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Introduction: Though various barriers to productive writing habits exist in academia, scholarship is a critical part of faculty expectations. One barrier that has not been well addressed in the literature is the presence and interference of a negative inner critic, an internal voice or dialogue that criticizes work, halts creativity, and paralyzes writing., Commentary: The purpose of this commentary is to describe the limited evidence-base and anecdotal strategies shown to support increased writing productivity by acknowledging and navigating the inner critic. With strategies such as proper identification, acknowledgment, strong mentor-mentee relationships, personifying the inner critic, embracing a growth mindset, and considering the distinct phases of writing, faculty can cope with their critical inner voice and reclaim control of their scholarly writing productivity., Implications: With such a heavy emphasis on writing productivity for faculty, faculty are encouraged to more formally explore and implement professional development strategies to help navigate their inner critic and bolster writing productivity., Competing Interests: Declaration of competing interest The authors have no conflicts of interest related to this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Purpose: The Accreditation Council for Pharmacy Education Standards 2016 and the Entrustable Professional Activities highlight the importance of continuing professional development (CPD) in pharmacy education. Furthermore, pharmacy graduates must self-direct their learning to sustain professional knowledge, skills, and practice. An advanced pharmacy practice experience (APPE) dedicated to CPD can help meet standards of pharmacy education and prepare students for a career of lifelong learning., Educational Activity and Setting: An innovative CPD APPE centered on the CPD framework and student self-directed learning was developed and implemented by three colleges of pharmacy. Students enrolled in the new CPD APPE were introduced to the CPD framework, engaged in reflection, developed personalized learning objectives, and participated in self-directed learning activities to meet identified educational needs., Findings: Student performance outcomes were assessed via written reflections, portfolio documentation, and attendance records. The novel CPD rotation showed positive findings regarding student-perceived satisfaction, achievement of learning outcomes, and foundational lifelong learning habits. As soon-to-be graduates and practicing pharmacists, final-year pharmacy students are well poised to learn and apply the CPD framework and develop the skills needed to become lifelong learners., Summary: Experiences across three colleges of pharmacy demonstrated that a CPD APPE is feasible, valuable, and effective to integrate comprehensive CPD training within pharmacy education. Other programs within the academy may utilize this scalable model to prepare APPE students to engage in self-directed CPD and lifelong learning as health professionals., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: There are limited data on the psychometric properties of instruments evaluating professional identity (PI) among student pharmacists., Objectives: This study analyzed the psychometric properties of an instrument to assess student pharmacists' perception of their PI., Methods: Data from a cross-sectional survey were used to establish validity and reliability evidence of student pharmacists' perception of PI using Rasch analysis. Linear regression was conducted to evaluate the association of students' characteristics with their perceived PI. Analyses were conducted in WINSTEPS (SWREG, Minnetonka, MN) and SAS (SAS, Cary, NC)., Results: The analysis included 118 student pharmacists. Primary analysis suggested inadequate scale functionality; thus, some response categories were merged. With modified item anchors and the removal of the most misfitting item, the data fit the model as measured by student and item infit and outfit mean-squared values. The item-person map showed appropriate distribution of item difficulty, identifying medicine adviser and entrepreneur being the easiest and hardest items to agree with, respectively. Students' abilities initially mismatched with item difficulty and exhibited a ceiling effect, requiring addition of items reflecting students' higher perceptions of PIs. Although students' reliability coefficient (RC) and separation index were 0.98 and 1.73, respectively, RC of the items was 0.94. Students who reported receiving formal PI training were 0.3 times more likely to have high perception of PI than those who did not report training., Conclusion: The instrument exhibited fair validity and reliability evidence for assessing the perception of PI among student pharmacists. Additional items to fill identified item gaps are needed to improve the instrument's content validity., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Introduction: Professional identity describes the internal feeling of belonging to a community, such that someone "thinks, feels, and acts" like a member of a profession. Clear professional identity formation can improve the transition from school to work. However, there is limited knowledge about student pharmacists' perceptions