Value of pre-licensure interprofessional education on post-licensure interprofessional collaboration: Perceptions and experiences of practicing professionals.

Interprofessional education (IPE) allows students in health professional programs to practice providing collaborative patient care before graduating. Understanding the perceptions and experiences of health care professionals' IPE received prior to entering the workforce is key for improving IPE programs. This study investigated participants' post-licensure interprofessional collaboration (IPC) experiences, how IPE helped prepare them for IPC post-licensure, their perceptions of the IPE they received as students, and their suggestions for improving IPE. This qualitative descriptive study included 20 healthcare workers from seven professions who graduated from two of three co-located post-secondary educational institutions. Data were collected using semi-structured interviews, which were audiotaped and transcribed verbatim. Inductive thematic analysis revealed five themes and six sub-themes: (a) Quality of care; (b) Role clarification; (c) Interpersonal skills (sub-themes: communication and self-confidence); (d) Co-location; and (e) Need for IPE improvements (sub-themes: additional IPE exposures, shadowing experiences, mandatory IPE, and informal peer learning). These findings appear to reinforce the perception that pre-licensure IPE may support the development of skills for IPC among practicing health professionals.

Exploring the Efficacy of a Virtual First Year Interprofessional Education Event.

Interprofessional education (IPE) activities are utilized in health education programs to develop interprofessional collaboration (IPC) competencies. All first-year healthcare students at three postsecondary learning institutions attend a mandatory introductory IPE event annually. During the 2020/2021 academic year, the event was moved from a face-to-face activity to a virtual format due to the COVID-19 pandemic restrictions. This study examined whether the virtual IPE activity was effective in supporting the development of interprofessional competencies for first-year healthcare students. Two hundred and six students attended a synchronous didactic presentation on IPE competencies and discussed a simulated case in interprofessional groups of eight students and two faculty facilitators. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used to measure the students' opinions on interprofessional competencies. Paired t-tests were used to compare the pre- and post-scores. One hundred and nine (52.9% response rate) students completed the survey. Surveys from 99 students with matched pre- and post-scores were included in the study. The ICCAS competencies showed improvements (p < 0.05) in all of the students' self-reported IPE competencies following the activity compared to before the training. Our findings indicate that the virtual IPE activity is effective in facilitating the development of IPC for first-year healthcare students.

Pilot of a community-based interprofessional "student-infused" pulmonary rehabilitation program in Saint John, New Brunswick.

Background: With the increasing prevalence of chronic pulmonary conditions in New Brunswick and Canada it is necessary to consider innovative interventions to improve access to rehabilitation and supportive care for affected clients. In Fall 2018 we piloted a pulmonary rehabilitation (PR) program for persons with moderate to severe chronic obstructive pulmonary disease (COPD) to demonstrate a novel approach of bridging interprofessional education of students in health care fields with provision of care in a community setting. Methods: An 8-week PR program was implemented and evaluated using a quasi-experimental design with pre- and post-testing to measure the effects of the program's exercise and educational interventions on persons with COPD. Participants were assessed using the 6-Minute Walk Test (6MWT), the St. George's Respiratory Questionnaire (SGRQ), and a custom questionnaire that rated the participants' activities of daily living and the PR program. Results: Seven participants completed our PR program. Following the intervention, participants' self-reported health demonstrated a statistically significant improvement. Even though changes on the 6MWT and SGRQ were not shown to be statistically significant, there was evidence of clinically meaningful improvements in those measures. On average, participants walked 25 m further postintervention and showed clinically meaningful improvements on the SGRQ. Conclusions: This pilot project demonstrated that a community-based PR program with active involvement of students from multiple health care programs can have positive outcomes for clients with COPD. It also illustrated how educational programs can provide an innovative means for increasing access to rehabilitation and supportive care for clients in the community.

FDA Perspectives on the Regulation of Neuromodulation Devices.

The United States Food and Drug Administration (FDA) ensures that patients in the United States have access to safe and effective medical devices. The division of neurological and physical medicine devices reviews medical technologies that interface with the nervous system, including many neuromodulation devices. This article focuses on neuromodulation devices and addresses how to navigate the FDA's regulatory landscape to successfully bring devices to patients.

