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Health Sciences Libraries: Supporting Public Libraries Supporting All of Us
Get PDFTitle: Health Sciences Libraries: Supporting Public Libraries Supporting All of Us
Objective: Public libraries are known for being community-centered institutions providing equitable access to information and resources, playing an important role in improving individuals\u27 access to health-related information. This project aimed to examine the perceived role and current practices of inner-city public librarians in delivering health-related information to members of their community.
Methods: An online survey was created using Qualtrics and distributed to branch libraries within a single library system serving diverse socioeconomic and demographic groups. The survey consisted of eighteen multiple choice and open-ended questions. Information was collected around four domains: demographics, perception of the role of public libraries in proving health-related information, current practices in providing health-related information, and perceived need for training to better support patrons with health information access. Both quantitative and qualitative assessments were conducted from the responses.
Results: 64 completed survey responses were collected from thirteen of the eighteen branch libraries surveyed. Understanding medical jargon, communicating with patrons, and limited availability of print resources were noted as being the top challenges in providing health-related information to patrons. When asked for health-related information, the majority of respondents reported consulting books from the library catalog as their go-to resources. 96% of respondents indicated that library employees need training on health literacy and ways to effectively provide health-related information to patrons.
Conclusions: Survey results indicated that many library workers believe public libraries play a significant role in providing equitable access to health-related information to patrons. However, many of respondents reported a need or want for additional training regarding available resources for finding adequate health-related information online. This study shows there is opportunity for health sciences libraries to partner with public libraries on programming and training needs in order to better support the needs of our communities
Health Status and Adults Willingness to Encounter A Provider by Telehealth
Get PDFTelehealth has proven to be a growing sector providing on-demand health services for consumers. A long history of development and refinement precede what we now know as telehealth technology. Access to telehealth technology has become widely available changing the landscape of healthcare. However, does that mean that consumers desire to use the technology? How does a factor such as health status play a role in the consumers’ willingness to encounter a provider using telehealth as the method for delivery of care? This research project aims to compare self-selected health status to consumers’ willingness to engage with telehealth services
A Mixed Methods Evaluation of Patient and Provider Perspectives of Chronic Illness Management Following Kidney Transplantation
Get PDFIntroduction: Inconsistent, fragmented care coordination in kidney transplant recipients (KTRs)—whose management requires long-term, complex care, and multiple handoffs among providers—has been shown to result in suboptimal care and higher costs. In order to move forward in improving long-term outcomes, it is necessary to fully assess current practice patterns with appropriate measures. With a full and accurate picture of how elements of the management plan influence both KTR and the health care provider (HCP), it will be possible to implement changes that improve long-term outcomes.Methods: The Chronic Care Model (CCM) was the framework for the study. A mixed method research approach was employed, integrating quantitative and qualitative methodologies in a single cross-sectional, correlational study with data collected from both KTRs and physicians. The 659 KTRs were selected from a list of KTRs who had received a kidney transplant at Methodist University Transplant Institute (MUTI). Physicians were recruited from a list of 96 referring nephrologists who practice in the region. The quantitative data were dichotomized results from Patient Assessment of Chronic Illness Care (PACIC) and Assessment of Chronic Illness Care (ACIC) questionnaires. Continuous data characteristics of the KTRs and HCPs were summarized, with means and standard deviations and medians and quartiles. Categorical data were reported as proportions. Chi-Square and Fisher’s Exact tests, as appropriate, were used to determine if any significant associations existed between categorical independent variables and the scale scores. Continuous variables were analyzed using t-tests and Wilcoxon Rank Sum, as appropriate.For qualitative data, NVivo 10 was used to organize the interviews and focus group discussion. Data were analyzed using five phase thematic content analysis.Results: There was variation in the perceptions of chronic illness management as assessed by the PACIC and the ACIC. The number of hospitalizations, time on dialysis and time with graft were the patient variables most associated with PACIC scores. Type of practice, embedded decision support, time in practice and age were the variables most associated with ACIC scores. Patients and providers recognized coordinated care/ follow- up, education, and community resources as barriers to chronic illness management.Discussion: The initial work presented here sought to clarify patient and provider perceptions of the influence of community resources and policies, as well as healthcare system organization using the CCM as a framework. An understanding of the perceptions and experiences of patients and providers will provide the foundation for future work that will address ways in which productive patient-provider interactions can be enhanced, thereby improving patient outcomes
