Application of standardized methods to evaluate the environmental safety of polyvinyl alcohol disposed of down the drain.

The purpose of this research was to use polyvinyl alcohol (PVOH) 18-88 as a case study to evaluate the environmental fate, ecotoxicity, and overall safety profile of water-soluble, nonmodified PVOH polymers used in detergent films. An OECD 303A Wastewater Treatment Plant Simulation Study was conducted with dissolved organic carbon as the analytical endpoint to evaluate the removal of PVOH 18-88 during wastewater treatment. During the plateau phase, high levels of removal due to biodegradation were observed (average 97.4 ± 7.1, range: 88%-116%). The OECD 303A study quantitatively verified that surface water is the dominant receiving compartment for PVOH 18-88 post wastewater treatment. Acute algae, invertebrate, and fish embryo (fish embryo acute toxicity test [FET]) ecotoxicity studies quanitified the 50% lethal/effect concentration (L/EC50) for PVOH 18-88. Due to the potential for the chorion to impact PVOH 18-88 bioavailability, both chorionated and dechorionated FET tests were conducted. L/EC50 > 1000 mg/L for FET (chorionated and dechorionated), invertebrate, and algae were observed. The Sustainable Futures (US) and REACH (EU) frameworks were used to evaluate environmental risk. For the US assessment, the Exposure and Fate Assessment Screening Tool was used to predict the single day lowest flow over a 10-year period (1Q10) surface water concentration and the seven consecutive days of lowest flow over a 10-year period (7Q10) surface water concentration and compared with acute and chronic concentrations of concern. For the EU assessment, the European Union System for the Evaluation of Substances was used to predict local and regional exposure concentrations and compared to the predicted no effect concentration. For both regulatory assessments, the exposure concentrations were >2 orders of magnitude below the effect concentrations. Integr Environ Assess Manag 2024;00:1-13. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Energy and Greenhouse Gas Emission Savings Associated with Implementation of an Abbreviated Cardiac MRI Protocol.

Supplemental material is available for this article. See also the article by Lenkinski and Rofsky in this issue. See also the article by McKee et al in this issue.

Planetary Health and Radiology: Why We Should Care and What We Can Do.

Climate change adversely affects the well-being of humans and the entire planet. A planetary health framework recognizes that sustaining a healthy planet is essential to achieving individual, community, and global health. Radiology contributes to the climate crisis by generating greenhouse gas (GHG) emissions during the production and use of medical imaging equipment and supplies. To promote planetary health, strategies that mitigate and adapt to climate change in radiology are needed. Mitigation strategies to reduce GHG emissions include switching to renewable energy sources, refurbishing rather than replacing imaging scanners, and powering down unused scanners. Radiology departments must also build resiliency to the now unavoidable impacts of the climate crisis. Adaptation strategies include education, upgrading building infrastructure, and developing departmental sustainability dashboards to track progress in achieving sustainability goals. Shifting practices to catalyze these necessary changes in radiology requires a coordinated approach. This includes partnering with key stakeholders, providing effective communication, and prioritizing high-impact interventions. This article reviews the intersection of planetary health and radiology. Its goals are to emphasize why we should care about sustainability, showcase actions we can take to mitigate our impact, and prepare us to adapt to the effects of climate change. © RSNA, 2024 Supplemental material is available for this article. See also the article by Ibrahim et al in this issue. See also the article by Lenkinski and Rofsky in this issue.

Building size and disinfectant type influence the detection and concentration of Mycobacterium spp. in hot water plumbing.

