Bridge Program Research Articles

P53 The Potential Problem of Picky Eating: A Pilot Study Among University Students of Food a Nutrition

<h3>Background</h3> Nutritional imbalances among adults are currently being recognized, particularly among those in their early 20s. Previous studies suggest that this problem might be related to adult picky eating (PE) behaviors. It has been taken for granted that university students majoring in food and nutrition, as prospective nutrition professionals, have already developed well-balanced dietary habits. However, this predisposition seems to be no longer entirely valid. <h3>Objective</h3> This pilot study aimed to explore the potential problem of PE among university students majoring in food and nutrition. <h3>Study Design, Setting, Participants</h3> The study included a total of 87 South Korean students majoring in food and nutrition. The Self-Designed Food Bridge Program was applied to identify the underlying causes of PE and examine the possibility of overcoming it. The program included planning and practicing step-wise exposures to target foods that were the subject of PE. <h3>Measurable Outcome/Analysis</h3> Descriptive statistics were calculated, and distributive differences between the success and failure groups in the program were analyzed using a chi-square test. <h3>Results</h3> Vegetables were the most commonly disliked foods (74.7%). About 46% of all students mentioned negative experiences as a reason for food dislikes. Almost half (45%) of these negative experiences were due to external coercion: forced eating (30%) and vomiting after forced eating (15%). About 66% of the students achieved relatively positive results in overcoming PE. The proportion of failures tended to be higher when the reasons for food dislike included negative experiences. <h3>Conclusions</h3> The results imply that students majoring in food and nutrition can be subject to PE. Despite some limitations, this study is meaningful in that it raises concerns over the potential problem of PE and its treatment among prospective nutrition professionals. The study is also expected to serve as a basis for further research on adult PE.

Nursing student and faculty competency improvement through a nurse-bridging program in Cambodia

BackgroundAn adequate number of high-quality nurses are a key factor for superior patient outcomes. However, in 2015, Cambodia reported only 52 nurses with bachelor's degrees, three with master's degrees, and one with a doctorate. The fast track to getting a highly educated nursing workforce requires providing a bridging program for associate's degree nurses to achieve baccalaureate degrees. ObjectivesTo assess improvement in the competency of nursing students and faculty members through a program that prepares associate's degree nurses to obtain bachelor's degrees in Cambodia. DesignMixed methods. SettingEducational institutes in Phnom Penh, Cambodia. ParticipantsA total of 45 Cambodian nursing students participated in the Cambodian nurse-bridging program and 12 Cambodian faculty members served as co-teachers. MethodsWe conducted three surveys to compare the competence of nursing students and faculty members before, during, and after the bridging program. We conducted focus-group interviews to support the qualitative results and explored changes in student and faculty competencies after the program. ResultsQuantitative analysis revealed significant improvements in students' nursing competency (p < .001), critical thinking (p < .001), and research competency (p < .001) and faculty members' teaching competency (p < .001) and research competency (p < .001) after the program. Through qualitative analysis, students showed improvement in physical assessment, patient communication, critical thinking, evidence-based nursing, and research competency. Faculty members indicated they had experienced new teaching strategies and subjects, gained increased confidence in teaching, and even though research competency had been improved, more training was required. ConclusionsThis study provides evidence to support the effectiveness of higher nurse education in developing countries, and illustrates an opportunity to produce high-quality human resources in nursing.

Bridging the gap: identifying and meeting the needs of lung cancer survivors

There is a growing population of lung cancer survivors who may have unmet physical, psychological, and practical needs as they transition from active treatment into recovery. The specific needs and best ways to meet them are unclear in this population. This paper describes the development and outcomes of a program aimed to transition patients to survivorship. Patients with early-stage lung cancer were assessed for the presence and severity of unmet physical, psychological, and practical needs at the end of active treatment. Patients also attended a multidisciplinary clinic visit to create an individualized survivorship care plan and provide appropriate referrals. They were surveyed 3 months later to assess effectiveness of the program. Eighty-four participants were enrolled in the program. All reported at least one unmet need, with a mean of seven unmet needs, particularly related to breathing, fatigue, pain, and fear/anxiety. Following program participation, there were fewer and/or less severe needs. The Bridge program identified and decreased the number and severity of unmet needs through connecting survivors to local resources. Challenges to program implementation included hesitancy of providers to refer, time constraints of survivors and staff, and lack of community resources, especially for identified mental health needs.

