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Functions of the Triceps Brachii in Humans: A Review
No full textThe triceps brachii (TB) is the only muscle that lies along the posterior humerus, and its role in elbow extension has been the topic of investigation for many decades. The TB research has also included subjects such as strength training, effects of aging, training adaptions, etc. The purpose of this paper was to review some of the more unique investigations regarding the functions of the human TB. Specifically, this paper discusses articles that have explored the actions of the TB when manipulating the angles of the joints it crosses, the elbow and shoulder
Professionalism lapses and hierarchies: A qualitative analysis of medical students’ narrated acts of resistance
No full textResistance is classified as a reaction against confining social structures. During their education, medical students encounter traditional medical and interprofessional hierarchies as they learn to become doctors. These create a power disparity that may prevent their empowerment and ability to resist. Despite their subordinate position, students are not always powerless when encountering situations that contradict their ethical, moral, and professional understandings of appropriate medical practice – so called ‘professionalism dilemmas.’ A qualitative analysis of over 1500 narratives from interviews, focus groups, and questionnaires with 808 medical students in the UK and Australia highlights how students draw on a number of direct and indirect, verbal and bodily, instantaneous and delayed forms of resistance to counter the professionalism lapses of their seniors, which they face in everyday clinical and educational interactions. Within students’ narratives of resistance we come to see how they resist hegemonic practices and their reasons for doing so, such as to prevent patient and student abuse, promote hygienic practice, and uphold patient consent. Through these various acts of resistance (and their narration), medical students may promote the subtle transformation of the dominant medical structure either consciously or unconsciously. They may do this through reflecting on acts of resistance to professionalism lapses, making sense of their moral position and the development of their professional identities, by encouraging others to also resist through sharing resistance narratives, and finally, by altering the professional conduct of their seniors. We encourage all workplace learning stakeholders to better understand the social dynamics of hierarchies and resistance and to encourage the enactment of resistance in the face of professionalism lapses in order to protect the health and wellbeing of learners and patients
Slums, race and mental health in New York (1938–1965)
No full textClaude Brown’s seminal 1965 memoir “Manchild in the Promised Land” appeared when Americans were trying to make sense of the Watts Rebellion of 1965. A “bildungsroman”, Brown’s autobiography details how he, a former juvenile delinquent and residential treatment center client, became a stable adult once he left his troubled Harlem neighborhood. This paper argues that Brown’s book revealed just how much liberal mid-twentieth century efforts to combat poverty and crime in segregated black communities by offering more mental health services struggled to fully grasp and address the relationship between mental health and environment. Between 1938 and 1965, officials and mental health experts with the Wiltwyck School for Boys, New York Domestic Relations Court and the New York Bureau of Child Guidance imagined that Harlem would become a more stable, law-abiding community if populated with emotionally healthier people. Methodologically, this paper compares the archival record of those programs’ goals with Brown’s memoir. Brown’s own experience as both a former charge of those institutions and a resident of Harlem led him to doubt that urban ghettoes were environmentally suited to support individuals struggling to overcome mental illness. In locating Brown’s recollection of his postwar youth within the context of local efforts to provide New York City’s black juvenile delinquents with psychiatric care in the postwar era, it becomes apparent that those liberal policies and programs were designed to produce therapeutic outcomes that proved difficult to sustain amid the challenging circumstances residents faced in socioeconomically depressed communities. As an intervention into the burgeoning literature on the US history of race and psychiatry, this research represents one of the first attempts to compare the intentions of mental health professionals seeking to improve the health care of African Americans and the perspectives of their African American clients
Nuclear Receptor Subfamily 1 Group D Member 1 Regulates Circadian Activity of NLRP3 Inflammasome to Reduce the Severity of Fulminant Hepatitis in Mice