Cellular Corrosion of CoCrMo Total Knee Implants: Understanding Underlying Mechanisms Through Retrieval Analysis and Simulated Inflammatory Conditions
Get PDFIntroduction. Total joint arthroplasty is considered one of the most beneficial aspects of modern orthopedic surgery. Due to the increase in population, obesity rates, and medical advances, total joint replacements have become more commonplace in the United States. Recently, a unique type of damage has been investigated in cobalt-chrome (CoCr) implants that remains poorly understood and highly controversial. Originally, it was believed that this damage type was caused by inflammatory cells directly attacking the metal surface, leading to damage of the oxide layer. However, damage caused by electrocautery tools has shown identical characteristics, leading some to believe this is the true cause. This study aims to distinguish between these two damage mechanisms and investigate the biological response of inflammatory cells to common orthopaedic metal alloys.Methods. Following institution review board approval, 41 Cobalt-Chromium-Molybdenum (CoCrMo) cadaveric primary total knee arthroplasty specimens were collected. After removal and cleaning, light microscopy was utilized to identify areas of ICIC-like damage scares. CoCrMo, zirconium nitride (ZrN)coated, and Oxinium knee implants were intentionally damaged by electrocautery from both Bovie and Aquamantys sources by a three second hover method. Bovie electrocautery damage was done at 30W, 45W, and 60W. Aquamantys electrocautery damage was done at 140W, 180W, and 220W. Using a scanning electron microscope 20 kV backscatter detection (BSD), and energy dispersive X-ray spectrometry (EDS) (Oxford, High Wycombe, UK) corroded regions were analyzed for both groups and the elemental compositions were reported. White light interferometry was utilized to examine the surface topography of the implants. Average roughness (Ra), max peak-to-valley height (Rmax,), kurtosis (Rk), and skewness (Rsk) measurements were collected to represent the topography on the damaged areas for the CoCr and Zirconium Nitride coated implants. After failing normality testing, Mann Whitney Rank Sum tests were utilized to determine any significant differences.In a separate experiment, IC-21 ATCC peritoneal macrophages were cultured with growth medium of RPMI 1640 with 10% fetal bovine serum (FBS), L-glutamine, and gentamicin. Interferon Gamma (IFNγ) and Lipopolysaccharide (LPS) were used to induce activation of macrophages. Stainless Steel, CoCr, and Titanium (Ti) discs were cut, polished, and placed into a 96 well plate. Stainless steel testing included 6 groups: standard medium, 20,000 cells, 40,000 cells, 20,000 activated cells, 40,000 activated cells. CoCr and Ti testing included the following: medium, 40,000 cells, 20,000 activated cells, cells, no disc + 20,000 cells, no disc + 40,000 cells. After cells were attached to the surface, culture medium was replaced and collected every 24 hours for stainless steel and every 12 hours for Ti and CoCr. Cell viability and number were measured with CellTiter 96® Aqueous One Solution Assay (Promega). The Griess Reagent Assay (ThermoFisher) was used to indirectly measure nitric oxide (NO) production from supernatant. Inductively coupled plasma mass spectrometry (ICP-MS), conducted at Brooks Applied Labs (Bothell, WA), was utilized to determine metal concentrations found in the supernatant. All statistical analysis was conducted using SigmaPlot (Systat Software, Chicago, IL)Results. Necropsy implants showed signs of ICIC in 7 out of 41 implants (17 %) examined. Iron (Fe), Nickel (N), Carbon (C), and Oxygen (O) content were taken from the data collected to serve as surrogate markers of corrosion. Fe/C ratios of the Bovie electrocautery damaged knee implant were shown to be statistically higher than that of necropsy retrieved implants. Median Ra measurements were shown to be statistically less (p=0.008) for Bovie damaged areas compared to ICIC damaged areas on CoCr. Median Rmax and Ra measurements were shown to be statistically less (p= 0.012, p\u3c 0.001 respectively) for Aquamantys damaged areas compared to ICIC damaged areas on CoCr. Median Rmax, Ra, and Rk, measurements were shown to be statistically higher for Bovie damaged areas compared to non-damaged areas on ZrN coated implants. Rsk measurements were shown to be statistically lower for both Bovie and Aquamantys damaged areas compared to non-damaged areas on ZrN coated implants.Activated IC-21 cells on stainless steel discs produced significantly more NO compared to their control counterparts after 8-10 days and remained elevated for the duration of the experiment. Cell viability and cell cou
Challenging the Paradigm of Clinical Triazole Resistance in Aspergillus fumigatus