The number of nontuberculous mycobacteria (NTM) lung disease cases is increasing in the United States (US). This respiratory disease is primarily caused by three NTM species: Mycobacterium avium, M. intracellulare, and M. abscessus. Since disease transmission could occur through water aerosolization, this study investigated these three species' occurrence (sporadic and persistent) in hot water samples collected from residences (n = 70) and office buildings (n = 30) across the US. A longitudinal survey design was used. Three quantitative Polymerase Chain Reaction (qPCR) assays were used to measure the mycobacterial species in the water samples. Additionally, the water's disinfectant residual was measured. A structure's age and square footage were evaluated to predict mycobacterial contamination. Also, the seasonal occurrence of each species was assessed by structure type. Residences had a 43 % (30/70), and office buildings had a 77 % (23/30) detection frequency of one or more Mycobacterium spp. in their hot water. The age of the structure influenced M. intracellulare detection frequency but not M. avium and M. abscessus. The structure's square footage affected M. avium and M. intracellulare detection frequency but not M. abscessus. In chlorinated water, M. intracellulare was detected 1.4× more often in office buildings' hot water than in chloraminated water. In chloraminated water, the Mycobacterium spp. were detected 2-2.5× more often in residences, while M. avium and M. abscessus were detected 1.5-2.3× more often in office buildings, compared to chlorinated water. Each Mycobacterium spp. had a different trend associated with the type of structure and disinfectant. Further research is needed to better understand NTM occurrence in the built environment to improve public health.

Thrust production and chordal flexion of the flukes of bottlenose dolphins performing tail stands at different efforts.

Dolphins have become famous for their ability to perform a wide variety of athletic and acrobatic behaviors including high-speed swimming, maneuverability, porpoising and tail stands. Tail stands are a behavior where part of the body is held vertically above the water's surface, achieved through thrust produced by horizontal tail fluke oscillations. Strong, efficient propulsors are needed to generate the force required to support the dolphin's body weight, exhibiting chordwise and spanwise flexibility throughout the stroke cycle. To determine how thrust production, fluke flexibility and tail stroke kinematics vary with effort, six adult bottlenose dolphins (Tursiops truncatus) were tested at three different levels based on the position of the center of mass (COM) relative to the water's surface: low (COM below surface), medium (COM at surface) and high (COM above surface) effort. Additionally, fluke flexibility was measured as a flex index (FI=chord length/camber length) at four points in the stroke cycle: center stroke up (CU), extreme top of stroke (ET), center stroke down (CD) and extreme bottom of stroke (EB). Video recordings were analyzed to determine the weight supported above the water (thrust production), peak-to-peak amplitude, stroke frequency and FI. Force production increased with low, medium and high efforts, respectively. Stroke frequency also increased with increased effort. Amplitude remained constant with a mean 33.8% of body length. Significant differences were seen in the FI during the stroke cycle. Changes in FI and stroke frequency allowed for increased force production with effort, and the peak-to-peak amplitude was higher compared with that for horizontal swimming.

The microvillar protocadherin CDHR5 associates with EBP50 to promote brush border assembly.

Transporting epithelial cells of the gut and kidney interact with their luminal environment through a densely packed collection of apical microvilli known as a brush border (BB). Proper brush border assembly depends on the intermicrovillar adhesion complex (IMAC), a protocadherin-based adhesion complex found at the distal tips of microvilli that mediates adhesion between neighboring protrusions to promote their organized packing. Loss of the IMAC adhesion molecule Cadherin-related family member 5 (CDHR5) results in significant brush border defects, though the functional properties of this protocadherin have not been thoroughly explored. Here, we show that the cytoplasmic tail of CDHR5 contributes to its correct apical targeting and functional properties in an isoform-specific manner. Library screening identified the Ezrin-associated scaffolds EBP50 and E3KARP as cytoplasmic binding partners for CDHR5. Consistent with this, loss of EBP50 disrupted proper brush border assembly with cells exhibiting markedly reduced apical IMAC levels. Together, our results shed light on the apical targeting determinants of CDHR5 and further define the interactome of the IMAC involved in brush border assembly.

Environmental Sustainability and MRI: Challenges, Opportunities, and a Call for Action.