No full textBackground & Aims: The innate immune system responds not only to bacterial signals, but also to non-infectious danger-associated molecular patterns that activate the NLRP3 inflammasome complex after tissue injury. Immune functions vary over the course of the day, but it is not clear whether these changes affect the activity of the NLRP3 inflammasome. We investigated whether the core clock component nuclear receptor subfamily 1 group D member 1 (NR1D1, also called Rev-erbα) regulates expression, activity of the NLRP3 inflammasome, and its signaling pathway. Methods: We collected naïve peritoneal macrophages and plasma, at multiple times of day, from Nr1d1–/– mice and their Nr1d1+/+ littermates (controls) and analyzed expression NLRP3, interleukin 1β (IL1B, in plasma), and IL18 (in plasma). We also collected bone marrow–derived primary macrophages from these mice. Levels of NR1D1 were knocked down with small hairpin RNAs in human primary macrophages. Bone marrow–derived primary macrophages from mice and human primary macrophages were incubated with lipopolysaccharide (LPS) to induce expression of NLRP3, IL1B, and IL18; cells were incubated with LPS and adenosine triphosphate to activate the NLRP3 complex. We analyzed caspase 1 activity and cytokine secretion. NR1D1 was activated in primary mouse and human macrophages by incubation with SR9009; some of the cells were also incubated with an NLRP3 inhibitor or inhibitors of caspase 1. Nr1d1–/– mice and control mice were given intraperitoneal injections of LPS to induce peritoneal inflammation; plasma samples were isolated and levels of cytokines were measured. Nr1d1–/– mice, control mice, and control mice given injections of SR9009 were given LPS and D-galactosamine to induce fulminant hepatitis and MCC950 to specifically inhibit NLRP3; plasma was collected to measure cytokines and a marker of liver failure (alanine aminotransferase); liver tissues were collected and analyzed by quantitative polymerase chain reaction, immunohistochemistry, and flow cytometry. Results: In peritoneal macrophages, expression of NLRP3 and activation of its complex varied with time of day (circadian rhythm)—this regulation required NR1D1. Primary macrophages from Nr1d1–/– mice and human macrophages with knockdown of NR1D1 had altered expression patterns of NLRP3, compared to macrophages that expressed NR1D1, and altered patterns of IL1B and 1L18 production. Mice with disruption of Nr1d1 developed more-severe acute peritoneal inflammation and fulminant hepatitis than control mice. Incubation of macrophage with the NR1D1 activator SR9009 reduced expression of NLRP3 and secretion of cytokines. Mice given SR9009 developed less-severe liver failure and had longer survival times than mice given saline (control). Conclusions: In studies of Nr1d1–/– mice and human macrophages with pharmacologic activation of NR1D1, we found NR1D1 to regulate the timing of NLRP3 expression and production of inflammatory cytokines by macrophages. Activation of NR1D1 reduced the severity of peritoneal inflammation and fulminant hepatitis in mice
Controlled Substances Background Check Policy
No full textTo comply with United States Drug Enforcement Administration (DEA) and Missouri Bureau of Narcotics and Dangerous Drugs (BNDD) requirements for individuals with access to controlled substances the University has established a special controlled substances background check procedure. HR will work with individuals (new hires, transfers, promotions, and duty changes) to ensure background checks and DEA/BNDD licenses are clean prior to access
Clinical epidemiology of carbapenem-resistant gram-negative sepsis among hospitalized patients: Shifting burden of disease?
No full textBackground: Infections caused by carbapenem-resistant gram-negative bacilli are an emerging public health threat. However, there is a paucity of data examining comparative incidence rates, risk factors, and outcomes in this population. Methods: This single-center retrospective cohort study was conducted at an urban tertiary-care academic medical center. We included patients admitted from 2012 to 2015 who met the following criteria: i) age ≥ 18 years; and ii) culture positive for carbapenem-resistant Enterobacteriaceae (CRE) or carbapenem-resistant non-Enterobacteriaceae (CRNE) from any site. Exclusion criteria were: i) \u3c 2 systemic inflammatory response criteria; ii) cystic fibrosis; and iii) no targeted treatment. We evaluated hospital survival by Cox regression and year-by-year differences in the distribution of cases by the Cochran-Armitage test. Results: 448 patients were analyzed (CRE, n = 111 [24.8%]; CRNE, n = 337 [75.2%]). CRE sepsis cases increased significantly over the study period (P \u3c.001), driven primarily by increasing incidence of Enterobacter spp. infection (P =.004). No difference was observed in hospital survival between patients with CRE versus CRNE sepsis (hazard ratio [HR], 1.29; 95% confidence interval [CI], 0.83-2.02; P =.285), even after adjusting for confounding factors (adjusted HR, 1.08; 95% CI, 0.62-1.87; P =.799). Conclusions: Clinical outcomes did not differ between patients with CRE versus CRNE sepsis. Dramatic increases in CRE, particularly Enterobacter spp., appear to be causing a shift in the burden of clinically significant carbapenem-resistant gram-negative infection
Sepsis-associated coagulopathy severity predicts hospital mortality
No full textObjectives: To assess whether sepsis-associated coagulopathy predicts hospital mortality. Design: Retrospective cohort study. Setting: One-thousand three-hundred beds urban academic medical center. Patients: Six-thousand one-hundred forty-eight consecutive patients hospitalized between January 1, 2010, and December 31, 2015. Interventions: Mild sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.2 and less than 1.4 plus platelet count less than or equal to 150,000/µL but greater than 100,000/µL; moderate sepsis-associated coagulopathy was defined with either an international normalized ratio greater than or equal to 1.4 but less than 1.6 or platelets less than or equal to 100,000/µL but greater than 80,000/µL; severe sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.6 and platelets less than or equal to 80,000/µL. Measurements and Main Results: Hospital mortality increased progressively from 25.4% in patients without sepsis-associated coagulopathy to 56.1% in patients with severe sepsis-associated coagulopathy. Similarly, duration of hospitalization and ICU care increased progressively as sepsis-associated coagulopathy severity increased. Multivariable analyses showed that the presence of sepsis-associated coagulopathy, as well as sepsis-associated coagulopathy severity, was independently associated with hospital mortality regardless of adjustments made for baseline patient characteristics, hospitalization variables, and the sepsis-associated coagulopathy-cancer interaction. Odds ratios ranged from 1.33 to 2.14 for the presence of sepsis-associated coagulopathy and from 1.18 to 1.51 for sepsis-associated coagulopathy severity for predicting hospital mortality (p \u3c 0.001 for all comparisons). Conclusions: The presence of sepsis-associated coagulopathy identifies a group of patients with sepsis at higher risk for mortality. Furthermore, there is an incremental risk of mortality as the severity of sepsis-associated coagulopathy increases