Clinical Instructors' Perceptions of Internationally Educated Physical Therapists' Readiness to Practise during Supervised Clinical Internships in a Bridging Programme.

Purpose: The purpose of this study was to describe clinical instructors' (CIs) comments on the Canadian Physiotherapy Assessment of Clinical Performance (ACP) that reflect areas of strength and areas requiring improvement among internationally educated physical therapists (IEPTs) during supervised clinical internships in a bridging programme. Method: We reviewed the assessment records of 100 IEPTs' clinical performance during two internships each for three successive cohorts of learners in a Canadian bridging programme. We extracted the CIs' text from 385 comment sections of the ACP completed during these internships and analyzed them using qualitative content analysis. Results: The iterative deductive coding process resulted in 36 subcategories: 14 for areas of strength and 22 for areas requiring improvement. We merged the 36 subcategories to produce nine categories: four areas of strength (subjective assessment, treatment, patient confidentiality, and professionalism) and five areas for improvement (objective assessment, clinical reasoning, establishment of treatment goals, communication, confidence, and time management). We then grouped these categories into two broad themes: professional practice and professional conduct. Conclusions: The CIs commended the IEPTs for their clinical competence in subjective assessment, treatment, patient confidentiality, and professionalism. The areas requiring improvement typically required more complex clinical decision-making skills, which may have been challenging for these IEPTs to demonstrate as competently during a short internship.

“BREAKING DOWN BARRIERS”: DEVELOPMENT OF AN ENGINEERING TECHNOLOGY TO ENGINEERING TRANSFER PATHWAY IN CANADA

College pathways significantly improve access to engineering degrees for marginalized or underrepresented students. Although several provinces in Canada have established pathways for students wishing to move from an engineering technology diploma to an engineering degree, such as Newfoundland and Labrador, Alberta, and British Columbia, no province-wide pathway in Ontario’s higher education system exists. As a result, transfer students are faced with a myriad of challenges and limited transfer pathways due to the institution-specific and complex nature of transfer articulation agreements in Ontario. This paper reports on the development of a province-wide diploma-to-degree engineering transfer pathway in Ontario. The proposed pathway program builds upon findings from a previous qualitative research study conducted by the co-authors which highlighted key factors necessary to develop future large-scale transfer pathways. The pathway was designed with the flexibility to incorporate extant institution specific pathways, while also providing a solid foundation for the development of a pilot multi-institutional bridge program. The challenges associated with creating a streamlined transfer pathway from engineering technology to engineering are myriad, and key outcomes from this project will continue to inform the development of possible approaches to a consistent, Ontario-wide engineering transfer program.

EXPANDING ACCESS TO ENGINEERING BY TEACHING PHYSICS THROUGH BIOENGINEERING: STUDENT IDENTITY REFLECTIONS

Diversity in engineering is a key goal, however a barrier for students from diverse backgrounds is the physics requirements in engineering. Often, they will have to choose between the three sciences, and don’t realize that without physics, their options are limited. We launched a pilot program in 2019 to expand access into engineering. Students without high school physics can take a summer bridge program to teach them the fundamentals and prepare them for first year engineering. Physics is taught through bioengineering to leverage their biology background knowledge. This paper presents a thematic analysis of student reflections in the program, using student identity development as a framework.

Activity systems analysis: A maze worth exploring

This paper seeks to reflectively discuss my use of Cultural Historical Activity Theory (CHAT) as a theoretical framework for the first time in a local case study. The study aimed to explore language teachers’ practices and challenges in the process of using videos as instructional tools at a language bridge program. Data included interviews, class observations, and document analysis. Using CHAT as the theoretical basis of the study, Activity Systems Analysis (ASA) was utilized to analyze the data. However, this was not an easy task for a beginning researcher. This reflective account will discuss how I attempted to understand CHAT and use ASA for my small-scale case study.Keywords: CHAT; activity systems analysis; theory application; educational researchPart of the Special Issue Debating the status of ‘theory’ in technology enhanced learning research

INVESTIGATING STUDENT EXPERIENCES OF ENGINEERING TECHNOLOGY TO ENGINEERING TRANSFER IN ONTARIO

The Ontario Council on Articulation and Transfer (ONCAT) Engineering Pathways Project aims to develop a large-scale network for transfer between engineering technology and engineering programs, enabling a streamlined transfer experience across multiple Ontario institutions. When developing a program of this nature, the lived experiences of students who have completed such a transition must be investigated. Eight interviews were completed with students and graduates of Ontario engineering technology to engineering transfer programs, with the intent to understand a) rationale for student transfer, b) experiences while studying, and c) experiences or plans post-graduation. A phenomenological methodology was used for analysis by inductive coding. Major results include the necessity of program accreditation for student enrollment, the benefits of short and rigorous bridging programs, and the marked lack of social and academic support students experienced during their transfer pathways. This research has been used to inform the development of the pilot phase of an Ontario-wide engineering transfer program.