The environmental impact of magnetic resonance imaging (MRI) has recently come into focus. This includes its enormous demand for electricity compared to other imaging modalities and contamination of water bodies with anthropogenic gadolinium related to contrast administration. Given the pressing threat of climate change, addressing these challenges to improve the environmental sustainability of MRI is imperative. The purpose of this review is to discuss the challenges, opportunities, and the need for action to reduce the environmental impact of MRI and prepare for the effects of climate change. The approaches outlined are categorized as strategies to reduce greenhouse gas (GHG) emissions from MRI during production and use phases, approaches to reduce the environmental impact of MRI including the preservation of finite resources, and development of adaption plans to prepare for the impact of climate change. Co-benefits of these strategies are emphasized including lower GHG emission and reduced cost along with improved heath and patient satisfaction. Although MRI is energy-intensive, there are many steps that can be taken now to improve the environmental sustainability of MRI and prepare for the effects of climate change. On-going research, technical development, and collaboration with industry partners are needed to achieve further reductions in MRI-related GHG emissions and to decrease the reliance on finite resources. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.

Finding our Voice: Evaluation of Goal Setting Using the Habits of Preceptors Rubric in Terms of Focus, "SMARTness," and Impact.

INTRODUCTION: Effective leadership propels teams from effectiveness to greatness and is accomplished when everyone achieves and contributes their full potential, or "voice." The Clinician Educators Program Teaching and Learning Curriculum fosters preceptor development using the Habits of Preceptors Rubric (HOP-R) to guide participants in finding their precepting "voice." After the HOP-R self-assessment, participants select a habit of focus (HOF) and craft a SMART (specific/measurable/achievable/relevant/time-bound) goal. This report describes a pilot rubric, SMART-EP (emotional intelligence(EI)/professionalism), exploring goal "SMARTness" alongside change (impact) in participants' perceived precepting capabilities. METHODS: HOP-R self-ratings (2018-2020) and HOF/SMART goals (2019-2020) were retrospectively reviewed by two raters. Perceived preceptor capabilities were measured by analyzing the change in self-assessed habit level ratings between the first/fourth-quarter surveys. SMART goals were categorized by HOF and inclusion of SMART-EP components. Participants were guided in the inclusion of SMART, but not -EP, components. RESULTS: In aggregate, 120 participants completed HOP-R surveys (2018-2020). Within-subject changes across all 11 habits were significant (P < .001). For the SMART-EP rubric analysis (2019-2020), 71 participants had an average "SMARTness" score of 3.92 (of 5) with corresponding interrater reliability of 0.91. Goals included 2.77 (of 4) EI traits and 1.72 (of 3) professionalism components. DISCUSSION: The SMART-EP rubric provided insights into preceptor development opportunities among participants. Beyond SMART components, participants often included elements of EI and professionalism. Ratings confirm and support the consistency of the HOP-R as a tool to assess precepting habits.

Who's Remembering to Buy the Eggs? The Meaning, Measurement, and Implications of Invisible Family Load.

Although much is known of the observable physical tasks associated with household management and child rearing, there is scant understanding of the less visible tasks that are just as critical. Grounding our research in the extant literature, the broader lay discussion, as well as our own qualitative research, we define, conceptualize, and operationalize this construct, which we label as "invisible family load." Using a mixed method, five-study approach, we offer a comprehensive, multidimensional definition and provide a nine-item, empirically validated scale to measure its component parts-managerial, cognitive, and emotional family load. In addition, we investigate gender differences and find, as expected, that women report higher levels of each dimension. We also examine the implications of invisible family load for employee health, well-being, and job attitudes, as well as family-to-work spillover. Although we substantiated some significant negative consequences, contrary to the popular view that consequences of invisible family load are uniformly negative, our results show some potential benefits. Even after accounting for conscientiousness and neuroticism, managerial family load related to greater family-work enrichment, and cognitive family load related to greater family satisfaction and job performance. Yet, emotional family load had uniformly negative potential consequences including greater family-to-work conflict, sleep problems, family and job exhaustion, and lower life and family satisfaction. Our research sets the stage for scholars to forge a path forward to enhance understanding of this phenomenon and its implications for individuals, their families, and the organizations for which they work. Supplementary Information: The online version contains supplementary material available at 10.1007/s10869-023-09887-7.