FDA Regulation of Neurological and Physical Medicine Devices: Access to Safe and Effective Neurotechnologies for All Americans.

The United States Food and Drug Administration (FDA) ensures that patients in the U.S. have access to safe and effective medical devices. The Division of Neurological and Physical Medicine Devices reviews medical technologies that interface with the nervous system. This article addresses how to navigate the FDA's regulatory landscape to successfully bring medical devices to patients.

Commissural neurons in the rat ventral cochlear nucleus.

Commissural neurons connect the cochlear nucleus complexes of both ears. Previous studies have suggested that the neurons may be separated into two anatomical subtypes on the basis of percent apposition (PA); that is, the percentage of the soma apposed by synaptic terminals. The present study combined tract tracing with synaptic immunolabeling to compare the soma area, relative number, and location of Type I (low PA) and Type II (high PA) commissural neurons in the ventral cochlear nucleus (VCN) of rats. Confocal microscopic analysis revealed that 261 of 377 (69%) commissural neurons have medium-sized somata with Type I axosomatic innervation. The commissural neurons also showed distinct topographical distributions. The majority of Type I neurons were located in the small cell cap of the VCN, which serves as a nexus for regulatory pathways within the auditory brainstem. Most Type II neurons were found in the magnocellular core. This anatomical dichotomy should broaden current views on the function of the commissural pathway that stress the fast inhibitory interactions generated by Type II neurons. The more prevalent Type I neurons may underlie slow regulatory influences that enhance binaural processing or the recovery of function after injury.

Structural and functional classes of multipolar cells in the ventral cochlear nucleus.

Multipolar cells in the ventral cochlear nucleus (VCN) are a structurally and functionally diverse group of projection neurons. Understanding their role in the ascending pathway involves partitioning multipolar cells into distinct populations and determining where in the brain each sends its coded messages. In this study, we used retrograde labeling techniques in rats to identify multipolar neurons that project their axons to the ipsilateral dorsal cochlear nucleus (DCN), the contralateral CN, or both structures. Three rats received injections of biotinylated dextran amine in the ipsilateral DCN and diamidino yellow in the contralateral CN. Several radiate multipolar neurons (defined by their axonal projections to the ipsilateral DCN and their dendrites that traverse VCN isofrequency sheets) were double-labeled but over 70% were not. This result suggests two distinct populations: (1) radiate-commissural (RC) multipolar cells that project to the ipsilateral DCN and the contralateral CN, and (2) radiate multipolar cells that project exclusively (in this context) to the ipsilateral DCN. In a different group of animals, we retrogradely labeled multipolar neurons that project their axons to the contralateral CN and measured the size of their cell bodies. The mean size of this population (266 +/- 156 microm2) was significantly smaller than those of RC-multipolar cells (418 +/- 140 microm2). We conclude that the CN commissural pathway is composed of at least two components: (1) RC multipolar cells and (2) commissural multipolar cells that are small- and medium-sized neurons that project exclusively (in this context) to the contralateral CN. These results identify separate structural groups of multipolar cells that may correspond to physiological unit types described in the literature. They also provide protocols for isolating and studying different populations of multipolar cells to determine the neural mechanisms that govern their responses to sound.

Projections from the spinal trigeminal nucleus to the cochlear nucleus in the rat.

The integration of information across sensory modalities enables sound to be processed in the context of position, movement, and object identity. Inputs to the granule cell domain (GCD) of the cochlear nucleus have been shown to arise from somatosensory brain stem structures, but the nature of the projection from the spinal trigeminal nucleus is unknown. In the present study, we labeled spinal trigeminal neurons projecting to the cochlear nucleus using the retrograde tracer, Fast Blue, and mapped their distribution. In a second set of experiments, we injected the anterograde tracer biotinylated dextran amine into the spinal trigeminal nucleus and studied the resulting anterograde projections with light and electron microscopy. Spinal trigeminal neurons were distributed primarily in pars caudalis and interpolaris and provided inputs to the cochlear nucleus. Their axons gave rise to small (1-3 microm in diameter) en passant swellings and terminal boutons in the GCD and deep layers of the dorsal cochlear nucleus. Less frequently, larger (3-15 microm in diameter) lobulated endings known as mossy fibers were distributed within the GCD. Ventrally placed injections had an additional projection into the anteroventral cochlear nucleus, whereas dorsally placed injections had an additional projection into the posteroventral cochlear nucleus. All endings were filled with round synaptic vesicles and formed asymmetric specializations with postsynaptic targets, implying that they are excitatory in nature. The postsynaptic targets of these terminals included dendrites of granule cells. These projections provide a structural substrate for somatosensory information to influence auditory processing at the earliest level of the central auditory pathways.