Abstract D059: Bridge to Good Living: Thriving beyond lung cancer in West Virginia

Abstract Introduction: The goal of the Bridge Program is to improve the overall coordination of care, increase quality of life, and decrease the consequences of treatment for patients diagnosed with lung cancer. Brief Description: Patients diagnosed with late stage lung cancer are often referred to supportive or palliative care programs that provide symptom management, psychosocial support and follow up, as well as advanced planning. In contrast, the needs of patients diagnosed at a curable or early stage often go unaddressed. The focus of the Bridge Program is to develop and implement a comprehensive survivorship program for Stage 1-3 lung cancer patients completing curative treatment. The Bridge Program enrolls and assesses patients at the end of cancer treatment utilizing a multidisciplinary team approach. The Program’s goal is to improve patient and caregiver quality of life in the major life domains of physical, social, psychological, and spiritual. We see this program bridging patients from active cancer care to the next step on their journey in life. Using a multidisciplinary team approach creates an opportunity for collaboration and information sharing that leads to the development of an enhanced survivorship care plan. Summary of Data: Between March 2017 and June 2019, the Bridge Program enrolled 81 patients across three locations. At the end of cancer care, 100% of these patients had at least one unmet need and nearly half had seven or more. Assessment identified a total of 540 unmet needs which resulted in 132 clinician referrals. When categorizing unmet needs into physical, practical, and emotional domains, Bridge patients identified more unmet needs in the physical category than any other. The most common referrals were for Physical Therapy and Occupational Therapy. Following enrollment into the Program, 93% of Bridge patients showed a decrease in the number of unmet needs at their first recurrence and monitoring visit. When comparing a cohort of Bridge enrolled verses non-Bridge patients, we found that prior to visiting the Emergency Department, Bridge patients contacted their treatment team at a higher rate than non-Bridge patients and that the completion of Survivorship Care Plans was 100% for Bridge patients and only 38% for non-Bridge patients. Conclusion: Lung cancer patients have many unmet needs following active treatment for lung cancer. The Bridge Program addresses a cancer that is not frequently talked about in survivorship care: lung cancer. With increased screening and improvements in treatment, we can anticipate an increase in the number of lung cancer survivors. The Bridge Program provides a novel patient-centered model that addresses a cohort of patients that are often older and sicker than other cancer patients. Note: This abstract was not presented at the conference. Citation Format: Stephenie K Kennedy-Rea, Anne Swisher, Adrienne Duckworth, Tara Miller, Salman Osmon, Abby Starkey, Megan Burkart, Garth Graebe, Mary Anne Yanosik, Rachel Harper, Amy Allen. Bridge to Good Living: Thriving beyond lung cancer in West Virginia [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D059.

The Baby Bridge program: A sustainable program that can improve therapy service delivery for preterm infants following NICU discharge.

ObjectiveThe aim of this project was to determine revenues and costs over time to assess the sustainability of the Baby Bridge program.MethodsThe Baby Bridge program was developed to promote timely, consistent and high quality early therapy services for high-risk infants following neonatal intensive care unit (NICU) discharge. Key features of the Baby Bridge program were defined as: 1) having the therapist establish rapport with the family while in the NICU, 2) scheduling the first home visit within one week of discharge and continuing weekly visits until other services commence, 3) conducting comprehensive assessments to inform targeted interventions by a skilled, single provider, and 4) using a comprehensive therapeutic approach while collaborating with the NICU medical team and community therapy providers. The Baby Bridge program was implemented with infants hospitalized in an urban Level IV NICU from January 2016 to January 2018. The number of infants enrolled increased gradually over the first several months to reach the case-load capacity associated with one full-time therapist by mid-2017. Costs of the therapists delivering Baby Bridge services, travel, and equipment were tracked and compared with claim records of participants. The operational cost of Baby Bridge programming at capacity was estimated based on the completed and anticipated claims and reimbursement of therapy services as a means to inform possible scale-ups of the program.ResultsIn 2016, the first year of programming, the Baby Bridge program experienced a loss of $26,460, with revenue to the program totaling $11,138 and expenses totaling $37,598. In 2017, the Baby Bridge program experienced a net positive income of $2,969, with revenues to the program totaling $53,989 and expenses totaling $51,020. By Spring 2017, 16 months after initiating Baby Bridge programming, program revenue began to exceed cost. It is projected that cumulative revenue would have exceeded cumulative costs by January 2019, 3 years following implementation. Net annual program income, once scaled up to capacity, would be approximately $16,308.DiscussionThere were initial losses during phase-in of Baby Bridge programming associated with operating far below capacity, yet the program achieved sustainability within 16 months of implementation. These costs related to implementation do not consider the potential cost reduction due to mitigated health burden for the community and families, particularly due to earlier receipt of therapy services, which is an important area for further inquiry.