Water quality influences Legionella pneumophila determination.

Legionellosis is a respiratory disease of public health concern. The bacterium Legionella pneumophila is the etiologic agent responsible for >90% of legionellosis cases in the United States. Legionellosis transmission primarily occurs through the inhalation or aspiration of contaminated water aerosols or droplets. Therefore, a thorough understanding of L. pneumophila detection methods and their performance in various water quality conditions is needed to develop preventive measures. Two hundred and nine potable water samples were collected from taps in buildings across the United States. L. pneumophila was determined using three culture methods: Buffered Charcoal Yeast Extract (BCYE) culture with Matrix-assisted Laser Desorption/Ionization Mass Spectrometry (MALDI-MS) identification, Legiolert® 10- and 100-mL tests, and one molecular method: quantitative Polymerase Chain Reaction (qPCR) assay. Culture and molecular positive results were confirmed by secondary testing including MALDI-MS. Eight water quality variables were studied, including source water type, secondary disinfectant, total chlorine residual, heterotrophic bacteria, total organic carbon (TOC), pH, water hardness, cold- and hot-water lines. The eight water quality variables were segmented into 28 categories, based on scale and ranges, and method performance was evaluated in each of these categories. Additionally, a Legionella genus qPCR assay was used to determine the water quality variables that promote or hinder Legionella spp. occurrence. L. pneumophila detection frequency ranged from 2 to 22% across the methods tested. Method performance parameters of sensitivity, specificity, positive and negative predictive values, and accuracy were >94% for the qPCR method but ranged from 9 to 100% for the culture methods. Water quality influenced L. pneumophila determination by culture and qPCR methods. L. pneumophila qPCR detection frequencies positively correlated with TOC and heterotrophic bacterial counts. The source water-disinfectant combination influenced the proportion of Legionella spp. that is L. pneumophila. Water quality influences L. pneumophila determination. To accurately detect L. pneumophila, method selection should consider the water quality in addition to the purpose of testing (general environmental monitoring versus disease-associated investigations).

Respuesta inmunitaria anti-SARS-CoV-2: Infección Naturalvs. Vacunación / Anti-SARS-CoV-2 immune response: natural infection vs vaccination

Este trabajo es una revisión bibliográfica que compara la inmunidad anti-SARS-CoV-2 inducida por la infección natural y la inducida por vacunación, para entenderlas particularidades de la respuesta en cada caso, así como sus ventajas y desventajas. Se escogieron artículos que reportaran la medición de concentración de anticuerpos séricos, determinantes de inmunidad celular y/o evolución clínica de los pacientes. Se encontró que: A) Los pacientes recuperados de una infección por SARS-CoV-2 presentaron una respuesta mayor y más heterogénea de anticuerpos y células B de memoria que los pacientes vacunados, con un mayor número de linfocitos TCD4+, que cooperan con la diferenciación de linfocitos B y con la producción de anticuerpos neutralizantes. B) La vacunación previene la tormenta de citocinas asociada a la infección natural. C) Dos dosis de una vacuna basada en ARN mensajero logran una concentración de anticuerpos de clase IgG prácticamente igual a la de los pacientes severamente enfermos, pero sin el daño a los nódulos linfáticos asociado a la infección natural. D) Se puede aumentar el número de linfocitos B administrando dosis de refuerzo de la vacuna. Si bien, tanto la vacunación como la infección natural generan respuestas anti-SARS-CoV-2 significativas, la vacunación es el método más seguro para proteger a la población, pues evita el riesgo a la inmunopatología y a la mortalidad asociados con la infección natural. Más aún, la inmunidad híbrida (aquella que adquieren los pacientes que superaron la infección natural y fueron después vacunados) induce una producción de anticuerpos capaces de neutralizar por completo al SARS-CoV-2(AU)

