Expanding Role Research Articles

Exploring the Expanded Role of Astrocytes in Primate Brain Evolution via Changes in Gene Expression.

Astrocytes are a subtype of glial cells, which are non-neuronal cells that do not produce electrical impulses. Rather, astrocytes are involved in various functions vital to a functioning brain including nutrient supply to neuronal cells, blood brain barrier maintenance, regulation of synaptic transmission, and repair following CNS injury. While in the past astrocytes were mostly examined in rodents, it is now clear that there is a large amount of astrocyte heterogeneity and increased complexity in mammals and primates (Oberheim et al. 2009; Falcone et al. 2019; Falcone et al. 2021; Falcone and Martinez-Cerdeno 2023). Astrocytes have expanded in the human lineage (density, soma volume, and ratio of astrocytes to total glial cells). The human prefrontal cortex also possesses an overall increased glia:neuron ratio relative to other primates, coinciding with allometric expectations based on overall brain size. What are the underlying changes in astrocytes in primate evolution? For this review, we will focus on gene expression evolution and gene regulation in astrocytes as a read out of the phenotypic changes seen in cellular morphology. This is an exciting time to understand this cell type in a more dynamic and complex way with new technologies such as induced pluripotent stem cells (iPSCs) and single-cell RNA sequencing (scRNA-Seq). Furthermore, understanding the evolution of astrocytes across primates will help to explain their role in neurological disease, as alterations in astrocyte function are implicated in many neurodegenerative states such as Alzheimer's disease and Parkinson's Disease.

P-1734. Pharmacist-Led Antibiotic Deprescribing for Negative Urine Cultures in the Emergency Department

Abstract Background Inappropriate antibiotic use in EDs, often due to empiric prescribing before urine culture results are available, poses significant challenges. This study evaluates the impact of a pharmacist-led intervention to deprescribe antibiotics for patients with negative urine culture results. Intervention Methods Conducted from May 1, 2023, to March 31, 2024, this study employed a two-phase approach involving a retrospective review and a prospective intervention. Inclusion criteria were patients prescribed antibiotics for a UTI with subsequent negative urine culture results during an ED visit. Exclusion criteria included patients admitted for inpatient treatment or transferred to other healthcare facilities. In Phase I (May to July 2023), a clinical pharmacist in the ED adjusted antibiotic therapy based on culture susceptibility results on weekdays. Phase II (January to March 2024) expanded to include antibiotic deprescribing in patients with negative results. The primary outcome was the number of ED readmissions within 30 days after antibiotic discontinuation for UTI symptoms or serious infection. Secondary outcomes included total antibiotic days saved, antibiotic days prescribed per patient at ED discharge, and post-intervention antibiotic days per patient. Statistical analyses utilized the Fisher Exact Test and Mann-Whitney U Test. Patient Characteristics Results The study included 78 patients: 27 in the retrospective phase and 51 in the prospective phase. Among the initial 51 patients, follow-ups with 17 revealed no continued UTI symptoms. There were no readmissions in our prospective intervention group compared to two in the retrospective group (P=0.117). Antibiotic days were significantly reduced from a pre-intervention average of 7.2 to 5.2 days per patient post-intervention (P=0.000468), saving a total of 82 antibiotic days. Results Conclusion Pharmacist-led deprescribing of antibiotics in patients with negative urine cultures significantly reduced total antibiotic days per patient without increasing ED readmissions for urinary tract infection symptoms. These findings demonstrate the feasibility and safety of deprescribing in a clinical ED setting and suggest potential changes in clinical practice, advocating for the expansion of pharmacist roles in antibiotic stewardship programs. Results Continued Disclosures All Authors: No reported disclosures

Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

Cardiovascular magnetic resonance (CMR) imaging has become a cornerstone in the diagnosis, risk stratification, and management of cardiovascular disease (CVD), particularly heart failure (HF) and cardiomyopathies. Renowned as the gold standard for non-invasive quantification of ventricular volumes and ejection fraction, CMR delivers superior spatial and temporal resolution with excellent tissue–blood contrast. Recent advancements, including T1, T2, and T2* mapping, extracellular volume quantification, and late gadolinium enhancement, enable precise tissue characterization, allowing early detection of myocardial changes such as fibrosis, edema, and infiltration. These features provide critical insights into the pathophysiological mechanisms underlying HF phenotypes and diverse cardiomyopathies, enhancing diagnostic accuracy and guiding therapeutic decisions. This review explores the expanding role of CMR in CV disease, highlighting its diagnostic value in HF and in several cardiomyopathies, as well as its contribution to improving patient outcomes through detailed tissue characterization and prognosis.