of their professional identity. This research aimed to identify and compare student pharmacists' perceptions of their professional identity and to compare those perceptions across class cohorts., Methods: Data were collected using an online questionnaire that incorporated professional identity labels drawn from previous research. The questionnaire was administered over four weeks to all student pharmacists at one United States pharmacy school. Data were analyzed using chi-square tests., Results: One hundred sixteen responses were received (24% response rate) from the four graduating class years (2020-2023). Respondents were predominantly female (73%), Caucasian (43%), and had obtained at least a bachelor's degree (58%). "Medicine Adviser" was the most frequently selected professional identity (38%). "Business Person" was the least frequently selected professional identity (0%). There was no relationship between professional identities and cohorts of students., Conclusions: Student pharmacists in this study selected multiple professional identities, suggesting pharmacy students and the profession have yet to consolidate their own identity. There was no relationship between student pharmacists' professional identity selections and cohort, suggesting that professional identity formation did not change as a result of moving through the didactic curriculum. Additional training, curricular modification, and faculty support may be warranted to support student pharmacists with their professional identity development., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: The effects of FLASH-level dose rates delivered at the spread-out Bragg peak (SOBP) on normal tissue damage in mice were investigated., Materials and Methods: Fifty nontumor-bearing mice received abdominal irradiation, 30 at FLASH dose rates (100 Gy/s) and 20 at conventional dose rates (0.1 Gy/s). Total dose values ranged from 10 to 19 Gy, delivered in a single spot by a synchrocyclotron proton therapy system. Centered on the abdomen, the collimated field delivered was an 11-mm diameter circle with a water-equivalent depth of 2.4 cm from entrance to distal 80% dose. A ridge filter was used to provide dose uniformity over the full 2.4-cm range. The spatial distribution was identical for both the FLASH and conventional deliveries., Results: Overall survival and individual mouse weights were tracked for 21 days after the exposure date, and LD50 values were compared for the FLASH and conventional dose rate groups. Mice exposed to FLASH dose rates had a higher LD50 value as compared with mice exposed to conventional dose rates, with a dose-dependent improvement in survivability of 10% to 20%. The FLASH cohort also showed greater or equal percent population survival for each day of the study., Conclusion: These results are preliminary confirmation of the potential for the combination of the advantages of the Bragg peak with the normal tissue sparing benefits of FLASH treatments. This experiment also confirms that pulsed synchrocyclotrons can be used for the purpose of FLASH research and treatment., Competing Interests: Conflicts of interest: Mevion Medical Systems is an advertiser with the International Journal of Particle Therapy. The authors are employees of Mevion Medical Systems, and thus benefit from the demonstration of the capabilities of Mevion's proton therapy systems., (©Copyright 2021 The Author(s).)

Neoadjuvant immunotherapy can induce immune responses within the tumor microenvironment. Gene expression can be used to assess responses with limited amounts of conventionally-fixed patient-derived samples. We aim to assess the cross-platform concordance of immune-related gene expression data. We performed comparisons across three panels in two platforms: Nanostring nCounter® PanCancer Immune Profiling Panel (nS), HTG EdgeSeq Oncology Biomarker Panel (HTG OBP) and Precision Immuno-Oncology Panel (HTG PIP). All tissue samples of 14 neoadjuvant GM-CSF treated, 14 neoadjuvant Provenge treated, and 12 untreated prostate cancer patients were radical prostatectomy (RP) tissues, while 6 prostatitis patients and 6 non-prostatitis subjects were biopsies. For all 52 patients, more than 90% of the common genes were significantly correlated (p < 0.05) and more than 76% of the common genes were highly correlated (r > 0.5) between any two panels. Co-inertia analysis also demonstrated high overall dataset structure similarity (correlation>0.84). Although both dimensionality reduction visualization analysis and unsupervised hierarchical cluster analysis for highly correlated common genes (r > 0.9) suggested a high-level of consistency across the panels, there were subsets of genes that were differentially expressed across the panels. In addition, while the effect size of the differential testing for neoadjuvant treated vs. untreated localized prostate cancer patients across the panels were significantly correlated, some genes were only differentially expressed in the HTG panels. Finally, the HTG PIP panel had the best classification performance among the 3 panels. These differences detected may be a result of the different panels or platforms due to their technical setting and focus. Thus, researchers should be aware of those potential differences when deciding which platform and panel to use., (Published by Elsevier B.V.)