Get PDFInvasive aspergillosis is a leading cause of morbidity and mortality among immunocompromised populations and is predicted to cause more than 200,000 life- threatening infections each year. Aspergillus fumigatus is the most prevalent pathogen isolated from patients with invasive aspergillosis, accounting for more than 60% of all cases. Currently, the only antifungal agents available with consistent activity against A. fumigatus are the mold-active triazoles and amphotericin B, of which the triazoles commonly represent both front-line and salvage therapeutic options. Unfortunately, the treatment of infections caused by A. fumigatus has recently been further complicated by the global emergence of triazole resistance among both clinical and environmental isolates, and a large proportion of this resistance remains unexplained. In this work, we characterize the contributions of previously identified mechanisms of triazole resistance, including mutations in the sterol-demethylase- encoding gene cyp51A, overexpression of sterol-demethylase genes, and overexpression of the efflux pump-encoding gene abcC, among a large collection of highly triazole- resistant clinical A. fumigatus isolates. Upon revealing that these mechanisms alone cannot substantiate the majority of triazole resistance exhibited by this collection, we then characterize the direct contribution of two additional efflux pump-encoding genes, abcA and atrI. Increased expression of abcA and atrI has previously been associated with triazole resistance in clinical isolates of A. fumigatus, and both of these genes exhibit a high degree of homology with the well characterized Candida albicans triazole efflux pump-encoding gene, CDR1. However, deletion of either abcA or atrI in triazole-resistant clinical isolates which overexpress these genes, did not result in a significant change in triazole susceptibility. Finally, upon demonstrating that the canonical mechanisms of triazole resistance poorly explain the high level of triazole resistance observed in this collection of clinical isolates, we subsequently describe the identification and characterization of a novel genetic determinant of triazole resistance. Mutations in the HMG-CoA reductase encoding gene, hmg1, were identified in a majority of triazole-resistant clinical isolates in our collection. Introduction of three different hmg1 mutations, predicted to encode residue alterations in the conserved sterol sensing domain of Hmg1, resulted in significantly increased resistance to the triazole class of agents. Additionally, correction of an hmg1 mutation in a pan-triazole-resistant clinical isolate of A. fumigatus with a novel Cas9-ribonucleoprotein (RNP) mediated system, was shown to restore clinical susceptibility to all triazole agents. Mutations in hmg1 were also shown to lead to the accumulation of ergosterol precursors, such as eburicol, by sterol profiling, while not altering the expression of sterol-demethylase genes. Taken together, the findings described in this work serve to demonstrate that mutations in hmg1 are a common and significant genetic determinant of triazole resistance in clinical isolates of A. fumigatus
Antibiotic Drug Discovery Targeting Bacterial Metabolism
Get PDFOver the last century, the use of antibiotics has enabled many advances in modern medicine, making life as we know it possible. In recent years, however, emerging bacterial resistance to virtually all major antibiotic classes has resulted in a worldwide increase in morbidity, mortality, and financial burden associated with drug resistant infections. The antimicrobial resistance crisis presents an urgent need for new antimicrobials with distinct mechanisms of action from existing drugs. The current pharmaceutical pipeline of new antibiotics is limited due to three obstacles: a lack of understanding of resistance mechanisms, a dearth of novel mechanisms of action among new antibiotics, and drug discovery challenges unique to bacteria due to their cellular and physiological composition. My dissertation research addressed each of these challenges. The mechanisms of resistance to folate biosynthesis inhibitors in Staphylococcus aureus were explored from a genetic, biological, biochemical, and structural basis. Unexpected roles in resistance and fitness were attributed to various mutations in the sulfonamide target dihydropteroate synthase. This information currently guides the development of next-generation antifolates designed to avoid these characterized resistance strategies. In the subsequent chapter, a conditional metabolic screening approach was employed to discover inhibitors disrupting metabolic pathways related to folate biosynthesis. The testing conditions were optimized to measure the biological activity of antimetabolites, which is often masked by nutrients present in standard testing media. This screen yielded an inhibitor of cysteine synthase A in Escherichia coli, which was characterized in chapter four. Multiple experimental approaches yielded indications that the cysteine synthase A inhibitors have a false-product mechanism, resulting in a widespread impact on several key branches of metabolism beyond cysteine biosynthesis. The final research chapter describes the adaptation of the cellular thermal shift assay to explore target engagement in the Gram-negative cell system. Drug entry and accumulation are especially challenging to achieve in Gram-negative cells due to their unique dual membrane system and associated efflux machinery. This assay provided an early stage tool to quickly assess the ability of antimicrobial candidates to engage the intended target in the intact cell system and also measure efflux sensitivity. Taken together, this dissertation contributes to the fight against the antimicrobial resistance crisis from multiple angles, all within the context of bacterial metabolism which is a rich source of exciting new antibiotic targets
Let\u27s Play KAHOOT! Teaching Epocrates to High School Students Through Online Game-Based Learning
Get PDFPoster Title: Let’s Play KAHOOT! Teaching Epocrates Through Online Game-Based Learning to High School Students.