Public Sector to Research Sector Bridges Program

Public Sector to Research Sector Bridges Program

The potential problem of picky eating: a pilot study among university students of food and nutrition

PurposeThis pilot study is aimed to explore the potential problem of picky eating (PE) among university students majoring in food and nutrition as prospective nutrition professionals.Design/methodology/approachThe current pilot study included a total of 87 South Korean students majoring in food and nutrition. The self-designed Food Bridge program was applied to identify the underlying causes of PE and examine the possibility of overcoming it. The program included planning and practicing stepwise exposures to target foods that were the subject of PE. Descriptive statistics were calculated, and distributive differences between the success and failure groups in the program were analyzed using a chi-squared test.FindingsVegetables were the most commonly disliked foods (74.7%). About 46% of all students mentioned negative experiences as a reason for food dislikes. Almost half (45%) of these negative experiences were due to external coercion: forced eating (30.0%) and vomiting after forced eating (15.0%). About 66% of the students achieved relatively positive results in overcoming PE. The proportion of failures tended to be higher when the reasons for food dislike included negative experiences.Originality/valueAs the current study implied, students majoring in food and nutrition can be subject to PE. Despite study limitations, this study is meaningful in that it raises concerns over the potential problem of PE and its treatment among prospective nutrition professionals. This study is also expected to serve as a basis for further research on adult PE.

MP11: Emergency physician attitudes on opioid use disorder and barriers to providing buprenorphine/naloxone

Introduction: Buprenorphine/naloxone (buprenorphine) has proven to be a life-saving intervention amidst the ongoing opioid epidemic in Canada. Research has shown benefits to initiating buprenorphine from the emergency department (ED) including improved treatment retention, systemic health care savings and fewer drug-related visits to the ED. Despite this, there has been little to no uptake of this evidence-based practice in our department. This qualitative study aimed to determine the local barriers and potential solutions to initiating buprenorphine in the ED and gain an understanding of physician attitudes and behaviours regarding harm reduction care and opioid use disorder management. Methods: ED physicians at a midsize Atlantic hospital were recruited by convenience sampling to participate in semi-structured privately conducted interviews. Audio recordings were transcribed verbatim and de-identified transcripts were uploaded to NVivo 12 plus for concept driven and inductive coding and a hierarchy of open, axial and selective coding was employed. Transcripts were independently reviewed by a local qualitative research expert and themes were compared for similarity to limit bias. Interview saturation was reached after 7 interviews. Results: Emergent themes included a narrow scope of harm reduction care that primarily focused on abstinence-based therapies and a multitude of biases including feelings of deception, fear of diversion, feeling buprenorphine induction was too time consuming for the ED and differentiating patients with opioid use disorder from ‘medically ill’ patients. Several barriers and proposed solutions to initiating buprenorphine from the ED were elicited including lack of training and need for formal education, poor familiarity with buprenorphine, the need for an algorithm and community bridge program and formal supports such as an addictions consult team for the ED. Conclusion: This study elicited several opportunities for improved care for patients with addictions presenting to our ED. Future education will focus on harm reduction care, specifically strategies for managing patients desiring to continue to use substances. Education will focus on addressing the multitude of biases elicited and dispelling common myths. A locally informed buprenorphine pathway will be developed. In future, this study may be used to advocate for improved formal supports for our department including an addictions consult team.

Using new careers in nursing research findings to develop an evidence-based pre-entry immersion program.