This work is a bibliographic review that comparesanti-SARS-CoV-2 inmmune response induced by natural infección with that induced by vaccination, to understand theparticularities of each response, as well as their advantages and disadvantages. Research articles that reported levels of antibodies in serum, determinants of cellular inmmunity and/or clinical evolution of patients were chosen. It was found that: A) Pacients previously infected with SARS-CoV-2 presented a larger and more heterogeneous response of antibodies and memory B cells than vaccined patients, with a larger number of CD4+T cells that cooperate with the differentiation of B cells and production of neutralizing antibodies. B) Vaccination prevents the cytokine storm associated with natural infection. C) Two doses of an mRNA vaccine induced an IgG concentration nearly equal to severe ill patients but without the damage to lymph nodes associated with natural infection. D) B cell levels can be increased by giving booster doses of the vaccine. Althought both vaccination and natural infection generate significant anti-SARS-CoV-2 immune responses, vaccination is the safest method to protect general population, because it avoids the risk of immunopathology and mortality associated with natural infection. Futhermore, hybrid immunity (thatadquired by patients who overcame the natural infection and were later vaccinated), induces production of antibodies capable of completely neutralizing SARS-CoV-2(AU)

Direct-reading instruments for aerosols: A review for occupational health and safety professionals part 1: Instruments and good practices.

With advances in technology, there are an increasing number of direct-reading instruments available to occupational health and safety professionals to evaluate occupational aerosol exposures. Despite the wide array of direct-reading instruments available to professionals, the adoption of direct-reading technology to monitor workplace exposures has been limited, partly due to a lack of knowledge on how the instruments operate, how to select an appropriate instrument, and challenges in data analysis techniques. This paper presents a review of direct-reading aerosol instruments available to occupational health and safety professionals, describes the principles of operation, guides instrument selection based on the workplace and exposure, and discusses data analysis techniques to overcome these barriers to adoption. This paper does not cover all direct-reading instruments for aerosols but only those that an occupational health and safety professional could use in a workplace to evaluate exposures. Therefore, this paper focuses on instruments that have the most potential for workplace use due to their robustness, past workplace use, and price with regard to return on investment. The instruments covered in this paper include those that measure aerosol number concentration, mass concentration, and aerosol size distributions.

Direct-reading instruments for aerosols: A review for occupational health and safety professionals part 2: Applications.

Direct reading instruments (DRIs) for aerosols have been used in industrial hygiene practice for many years, but their potential has not been fully realized by many occupational health and safety professionals. Although some DRIs quantify other metrics, this article will primarily focus on DRIs that measure aerosol number, size, or mass. This review addresses three applications of aerosol DRIs that occupational health and safety professionals can use to discern, characterize, and document exposure conditions and resolve aerosol-related problems in the workplace. The most common application of aerosol DRIs is the evaluation of engineering controls. Examples are provided for many types of workplaces and situations including construction, agriculture, mining, conventional manufacturing, advanced manufacturing (nanoparticle technology and additive manufacturing), and non-industrial sites. Aerosol DRIs can help identify the effectiveness of existing controls and, as needed, develop new strategies to reduce potential aerosol exposures. Aerosol concentration mapping (ACM) using DRI data can focus attention on emission sources in the workplace spatially illustrate the effectiveness of controls and constructively convey concerns to management and workers. Examples and good practices of ACM are included. Video Exposure Monitoring (VEM) is another useful technique in which video photography is synced with the concentration output of an aerosol DRI. This combination allows the occupational health and safety professional to see what tasks, environmental situations, and/or worker actions contribute to aerosol concentration and potential exposure. VEM can help identify factors responsible for temporal variations in concentration. VEM can assist with training, engage workers, convince managers about necessary remedial actions, and provide for continuous improvement of the workplace environment. Although using DRIs for control evaluation, ACM and VEM can be time-consuming, the resulting information can provide useful data to prompt needed action by employers and employees. Other barriers to adoption include privacy and security issues in some worksites. This review seeks to provide information so occupational health and safety professionals can better understand and effectively use these powerful applications of aerosol DRIs.

