The Role of Consumerism in Pharmacy Education.

The notion of consumerism and that students are customers of pharmacy colleges was explored by proponents and opponents of the idea. First, a working definition of a "customer" in pharmacy education is pondered with respect to the roles and responsibilities of students and schools/colleges of pharmacy. Second, the pros and cons of "student-centered" education are considered in the light of students and their families being consumers of the educational experience. Third, the duality of student-centered education is discussed including student engagement/disengagement in their learning, professional/unprofessional behaviors, and shared/individual responsibilities. Lastly, learning and teaching environment dynamics are discerned when higher education becomes more student-centric and how that may affect the overall outcome of the student and the goals of pharmacy educational programs.

Primary central nervous system post-transplantation lymphoproliferative disorder: A case report and systematic review of imaging findings.

Primary central nervous system post-transplant lymphoproliferative disease (PCNS-PTLD) is a rare subset of post-transplant lymphoproliferative disorder (PTLD) isolated to the CNS without nodal or extra-nodal organ involvement [1,2]. PCNS-PTLD occurs primarily in patients following either solid organ transplants or hematopoietic stem cell transplants and tends to be monomorphic DLBCL. The development of PCNS-PTLD is commonly associated with EBV infection [3]. Many intracranial pathologies can resemble the imaging appearance of PCNS-PTLD, including primary CNS lymphoma, glial tumors, metastatic disease, and intracranial abscesses. The purpose of this systematic review is to identify the most common imaging characteristics of PCNS-PTLD. Our review included 97 sources that describe the imaging appearance of PCNS-PTLD. Based on our review, PCNS-PTLD lesions are typically multifocal, ring-enhancing and diffusion-restricting. PCNS-PTLD lesions typically demonstrate focal FDG avidity. Despite advancement in medical imaging, PCNS-PTLD remains a diagnostic challenge due to its rare incidence. Limited data is available on advanced imaging with regards to PTLD, but techniques including DCE-MRI and fMRI demonstrate promising results that may help further delineate PCNS-PTLD.

Why We Need to Pay Attention to Stereotype Threat.

Although "implicit bias" has been a major focus in diversity, equity, inclusion, and antiracism educational efforts, less attention has been directed to "stereotype threat." This commentary aimed to bring increased awareness to the pharmacy academy about stereotype threat phenomena as well as explore its impact in the areas of education, with a specific focus on health professions education. In addition, potential and practical strategies are discussed to mitigate its occurrence in pharmacy education.

Surveillance Imaging Strategies for Pituitary Adenomas: When, How Frequent, and When to Stop.

OBJECTIVE: To describe a practical approach of when and how often to perform imaging, and when to stop imaging pituitary adenomas (PAs). METHODS: A literature review was carried out and recommendations provided are derived largely from personal experience. RESULTS: Magnetic resonance imaging is the mainstay imaging modality of choice in the assessment, treatment planning, and follow-up of PAs. These adenomas are discovered incidentally during imaging for a variety of unrelated conditions, because of clinical symptoms related to mass effects on the adjacent structures, or during workup for functional alterations of the adenoma. Imaging is also used in the preoperative and postoperative phases of assessment of PAs, for surgical and radiotherapy planning, for postoperative surveillance to assess for adenoma stability and detection of adenoma recurrence, and for surveillance to monitor for adenoma growth in unoperated PAs. Currently, because there are no evidence-based consensus recommendations, the optimal strategy for surveillance imaging of PAs is not clearly established. Younger age, initial adenoma size, extrasellar extension, mass effect, cavernous sinus invasion, functional status, histopathologic characteristics, cost considerations, imaging accessibility, patient preference, and patient contraindications (eg, implanted metallic devices and patient claustrophobia) are all important factors that influence the strategy for surveillance imaging. CONCLUSIONS: This review provides a practical approach of performing surveillance imaging strategies for PAs that should be individualized based on clinical presentation, history, adenoma morphology on imaging, and histopathologic characteristics.

Impact of COVID-19 on Pharmacy Education and Practice: Strategies to Boost Advocacy and Unity among Health Care Organizations.