New Careers In Nursing (NCIN) data analysis results were used to inform the development of The Bridge to Nursing Success Program (Bridge). NCIN data revealed that participation in a pre-entry immersion program (PIP) was associated with higher rates of retention and graduation. The purpose of this article is to 1). describe the findings of the NCIN Scholarship Program in relation to pre-entry immersion (PIP) programs. 2). Discuss and report the development of The Bridge to Nursing Success Program 3). Report results of the Bridgeto Nursing Success Program. The Bridge to Nursing Success Program (Bridge Program) was developed based on NCIN findings. Two Bridge cohorts (N=44) of accelerated nursing students participated in a nine-day pre-immersion program (PIP) that included face to face classes and discussions. Post program surveys were administered to assess helpfulness of program content. Student evaluations revealed an overwhelmingly positive response to the program. Both Bridge participants and non-Bridge participants performed equally through the first semester. Students who participated in the Bridge Program were less likely to fail a course in the first semester, and Bridge participants were six times more likely to be successful in the pathophysiology course. The study provides an evidence-based PIP model that offers academic support and coping strategies prior to an accelerated nursing program. Long-term follow up of the participating cohorts may reveal whether there is a relationship to this PIP program and persistence through to graduation.

Variations in the California Emergency Medical Services Response to Opioid Use Disorder.

IntroductionOpioids contributed to over 300,000 deaths in the United States in the past 10 years. Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA).MethodsWe surveyed medical directors of all 33 California LEMSAs with 25 multiple-choice and free-answer questions. Results were collected in RedCap and downloaded into Excel (Microsoft Corporation, Redmond WA). This study was exempt from review by the Alameda Health System - Highland Hospital Institutional Review Board.ResultsOf the 33 California LEMSAs, 100% responded, all indicating that OUD significantly affects their patients. Most (91%) had specific protocols directing care of those patients and repeat naloxone dosing. After naloxone administration, none permitted release to law enforcement custody, 6% permitted patient refusal of care, and 45% directed base hospital contact for refusal of care. Few protocols directed screening or treatment of OUD or withdrawal symptoms. Regular data collection occurred in 76% of LEMSAs, with only 48% linking EMS data with hospital or coroner outcomes. In only 30% did the medical director oversee regular quality improvement meetings. Of respondents, 64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral). Only 9% oversaw naloxone kit distribution (all under the medical director), and 6% had EMS-based outreach programs. In almost all (94%), law enforcement officers carried naloxone and administered it anywhere from a few times a year to greater than 200 in one LEMSA.ConclusionThis study represents an important description of EMS medical directors’ approaches to the impact of OUD as well as trends in protocols and interventions to treat and prevent overdoses. Through this study, we can better understand the variable response to patients with OUD across California.

Building Bridges Back to Back: 5 years of an outreach initiative in Anatomical Sciences and Medical Education between Brazil and US

The Building Bridges program has fostered collaborations and exchange experiences in Anatomical Sciences among students, researchers, and educators through lectures, colloquia, and student‐faculty exchange sessions. These have taken place in Sao Paulo (Santa Casa School of Medical Sciences), Ribeirao Preto (University of Sao Paulo School of Medicine, USP‐RP) and Rio de Janeiro (Federal University of Rio de Janeiro, UFRJ; Federal University of the State of Rio de Janeiro, UNIRIO; and the Brazilian National Academy of Medicine), since 2015. In August 2019, our group represented the American Association of Anatomists in London, at the 19th Congress of the International Federation of Associations of Anatomists (IFAA), contributing in a workshop addressing the topic International Connections of Anatomists in Global Health. Here, we comment on the outcomes of this workshop and report our upcoming endeavor in New York: the mini symposium Building Bridges Back to Back that will be hosted at the Icahn School of Medicine at Mount Sinai, December 2019. The meeting celebrates the 5th year anniversary of our international outreach initiative. It will bring together leaders from Medical Education from Brazil and connect other participants through videoconference channels. In the Medical Education session, the program includes the Dean of the Santa Casa School of Medical Sciences of Sao Paulo—Dr. Carlos Alberto Malheiros, as keynote lecturer. In the academic publishing session, the keynote lecturers will be the Director of the Graduate Program and Chief of the Surgery Department of the Medical Course at the Federal University of the State of Rio de Janeiro (UNIRIO), member of the Brazilian Academy of Medicine—Dr. Rossano Fiorelli; and the Editor in Chief of the Anatomical Record—Dr. Kurt Albertine. Within the two main sessions, Medical Education and Academic Publishing, the meeting will also cover new advances in Brazilian science, bringing leaders in education and research from different states in Brazil and the US. The event marks the launch of an international exchange program at the Icahn School of Medicine at Mount Sinai and Brazilian medical schools. Our goal is to offer opportunities for Brazilian students to experience medical learning in New York with the intent to help forge new leaderships and role models in medicine and health sciences in Brazil. We expect that this meeting will build the foundation to this exchange project and enhance the cooperation with the health care, medical and anatomical communities of the two countries.Support or Funding InformationMeeting support funded in part by The Anatomical Record; Research reported funded in part by CNPq grant PDE #249582/2013–9