Purpose: The purpose of this reflection or wisdom of experience article is to describe and reflect on the impacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on experiential education (EE) leadership and teams. Additionally, this reflection will shift the focus from the spring 2020 environment of SARS-CoV-2 to what EE teams and college administration can learn from those experiences. Moving forward, EE teams and administrators can be better equipped to proactively plan for future emergencies., Description: Using the "What? So What? Now What?" model of reflection, this manuscript will broadly describe the experiences of three EE administrators and their teams during the SARS-CoV-2 pandemic. Proposed lessons learned as well as future planning strategies will be presented., Analysis/interpretation: The world of education was unprepared for the SARS-CoV-2 pandemic, and most sectors were left scrambling to adjust to new models very quickly with no planning or preparation. In the realm of pharmacy education, SARS-CoV-2 caused complete disruption for pharmacy students on rotations, clinical sites, preceptors, and EE teams. In reflecting on spring 2020, much can be gained and applied to future planning efforts so that institutions can be better prepared for future crises., Conclusions/implications: While still in the pandemic, schools must plan for the coming year. EE teams can work together to prepare for emergencies, craft contingency plans, and build additional capacity into their teams and available rotation offerings., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: The pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists' perspectives of CPAs, including barriers and facilitators to CPA implementation., Methods: Semistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes., Results: Seventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients' health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process., Conclusions: The pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: To (1) evaluate the use of the pharmacists' patient care process (PPCP) by licensed pharmacists through a simulated patient activity and (2) describe pharmacists' awareness and perceptions of the PPCP in the state of Arizona., Design: Interviews were conducted to elicit pharmacists' perceptions and awareness of the PPCP. A simulated patient activity involved a role-play pharmacist-patient interaction in a community pharmacy setting. The PPCP was employed as the evaluative framework to assess pharmacist behavior., Setting and Participants: Pharmacists licensed in the state of Arizona practicing in various pharmacy settings were recruited through e-mail list serves and snowball recruitment. Data were collected in person, by telephone, and via video chat., Outcome Measures: Emergent qualitative themes from interviews were used to describe pharmacists' awareness and perceptions of the PPCP. The presence or absence of PPCP elements were assessed during the simulations., Results: A total of 17 pharmacists were interviewed; 16 participated in the simulated activity. Of these, 7 (41.2%) participants recalled specific details regarding the PPCP process. Participants felt that the PPCP accurately reflected their daily workflow. Accordingly, a mean of 15.8 of the 19 PPCP elements was observed in simulated pharmacist-patient interactions, still allowing room for improvement in pharmacist-led care planning. Participants indicated perceived value in a shared patient care process that facilitates collaboration with myriad health professionals and as an aid to leverage pharmacists' role on health care teams., Conclusion: In this study, pharmacists practicing in Arizona in various settings expressed an awareness of the PPCP, felt it accurately reflected the work they do, and expressed that the tool potentially added value to their work., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Develop and assess the effectiveness of an interprofessional co-curricular elective in improving pharmacy students' confidence in providing diabetes self-management education and support (DSMES) to patients., Educational Activity and Setting: As part of an interprofessional collaboration, a student organized diabetes-specific enrichment elective, was offered originally to medical students and then extended to include pharmacy students. The interprofessional elective included an overview of diabetes and its prevention, medications, insulin therapy/administration, blood glucose monitoring, insulin pumps, nutrition and fitness. This elective served as a co-curricular activity, in that it was not offered for course credits, rather provided an opportunity to learn in an interprofessional environment with small group, unstructured interactions. The impact of the elective on pharmacy student confidence was evaluated using a retrospective pre-post survey., Findings: A total of 16 pharmacy students participated (response rate of 63%). A Wilcoxon signed-rank test revealed an increase in students' confidence in most of the areas assessed. Eighty percent of respondents found the elective valuable., Summary: An interprofessional co-curricular diabetes-specific elective significantly improved pharmacy students' confidence