The global COVID-19 pandemic impacted pharmacy education and changed the pharmacists' scope of practice at the federal and state levels. Based on the Amended Public Readiness and Emergency Preparedness Act, pharmacists were authorized to provide essential services, including testing, treatments, and immunizations at various practice settings. Specifically, the United States Food and Drug Administration issued emergency use authorization for several medications, vaccines, and medical devices. The pandemic also affected the regulatory landscape for pharmacists, pharmacy education, access to care, and delivery of pharmacy services in-person and through telehealth. The pandemic's specific impact on pharmacy education heightened awareness of the well-being of the Academy. This commentary will highlight the impact of COVID-19 on both pharmacy education and practice. It will also provide strategies that educators, researchers, and practitioners can take into future research and action to help promote advocacy and unity among pharmacy organizations.

Practicing Cultural Humility by Using Actionable Steps for Improving Name Pronunciation and Use.

Name spelling and pronunciation are connected to multiple social classifications such as race, ethnicity, gender, religion, and presumed language skills. Individuals with names that do not conform to dominant norms may experience exclusion, discrimination, ridicule, and stigmatization. Having one's name mispronounced, derided, changed, or avoided can have a lasting effect on how an individual sees themselves and the rest of society. Name mispronunciation also has the potential to create breakdowns in teams and communities, including those in the workplace and educational environments. Proper name pronunciation can promote feelings of belonging and psychological safety in the learning environment, promoting team formation, development, and entitativity. Strategies can be employed to improve name pronunciation and acceptance of name spellings, thus reducing associated inequities in the workplace and differential treatment in education. At the organizational level strategies can be implemented to improve name pronunciation and acceptance of name spellings, as well as to minimize intentional and unintentional othering, de-racialization, microaggressions, and othering. Herein, we describe techniques for honoring and respecting name preference and pronunciation by improving self-awareness and implementing strategies on a personal, classroom, and organizational level.

A Critical Appraisal of Educational Theory to Examine HBCU and Black Students' Professional Identity Formation.

OBJECTIVES: This article explores educational theories and existing literature that describe the impact of Historically Black College or University (HBCU) educational environments on Black students' personal and professional development. Literature on professional identity formation (PIF) in pharmacy education is also examined to describe the influence of HBCU pharmacy education on Black pharmacy students' PIF. FINDINGS: Tinto's theory of student retention, Arroyo and Gasman's HBCU educational framework, and Bank's theory of multicultural education are described, as key elements of HBCU education that foster PIF in minoritized student populations. Each of the 3 models addresses professional identity traits associated with pharmacists and pharmacy students, and this review examines the role of HBCU education in Black Doctor of Pharmacy students' development of academic competence, leadership, professional communication, and advocacy. SUMMARY: Existing educational frameworks and models of student retention can be applied to promote student growth, psychological safety, and feelings of belonging in minoritized student populations. By engaging these models, pharmacy training environments can support Black students and other minoritized student populations as they develop their own professional identities in the pursuit of fulfilling careers.

Reevaluating Core Elements of Emotional Intelligence in Professional Identity Formation for Inclusion in Pharmacy Education.

OBJECTIVES: The objectives of this review are to (1) analyze the core concepts of emotional intelligence self-perception, self-expression, interpersonal relationships, decision-making skills, and stress management and their role in professional identity formation, and (2) investigate the methods and strategies to incorporate emotional intelligence in pharmacy education. FINDINGS: A literature review of emotional intelligence in health care education was conducted by searching the electronic databases PubMed, Google Scholar, ProQuest, and ERIC. The following search terms were included: emotional intelligence, emotional quotient, in association with professional identity formation, pharmacy curriculum, pharmacy cocurriculum, entrustable professional activities, medicine, and nursing. Only full-length, free-access, English-text articles were included. Twenty articles addressed the inclusion and/or assessment of core elements of emotional intelligence in pharmacy education. Commonly taught, cultivated, and assessed core elements include self-awareness, empathy, and interdisciplinary relationships. Assessment tools used to evaluate emotional intelligence in pharmacy education are subjective, qualitative, and semiquantitative, and may include pre and postcourse surveys, event surveys, and questionnaires. SUMMARY: The pharmacy literature is scarce on how best to analyze emotional intelligence and the role it plays in the pharmacist's education and practice. A comprehensive integration of emotional intelligence into the pharmacy curriculum is a challenging task and requires additional in-depth discussions on how best to incorporate it in the pharmacist's professional identity formation. The Academy will benefit from re-engaging its constituents in addressing the gaps of emotional intelligence in the professional curriculum in preparation for the Accreditation Council for Pharmacy Education 2025 standards.

