2A gene (IIA+ mice). Despite no differences in food intake, the IIA+ mice weighed less, had increased oxygen consumption and energy expenditure, increased glucose tolerance and insulin sensitivity, and significantly less fat mass. There was a significant induction of uncoupling protein 1 (UCP1) in the brown adipose tissue (BAT) of IIA+ mice, suggesting enhanced mitochondrial uncoupling in their adipose tissue to drive this metabolic phenotype. Previous work in Dr. Park’s laboratory suggested that hepatic PLA2G2A expression is negatively regulated by acute thyroid hormone administration. We also examined the regulation of PLA2G2A and the metabolic changes that occur in response to variations in thyroid status. The impact of PLA2G2A on brown adipose tissue thermogenic gene expression was explored. C57BL/6 and IIA+ mice were made hypothyroid over a 10-week period or treated with thyroid hormone (T3) for 5 weeks. There were no significant changes in PLA2G2A abundance in response to thyroid status. The hypothyroid IIA+ mice did not increase their energy expenditure even with T3 administration. However, the energy expenditure, substrate utilization, insulin sensitivity and glucose tolerance were all elevated in the IIA+ mice given T3. Moreover, white adipocytes from IIA+ mice were much more prone to ‘beiging,’ including increased expression of brown adipose thermogenic markers such as uncoupling protein 1 (UCP1), PR domain containing 16 (PRDM-16), and early B cell factor 2 (EBF2). Finally, the brown adipose tissue of IIA+ mice had increased UCP1. Further metabolic analysis of C57BL/6 and IIA+ mice revealed that even at thermoneutrality the IIA+ mice display elevated oxygen consumption and energy expenditure. Moreover, citrate synthase activity was increased in the brown adipose tissue but not muscle in IIA+ animals, suggesting that the elevated thermogenesis is adipose tissue-specific. Finally, RNA microarray analysis of brown adipose tissue from C57BL/6 and IIA+ mice showed induction of numerous genes related to fuel substrate transport and metabolism, indicating an increase in substrate flux to fuel brown adipose tissue activity the IIA+ mice. These data illustrate that PLA2G2A elevates thermogenesis in an adipose tissue-specific manner, in part through elevated fuel utilization and increased mitochondrial content in BAT
Fear Learning and the Olfactory Bulb: Neural Correlates of Behavioral Fear Generalization
Get PDFThe exploration of how learning alters neural coding to guide behaviors remains fundamental to neuroscience. At the most basic level, the ability for organisms to flexibly adapt to changing environments and situations is paramount to biological success and often manifests in behavioral responses controlled by neural activity. For example, organisms must modify their behavior to defensive responses in the face of biological threat. Neural circuitry is involved in coordinating an initial defensive behavioral response but must undergo reorganization in order to reliably employ defensive responses in subsequent encounters based on a cue that signals imminent danger. One such form of this learning is associative fear learning, in which an organism learns to associate an initially neutral stimulus, which by itself has no biological relevance, with an innately fear-inducing stimulus. After temporally pairing the two stimuli, organisms learn that the initially neutral stimulus predicts the fear-inducing stimulus such that encountering the former induces similar behavioral responses as the latter. Interestingly, associative fear learning is often not specific and organisms display fear responses to completely neutral stimuli that have never been associated with the innately fear-inducing stimulus. This aberrant expression of fear is referred to as generalization and is a hallmark of many psychological disorders such as anxiety and post-traumatic stress disorder. The underlying cause of fear generalization remains unknown; however, there are two predominant theories. One theory is fear generalization arises as a better-safe-than-sorry strategy, wherein sensory information remains perceptually segregated between fear predictive and neutral stimuli but the organism responds to both the same way despite the perceptual information. The second theory argues that learning alters sensory processing to make the stimuli more difficult to perceptually distinguish, which cascades into behaviorally treating them as the same. The olfactory bulb (OB) represents an ideal model system for studying the extent to which fear learning alters sensory coding in ways that support failure of perceptual discrimination due to its odotopic organization that creates unique “maps” of odor representation for each experience odor. Therefore, we used both wide-field and 2-photon (2P) calcium imaging of the OBs of awake mice in combination with classical olfactory fear conditioning to investigate how learning changes sensory representation of the conditioned odor, the initially neutral odor specifically paired with fear-inducing foot shock, as well as neutral odors never paired with shock. This allowed direct testing of the extent to which fear learning reorganizes olfactory processing in a manner that supports the failure to discriminate hypothesis of fear generalization. Both wide-field and 2P imaging revealed enhanced odor-evoked responses following fear learning that likely signal increased salience of incoming sensory information. Furthermore, the responses evoked by neutral odors became more similar to those evoked by the conditioned odor at both the population level (wide-field) and in a specific subset of OB output cells (2P), indicating neutral odors were more difficult to distinguish from the conditioned odor. Importantly, the enhanced odor-evoked responses were not attributable to behavioral state change nor