Background: The Florida State University College of Medicine hosts a one-week residential summer program on campus for high school students. The Science Students Together Reaching Instructional Diversity & Excellence (SSTRIDE) Summer Institute motivates students to excel academically, introduces students to a variety of clinical settings, provides standardized test preparation for ACT and SAT, provides mentoring, exposes students to college life, gives students a perspective on the life of a medical student, expose students to certain aspects of the medical school curriculum through interaction with faculty and participation in faculty led presentations about medical topics, and inspires students to pursue careers in health-care professions. The opportunity arose for the Maguire Medical Library to conduct the Informatics session of the SSTRIDE Summer Institute. An hour long informatics sessions is given during each week-long camp. Mobile health technology is discussed with the group followed by learning how to use Epocrates® through the online game-based learning tool KAHOOT!
Methods: Over the past five years, the Maguire Medical Library has extended their presence by becoming integrated into the SSTRIDE experience, taking on expanded faculty roles as needs were presented. The librarians demonstrated their usefulness by participating in the evolution of the Informatics session, by moving the learning content from a plug-and-play Jeopardy game to KAHOOT! followed by taking the leadership role of teaching the SSTRIDE Informatics session.
Conclusions: The possibilities for a medical librarian in a college of medicine are encouraging and require librarians to integrate themselves in the designing of objectives and learning opportunities outside of the library itself. Identifying these opportunities, however small, has demonstrated how increase library involvement can strengthen not only the SSTRIDE program but is value added to the overall mission of the Florida State University College of Medicine
Three Year Trend in Interlibrary Loan Requests
Get PDFObjective: Background: In response to the National Library of Medicine\u27s (NLM) ILL service increase from 12, and in preparation for an upcoming retreat discussion in April 2018, the Consortium of Southern Biomedical Libraries (CONBLS) polled its 21 member libraries for ILL fills and borrows to and from other CONBLS libraries for calendar years 2016 and 2017.
Methods: To analyze three years of data, 2018 ILL statistics was requested from CONBLS libraries and permission was obtained to use it and the previously collected 2016 and 2017 ILL CONBLS statistics for this poster. Data was combined in Excel and analyzed for trends.
Results: Requested 2018 ILL statistics were received from 20 of 21 CONBLS institutions. Data showed that the number of fills declined in the case of 12 libraries, while the other 9 libraries experienced increases. There was an overall 19 percent decrease in the number of fills. In the case of borrows, 15 libraries saw decreases while 6 libraries showed increases. Overall, there was a slight increase of 1 percent in the number of borrows.
Conclusions: The decline in overall CONBLS ILL services was not unexpected and reflects the decline in certain more traditional services in academic medical libraries. There are numerous factors affecting ILL use and among them are the proliferation of open access publications; Patron-Driven Acquisition; library subsidized pay-for-view; technologies that facilitate ease of information sharing; the availability of extensive digital back-files; and more restrictive publishers\u27 licensing agreements. Even though ILL use has declined, it still plays an important role in providing needed resources to library users, helping libraries understand the needs of their users, and serving as an important tool in collection development. The discrepancy between a 19.16% decrease in fills and relatively stable number of borrows (+1.15%) over three years indicates that the CONBLS libraries were unable to provide what their users needed in 2018 at the same level they were able to in 2016. This may be due to flat or decreased budgets resulting is fewer lendable resources and less staff to provide ILL services. It is an indicator of the libraries’ decreasing ability to serve the information needs of their patrons through Interlibrary Loan Services
Thinking Outside the Box to Square the Circle: Realigning Library Services with Stakeholder Needs
Get PDFObjectives: In an age of electronic databases and Google, librarians must find ways to expand library services to meet the needs of patrons who no longer seek some traditional services. How do we identify needs in our organizations that are not being met, and market our abilities to fill those needs while maintaining our identity as librarians?