Associating Growth Mindset with Emotional Intelligence and Why It's Needed for Professional Identity Formation.

Nurturing professional identity formation (PIF) is incumbent for the future of a pharmacist. The process of PIF incorporates norms, roles, and expectations of the profession into existing identities. This process can be particularly challenging when there are conflicting identities that provoke strong emotional experiences. Emotions are driven by beliefs and thoughts which serve as the catalyst for our reactions and behavior. Dealing with strong emotions can be uncomfortable, requiring proper regulation and management. Emotional intelligence and a growth mindset are fundamental traits that significantly influence a learner's ability to navigate the emotional complexities and thoughts associated with PIF. Although there is some evidence in the literature on the benefits of cultivating emotionally intelligent pharmacists there is a paucity of information on its association with growth mindset and PIF. Emotional intelligence and growth mindset are not mutually exclusive traits and development of both is needed for a learner's professional identity.

Lessons from a cross-institutional online professional development pilot.

PURPOSE: To reflect on a collaborative approach used by a group of faculty and administrators from historically Black colleges and universities (HBCU) and predominantly Black institution (PBI) pharmacy programs to provide high quality, multiple institution, faculty development programming in online environments. DESCRIPTION: A pilot for a shared online professional development initiative between pharmacy programs at five HBCUs and one PBI was implemented as a two-hour combined video conference and webinar, with structured networking, instructional programming, and breakout group sessions. Learning outcomes focused on increasing knowledge and awareness of mindsets in faculty and students with additional project goals of beta-testing interactive web conference formats, developing cross-institutional networking, and identifying avenues for sharing resources and expertise. ANALYSIS/INTERPRETATION: Kolb's Cycle of Experiential Learning (Concrete Experience, Reflective Observation, Abstract Conceptualization, and Active Experimentation) was used to guide reflection on the joint workshop. The instructional design, delivery, and learning experiences of the program itself were analyzed using Garrison's Community of Inquiry Framework. CONCLUSIONS: Action research approaches can be applied to facilitate the continuous quality improvement cycle in multi-institution initiatives, such as joint faculty development programming. IMPLICATIONS: Lessons related to cross-institutional collaboration, communities of practice development, networking, and communication can be used for future joint faculty development sessions and other shared initiatives for institutions serving minoritized students as well as other multiple institution consortiums.

Indian Hedgehog release from TNF-activated renal epithelia drives local and remote organ fibrosis.

Progressive fibrosis is a feature of aging and chronic tissue injury in multiple organs, including the kidney and heart. Glioma-associated oncogene 1 expressing (Gli1+) cells are a major source of activated fibroblasts in multiple organs, but the links between injury, inflammation, and Gli1+ cell expansion and tissue fibrosis remain incompletely understood. We demonstrated that leukocyte-derived tumor necrosis factor (TNF) promoted Gli1+ cell proliferation and cardiorenal fibrosis through induction and release of Indian Hedgehog (IHH) from renal epithelial cells. Using single-cell-resolution transcriptomic analysis, we identified an "inflammatory" proximal tubular epithelial (iPT) population contributing to TNF- and nuclear factor κB (NF-κB)-induced IHH production in vivo. TNF-induced Ubiquitin D (Ubd) expression was observed in human proximal tubular cells in vitro and during murine and human renal disease and aging. Studies using pharmacological and conditional genetic ablation of TNF-induced IHH signaling revealed that IHH activated canonical Hedgehog signaling in Gli1+ cells, which led to their activation, proliferation, and fibrosis within the injured and aging kidney and heart. These changes were inhibited in mice by Ihh deletion in Pax8-expressing cells or by pharmacological blockade of TNF, NF-κB, or Gli1 signaling. Increased amounts of circulating IHH were associated with loss of renal function and higher rates of cardiovascular disease in patients with chronic kidney disease. Thus, IHH connects leukocyte activation to Gli1+ cell expansion and represents a potential target for therapies to inhibit inflammation-induced fibrosis.

