Digital Commons Network^™

Trends In Private Equity Acquisitions Of Assisted Living Facilities., Jennifer N. Bunker, Yashaswini Singh, Gauri Gadkari, John Bowblis, Lindsey Smith, Paula Carder, Sean Huang, Momotazur Rahman, Kali S. Thomas

Institute on Aging Publications

This cross-sectional study examines trends in private equity acquisitions of assisted living facilities across the US.

2025-11-03 Final Draft Revision Of Pac-22, Morehead State University. Faculty Senate.

Faculty Senate Records

The final draft revision of PAc-22 submitted to the Faculty Senate on November 3, 2025.

Creating Sustainable School And Home Gardens: Water-Wise Gardening, Kathy Cabe Trundle, Lawrence Krissek

All Current Publications

Water-wise gardening, also known as xeriscaping, involves using water efficiently and effectively to create a functional and aesthetically pleasing landscape for residential and commercial properties. This fact sheet defines water-wise gardening, its benefits, and provides ideas for planning and improving a landscape to conserve a precious resource: water.

Survival And Recovery Of Three Shark Species In North-East Atlantic Recreational Fisheries, Francesco Garzon, Ghalia Abel, Ian Burrett, Owen Exeter, Lucy A. Hawkes, Thomas Horton, Mario Lambrette, Alex Plaster, David Righton, Hannah Rudd, Jessica Rudd, Bryce Stewart, Simon Thomas, James Thorburn, Paul Whittaker, Matthew J. Witt

School of Biological and Marine Sciences

Understanding how sharks respond to catch and release (C&R) recreational fisheries is an important requirement for effective management. Post-release survival and recovery in recreational fisheries can be species- and setting-dependent. Nevertheless, no study on sharks has been conducted in European recreational fisheries, despite their popularity as target. This study presents the first example of biologging to assess C&R effects on blue sharks (Prionace glauca), porbeagle sharks (Lamna nasus) and tope sharks (Galeorhinus galeus) in the UK. Pop-up satellite archival tags (n = 23 blue shark, 20 porbeagle shark, 26 tope shark) revealed high (94.7–96.2%) survival rates in all three species, …

Therapeutic Radiation Drives Leptomeningeal Dissemination Of Medulloblastoma Through An Innate Immune Process, Carolina Nör, Kaitlin Kharas, Alex Rasnitsyn, Maria C Vladoiu, Nam Woo Cho, Jacob S Young, Felipe Nör, Ncedile Mankahla, Joonas Haapasalo, Kristiina Nordfors, Sara Rapic, Patryk Skowron, Raúl A Suárez, Alexander T Bahcheli, Oliver Ocsenas, Xin Chen, Shahrzad Bahrampour, Ali Momin, Lakshmikirupa Sundaresan, Winnie Ong, Liam D Hendrikse, Namal Abeysundara, Kyle Juraschka, Michelle Ly, Jonelle G Pallota, Tajana Douglas, Ning Huang, Hao Wang, Esta Mak, Lei Qin, Jessica Liu, Lily Shen, Betty Luu, Alex Manno, Sachin A Kumar, Laura K Donovan, Vernon Fong, Cory Richman, Craig Daniels, Livia Garzia, Jeremy N Rich, Cynthia Hawkins, Xiaochong Wu, Ralph Dacosta, Jüri Reimand, Xi Huang, Vijay Ramaswamy, David R Raleigh, Michael D Taylor

Faculty, Staff and Students Publications

Leptomeningeal metastases are the most important source of morbidity and mortality for medulloblastoma patients. Radiation of the entire brain is highly effective in the treatment and/or prevention of medulloblastoma leptomeningeal metastases. Infants treated on clinical trials with focal tumor radiation recur metastatically, whereas infants treated with only chemotherapy relapse locally. In murine medulloblastoma model systems, provision of a single dose of radiation to the tumor drives leptomeningeal dissemination. An inflammatory response after radiation-induced tumor cell death recruits a variety of immune cells. Inflammation opens the local blood-brain barrier, allowing intravasation of medulloblastoma cells. Experimental induction of inflammation with lipopolysaccharide drives …