The source of corticocollicular and corticobulbar projections in area Te1 of the rat.

Cortical area Te1 in the rat commonly is associated with primary auditory cortex. It is the source of direct projections to the inferior colliculus (IC), superior olivary complex (SOC), and the cochlear nucleus (CN). A question that arises is whether these descending pathways derive from a common source or separate populations of cortical neurons. We addressed this question in seven rats by injecting either Diamidino yellow (DiY) or Fast blue (FB) into the IC and injecting the other tracer into the CN (n=4) or SOC (n=3). All injections were made on the left side of the brain. In a sample of sections through area Te1 in both hemispheres, we counted single- and double-labeled cells. We estimate that IC-projecting cells outnumber those projecting to the CN or SOC by at least a factor of ten. The source of corticofugal pathways to the left IC was heavily biased towards the same side of the brain (ipsi/contra ratio 8 +/- 2.5), whereas it was more equally distributed between the two hemispheres for the left CN and SOC (ipsi/contra ratios ranged from 0.7-2.3). Finally, we observed that only 10-20% of those cells filled with a tracer injection in the CN or SOC also contained the tracer injected into the IC. In a previous study, we observed a similarly small percentage of double labeled cells when FB and DiY were injected into the CN and SOC, respectively. Combined with the distinct laminar distribution of IC-, SOC-, and CN-projecting neurons within layer V, the results suggest that these three pathways largely derive from different populations of cortical neurons.

Multimodal inputs to the granule cell domain of the cochlear nucleus.

There is growing evidence that hearing involves the integration of many brain functions, including vision, balance, somatic sensation, learning and memory, and emotional state. Some of these integrative processes begin at the earliest stages of the central auditory system. In this review, we will discuss evidence that reveals multimodal projections into the granule cell domain of the cochlear nucleus.

Axonal pathways to the lateral superior olive labeled with biotinylated dextran amine injections in the dorsal cochlear nucleus of rats.

The lateral superior olive (LSO) contains cells that are sensitive to intensity differences between the two ears, a feature used by the brain to localize sounds in space. This report describes a source of input to the LSO that complements bushy cell projections from the ventral cochlear nucleus (VCN). Injections of biotinylated dextran amine (BDA) into the dorsal cochlear nucleus (DCN) of the rat label axons and swellings in several brainstem structures, including the ipsilateral LSO. Labeling in the ipsilateral LSO was confined to a thin band that extended throughout the length of the structure such that it resembled an LSO isofrequency lamina. The source of this labeled pathway was not obvious, because DCN neurons do not project to the LSO, and VCN bushy cells were not filled by these injections. Filled neurons in several brainstem structures emerged as possible sources. Three observations suggest that most of the axonal labeling in the LSO derives from a single source. First, the number of labeled VCN planar multipolar cells and the amount of labeling in the LSO were consistent and robust across animals. In contrast, the number of labeled cells in most other structures was small and highly variable. Second, the locations of planar cells and filled axons in the LSO were related topographically to the position of the DCN injection site. Third, labeled terminal arborizations in the LSO arose from collaterals of axons in the trapezoid body (output tract of planar cells). We infer that planar multipolar cells, in addition to bushy cells, are a source of ascending input from the cochlear nucleus to the LSO.

Ultrastructural examination of the somatic innervation of ventrotubercular cells in the rat.

