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This article describes how an unfolding case study can be used to promote the development of clinical reasoning through students' self-reported perceptions, although at the same time facilitating collaboration among providers from various specialties. An unfolding case (evolving case) provides sequential information about a patient's illness trajectory as they experience the illness and related symptomology. An unfolding case study was implemented during a college skills laboratory immersion experience for 33 nurse practitioner (NP) students who were in their final year of the NP program. Students were invited per email to complete a confidential REDCap survey after the case presentation and discussion. Twenty-three students completed the survey. More than half of the students (52%) stated the review of the unfolding case offered "significant learning value" and 78% rated the unfolding case as being "very to extremely" helpful in creating opportunities for critical thinking and engagement in clinical reasoning. Implementing unfolding case studies in NP student program curricula promotes critical thinking, clinical reasoning, and allows opportunities to engage in interprofessional collaboration.

Long-acting injectable (LAI) antipsychotic medications may be an important modality of reducing costs, improving symptoms, and fostering quality of life outcomes for those with schizophrenia. Our objective was to systematically review and conduct a meta-analysis of the effectiveness of LAIs compared with oral antipsychotics on medication adherence, symptom remission/relapse, rehospitalization, outpatient visits, emergency department visits, healthcare costs, and social functioning. We performed a systematic search of PsycInfo, CINAHL, PubMed, and Scopus databases to examine studies meeting inclusion criteria prior to August 30th, 2020. Randomized controlled trials, retrospective studies, prospective studies among people with schizophrenia with at least 6-month follow-up data were obtained. Overall effect sizes and associated 95% confidence intervals (CI) were estimated with random-effects modeling. We found 75 articles meeting our inclusion criteria, including 341 730 individuals with schizophrenia. Systematic review results indicated that LAIs compared with orals improved medication adherence (25/29 studies), symptom remission/relapse (10/18 studies), rehospitalizations (26/49 studies), emergency department visits (9/17 studies), medical costs (11/15 studies), and social functioning (5/9 studies); however, LAIs also increased outpatient visits (7/16 studies) and pharmacy costs (10/10 studies). Meta-analytic results of studies with similar outcome measures did not find differences between LAIs and orals in respect to outcomes, except lowering emergency department visits and increasing pharmacy costs. The differences between the results of the narrative synthesis and the meta-analyses were possibly because of the low availability of studies with similar outcomes in the pooled analyses. Our overall results suggest that LAIs are at least comparable to orals in supporting important healthcare outcomes for those with schizophrenia. These findings support clinical practice in encouraging providers to prescribe LAIs when indicated.

Graduate level nursing programs are having increasing difficulty obtaining clinical sites for their students. Nurse practitioner (NP) students need a minimum of 500 direct care hours in addition to indirect hours. Simulation experiences may not be used as direct patient care hours for NP students, but telehealth experiences may be used if the focus is on obtaining similar competencies to what would be acquired with face-to-face patient experiences. One college of nursing adapted several opportunities for NP students to acquire indirect clinical experiences and specific NP competencies during the coronavirus (COVID-19) pandemic. Several different clinically focused teaching methodologies were planned and implemented. These varied by NP specialty track and included complex case analyses, virtual (Zoom) rounds, well-child cases, and objective structured clinical examinations. These adapted clinical experiences are effective methods of helping students acquire clinical competencies and skills; however, they bring their own challenges. Post-COVID may be a time of new beginnings, moving nursing education forward on finding new and better ways to ensure that students acquire clinical competencies. What the new normal will be for nursing education is yet to be determined, but nursing education will likely never return to where we were before the pandemic.

The manufacturing of 3D cell scaffoldings provides advantages for modeling diseases and injuries by physiologically relevant platforms. A triple-flow microfluidic device was developed to rapidly fabricate alginate/graphene hollow microfibers based on the gelation of alginate induced with CaCl2. This five-channel pattern actualized continuous mild fabrication of hollow fibers under an optimized flowing rate ratio of 300: 200: 100 μL.min−1. The polymer solution was 2.5% alginate in 0.1% graphene, and a 30% polyethylene glycol solution was used as the sheath and core solutions. The morphology and physical properties of microstructures were investigated by scanning electron microscopy, electrochemical, and surface area analyzers. Subsequently, these conductive microfibers’ biocompatibility was studied by encapsulating mouse astrocyte cells within these scaffolds. The cells could successfully survive both the manufacturing process and prolonged encapsulation for up to 8 days. These unique 3D hollow scaffolds could significantly enhance the available surface area for nutrient transport to the cells. In addition, these conductive hollow scaffolds illustrated unique advantages such as 0.728 cm3.gr−1 porosity and twice more electrical conductivity in comparison to alginate scaffolds. The results confirm the potential of these scaffolds as a microenvironment that supports cell growth.