in providing DMSES to patients in the majority of assessed areas. Pharmacy and medical students were given the opportunity to learn alongside one another and learn from an interprofessional team of instructors in a setting that modeled such communication and collaboration. Developing such enrichment electives may be beneficial to equip students with the skills needed to provide education/support to patients with chronic diseases and interact with other health professionals effectively., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Transbronchial lung cryobiopsy (TBLC) has become a popular option for tissue diagnosis of interstitial lung disease (ILD), however reports vary regarding the safety of this procedure. Herein, we evaluate the safety of transbronchial cryobiopsy in hospitalized patients, comparing adverse events to outpatient procedures., Methods and Measurements: This is a single center, retrospective chart review of all TBLC performed for suspected ILD between November 2013 and March 2017. Biopsies were performed by a board certified interventional pulmonologist or interventional pulmonology fellow using a two-scope technique., Results: One hundred fifty-nine cryobiopsies were performed for the diagnosis of ILD. Rates of adverse events are as follows: pneumothorax 11%, persistent air leak 1.3%, moderate-severe bleeding 3.8%, ICU transfer within 48 h 3.1%, and all cause 30-day mortality 1.9%. No deaths were attributed to the procedure. Comparing adverse events between hospitalized patients and outpatients, rates of pneumothorax were 24% vs 9.9%, persistent air leak 5.9% vs 0.7%, ICU transfer 12% vs 2.1%, and 30-day mortality 5.9% vs 1.4%. However, no differences were statistically significant., Conclusion: Practitioners should recognize that while cryobiopsies are a high-yield, safe, and cost-effective alternative to surgical lung biopsy, not all procedures carry the same risk profiles. Hospitalized patients may have a greater propensity for pneumothorax, persistent air leak, transfer to the ICU, and 30-day mortality., (Published by Elsevier Ltd.)

Objectives: Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery., Methods: We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1.2 µg/mL clonidine in 0.1% bupivacaine, for labor and post-cesarean analgesia in parturients on buprenorphine therapy. All cesarean deliveries were performed with a combined spinal-epidural technique and the catheters maintained for immediate postoperative analgesia using an epidural infusion. Catheters were discontinued the next day and patients were then managed with other analgesics based on obstetric preference. We recorded pain scores during labor and in the immediate post-surgical period; and supplemental medications given after epidural catheter removal., Results: Fourteen patients were included in the study, of whom seven presented in spontaneous labor and seven had elective cesarean delivery. All laboring patients achieved good analgesia, and five of seven avoided supplemental opioid use in the postpartum phase. Of the postsurgical patients, six of seven had pain scores less than 5/10 at epidural catheter removal and three of seven avoided supplemental opioids postoperatively., Conclusions: The combination of clonidine and bupivacaine appears effective in parturients on buprenorphine therapy for opioid addiction maintenance. As study numbers were small and several factors were not examined, further confirmatory research is needed, including to determine the ideal dose of epidural clonidine in this setting., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: Recent randomized trials have demonstrated that endovascular therapy improves outcomes in patients with an acute ischemic stroke from a large vessel occlusion. Subgroup analysis of the Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) study found that patients undergoing general anesthesia (GA) for the procedure did worse than those with nongeneral anesthesia (non-GA). Current guidelines now suggest that we consider non-GA over GA, without large, randomized trials specifically designed to address this issue. We sought to review our experience and outcomes in a program where we routinely use GA in patients undergoing mechanical thrombectomy with similar techniques., Methods: Patients with anterior circulation strokes who received intravenous tissue plasminogen activator (IV-tPA) and endovascular stroke therapy were included in the analysis. The National Institutes of Health Stroke Scale (NIHSS) on admission and discharge and modified Rankin scale scores at discharge were recorded and compared with the outcome measurements of MR CLEAN., Results: Sixty patients were identified: 39 males and 21 females with a mean age of 62 (range of 29-88). Forty-seven patients were transferred from outside primary stroke centers, while 13 patients presented directly to our institution. Median NIHSS on admission was 15. The median time of symptom onset to endovascular therapy was 265 minutes, with an interquartile range of 81 minutes. Using the thrombolysis in cerebral infarction (TICI) scale, recanalization of TICI 2b-3 was achieved in 76.4% of recorded patients (42/55 recorded). At discharge, mortality was 