The Expanding Role of the U.S. Army Paramedic.

The combat medic (68W) will play a critical role in medical operations in the event of future large-scale combat operations (LSCOs). However, the combat medic is largely not prepared for LSCOs. The revised Medical Education and Demonstration of Individual Competence (TC 8-800) state 68Ws much be able to provide advanced airway and trauma management, medication administration, and advanced casualty movement. To meet the increased prehospital medical demands under LSCOs, the U.S. Army should require the Battalion, Brigade, and Division Medical Readiness Noncommisioned Officers (NCOs) to be Nationally Registered Paramedics (who are identified with the 3P Additional Skill Identifier [ASI]). They should have the responsibility to oversee the wartime medical skills sustainment of Combat Medic Specialists (68W) within their organization. These paramedics should drive medical simulation training events and improve current operation medical skills training. These medical readiness NCOs should attend the Medic Master Training Course and serve as advisors to commanders on the status of medic skill readiness within their organization. Commanders will be able to utilize these paramedics to augment the ongoing medical training of their medics to ensure they are operating at the fullest extent of their scope of practice.

Enablers and barriers to community pharmacists' readiness to implement deprescribing of inappropriate medications for older adults in Qatar.

There is paucity of studies focused on the enablers and barriers to community pharmacists' readiness to deprescribe inappropriate medications for older adults in developing settings. The current study assessed the enablers and barriers to community pharmacists' readiness to implement deprescribing of inappropriate medications for older adults. A cross-sectional survey of 252 community pharmacists was conducted in Qatar with a pre-tested 24-item questionnaire developed with the theory of domain framework. Information about perceived enablers and barriers were elicited with a 5-point Likert-type scale. The response rate was 79.4% (200/252). The majority of the community pharmacists were females (54.5%), within the age range of 20-40 years (88.0%), had BSc / BPharm as the highest educational qualification (70.5%), were full-time employee (97.0%). The top-ranked enablers of community pharmacists' readiness to implement deprescribing were exposure to CPD on the use of deprescribing toolkits and algorithm (66%), interprofessional collaboration with physicians (60.5%) and shared electronic patient record (59.5%), and improved remuneration / re-imbursement 58%). The top-ranked barriers were lack of access to patient records (70.5%), ineffective collaboration with physicians (66.5%), lack of time due to heavy workload (65%), regulatory framework that limit expansion of clinical roles (51%) and intense focus on sales target (49%). The top-ranked enablers of community pharmacists' readiness to implement deprescribing were exposure to CPD on the use of deprescribing toolkits and algorithm, interprofessional collaboration with physicians and shared electronic patient record. These findings bode well for the implementation of community pharmacists-led deprescribing of inappropriate medications for older adults in Qatar. However, a number of critical barriers were identified, and these will require institutional, regulatory and organizational interventions to improve readiness.

Improving Adult Immunization Uptake: An Expanded Role for the Nurse Practitioner

Improving Adult Immunization Uptake: An Expanded Role for the Nurse Practitioner

The Unique Challenges and Expanded Role of Infection Prevention and Control in the Military: A Strategic Approach for Wartime and Peacetime

The Unique Challenges and Expanded Role of Infection Prevention and Control in the Military: A Strategic Approach for Wartime and Peacetime

Reimagining educator roles for adaptive learning: insights from the Gioia methodology in a tech-driven future

