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In 2000, the Senior Mentor Program was implemented as an innovative, instructional method in the University of South Carolina's medical school curriculum designed to enhance and strengthen student training in geriatrics. This study qualitatively analyzed second- year medical students' and senior participants' perceptions of and attitudes towards the Senior Mentor Program as an effective learning modality. A total of 36 second-year students from two consecutive classes (2002-2003) and 42 senior mentors at USC's School of Medicine participated in five and seven separate focus group interviews, respectively. The group discussions were transcribed and a content analysis performed using NVivo. The coding scheme and analyses were driven by the data collected and recurrent themes were examined across all focus groups. Overall, student and senior mentor participants viewed the program positively. Thematic comparisons by participant type indicate a shared view that the mentoring relationship has a far-reaching, educational, professional, and personal impact. Both students and seniors agreed that myths and stereotypes about aging were dispelled and students indicated that a close, caring relationship with an older person will change they way they practice. A longitudinal mentoring program that pairs students with community-dwelling seniors can be a valuable addition to traditional geriatric curricular activities designed to increase students' skills and compassion for caring for older adults. [ABSTRACT FROM AUTHOR]

Caffeine abuse is so common in our society that its effects are often not addressed as clinical issues. This article seeks to explain the psychological and physiological impact caffeine abuse can have on a rehabilitation client by examining recent research findings applicable to specific disability populations and to consumers of general rehabilitation services. In addition, these findings are examined as they pertain to day-to-day social and vocational life. The article offers specific suggestions for rehabilitation counselors and other professionals to help them evaluate caffeine abuse among clients and to assess its impact on the rehabilitation process. [ABSTRACT FROM AUTHOR]

Members from Cohort 13 of the Academic Leadership Fellows Program (ALFP) 2016-2017 were challenged to present a debate on the topic: "In Turbulent Times, Pharmacy Education Leaders Must Take Aggressive Action to Prevent Further Declines in Enrollment" at the American Association of Colleges of Pharmacy INfluence 2017 meeting in Rio Grande, Puerto Rico. This paper is the result of thoughtful insights emerging from this debate. We present a discussion of the question of whether pharmacy education leaders must take aggressive action or strategic approaches to prevent further declines in enrollment. There are many thoughts regarding current declines in enrollment. Some educators contend that a more aggressive approach is needed while others argue that, while aggressive actions might lead to short-term gains, a more viable approach involves strategic actions targeting the underlying causes for decreasing enrollment. This paper explores themes of enrollment challenges, current and future workforce needs, and financial issues for both pharmacy programs and students. In summation, both aggressive actions and a strategic, sustainable approach are urgently needed to address declining enrollment.

Although chronic graft-versus-host disease (GVHD) remains a frequent complication of bone marrow transplantation (BMT), the pathogenesis remains unclear. We examined the potential role of cytokines in mediating chronic GVHD. Skin samples from seven patients with cutaneous chronic GVHD, six post-BMT controls and six normal controls were evaluated by reverse transcription polymerase chain reaction for the proinflammatory cytokines interleukin-1 alpha (IL-1 alpha) and tumor necrosis factor-alpha (TNF-alpha), Th1-associated cytokines IL-2 and interferon-gamma (IFN-gamma), Th2-associated cytokines IL-4, IL-5 and IL-10, and fibrosis-associated cytokines platelet derived growth factor (PDGF) and transforming growth factor-beta (TGF-beta). IFN-gamma transcription was significantly more frequent in cutaneous chronic GVHD (86%) vs post-BMT and normal controls (17% (P = 0.03) and 0 (P = 0.005), respectively). IL-2 transcription was more frequent in chronic GVHD (28%) and post-BMT controls (50%) vs normal controls (17%). TNF-alpha mRNA was frequent in chronic GVHD (71%) and post-BMT controls (83%), but not significantly more than in normal controls (50%). Transcription of IL-1alpha, IL-4, IL-5 and IL-10 was infrequent in all three groups. PDGF and TGF-beta mRNA were detected in the majority of all samples. The frequent transcription of IFN-gamma in cutaneous chronic GVHD supports its potential role in mediating the associated tissue injury. While the cellular sources of these cytokines are uncertain, their expression and secretion in situ may propagate the cytotoxic cascade and perpetuate the tissue injury. Better understanding of the contribution of FN-gamma and other cytokines to the pathogenesis of chronic GVHD may allow the design of more specific and more effective therapy.

We analyzed factors associated with the development of chronic graft-versus-host disease (GVHD) in 469 consecutive patients receiving matched sibling allogeneic bone marrow transplantation (BMT). Overall, 41 +/- 6% (95% confidence interval) developed chronic GVHD between 2 and 50 months after BMT. Multivariate analysis showed that previous acute GVHD was the dominant independent risk factor predisposing to chronic GVHD (Relative Risk 4.82, p < 0.0001). In addition, recipient age of > or = 18 years and male recipient with female donor were also independent predictive factors for development of chronic GVHD. When acute GVHD and recipient age were considered, groups with distinctive risks of chronic GVHD were identified. Patients under 18 without previous grade II-IV acute GVHD had only a 10 +/- 5% risk of chronic GVHD. Patients over 18 with no prior grade II-IV acute GVHD had a 31 +/- 12% risk while patients with advanced acute GVHD, regardless of age, had the highest risk and 70 +/- 8% developed chronic GVHD. It is important to consider these factors when designing and assessing clinical trials of chronic GVHD prophylaxis and treatment.