Orphan Nuclear Receptor 4a1 (Nr4a1) And Nr4a2 Are Endogenous Regulators Of Cd71 And Their Ligands Induce Ferroptosis In Breast Cancer, Arafat Rahman Oany, Srijana Upadhyay, Wai Ning Tiffany Tsui, Amanuel Hailemariam, Sarah Latka, John D Landua, Sandra D Scherer, Alana L Welm, Hugo Villanueva, Michael T Lewis, Stephen Safe

Faculty, Staff and Students Publications

Ferroptosis is an iron-dependent cell death pathway that involves multiple genes, including the transferrin receptor (TFRC/CD71), glutathione peroxidase 4 (GPX4) and cystine-glutamate antiporter (SLC7A11). This study is based on the hypothesis that orphan nuclear receptor 4A1 (NR4A1) and NR4A2 maintain low levels of ferroptosis in triple negative breast cancer (TNBC) cells and bis-indole derived (CDIM) compounds act as NR4A1/2 ligands that induce ferroptosis by enhancing CD71 expression. 1,1-Bis(3'-indolyl)-1-(3,5-disubstitutedphenyl)methane (DIM-3,5) analogs were investigated for their cytotoxicity and effects on NR4A1 and NR4A2 regulated genes and induction of ferroptosis. Several assays also determined enhanced lipoperoxidation, reactive oxygen species and malondialdehyde formation in …

Burden Of Central Nervous System Cancer In The United States, 1990-2021, Hyun Jin Han, Yun Seo Kim, Seoyeon Park, Jae Il Shin, Min Seo Kim, Ju Hyung Moon, Yong Bae Kim, Hazim S Ababneh, Ahmed Abu-Zaid, Demelash Areda, Santhosh Arul, Ahmed Y Azzam, Mainak Bardhan, Mohammad Amin Bayat Tork, Babak Behnam, Gokce Belge Bilgin, Prarthna V Bhardwaj, Soumitra S Bhuyan, Nima Broomand Lomer, Meng Xuan Chen, Suma Sri Chennapragada, Xiaochen Dai, Frances E Dean, Sindhura Deekonda, Xueting Ding, Ojas Prakashbhai Doshi, Abdel Rahman E'Mar, Muhammed Elhadi, Jawad Fares, Patrick Fazeli, James L Fisher, Maryam Fotouhi, Ali Gholamrezanezhad, Fidelia Ida, Chidozie Declan Iwu, Mohamed Jalloh, Chinmay T Jani, Rizwan Kalani, Samuel Berchi Kankam, Foad Kazemi, Ariz Keshwani, Atulya Aman Khosla, Stephen S Lim, Riffat Mehboob, Tomislav Mestrovic, Ali H Mokdad, Christopher J L Murray, Gurudatta Naik, Zuhair S Natto, Dang Nguyen, Fred Nugen, Atakan Orscelik, Romil R Parikh, Louise Penberthy, Richard G Pestell, Disha Prabhu, Jagadeesh Puvvula, Shakthi Kumaran Ramasamy, Cameron John Sabet, Austin E Schumacher, Yigit Can Senol, Sunder Sham, Samendra P Sherchan, Gizeaddis Lamesgin Simegn, Jasvinder A Singh, Ranjan Solanki, Bahadar S Srichawla, Jabeen Taiba, Manoj Tanwar, Mike Tuffour Amirikah, Anjul Verma, Ismaeel Yunusa, David X Zheng, Dong Keon Yon, Keun Young Park

Faculty, Staff and Students Publications

Importance: Primary brain and central nervous system cancer (collectively referred to as CNS cancer) comprises 2% of all human cancers and poses significant health and economic challenges in the United States.

Objective: To analyze CNS cancer burden in the US, stratified by time, location (state and division), sex, age group, and Sociodemographic Index (SDI).