The significance and value of Doctor of Nursing Practice (DNP) projects can be potentiated by collaboration between educators and practice leaders and when students build on previous DNP projects, as demonstrated in this article. Projects can have a longstanding financial, quality, and outcome impact, helping demonstrate the worth and efficacy of the DNP degree.

Context: Vitamin D deficiency is a global concern. There are many factors that affect the levels of vitamin D including demographics, gender, skin pigmentation, geographic location, and body mass index (BMI). In Lima, Peru, vitamin D levels may be influenced by ethnicity, socioeconomic status, overcrowded conditions, air pollution, and chronic disease status. Objective: The purpose of this cross-sectional study was to measure the prevalence of vitamin D deficiency and insufficiency in a sample of impoverished adults living in northern Lima. It was hypothesized that more than 40% of the study sample would have deficient levels of vitamin D. The Endocrine Society defines deficient levels asbeing < 20 ng/mL of 25(OH)D3, insufficient being 21–29 ng/mL of 25(OH)D3. Methods: In June 2016, a Global Health team from Ohio University Heritage College of Osteopathic Medicine provided medical clinics in impoverished communities in northern Lima. From a random sample of consenting adults, finger stick capillary blood samples were applied to Whatman protein saver cards and subsequently dried.Dried blood samples were punched, extracted, and analyzed by liquid chromatography tandem mass spectrometry. Participants had BMI measured as well. Results: 25(OH)D3 samples were obtained from 144 adults, 116 (80.6%) women, 20 (13.9%) men, 8 (5.6%) unspecified gender, age range of 18–94 with a mean of 39 years. In 66 patients (45.8%), 25(OH)D3 was deficient. In 74 patients (51.4%), 25(OH)D3 was insufficient. In 4 patients (2.8%), 25(OH)D3 was sufficient. For the women, 57 (49.1%) were deficient, 56 (48.3%) insufficient. For the men, 7 (35%) were deficient, 13 (65%) insufficient. Mean BMI was 27.3, with a range of 17.3–43.3; 40.3% were overweight and 23.6% were obese. No relationship between vitamin D levels and gender was identified (p = 0.203). There was no significant association betweenBMI levels and vitamin D levels (p = 0.418). Conclusions: In this sample, nearly one half of those tested had deficient levels of 25(OH)D3, with the vast majority (97%) having less than sufficient levels. This study population also demonstrated an average BMI of 27.3. Further study is needed to clarify the role of vitamin D as a therapeutic and its relationship with BMI.

BACKGROUND. African American (AA) men are disproportionately affected by both prostate cancer (PCa) and vitamin D deficiency compared with European American (EA) men. Vitamin D deficiency is linked to increased PCa aggressiveness and mortality. Therefore, it has been hypothesized that vitamin D deficiency may contribute to the PCa disparity between AA and EA men. METHODS. We studied a cross sectional group of 60 PCa patients (AA, n = 31; EA, n = 29) who underwent radical prostatectomy. Vitamin D metabolites 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured in the serum and tissue by uHPLC-MS-MS. Tissue was laser capture microdissected, and gene expression was quantified by microarray. DNA isolated from whole blood was genotyped for West African ancestry markers and vitamin D-related SNPs. RESULTS. Serum concentrations of 25(OH)D were lower in AAs, but concentrations of 1,25(OH)2D in the prostate tissue were higher compared with EAs. Expression of the vitamin D receptor was higher in prostate tissue from AAs. Expression of the extracellular receptor of vitamin D binding protein, LRP2, was positively associated with West African ancestry and inversely associated with tissue 25(OH)D concentrations in AAs. CONCLUSIONS. The relationships between vitamin D binding protein LRP2 and vitamin D metabolites suggest that the prohormone is actively transported into the prostate, followed by intraprostatic conversion to the active hormone, rather than passive diffusion. These findings support the presence of a compensatory response in prostate tissue to vitamin D deficiency in AAs and reveal a previously unknown complexity involving tissue distribution of vitamin D metabolites. FUNDING. Department of Defense Prostate Cancer Research Program Idea Award for Disparities Research PC121923 (LN and RK) and the NIH 1R01MD007105 (RK).