Ventrotubercular cells are multipolar cells in the ventral cochlear nucleus (VCN) that project a collateral axon to the ipsilateral dorsal cochlear nucleus (DCN). These cells are thought to be involved in sensitizing DCN output neurons to spectral shapes that represent the location of a sound source in space. The present report focused on the neuronal composition of this pathway. Intracellular labeling studies in cats and mice have described two types of ventrotubercular cells (Smith and Rhode [1989] J Comp Neurol. 282:595-626; Oertel et al. [1990] J Comp Neurol. 295:136-154). In cats, one difference between the two classes is that type I multipolar neurons have fewer than 35% of their somata apposed by terminals, whereas type II cells have greater than 70% apposition values. Intracellular recordings from single cells, however, are difficult and thus limit the yield of data. We investigated whether a two-component description of the ventrotubercular pathway was representative of a larger population. This issue was addressed by retrogradely labeling ventrotubercular neurons with an extracellular injection of biotinylated dextran amine into the DCN of rats. These injections labeled many VCN neurons, thus providing a more complete view of the pathway than previous studies. Thirty-eight labeled cells were selected for electron microscopic analysis with respect to their location, cell body size, and ultrastructural morphology. We observed labeled type I and type II neurons, but unlike ventrotubercular cells in cats, many of these neurons in rats (17 of 38 cells) had appositions between 35% and 70%. On the basis of this analysis, a third class of ventrotubercular cell, called the adendritic neuron, was revealed. Adendritic neurons have small somata with many filopodial appendages, no observable dendrites, and high percentage of terminal appositions (>80%). The results demonstrated that the ventrotubercular pathway in the rat is diverse.

Commissural glycinergic inhibition of bushy and stellate cells in the anteroventral cochlear nucleus.

Synaptic inputs from one cochlear nucleus (CN) to the other can play an important role in modulating the activity of CN neurons. Using the isolated whole brain preparation of the guinea pig, we tested the effects of electrical stimulation of the contralateral auditory nerve (AN) on intracellularly recorded and stained neurons of the anteroventral cochlear nucleus. Stimulation of the contralateral AN evoked only inhibitory postsynaptic potentials (IPSPs) in 63% of recorded neurons, including bushy and stellate cells. The latency of most IPSPs (88%) was in the range 3.3-7.6 ms, consistent with mono- and disynaptic transmission from the contralateral CN. The IPSPs had an average amplitude of 2.6 +/- 1.9 mV and were blocked by strychnine suggesting their glycinergic nature. These data, together with our similar findings in other CN subdivisions, indicate that principal cells of the CN contribute to binaural interactions at earliest stages of acoustic processing.

The cellular origin of corticofugal projections to the superior olivary complex in the rat.

Corticofugal pathways originating in auditory cortex innervate most subcortical auditory nuclei in the ascending pathway [Auditory Neurosci. 1 (1995) 287-308; J. Comp. Neurol. 371 (1996) 15-40]. Our goal is to determine if these projections arise from the same neurons or if different neurons project to each of the separate structures. We also seek to identify the layers and fields of auditory cortex from which these neurons originate. In the present study, we answer these questions with respect to the projections to the superior olivary complex (SOC). Fluorescent retrograde tracers, Fast Blue (FB) or Diamidino Yellow (DiY), were injected into the SOC and the pattern of labeled cells was determined in temporal neocortex. We also injected FB into the granule cell domain (GCD) of the cochlear nucleus. Cortical projections to the GCD derive exclusively from layer V pyramidal cells in primary auditory cortex [Brain Res. 706 (1996) 97-102]. Thus the pattern of labeling produced by injections in the GCD provided a reference for interpreting the labeling after SOC injections. Layer V pyramidal cells project to the SOC, and these neurons were distributed bilaterally in primary and secondary areas of auditory cortex. The projections to the SOC from primary auditory cortex are predominantly uncrossed, whereas those from secondary auditory cortex are nearly equal for the two hemispheres. In animals that received injections of FB in the GCD and DiY in the SOC, cells labeled by each injection had a different laminar distribution and very few cells were double labeled. These data suggest that the cortical pathways ending in the cochlear nucleus and SOC are largely independent. We discuss the implications of these findings with respect to the multifunctional nature of the SOC in brainstem auditory processing.