PurposeThe purpose of this paper is to investigate how educators perceive and adapt their roles in the face of changes in technology-driven learning environments. The Gioia methodology explores how educators enable adaptive learning, broaden their pedagogical practice and promote cultural inclusivity to educate diverse students.Design/methodology/approachThis paper involves a qualitative interpretive phenomenological research design using the Gioia methodology. Data was collected through semi-structured interviews with 14 educators across various disciplines. Gioia methodology is a structured exploration of first- and second-order themes and aggregate dimensions that capture the nuanced ways in which educators navigate adaptive learning contexts.FindingsThis study highlights how digital tools help enable personalized self-directed learning, how adaptive learning adapts educators to become more than just traditional teachers and how the culturally responsive teaching that is required in a globalized learning environment promotes inclusivity and resilience in a diverse group of learners.Originality/valueThis study contributes to the growing body of literature on adaptive learning and identifies educators’ critical, expanded roles in a technology-centred world. This research provides a structured, in-depth analysis of educator perspectives on adaptive learning using the Gioia methodology, offering unique insights into the policy and practice implications.

Navigating Liminality in Evolving Forensic Anthropology Professionalism.

Emerging aspects of professionalism within forensic anthropology, while enhancing the scientific foundation and practice for the discipline, have created liminalistic spaces and experiences in education and training, employment, ethics, and identities that reflect the broader transitional status in the discipline as a whole. These liminal states and problems are discussed in terms of their creation, development, and potential for resolution. They are interpreted within a liminal framework which requires navigation through significant changes in roles, status, and identity in forensic anthropology practice. Recommendations for mitigating the identified deficiencies, ambiguities, and frustrations they produce include expansion of educational training, certification, employment options, and roles and responsibilities, as well as adherence to standards and recognition and promotion of self-care. Successful navigation of these issues will lead to a stronger future for both the discipline and the practitioner.

Defining and responding to the contextual drivers for implementation of antimicrobial stewardship in 14 neonatal units in South Africa.

Research on the contextual drivers of antimicrobial stewardship (AMS) programme interventions in neonatal units is limited. As part of a prospective mixed-methods multidisciplinary neonatal AMS (NeoAMS) interventional study in 14 South African hospitals, we applied a three-phased process to assess implementation barriers and contextual drivers experienced by participating health professionals. The study included: (Phase one; P1) a survey of pre-intervention barriers and enablers; (P2) written feedback during the study intervention phase; and (P3) semi-structured exit interviews. Respondents to the P1 survey (n = 100) identified 15 barriers, 9 in the domain of personnel resources, including staffing, time and workload constraints. Other barriers related to limited access to antimicrobial use and surveillance trends, complexity of neonatal care, absence of multidisciplinary team (MDT) AMS and change resistance. For P2, written feedback during implementation (n = 42) confirmed that the MDT approach facilitated systems changes, including policy adaptations, process improvements, strengthened infection control practices, and expansion of AMS MDT roles. MDT benefits were described as aligned team purpose, improved communication, and knowledge sharing. Reported challenges included time to meet and building trust. In P3 interviews (n = 42), improved interpersonal communication, trust, personal growth and confidence building were cited as highlights of working in multidisciplinary AMS teams. Extending the MDT approach to other hospitals, training more health professionals in AMS and increasing management involvement were identified as priorities going forward. Understanding the organizational and interprofessional context for NeoAMS implementation enabled an MDT approach to develop and optimize neonatal AMS with potential for adoption in similar resource-constrained settings.

From Chrysalis to Taking Flight, the Metamorphosis of the ACGME During Dr Thomas Nasca's Tenure as CEO.

Thomas J. Nasca, MD, MACP, served as the President and Chief Executive Officer (CEO) of the Accreditation Council for Graduate Medical Education (ACGME) for 17 years, with his tenure ending December 2024. During this time he led and supported significant changes in accreditation and medical education. This article will examine the changes during this period through the lens of key themes, including the redesign of the graduate medical education (GME) accreditation model and new and expanded roles that the ACGME assumed during 3 phases between 2007 and 2024: (1) the development years leading to the Next Accreditation System (NAS), (2) implementation of the NAS, and (3) the COVID-19 pandemic. Launched in 2012, the NAS redesigned accreditation as a balanced combination of assurance- and improvement-focused policies and activities. The NAS served as the foundation for harmonizing GME training through the creation of the single accreditation system. The ACGME also took on new roles within the professional self-regulatory system by tackling difficult issues such as wellness and physician suicide, as well as diversity, equity, and inclusion in medical education. In addition, the ACGME substantially expanded its role as facilitator and educator via the introduction of multiple resources to support GME. However, the medical education landscape remains complex and faces continued uncertainty, especially as it emerges from the effects of the COVID-19 pandemic. The next ACGME President and CEO faces critical issues in GME.