Lecture Capture Is the New Standard of Practice in Pharmacy Education.

The desire and need for remote access to education dramatically increased during the COVID-19 pandemic. As higher education struggles to find its "new normal," pharmacy programs have begun to review changes and approaches to decide which should be continued. This Commentary advocates that the use of lecture capture as an instructional delivery strategy, is no longer just a supplement to learning, but is now a standard of practice in health professions education. Lecture capture creates equity for students by providing additional opportunities to review material. Students may be balancing schoolwork with a job, caring for their children, or fulfilling other obligations. Lecture capture allows students to acquire information at lower levels of Bloom's taxonomy at a time that fits into their schedule, at a pace appropriate for them, and in a method that may better suit their learning needs. Students entering pharmacy school at this time have learned from audio/video media (eg, YouTube, Ted Talks, podcasts) and nontraditional educational competitors (eg, Khan Academy, Coursera, MasterClass). Students have become accustomed to learning via media technology and regularly do so in their everyday lives. Students desire lecture capture as it provides an opportunity to review unclear, complicated, or missed concepts as part of the studying process. Though its use is flexible, like any tool, lecture capture should not be used for all situations. Benefits and disadvantages of lecture capture for students, faculty, and institutions are described herein.

Research engagement by British early-career practitioners in nephrology: a multidisciplinary survey.

OBJECTIVES: To establish barriers and motivators underlying research engagement among early-career practitioners in nephrology across the UK, in order to guide potential interventions to enhance research involvement in renal units. DESIGN: Cross-sectional online survey employing a range of free-text, Likert scale and binomial/multiple-choice responses, distributed via mailing lists and social media. Topics covered research experience, research involvement and barriers, impact of COVID-19 and strategies to improve research engagement. Thematic analysis was used to assess free-text responses. SETTING: Renal units throughout the UK. PARTICIPANTS: Non-consultant healthcare staff self-identifying as working in nephrology were included (n=211), with responses from non-UK respondents or consultant nephrologists excluded (n=12). RESULTS: Responses were received from across the multidisciplinary team (physicians (n=83) and nurses (n=83)) and other allied health professionals (n=45). Most were aware of ongoing local research, but under half of them were actively involved. Multivariate analysis indicated employment as a physician, protected time for research activity and provision of appropriate training were associated with greater research experience and output. There was general enthusiasm to undertake research, but perceived barriers included insufficient staffing, lack of time, funding and encouragement. COVID-19 was felt to have further impacted negatively upon opportunities. Among the suggested strategies to promote engagement, mentorship and an online research resource were felt to be of most interest. CONCLUSIONS: In the first survey of this type in nephrology, we demonstrate differences across the multidisciplinary spectrum in perceived research experience and accessibility, which have been worsened by COVID-19. Our findings will guide strategies to broaden engagement in early-career practitioners and serve as a baseline to assess the impact of these interventions.

Single-cell analysis of senescent epithelia reveals targetable mechanisms promoting fibrosis.