Transforming gender relations in Nepal's trail bridge programme: policies and practice

This paper considers the extent to which the full and equal rights guaranteed in Nepal's constitution are reflected in the government's trail bridge programme (TBP). A review of the legal provisions and relevant literature was used to inform interviews and field enquiries at nine short-span trail bridges and one long-span bridge. The analysis indicates that the TBP is broadly gender responsive in its policies, but often falls short at field level. Analysis of the findings of the study was guided by five drivers of change for women's economic empowerment identified by the 2016 United Nations High-Level Panel. It considered the degree to which the TBP tackles adverse gender norms and promotes positive role models; addresses unpaid care work; promotes women's assets, representation and leadership; and contributes to a revision of gender-discriminatory laws. The paper concludes with five key suggestions for rendering the TBP more gender transformative: to address the time constraints imposed on women by unpaid care work; to ensure better facilitation of social processes; to strengthen women's leadership; to maximise women's income from wage labour through avoiding debt, turning it into assets and undertaking skills training; to incorporate inclusive community planning and construction of long-span bridges.

An Anti‐Mesothelin Recombinant Immunotoxin Based on Deoxyribonuclease‐I

Recombinant immunotoxins (RITs) are fusion proteins consisting of a toxin attached to an antibody fragment. Unlike traditional chemotherapy, RITs used in cancer therapy can be specifically targeted to tumor cells while sparing healthy cells. One shortcoming of RITs is their immunogenicity, which is the immune response of patients to treatment with RITs. Patients with intact immune systems often produce antibodies to the toxin that neutralize its function. For this experiment, we attempted to prepare a RIT using deoxyribonuclease‐ I (DNase‐I) instead of a typical bacterial or plant‐derived toxin. DNase‐I is an endogenous human protein that catalyzes the degradation of DNA into its component nucleotides. Previous research shows that DNase‐I can be toxic to cells if delivered through targeted endocytosis. Furthermore, we predict that DNase‐I will be less immunogenic than other toxins, because it is a human protein. We successfully cloned an expression vector joining DNase‐I to an anti‐mesothelin antibody fragment and expressed it in E. coli. The resulting protein, however, was unstable and we were unable to purify it after refolding from inclusion bodies. We concluded that the design of the fusion protein needs improvement to enhance its stability. It is also possible that the refolding conditions need further optimization. Future directions include exploring both of these possibilities.Support or Funding InformationI would like to thank the Towson Bridges Program and CCBC for the opportunity. Thank you to Dr. Laing, Dr. Snyder, Dr. Berlyn and Trudymae for guidance throughout the program. Thank you to the NIH Bridges Grant 5 R25 GM058264 16 for funding. Special thanks to Dr. Weldon, Jillian Baker and all students that have helped throughout the project.

Center and Donor Factors Associated with Discrepant Responses to Donor Lung Offers