16.7% (10/60), median NIHSS was 5, and 38.3% (23/60) of patients had a modified Rankin Scale score of 0-2., Conclusions: General anesthesia does not worsen outcome in patients undergoing mechanical thrombectomy when compared to historical subgroups. Despite a longer time from symptom onset to treatment, our outcomes for patients receiving GA compare favorably to the GA and non-GA groups in MR CLEAN., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To investigate the hypothesis that elbow extension alters the biomechanics of forearm rotation including force transmission in the distal and proximal radioulnar joints (DRUJ and PRUJ) and the interosseous ligament (IOL)., Methods: A cadaver model with a custom-designed jig was used to measure forearm pronosupination ranges, transmitted forces and contact areas across the PRUJ and DRUJ, and tension in the 3 main components of the IOL's central band. Testing with applied loads was undertaken throughout pronosupination with the elbow fully flexed (n = 15) and fully extended (n = 11)., Results: Elbow extension-flexion affected the range of forearm pronosupination, shifting the arc of rotation such that the forearm supinated maximally with the elbow flexed and pronated maximally with the elbow extended. Elbow extension also increased transmitted forces across the DRUJ and PRUJ while also increasing contact areas within the DRUJ and PRUJ. Elbow extension significantly increased tension in the central band of the IOL when the forearm was maximally pronated., Conclusions: Maximum supination occurred with the elbow flexed. Maximum pronation occurred with it extended. Elbow position altered forearm biomechanics, including force transmission across the PRUJ and DRUJ and transmitted tension in the IOL., Clinical Relevance: The interplay of osseoligamentous forearm structures is such that we would anticipate surgical alteration of any one of them to have effects upon function of the others., (Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

As information technology permeates healthcare (particularly provider-facing systems), maximizing system effectiveness requires the ability to document and analyze tricky or troublesome usage scenarios. However, real-world health IT systems are typically replete with privacy-sensitive data regarding patients, diagnoses, clinicians, and EMR user interface details; instrumentation for screen capture (capturing and recording the scenario depicted on the screen) needs to respect these privacy constraints. Furthermore, real-world health IT systems are typically composed of modules from many sources, mission-critical and often closed-source; any instrumentation for screen capture can rely neither on access to structured output nor access to software internals. In this paper, we present a tool to help solve this problem: a system that combines keyboard video mouse (KVM) capture with automatic text redaction (and interactively selectable unredaction) to produce precise technical content that can enrich stakeholder communications and improve end-user influence on system evolution. KVM-based capture makes our system both application-independent and OS-independent because it eliminates software-interface dependencies on capture targets. Using a corpus of EMR screenshots, we present empirical measurements of redaction effectiveness and processing latency to demonstrate system performances. We discuss how these techniques can translate into instrumentation systems that improve real-world health IT deployments., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Silica, zirconia, and titania columns were compared for their ability to separate diesel samples into saturates, mono-, di-, tri-, and polyaromatics by supercritical fluid chromatography (SFC) using pure CO(2) according to ASTM method D 5186-03. A titania column coupled in series to a silica column was found to provide the highest overall group-type resolutions based on 20 model compounds, with resolutions as high as 14.7 for saturates versus monoaromatics and 11.9 for monoaromatics versus diaromatics. An oilsands-derived Synfuel light diesel, a commercial Ontario diesel, and a heavy Shell Canada Ltd. diesel blending feedstock were studied on a titania-silica coupled column as well as on a conventional silica column. The Synfuel results were similar (within 0.5 mass%) on both the conventional bare silica column and the titania-silica coupled column. The heavier commercial diesel and diesel blending feedstock samples yielded different results on the titania-silica coupled column compared to the silica column alone, demonstrating the importance of achieving the highest possible resolutions when baseline separation of group-types is not obtained.

The effects of argon laser light on endotracheal tubes and gas mixtures have been studied. In recommended use accidental exposure to red rubber and PVC tubes caused minimal damage. Prolonged exposure of PVC tubing and a 2:1 nitrous oxide:oxygen mixture produced a minimal increase in temperature and no detectable increase in the concentration of higher oxides of nitrogen. Transparent endotracheal tubes are recommended if the argon laser is being used in the management of cutaneous lesions of the head and neck.