Study protocol for a randomized trial of bridge: Person-centered collaborative care for serious mental illness and cancer.

BACKGROUND: Individuals with serious mental illness (SMI) experience inequities in cancer care that contribute to increased cancer mortality. Involving mental health at the time of cancer diagnosis may improve cancer care delivery for patients with SMI yet access to care remains challenging. Collaborative care is a promising approach to integrate mental health and cancer care that has not yet been studied in this marginalized population. METHODS/DESIGN: We describe a 24-week, two-arm, single-site randomized trial of person-centered collaborative care (Bridge) for patients with SMI (schizophrenia, bipolar disorder, or major depression with psychiatric hospitalization) and their caregivers. 120 patients are randomized 1:1 to Bridge or Enhanced Usual Care (EUC) along with their caregivers. Researchers proactively identify individuals with SMI and a new breast, lung, gastrointestinal, or head and neck cancer that can be treated with curative intent. EUC includes informing oncologists about the patient's psychiatric diagnosis, notifying patients about available psychosocial services, and tracking patient and caregiver outcomes. Bridge includes a proactive assessment by psychiatry and social work, a person-centered, team approach including collaboration between mental health and oncology, and increased access to evidence-based psycho-oncology care. The primary outcome is cancer care disruptions evaluated by a blinded panel of oncologists. Secondary outcomes include patient and caregiver-reported outcomes and healthcare utilization. Barriers to Bridge implementation and dissemination are assessed using mixed methods. DISCUSSION: This trial will inform efforts to systematically identify individuals with SMI and cancer and generate the first experimental evidence for the impact of person-centered collaborative care on cancer care for this underserved population.

Hot water plumbing in residences and office buildings have distinctive risk of Legionella pneumophila contamination.

AIM: To observe how Legionella pneumophila, the causative agent for legionellosis, can transmit through the hot water plumbing of residences and office buildings. METHOD AND RESULTS: Using qPCR, L. pneumophila and L. pneumophila Serogroup (Sg)1 were measured in hot water samples collected from 100 structures, consisting of 70 residences and 30 office buildings. The hot water samples collected from office buildings had a higher L. pneumophila detection frequency of 53% (16/30) than residences, with a 103 GU/L (median) concentration. An office building's age was not a statistically significant predictor of contamination, but its area (>100,000 sq. ft.) was, P = <0.001. Hot water samples collected at residences had a lower L. pneumophila detection frequency of 36% (25/70) than office buildings, with a 100 GU/L (median) concentration. A residence's age was a significant predictor of contamination, P = 0.009, but not its area. The water's secondary disinfectant type did not affect L. pneumophila detection frequency nor its concentration in residences, but the secondary disinfectant type did affect results in office buildings. Legionella pneumophila's highest detection frequencies were in samples collected in March-August for office buildings and in June-November for residences. CONCLUSION: This study revealed that the built environment influences L. pneumophila transport and fate. Residential plumbing could be a potential "conduit" for L. pneumophila exposure from a source upstream of the hot water environment. Both old and newly built office buildings had an equal probability of L. pneumophila contamination. Legionella-related remediation efforts in office buildings (that contain commercial functions only) might not significantly improve a community's public health.

Oxygen uptake rates have contrasting responses to temperature in the root meristem and elongation zone.

Growing at either 15 or 25°C, roots of Arabidopsis thaliana, Columbia accession, produce cells at the same rate and have growth zones of the same length. To determine whether this constancy is related to energetics, we measured oxygen uptake by means of a vibrating oxygen-selective electrode. Concomitantly, the spatial distribution of elongation was measured kinematically, delineating meristem and elongation zone. All seedlings were germinated, grown, and measured at a given temperature (15 or 25°C). Columbia was compared to lines where cell production rate roughly doubles between 15 and 25°C: Landsberg and two Columbia mutants, er-105 and ahk3-3. For all genotypes and temperatures, oxygen uptake rate at any position was highest at the root cap, where mitochondrial density was maximal, based on the fluorescence of a reporter. Uptake rate declined through the meristem to plateau within the elongation zone. For oxygen uptake rate integrated over a zone, the meristem had steady-state Q10 values ranging from 0.7 to 2.1; by contrast, the elongation zone had values ranging from 2.6 to 3.3, implying that this zone exerts a greater respiratory demand. These results highlight a substantial energy consumption by the root cap, perhaps helpful for maintaining hypoxia in stem cells, and suggest that rapid elongation is metabolically more costly than is cell division.