Practice standardization may decrease donor lung shortages, however, the cause of organ acceptance pattern variation is not known. Our objective was to compare donor call practices in diverse settings. This was a prospective, multi-center study of 10 centers from 6 distinct regions. Characteristics of consecutive, first-recipient eligible, donor offers (aged ≥13) received by participating centers with definitive decisions from May 1, 2016 to October 31, 2016 were abstracted along with reasons for organ offer turn downs (as applicable) and final organ disposition. A discrepant decision was defined as a donor lung offer declined by one center that was then accepted for transplant by an alternate center. We evaluated 2,000 consecutive offers; the majority (89.9%) were brain dead donors (BDD). Mean transplant volume was 33 transplants/year (range 11-98). Most centers had ex vivo lung perfusion and all had extra-corporeal membrane oxygenation bridging programs. Surgeons made final acceptance determinations at all centers. Declined organs had a mean donor age of 39 years, with a mean PaO2 to FiO2 (P/f) ratio of 352. The most common primary reason for offer decline was abnormal imaging followed by a low or decreasing P/f ratio. There were 412 (20.7%) discrepant offer decisions (8.1 to 41.2% of offers depending on center). Discrepant decisions significantly differed from non-discrepant decisions by transplant center mean annual volume, donor age, absolute and decreasing P/f ratio, and donor type (BDD versus circulatory death) (p<0.001 in all cases). Age was associated with an increased odds of discrepant offer (OR 3.5, 95% CI 2.2-5.7, p<0.001). For every 10-year increase in donor age, the odds of a discrepant decision increased 1.23 fold. Conversely, for every 50-unit increase in P/f ratio, the odds of a discrepant decision decreased (OR 0.79, 95% CI 0.75-0.84; p<0.001.) Although donor smoking status was not different between discrepant and non-discrepant decisions, for every 5-pack-year increase in donor smoking history the odds of a discrepant decision increased by 1.22 fold. (95% CI 1.1-1.36; p<0.001). One in five donor offers that were initially declined by one transplant center were accepted for transplantation by another, highlighting significant variability in donor practices . Key donor and center factors were associated with discrepant decisions.

Using Stories to Teach

Using Stories to Teach Aretha Matt (bio) I grew up on the Navajo reservation during the 1980s and 1990s. I attended a public school in a small rural community and graduated with about sixty other students. I left my home in Querino Canyon, Arizona, two weeks after graduation to attend a summer bridge program at Northern Arizona University in Flagstaff, Arizona. This program was designed to integrate students of color successfully into colleges and universities. Students selected for this program were also first-generation college students or students from low-income backgrounds. This program helped me to integrate successfully because they were intrusive and continued their support into my second year of college. I credit this program for my success as an undergraduate student because they provided the resources and support that I needed to acculturate and operate in a new academic environment. I faced challenges and setbacks as a college student; but I did not allow these to deter my decision to complete degrees, including a doctoral degree in English. Along the way, I found that many educators and administrators at colleges and universities were available and supportive when it came to acculturating students to the academic environment; however, I also learned that many of them lacked understanding about Native Americans and our cultures. During my time as a graduate assistant instructor at the University of Arizona, Tucson, Arizona, I was categorized by faculty and graduate students on separate occasions as "quiet," "introverted," or "silent." They would also usually follow their remarks with a comment [End Page 86] about how they had Native American students in their classes who, like me, were also quiet. They often reported that they did not know how to approach the student in a way that would open communication. Most Americans know little about Native Americans because our Native histories, stories, and experiences are ignored and/or silenced in schools across America. Most people know only what they learned in primary and secondary grades, which is limited to a paragraph, a page, or a chapter in an American history book or events that occur during Native American month. I felt compelled to teach fellow instructors and my peers about my upbringing and my Navajo (Diné) culture because I feared the lack of knowledge would cause them to develop stereotypical perspectives and other common misconceptions about their students. These instructors needed contextual knowledge to better assist their students. My quiet nature developed, in part, by how I grew up. Some Navajo parents, including my parents, taught their children that words carry weight and/or have creative power. This shaped how I interacted with others. I often heard elders say that it was important to think before we acted (or spoke). Because of this, I will always consider if what I will say will contribute in positive or negative ways to group discussions or one-on-one conversations. Elders, including my parents, reminded us that incessant talking was not looked well upon in the Navajo community because it called attention to self. My parents used shame tactics to correct me when I was overly talkative and boastful. Moreover, listening and observing were more esteemed qualities compared with speaking well. My family and other community leaders ingrained in us that learning was equivalent to listening and observing. There was an expectation that we could learn whatever was heard or observed. This way of learning taught me that my learning was my responsibility. I carried this learning style into my classes and was always a careful listener or observer—absorbing and retaining information. I rarely had questions to ask instructors because I was often still processing the lessons in my mind. I shared these kinds of facts and stories pertaining to my upbringing and my literacy practices to give other instructors some idea about my challenges as a Native American student and writer. I share the following story about my literacy journey to shed light on the challenges that some Native American students face on the pathway to literacy learning. This story is about me; however, it may compare to what other Native Americans, particularly Navajo students, have experienced. I grew up understanding that stories impart knowledge. I...