Methods: With the full support of the library director, whose priority was to update academic and clinical services, newly hired librarians took time to observe the initiatives and goals already established across their respective residency and nursing departments. Despite increased liaison activity, decreasing demand for literature searches led us to investigate other ways we could serve the departments. We discovered needs that librarians could help with such as: assisting with surveys and pretests, measuring research impact, growing institutional knowledge through tutorials and archives, finding grant opportunities, and dealing with technology questions. A search of the literature and recent job postings provided additional ideas for value-added services, as well as best practices for identifying needs and building patron relationships.
Results: Librarians focused on outreach, listened to their stakeholders’ pain points, and offered to take on different kinds of projects. This required additional training in some cases, flexibility and willingness to fail, and undertaking responsibilities that might be seen as outside a librarian’s normal duties. However, these new assignments resulted in increased collaboration and visibility for librarians.
Conclusions: While there is still a need for librarians in healthcare organizations, they must work harder than ever to market themselves and offer more value-added services. By defining those services through outreach and research, librarians can better align their goals with those of their respective stakeholders
Roles of γδ T Cells in Influenza Infections and Methods for TCR Expression and Characterization
Get PDFInfluenza virus is a significant pathogen in humans and animals with the ability to cause extensive morbidity and mortality. Exuberant immune responses associated with immune cell migration/activation and cytokine/chemokine release, can be induced after infections. Recent studies have painted a complex picture of viral clearance and tissue repair in adults. The immune responses in neonatal influenza infections and the potential methods to engineer antigen-specific T cells for immunotherapy against cancers and infections will be the focus of this dissertation. Compared to adults, infants suffer higher rates of hospitalization, severe clinical complications, and mortality due to influenza infection. We found that γδ T cells protected neonatal mice against mortality during influenza infection. γδ T cell deficiency did not alter viral clearance or interferon-γ production. Instead, neonatal influenza infection induced the accumulation of interleukin-17A (IL-17A)-producing γδ T cells, which was associated with IL-33 production by lung epithelial cells. Neonates lacking IL-17A-expressing γδ T cells or Il33 had higher mortality upon influenza infection. γδ T cells and IL-33 promoted lung infiltration of group 2 innate lymphoid cells and regulatory T cells, resulting in increased amphiregulin secretion and tissue repair. In influenza-infected children, IL-17A, IL-33, and amphiregulin expression were positively correlated, and increased IL-17A levels in nasal aspirates were associated with better clinical outcomes. Our results indicate that γδ T cells are required in influenza-infected neonates to initiate protective immunity and mediate lung homeostasis. In addition, transgenic expression of antigen-specific T cell receptor (TCR) genes is a promising approach for immunotherapy against infectious diseases and cancers. A key to the efficient application of this approach is the rapid and specific isolation and cloning of TCRs. Current methods are often labor-intensive, nonspecific, and/or relatively slow. Here, we describe an efficient system for antigen-specific TCR cloning and CDR3 substitution. We demonstrate the capability of cloning influenza-specific TCRs within 10 days using single-cell polymerase chain reaction (PCR) and Gibson Assembly techniques. This process can be accelerated to 5 days by generating receptor libraries, requiring only the exchange of the antigen-specific CDR3 region into an existing backbone. We describe the construction of this library for human γδ TCRs and report the cloning and expression of a TRGV9/TRDV2 receptor that is activated by zoledronic acid. The functional activity of these α and γδ TCRs can be characterized in a novel reporter cell line (Nur77-GFP Jurkat 76 TCR-null) for screening of TCR specificity and avidity. In summary, we provide a rapid method for the cloning, expression, and functional characterization of human and mouse TCRs that can assist in the development of TCR-mediated therapeutics. Overall, this dissertation addresses the protective roles of γδ T cells in murine and human neonatal influenza infections, and establishes the rapid system for TCR characterization, cloning and expression, which may shed light on T cell adoptive transfer immunotherapy for viral infections