top-down influence from the amygdala, the area widely believed to be involved in aberrant fear. Together, this evidence supported the failure of perceptual discrimination at early stages of sensory process as the underlying mechanism of fear generalization. We additionally investigated the role of neuromodulators in basic olfactory fear learning through in vivo pharmacology, optogenetics, and relative gene expression analysis. Manipulation of acetylcholine in the OB during olfactory fear learning established cholinergic neurotransmission can enhance the strength of learned fear and that signaling through muscarinic receptors is required for the formation of olfactory fear. Gene expression analysis revealed that several neurotransmitter receptors are downregulated 4 hours following odor-shock pairing. The majority of the downregulated genes were associated with OB inhibition suggesting that fear learning, behavioral fear generalization, and altered OB coding may arise from decreased inhibition in the OB. Altogether these results characterize neural correlates of fear generalization in the olfactory bulb at both the population and single cell level and demonstrate the importance of neuromodulation in fear learning, supporting the idea that fear generalization may initially arise from altered processing of incoming information in sensory areas. These results also highlight the importance of investigating the mechanisms of learning-induced sensory processing alterations as they relate to behavior in understanding fear generalization. This will bring insights into basic processes of learning and has the immense potential to translate to the treatment of disorders of fear generalization
E Pluribus Unum: Using Google Classroom to bring together a statewide student and faculty cohort
Get PDFHow to Stop Being a Librarian: Student-Centered Library Guide Design and Content Curation
Get PDFObjective: The objective of this paper is to discuss information seeking behavior of digital-native students verses librarians and how this affects the design, layout, and content of effective library guides. Topics covered will include effective content curation for guides, web-user’s behavior patterns, design consistency, and tips & tricks for integrating design and content best practices across a library guide system.
Methods: Springshare’s LibGuides is a platform that allows librarians to create and design topic-centered web pages called Library Guides which contain curated content; including library resources. While librarians generally follow webpage design best-practices in their library guides to increase their usage, these efforts may be undermined by the content that is later added to the guide. According to Sinkinson et al, most library guide content reflects the information seeking behavior of librarians instead of the information seeking behavior of their students. This leads to guides that students found “overwhelming and cluttered” despite librarians recognizing that students have different user behaviors and needs when designing their guides (Portal Libr Acad. 2012; 12(1):63-84. doi:10.1353/pla.2012.0008). This paper will discuss how librarians can use basic web-user behavior patterns, such as page scanning, viewing patterns, satisficing, and scrolling, to help them step into a student mindset to better curate their guide content and reinforce its use with their guide design. Basic strategies for implementing these changes across large library guide systems will also be covered.
Results: A comparison of guide content clicks from Springshare’s LibGuide statistics platform, before and after the adoption of student-centered, best-practices guide design layout and content curation, shows a significant increase in the use of guide content.
Conclusions: Using basic web-user behavior patterns, librarians can create best-practices for guide development that contain student-centered content along with guide layouts that assist students in finding convenient, curated, library resources
Going It Alone: Successes and Failures Developing a Single-Staff Systematic Review Service
Get PDFObjective: The purpose of this study is to document the successes and failures of solely developing and supporting a systematic review consultation service. While these insights are specific to the systematic review service creation process, the tips can be applied to any service idea met with high demand and little resources.
Methods: The systematic review service described in this study was developed at a non-health sciences specific university library at a Carnegie-R1 research institution. The service has a multi-tiered approach created using best practices identified from systematic review services offered at other institutions, and the strengths and weaknesses of the service are documented by the experiences of the service’s sole administrator.
Results: The success of the service demonstrates the feasibility of developing and offering a systematic review consultation service with limited staff and resources.The high usage of the systematic review service indicates that the level of the service offered, even as a partial responsibility of one librarian, is meeting the present-day need for systematic review services at this library. The weakness of the service, as well as its strengths, showcases anticipated areas for growth. In addition to meeting researcher needs, the service contributes to benefits to the library as a whole, including forging closer relationships with university research teams, establishing the library as an expert research hub, and demonstrating the value of a health sciences librarian in a non-health sciences library.
Conclusion: The success of this systematic review service demonstrates the feasibility of offering a systematic-review service at a high-demand library with limited personnel and resources