Using High-Fidelity Simulation to Improve Registered Nurse Confidence and Evaluate Outcomes of a Registered Nurse–Initiated Anaphylaxis Protocol in a Radiology Department: An Evidence-Based Quality Improvement Project

PurposeThis quality improvement project uses high-fidelity simulation to evaluate a registered nurse (RN)–initiated protocol to treat anaphylactoid contrast reactions, with a secondary outcome to measure the effects of simulation on RN confidence. ProblemAnaphylactoid reactions are rare life-threatening occurrences in radiology departments. Recently updated professional recommendations allow the expansion of the RN role in supervising and treating contrast reactions. MethodsForty-six radiology nurses and 5 providers participated in simulated contrast reactions. Time to recognition and treatment were recorded. Simulation was assessed via a validated tool, and RN confidence was measured with presurveys and postsurveys. InterventionsFeasibility of a symptom-driven assessment tool and RN protocol to manage contrast reaction until physician arrival were evaluated. ResultsTime from recognition of reaction to treatment was significantly longer using an RN protocol (difference = 102, 95% confidence interval: (64, 140), p value <.001), although not clinically significant. Presurvey and postsurveys demonstrated increased RN confidence in 10 measures, and a validated tool found 85% of responses to simulation favorable. ConclusionsTreating contrast reactions via RN protocol may be clinically useful for managing severe contrast reactions when a physician is not immediately available. Simulation significantly increases RN confidence and should be considered for continuing education.

A Review on the Expanding Role of Dentists in Facial Esthetics

ABSTRACT Dentists’ role in facial esthetics is growing, with advancements in cosmetic procedures, such as Botox and dermal fillers. Understanding the range of practitioners and their professional backgrounds is crucial for addressing risks. Data collection and analysis was done to retrieve scholarly papers using databases, such as PubMed and advanced Google search, and analyze. Currently, the role of dentists in facial beauty is gaining huge interest. This is a new and controversial issue in this era of society. Botox and dermal fillers help general dentists create a harmonious smile by controlling soft tissues. Further training may be required to perform esthetic procedures, such as Botox or dermal fillers, in areas other than the perioral region. Complications might occur due to inadequate education. Dentists must be competent to administer these agents, such as traditional providers. The review paper concludes that dentistry students are becoming more interested in cosmetic treatments. Cosmetic practice in dental education may be strengthened by combining topics, such as dermal fillers in materials science, botulinum toxin (BTX) in pharmacology, and anatomy of the aging face in dentistry with emphasis on medicolegal laws, policies, and ethics involved.

The Expanding Role of Cameras in Health Diagnostics

The Expanding Role of Cameras in Health Diagnostics

Barriers and facilitators to the application of nurse practitioners' training pilot programs in China: A CFIR-guided descriptive qualitative study