Progressive fibrosis and maladaptive organ repair result in significant morbidity and millions of premature deaths annually. Senescent cells accumulate with aging and after injury and are implicated in organ fibrosis, but the mechanisms by which senescence influences repair are poorly understood. Using 2 murine models of injury and repair, we show that obstructive injury generated senescent epithelia, which persisted after resolution of the original injury, promoted ongoing fibrosis, and impeded adaptive repair. Depletion of senescent cells with ABT-263 reduced fibrosis in reversed ureteric obstruction and after renal ischemia/reperfusion injury. We validated these findings in humans, showing that senescence and fibrosis persisted after relieved renal obstruction. We next characterized senescent epithelia in murine renal injury using single-cell RNA-Seq. We extended our classification to human kidney and liver disease and identified conserved profibrotic proteins, which we validated in vitro and in human disease. We demonstrated that increased levels of protein disulfide isomerase family A member 3 (PDIA3) augmented TGF-ß-mediated fibroblast activation. Inhibition of PDIA3 in vivo significantly reduced kidney fibrosis during ongoing renal injury and as such represented a new potential therapeutic pathway. Analysis of the signaling pathways of senescent epithelia connected senescence to organ fibrosis, permitting rational design of antifibrotic therapies.

Guidelines for Assessing and Enhancing the Organizational Vitality of Pharmacy Educational Programs: A Call to Action!

Organizational vitality encompasses organizational mission and identity, organizational purpose and values, and employee engagement, cohesiveness, anxiety, and information sharing. Using the organizational vitality framework consisting of the following five pillars: (1) human, (2) knowledge, (3) intellectual, (4) financial capital, and (5) market value, we propose a reflection guide and specific calls to action for academic leaders including deans, department chairs, assistant/associate deans, and others within pharmacy and healthcare education systems. Our overall aim is to provide a blueprint for academic leaders to assess and enhance the organizational health, vitality, resiliency, and sustainability of their pharmacy educational programs using an established organizational vitality framework. This guide can help academic leaders at all levels to reflect on their organization's vitality and use the steps outlined here to renew conversations about faculty life, identities as leaders, the global pharmacy Academy's core mission and values, and the pursuit of work-life harmony in the context of their pharmacy schools' organizational vitality. All leaders within pharmacy educational programs should identify and embrace a holistic and guided framework that emphasizes organizational vitality.

Assessment of cervical spinal cord volume in pediatric-onset multiple sclerosis.

PURPOSE: Several studies of adult-onset multiple sclerosis (AOMS) patients have demonstrated that spinal cord volume loss is associated with disease progression and clinical disability. However, complementary studies of young patients with pediatric-onset multiple sclerosis (POMS) are lacking. Our retrospective study aimed to assess spinal cord volume in POMS patients compared with that in healthy controls. METHODS: Cervical spinal cord magnetic resonance images were evaluated for 20 POMS patients and 20 age- and sex-matched controls. Cross-sectional areas (CSAs) were measured at C2 and C7, along with the spinal cord average segmental area (CASA). The POMS group was further subdivided based on the presence or absence of spinal cord lesions, specifically C2 lesions. Pairwise area and volume comparisons were made across the different groups. RESULTS: No significant difference was found in CASA and CSA at C2 and C7 between POMS patients and comparative controls. However, CASA, CSA at C7, and estimated spinal cord volume were significantly lower in a small subset of POMS patients with C2 lesions (3 patients) than in controls (P = 0.001, 0.02, and 0.001, respectively). CONCLUSION: No significant difference was found in spinal cord areas and volumes between POMS patients and controls. This finding contrasts with spinal cord volume measurements in AOMS patients.

Sonoporation of Human Renal Proximal Tubular Epithelial Cells In Vitro to Enhance the Liberation of Intracellular miRNA Biomarkers.

Ultrasound has previously been demonstrated to non-invasively cause tissue disruption. Small animal studies have demonstrated that this effect can be enhanced by contrast microbubbles and has the potential to be clinically beneficial in techniques such as targeted drug delivery or enhancing liquid biopsies when a physical biopsy may be inappropriate. Cavitating microbubbles in close proximity to cells increases membrane permeability, allowing small intracellular molecules to leak into the extracellular space. This study sought to establish whether cavitating microbubbles could liberate cell-specific miRNAs, augmenting biomarker detection for non-invasive liquid biopsies. Insonating human polarized renal proximal tubular epithelial cells (RPTECs), in the presence of SonoVue microbubbles, revealed that cellular health could be maintained while achieving the release of miRNAs, miR-21, miR-30e, miR-192 and miR-194 (respectively, 10.9-fold, 7.17-fold, 5.95-fold and 5.36-fold). To examine the mechanism of release, RPTECs expressing enhanced green fluorescent protein were generated and the protein successfully liberated. Cell polarization, cellular phenotype and cell viability after sonoporation were measured by a number of techniques. Ultrastructural studies using electron microscopy showed gap-junction disruption and pore formation on cellular surfaces. These studies revealed that cell-specific miRNAs can be non-specifically liberated from RPTECs by sonoporation without a significant decrease in cell viability.

