Increasing emphasis has been placed on improving clinician resilience and well-being due to concerning rates of burnout, depression, and suicide in healthcare professionals. Session participants will learn how multiple instiutions have created initiatives that promote a culture of health and well-being for students, staff, and faculty. Particpants will learn about practical strategies for performing an environmental scan of current culture and incorporating assessment tools, educational programs, and workplace wellness into their own organizational initiatives.

Presentation will describe the overarching recommendations put forth by the PMTF and apply findings from the PMTF report in the context of South Central Appalachia.

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Explain the concept of wellbeing and factors that influence it Describe downstream consequences of burnout and distress Analyze personal wellbeing across multiple domains Evaluate the extent to which wellbeing is supported across organization levels Describe interventions that could be implemented to foster a culture of wellbeing

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Oral vitamin K is administered to patients who have very high INR lab values and are on warfarin therapy. Due to the inability of some patients to swallow tablets, and the commercial formulation of vitamin K being available only as a tablet or an injectable emulsion, it may be necessary to compound an oral liquid formulation. When compounding batches of oral solutions, it is sometimes convenient to measure the product in unit doses. In this project, we compared liquid vitamin K in sterile water (1mg/mL) verses liquid vitamin K in Ora-Sweet (1mg/mL) stored in amber plastic syringes. Vitamin K is light sensitive and is best stored in amber containers. Vitamin K is also lipophilic and may adsorb to the plastic syringes. In this study, we investigated the feasibility of bulk compounding oral vitamin K solutions, and aliquoting them for storage in amber plastic syringes. The Vitamin K in sterile water syringes were made by mixing 45 mL of sterile water and 5 ampules, each containing 10mg/mL of vitamin K emulsion, together in an amber glass bottle for a final concentration of 1mg/mL. Thirty 1mL plastic amber syringes were filled with the mixture, capped, and placed in the refrigerator. The same process was repeated using Ora-Sweet instead of sterile water to fill thirty more plastic amber syringes. Three syringes of vitamin K in sterile water mixture, three syringes of vitamin K in Ora-Sweet mixture, and one Vitamin K reference standard were all analyzed using HPLC-UV on the day of compounding, and at day 1, 2, 4, 7, 14, 21, 30, 60, and 90. If stability is defined as 90-110% active ingredient, then Vitamin K in sterile water is stable to fourteen days, 95.3±3.5% recovery, but some samples fell below 90% recovery after 14 days. By day ninety, the recovery in SWFI syringes was 84.2±8.9%. For vitamin K in Ora-Sweet, the within-day variability was very high due to limitations in drug dissolution; as such the average concentration was not consistently above 90%. On the day of compounding, the percent recovery in the Ora-Sweet syringes was 92.7±9.9%, despite 1 hour of stirring. In conclusion, the Vitamin K in sterile water mixture can be stored in refrigerated, amber oral plastic syringes for 14 days, but plastic amber syringes were not appropriate for storage of the Vitamin K in Ora-Sweet mixture.

The effects of a physiologically balanced mixture of amino acids on the synthesis of proteins has been investigated. The roles of leucine and tryptophan, both implicated in the regulation of protein synthesis, were also studied. The balance of amino acids is important under specific rate-limiting conditions; the physiological balance "protects" the protein synthesizing system from the stressed condition of leucine limitation. Leucine is an important regulator of protein synthesis and the tryptophan effect on translation is dependent on the concentration of leucine. Thus tryptophan is a secondary regulator. The relative concentration of amino acids, described as balance, alterned the synthesis of protein in cell-free and intact cell culture experiments, when leucine was limiting. Both qualitative and quantitative differences were observed. The effect of the amino acid mixture decreased when the concentration of leucine was physiological. Two different components were sensitive to added leucine. This sensitivity was indicated by different kinetics; one component showed low Km and Vmax values while the other showed high Km and Vmax values. The initial rate of protein synthesis was first order with respect to leucine when it was limiting and mixed order when it was physiological. The effect of tryptophan on stimulation of protein synthesis was small in comparison to the effect of leucine, and was dependent on the ooncentration of leucine. The incorporation of leucine into protein was changed as the tryptophan concentration changed when leucine was limiting; synthesis of albumin was slightly stimulated. The ribosome distribution did not change as indicated by polysome analysis. The incorporation of leucine into protein did not change when· leucine was physiological and tryptophan was. varied. However, the ribosome distribution was altered. A low molecular weight inhibitor of protein synthesis was found in cell extracts which acted independently of amino acid or leucine concentrations. It could be partially removed by treatment with G-25 Sephadex, but has not been purified. Several nucleotide effects independent of amino acid concentration were also observed. ATP, at increasing concentrations, significantly depressed levels of synthesis and concentrations greater than 4 mM caused 100% inhibition of the protein synthesizing system. The phosphodiesterase inhibitor, theophyllin~ enhanced synthesis of albumin, although the cyclic nucleotide, cAMP, did not itself alter synthesis of protein. Finally, the concentrations of amino acids in plasma of C3HeB/FeJ mice were determined. The two amino acids examined in the protein synthesis experiments, tryptophan and leucine, were found to remain relatively constant, regardless of the fed or fasted condition of the animals, but showed changes with the age of the animals.

Until the past few years, cellulose derivatives, (e.g., cellophane, collodion, and parchment) and animal membranes (e.g., goldbeater’s skin) have been the only dialysis membranes employed commercially. Cellophane has been used as the dialysis membrane in the artificial kidney since the machine’s inception in 1914. It continues to serve in this capacity, even though, in the last few years, attempts have been made to develop better films. An appreciation of both the “solution theory” and the “pore theory” is in order for this discussion. By incorporating the dynamics of these theories in the techniques of membram formulation, improved membrane performance can be exhibited. In the following discussion which considers membrane formulation, improved membrane performance can be displayed by higher particle transfer rates and greater particle selectivity.

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