Evaluation of student-perceived growth in entrustable professional activities after involvement in a transitions-of-care process within an adult medicine advanced pharmacy practice experience.

BACKGROUND AND PURPOSE: Involvement of pharmacists and trainees in care transitions reduces medication-related problems. Participation in the transitions-of-care (TOC) process may impact self-perceived growth of autonomy within selected entrustable professional activities (EPAs). EDUCATIONAL ACTIVITY AND SETTING: A student-driven TOC documentation process was implemented within an inpatient family medicine advanced pharmacy practice experience. During the month-long rotation, students rounded with an interdisciplinary care team. Responsibilities included ensuring accurate medication reconciliation at care transitions throughout hospitalization and prior to discharge as well as medication optimization during hospitalization. Another responsibility was completing a medication-specific TOC note in the clinic-based electronic health record at discharge for patients receiving primary care from the associated clinic. The note was available to the outpatient interdisciplinary care team during the hospital follow-up appointment. Student-perceived growth in autonomy within selected EPAs was determined through an online anonymous survey. FINDINGS: Ninety percent (n = 18) of eligible students completed the survey. For specific EPA statements (collecting information, establishing patient-centered goals and establishing a care plan, implementing a care plan, collaborating as an interdisciplinary team member, and ensuring immunization), student-perceived autonomy increased after involvement in this student-driven TOC process. During the study period, 215 notes were generated by student pharmacists and included interventions/recommendations within the following themes: evidence-based changes in therapy, patient counseling, and medication access. SUMMARY: The importance of pharmacist and pharmacy trainee involvement in the TOC process has been well-documented. Involving students in student-driven TOC documentation processes serves to facilitate student-perceived growth in autonomy within selected EPAs.

High Value Care in Cancer Surveillance and Screening: Evaluating an e-Curriculum for Primary Care Providers.

BACKGROUND: With an expected shortage of oncologists, primary care providers (PCPs) may need to manage more cancer surveillance and screening, areas where educational resources for PCPs have been limited. The goal of this e-curriculum was for PCPs to learn surveillance and screening for several common cancers. METHODS: The e-curriculum covered breast and colorectal cancer surveillance and lung cancer screening with (1) a pre-test assessing knowledge, attitudes, practice patterns, and confidence; (2) case vignette-based teaching; and (3) an immediate post-test (with knowledge and confidence items identical to the pre-test) providing feedback. A delayed post-test was administered several months later. The curriculum and test items were developed by content experts and evaluated in a primary care group practice. RESULTS: Of 167 community PCPs, 152 completed the pre-test (91%), 145 completed the immediate post-test (87%), and 63 completed the delayed post-test (37%); 62 PCPs completed all three tests (37%). The median score on the pre-test was 43%, immediate post-test was 93%, and delayed post-test was 70%. For PCPs completing all three tests, the median scores were 50%, 90%, and 70%, respectively (p < 0.0001). The percentage of PCPs confident in their knowledge 4 to 6 months after module completion compared to the pre-test baseline was statistically significant for lung cancer screening but not for cancer surveillance. CONCLUSION: This curriculum provided concise, effective education for PCPs on 3 common cancers. Limitations include content breadth and lack of data reflecting physician ordering patterns. Curricular strengths include its accessibility, immediate feedback, and effectiveness, with a significant improvement in immediate and delayed post-test knowledge. Given a lack of increased confidence to provide cancer surveillance, PCPs should rely on electronic medical record tools and other resources to guide appropriate surveillance care.