Incidence and clinical significance of epidural fluid signal on spinal magnetic resonance imaging after image-guided lumbar puncture in adults.

PURPOSE: We determined the incidence of epidural fluid signal on spinal magnetic resonance imaging (MRI) after image-guided lumbar puncture (LP) in adults. We correlated those imaging findings with clinical status. METHODS: We searched our institution's medical records from January 2013 through April 2020 to identify adult patients who underwent image-guided LP and postdural puncture MRI. We examined the incidence of epidural fluid signal intensity in adults after image-guided dural puncture, characterized its imaging features, and evaluated its associated clinical factors. RESULTS: Of 91 patients who underwent image-guided dural puncture and subsequent spinal MRI within 7 days, 18 (20%) demonstrated epidural fluid signal on postdural puncture MRI. Univariate analysis showed that larger needle size correlated with signal presence (4/8 [50%] LP with a 20-gauge needle vs 13/82 [16%] with a 22-gauge needle, P = 0.03). The odds of observing epidural fluid signal on postdural puncture MRI decreased by 8% per 1-year increase in age (P < 0.001). Postdural puncture symptoms did not differ between those with and without epidural fluid signal intensity. CONCLUSION: Epidural fluid signal on MRI in adults may be an incidental finding more commonly observed in younger patients after dural puncture with larger needles, without a significant correlation with symptomatology.

Nrf2 activation in the human brain after stroke due to supratentorial intracerebral haemorrhage: a case-control study.

Aims: Pharmacological activation of the antioxidative transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) improves outcomes in experimental models of intracerebral haemorrhage (ICH). However, the Nrf2 pathway has not been previously studied in humans after ICH. Our study aims to address this gap. Methods: We selected cases with fatal ICH from a prospective community-based inception cohort study and age-matched and sex-matched controls who died suddenly of non-neurological disease. We used immunohistochemistry to quantify Nrf2 (% total area stained overall and % of nuclei stained) and CD68 expression in controls and perihaematomal, ipsilateral and contralateral brain tissue from cases. We measured downstream haem oxygenase-1 (HMOX1) and NAD(P)H dehydrogenase quinone 1 [NQO1] expression using RNA in situ hybridisation. Results: 26 ICH cases (median age: 82 (IQR 76-86); 13 (50%) male) and eight controls (median age: 79 (IQR 77-80); 3 (37.5%) male) were included. We found no significant differences in overall % of Nrf2 staining between ICH cases and controls. However, the mean % of nuclei staining for Nrf2 seemed higher in perihaematomal compared with contralateral regions, although this was only statistically significant >60 days after ICH (25% (95% CI 17% to 33%) vs 14% (95% CI 11% to 17%), p=0.029). The percentage of perihaematomal tissue staining for CD68 was higher >60 days after ICH (6.75%, 95% CI 2.78% to 10.73%) compared with contralateral tissue (1.45%, 95% CI 0.93% to 1.96%, p=0.027) and controls (1.08%, 95% CI 0.20% to 1.97%, p=0.0008). RNA in situ hybridisation suggested increased abundance of HMOX1 and NQO1 transcripts in perihaematomal versus distant ipsilateral brain tissue obtained <7 days from onset of ICH. Conclusions: We found evidence of Nrf2 activation in human brain tissue after ICH. Pharmacological augmentation of Nrf2 activation after ICH might be a promising therapeutic approach.