BackgroundThe Guidelines on Prescriptive Authority for Nurses released by the International Council of Nurses indicate that 44 countries or territories worldwide have enacted legislation granting prescriptive authority to nurses. In the US, 27 states, two territories, and Washington, D.C. have authorized certified nurse practitioners full practice authority, including prescriptive authority, and momentum is building. Currently, in mainland China, there is no national legal mandate for nurse practitioners to prescribe, although a few institutions have initiated pilot training programs for nurse practitioners. However, little is known about the factors influencing their prescribing. Research on the value of such pilot programs from the perspectives of nurse practitioners and stakeholders is required.AimThe purpose of this study is to identify, assess and synthesize the perceptions of nurse practitioners and stakeholders in two pilot training programs on the barriers and facilitators to the potential development and implementation of nurse prescribing in mainland China. DesignA descriptive qualitative research design. SettingsThe study was conducted at two nurse practitioner pilot institutions in mainland China. ParticipantsFive nurse practitioners, three collaborators, three policymakers and three trainers of nurse practitioners from two pilot institutions. MethodsData were collected via semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used as a framework to orient the data analysis. ResultsWithin the five Consolidated Framework for Implementation Research domains, we identified 31 barriers and 50 facilitators influencing the potential implementation of nurse practitioner prescribing. Barriers mainly included insufficient urgency for change, lack of policy and legal support, inadequate education and training on prescribing, and low public awareness. Facilitators encompassed nurses' practical prescribing experience, their competence and confidence in role expansion, effective teamwork, and a strong demand orientation within healthcare settings. ConclusionOur findings suggest that China possesses significant potential to successfully carry out nurse practitioner prescribing initiatives. It is crucial to explore factors hindering or promoting the development of nurse practitioners to effectively support their implementation within healthcare systems while strategizing for future advancements in this area. In the case that the national policy has not yet been promulgated, the outcomes derived from our pilot work will carry substantial influence over national policies.

The Expanding Role of Public Libraries in Tribal Settings: From Traditional Services to (Advanced) Digital Skills, Citizen Engagement, and Innovation

ABSTRACT This paper presents a case study of Ignacio Community Library (ICL) on the Southern Ute Indian Tribe Reservation (Colorado) to show how public libraries in tribal settings currently contribute to their communities and whether such context influences these contributions. Based on existing literature and a dozen in-depth interviews, we find that ICL meets various needs and empowers citizens with (advanced) digital skills to use (emerging) technologies for specific purposes and also to innovate. Further, ICL expands opportunities for active citizen engagement in public affairs. These contributions align with local priorities and demonstrate how unique local circumstances affect specific ICL’s contributions.

The Expanding Role of Designated Institutional Officials in Graduate Medical Education.

The Accreditation Council for Graduate Medical Education (ACGME) plays a pivotal role in ensuring the quality of graduate medical education (GME) training across the United States. Central to the success of this mission are designated institutional officials (DIOs), who usually serve as chief GME officers within the ACGME-accredited sponsoring institutions (SIs). Despite the critical role of DIOs, the qualifications, level of administrative support, and responsibilities of DIOs are not defined and vary significantly among SIs. Although responsibilities mandated by ACGME Institutional Requirements provide a framework, the actual scope of work of DIOs often extends far beyond what is outlined in the ACGME Institutional Requirements, involving collaboration with a wide variety of institutional stakeholders and harnessing the GME enterprise to achieve institutional goals. Nearly all DIOs face a multitude of challenges, including adapting to new ACGME requirements and initiatives, addressing resident and fellow wellness concerns, promoting health equity, nurturing scholarly endeavors, and advocating for their residents and fellows. Additionally, emerging technologies and innovations as well as the changing financial climate for SIs and the health care facilities that host GME learners can present both educational opportunities and new challenges for DIOs in ensuring trainees are prepared for their roles as the next generation of physicians. As the health care landscape evolves, DIOs will continue to play a vital role in shaping the educational experiences of physicians in training while balancing institutional priorities and ensuring high-quality patient care.

Aligning training, regulation, and payment policy to advance the behavioral health workforce.

The United States is facing an unprecedented behavioral health crisis, exacerbated by workforce shortages that limit access to treatment. In response, states are attempting to increase access to behavioral health services by developing new professions and roles and expanding the functions of the existing behavioral health workforce. Yet, training, regulation, and payment policies are often not aligned to effectively deploy the workforce to serve in new or expanded roles to meet behavioral health needs. We envision training, regulation, and payment as a three-legged stool that supports the health care workforce. In this commentary, we discuss why each leg of the stool is essential, offer examples of how misalignment occurs in the behavioral health workforce, and provide an example of how states can align these three factors to meet community behavioral health needs.

Advanced practice nursing in Portugal – Where do we stand?