Design, setting, and participants: This cross-sectional study involved a repeated analysis of Global Burden of Disease Study (GBD) 2021 data in 2024. Using data from 183 sources, CNS cancer metrics in the US were estimated across states and years. US CNS cancer metrics across all sexes …

A Multiomics Recovery Factor Predicts Long Covid In The Impacc Study, Gisela Gabernet, Jessica Maciuch, Jeremy P Gygi, John F Moore, Annmarie Hoch, Caitlin Syphurs, Tianyi Chu, Naresh Doni Jayavelu, David B Corry, Farrah Kheradmand, Lindsey R Baden, Rafick-Pierre Sekaly, Grace A Mccomsey, Elias K Haddad, Charles B Cairns, Nadine Rouphael, Ana Fernandez-Sesma, Viviana Simon, Jordan P Metcalf, Nelson I Agudelo Higuita, Catherine L Hough, William B Messer, Mark M Davis, Kari C Nadeau, Bali Pulendran, Monica Kraft, Chris Bime, Elaine F Reed, Joanna Schaenman, David J Erle, Carolyn S Calfee, Mark A Atkinson, Scott C Brakenridge, Esther Melamed, Albert C Shaw, David A Hafler, Alison D Augustine, Patrice M Becker, Al Ozonoff, Steven E Bosinger, Walter Eckalbar, Holden T Maecker, Seunghee Kim-Schulze, Hanno Steen, Florian Krammer, Kerstin Westendorf, Bjoern Peters, Slim Fourati, Matthew C Altman, Ofer Levy, Kinga K Smolen, Ruth R Montgomery, Joann Diray-Arce, Steven H Kleinstein, Leying Guan, Lauren Ir Ehrlich

Faculty, Staff and Students Publications

Background: Following SARS-CoV-2 infection, approximately 10%–35% of patients with COVID-19 experience long COVID (LC), in which debilitating symptoms persist for at least 3 months. Elucidating the biologic underpinnings of LC could identify therapeutic opportunities.

Methods: We utilized machine learning methods on biologic analytes provided over 12 months after hospital discharge from more than 500 patients with COVID-19 in the IMPACC cohort to identify a multiomics “recovery factor,” trained on patient-reported physical function survey scores. Immune profiling data included PBMC transcriptomics, serum O-link and plasma proteomics, plasma metabolomics, and blood mass cytometry by time of flight (CyTOF) protein levels. Recovery factor …

Integrative Proteogenomics And Forward Genetics Reveal A Novel Mitotic Vulnerability In Triple-Negative Breast Cancer, Nicholas J Neill, Shankha Satpathy, Karsten Krug, Jitendra K Meena, Nivetha Ramesh Babu, Cheyenne Calderon, Desmon Reed, Marcus J Weber, Lacey E Dobrolecki, Alaina Lewis, Christina Sallas, Meenakshi Anurag, Kimberly R Holloway, Chen Huang, Suhas Vasaikar, Maria F Cardenas, Beom-Jun Kim, Doug W Chan, Shayan C Avanessian, Siddhartha Tyagi, Mayra Orellana, Sufeng Mao, Heyuan Li, Fade Gong, Sarah J Kurley, Kristen L Meerbrey, Calla M Olson, Amritha Nair, Tingting Sun, Hsiang-Ching Chung, Elizabeth A Bowling, Jarey H Wang, Pengju Zhang, Peng Xiao, Duxiao Yang, Fabio Stossi, Mei-Yin C Polley, Alexander B Saltzman, Filip Mundt, D R Mani, Michael A Gillette, Susan G Hilsenbeck, George Miles, Carolina Gutierrez, C Kent Osborne, Charles Y Lin, Nathanael S Gray, Jinpeng Sun, David A Wheeler, Charles M Perou, Anna Malovannaya, Michael T Lewis, Bing Zhang, Matthew J Ellis, Steven A Carr, Thomas F Westbrook

Faculty, Staff and Students Publications

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with few effective targeted therapies. Taxanes and other microtubule-targeting agents (MTAs) are frontline chemotherapies for TNBC; however, the molecular pathways that cause TNBC taxane sensitivity are largely unknown, preventing selection of taxane-responsive patients and development of more selective therapeutic strategies. In this study, we identified tumor-selective vulnerabilities in TNBC harboring inactivation of the tumor suppressor PTPN12 by integrating proteogenomic characterization and synthetic lethality screening. We discovered that PTPN12 inactivation drives mitotic defects through aberrant hyperactivation of the ubiquitin ligase complex APCFZR1, a critical regulator of the cell cycle. Consistent …

Acute Myeloid Leukemia Drives Atrial Fibrillation Through Tnfα Signaling Activation, Ninad Oak, Jose Alberto Navarro-Garcia, Minhua Li, Mara R Turkieltaub Paredes, Satadru K Lahiri, Bharat K Kantharia, Daisuke Nakada, Xander H T Wehrens, Mohit M Hulsurkar

Faculty, Staff and Students Publications

No abstract provided.