What patients know about services to help manage chronic diseases and medications: Findings from focus groups on medication therapy management
No full textBACKGROUND: Managing and treating patients with multiple chronic conditions presents challenges on many levels. Pharmacist-delivered medication therapy management (MTM) services, mandated as part of the Medicare Part D drug benefit, are designed to help patients manage their chronic conditions and medications. OBJECTIVE: To identify factors that influence patient understanding and use of MTM services and potential strategies to educate individuals about MTM. METHODS: Participants who had at least 2 chronic conditions, were taking 2 or more prescription medications, and were aged 18 years or older were recruited from community-based settings to participate in focus groups. The focus groups aimed to identify participants\u27 perceptions and use of MTM services, barriers and facilitators to utilization, and medication problems. Participants were asked to complete a 14-item health care questionnaire and view a brief, 3-minute video introducing the topic of MTM before the group discussion. The health care questionnaire data were analyzed in Microsoft Excel. The focus group responses were transcribed and entered into the computer program ATLAS.ti for thematic analysis. Two independent reviewers qualitatively coded the discussion question responses; a third reviewer investigated discrepancies and facilitated consensus among the reviewers. RESULTS: Participants (N = 27) were mostly female (70.4%), college educated (62.9%), and had Medicare insurance (81.5%). Seven themes were identified: (1) new proposed names for MTM, (2) mechanisms to gain interest in and to promote the value of MTM, (3) familiarity with MTM, (4) pharmacists\u27 training and expertise in MTM, (5) experience with MTM, (6) reasons for nonparticipation in MTM, and (7) preferred method to learn about MTM. Participants did not understand the term medication therapy management and felt the interpretation of therapy \u27 differed between health care professionals and the public. Some participants used MTM services to learn about appropriate use of their medications, while others were unsure about their eligibility, associated costs, and how to access the services. Participants had limited pharmaceutical knowledge but felt pharmacist- provided MTM services were helpful. Participants were unfamiliar with pharmacists\u27 skills and training. Participants\u27 experiences with MTM services ranged from disregarding the invitation to participate to having pharmacists identify drug-drug interactions. Reasons for nonparticipation in MTM services included being unaware of their eligibility, failing to read excessive information from insurance companies, and being uncertain of the identity of the telephone caller. Preferred methods for learning more about MTM services included the Internet, e-mail, information availability at physician\u27s office, and television advertisements. CONCLUSIONS: These results suggest that the lay public remains largely unaware of MTM services and that the term MTM is not well understood. Clearly, tailored public health campaigns and patient engagement strategies are needed to promote MTM in chronic disease management, pharmacists as respected providers, and the importance of the prescriber-MTM pharmacist collaborative relationship in managing medications for patients with multiple chronic conditions
Hazardous Waste Management Program
No full textThe primary purpose of this program is to help University of Health Sciences and Pharmacy in St. Louis, a small-quantity generator of hazardous wastes, comply with federal and state laws pertaining to proper hazardous waste management procedures. Small Quantity Generators are institutions that produce between 220 and 2,200 pounds of hazardous waste monthly, or that accumulate such amounts. Hazardous waste regulations often are complex and difficult to interpret. A six-step compliance procedure has been chosen for the program. These steps include: Identification of hazardous waste; Registration of waste streams; Storing and labeling hazardous waste; Safety requirements; Transportation, management and disposal of hazardous waste; Payment of fees and taxes and penalties or violations;
Applies to University of Health Sciences and Pharmacy in St. Louis laboratory personnel that generate hazardous waste
Laboratory Materials Recycling Policy
No full textTo ensure the safety of the University of Health Sciences and Pharmacy in St. Louis community and outside vendors, all laboratory containers and materials approved for recycling must be triple rinsed, labels defaced or removed, and uncapped before it is placed into one of the single stream recycling containers. This policy was adopted to ensure standardized and appropriate recycling methods throughout the college and college laboratories