Background: Portugal's health workforce has been described as an inefficient mix of resources, impacting productivity and access to health services. To address these issues, stakeholders have advocated for Advanced Practice Nursing (APN) to strengthen the nursing role and improve service delivery. Aim: To analyze the relevance, pertinence, feasibility, and main barriers and facilitators of APN implementation in Portugal. Methods: A scoping review was conducted in the CINAHL, MEDLINE Complete, PubMed, and ScienceDirect databases for peer-reviewed articles in English and Portuguese, published after 2000, on human resource configurations in health and nursing role expansion in Portugal. A review of grey literature further complemented the research. Results: A total of 59 studies (43 international, 16 national), 31 technical reports (17 international, 14 national), seven press articles, and two theses were screened. Findings were grouped into themes of APN conceptualization, regulation, barriers and facilitators, and funding. APN implementation depends on a consensus regarding APN conceptualization, regulation, and scope of practice. Key barriers include medical opposition, limited political commitment, and lack of comprehensive data on APNs' social and financial impact in Portugal. Conclusions: The implementation of Advanced Practice Nursing in Portugal is relevant and necessary, though its feasibility depends on strong leadership, political commitment, and consensus among stakeholders. Further research is essential to assess APNs' social and economic impacts within the Portuguese healthcare system.

Evolving HIV service delivery: scalability of pharmacist-led care

Abstract Introduction With declining healthcare budgets and numbers of HIV medical trainees1, workforce innovation is crucial to sustain delivery of HIV care. Since local introduction of an advanced pharmacist practitioner (APP) role, we have demonstrated the ability of pharmacists to provide holistic care to people living with HIV, including those with complex medical needs. Scaling up pharmacist-led care may be a potential solution to sustain service delivery2 whilst addressing the needs of an ageing cohort3. Further APP clinics were introduced with consultant support and supervision. Aim We aim to evaluate the impact and outcomes of these APP clinics. Method Prospective data collection of consultations conducted by four pharmacist practitioners (PP) across four HIV clinics between January to December 2023. Surveys were distributed after the appointment to capture service users’ opinions on the pharmacists’ role and care provided. Ethical approval was not required as this does not constitute as research. This was registered as a service evaluation with the research and innovation team at Chelsea and Westminster NHS Foundation Trust. All patient information is anonymised. Results A total of 634 consultations (513 individuals) within 170 clinical sessions were conducted during the 12 month period: 585 (92%) in person; 176 (34%) female; median age 52 (IQR 43-58); 233 (45%) non-white ethnicity; mean number of co-morbidities 2 (0-8); 87 (17%) had more than 5 co-medications (0-21); 87% virologically suppressed [viral load (VL) &amp;lt;50cp/mL]. Of 55 individuals seen with detectable VL, 32 (58%) resuppressed within 6 months. PPs have made 522 interventions and investigations in total, for example 147 referrals to other specialities such as dietitians and mental health services, 112 imaging requested (e.g DEXA and liver ultrasounds) and 99 initiation or switching of antiretroviral therapy (ART). Following investigations, 44 new medical conditions were identified and managed by the PPs which included namely 18 cases of micronutrient deficiencies, 8 cases of skin conditions and 6 cases of metabolic disorders. From the survey, 55% (30/55) of service users were aware that pharmacists could review their overall health. All (100%) respondents felt that the quality of care received met or exceeded expectations and 54 (98%) would attend a pharmacist-led appointment in future. Discussion/Conclusion We have previously successfully demonstrated implementation of pharmacist practitioner clinics as a novel way of utilising and developing the pharmacist workforce. We demonstrate scalability of this service delivery model in our large, urban multi-site centre by successfully increasing the number of pharmacist practitioner clinics from three clinics to six clinics week. The positive feedback from service users indicates high acceptability of this model. HIV services may consider investment into mobilising senior pharmacists to facilitate expansion of this advanced practitioner role in order to address increasing levels of co-morbidities, polypharmacy and complex medical needs observed in our ageing population. The knowledge base of HIV pharmacists means they are ideally placed to facilitate communication across sectors, specialties and disciplines. Future development plans include expanding to other specialist areas such as HIV pre-exposure prophylaxis, contraception, gender health and research delivery and enhanced skills such as phlebotomy, injectable ART administration.