Starting An Equine-Assisted Services Program, Makenna L. Pahlke

All Current Publications

Starting an equine-assisted services (EAS) program requires more than just access to horses and a passion for helping others. This fact sheet outlines the key considerations for communities and individuals interested in developing safe, sustainable, and impactful equine-assisted programs.

What Are Equine-Assisted Services? A Practical Guide For Families And Communities, Makenna L. Pahlke

All Current Publications

Horses are very present animals, meaning they provide immediate, nonjudgmental feedback. Their nature and size can often encourage confidence, responsibility, and self-regulation. Families and communities considering equine-assisted services (EAS) for themselves or a loved one need to understand terms, as they will help guide them to the type of program best suited to meet their expected needs, as well as help them find quality programs.

Developing Optogenetic Approaches To Study Ca2+ Signaling Processes, Tatsuki Nonomura, Xiaoxuan Liu, Megan Chiu, Zhi Tan, Tien-Hung Lan, Yubin Zhou

Faculty, Staff and Students Publications

Calcium ions (Ca2+) are essential second messengers intimately implicated in a variety of biological processes, ranging from short-term events such as muscle contraction to long-term effects like gene expression. Dysregulated Ca2+ signaling can disrupt cellular function and contribute to the development of various human diseases, including developmental, neurological, immunoinflammatory, metabolic, and cardiovascular disorders. To study the mechanisms and biological consequences of Ca2+ signaling, optogenetic approaches have proven invaluable, as they offer exceptional spatiotemporal resolution compared to traditional methods. Recent progress in non-opsin-based optogenetics, particularly those engineered from Ca2+ release–activated Ca2+ (CRAC) channels, has substantially advanced our understanding of Ca2+ signaling …

Availability Of Multidisciplinary Treatment Modalities And Outcomes Among Patients With Resected Early-Stage Non-Small Cell Lung Cancer, Brendan T Heiden, Su-Hsin Chang, Yan Yan, Ana A Baumann, Theodore S Thomas, Steven Tohmasi, Nikki Rossetti, Daniel Kreisel, Ruben G Nava, Bryan F Meyers, Benjamin D Kozower, Varun Puri, Et Al.

2020-Current year OA Pubs

BACKGROUND: Comprehensive, multidisciplinary care is crucial for managing early-stage non-small cell lung cancer (NSCLC), typically treated via lung resection or stereotactic body radiation therapy (SBRT). We evaluated how variable access to on-site SBRT may be associated with clinical outcomes for patients with stage I NSCLC receiving surgical resection within an integrated health-care system.

METHODS: We performed a retrospective cohort study of patients with stage I NSCLC treated with lung resection at Veterans Health Administration (VHA) facilities between 2006 and 2016. The VHA provides thoracic surgery at approximately 100 facilities, whereas lung SBRT is currently available at approximately 20 facilities. We …

Opioid-Free Anesthesia: A Scoping Review Of Efficacy, Safety, And Implementation Challenges, Amogh Pershad, Ofelia Loani Elvir Lazo, Robert Wong

Student Publications

Background: Opioid-free anesthesia (OFA) is a multimodal strategy to avoid intraoperative opioids and minimize associated complications, though evidence remains variable.

Methods: A systematic search of PubMed and Google Scholar (2010–2025), supplemented by AI tools (Google Gemini) for earlier publications, summarized eligible studies (RCTs, cohorts, systematic reviews, and meta-analyses) comparing OFA to opioid-based anesthesia (OBA). Data were summarized following PRISMA-ScR guidelines.

Results: Across 23 randomized controlled trials and one cohort study, OFA consistently reduced PONV, while demonstrating analgesia and recovery outcomes comparable to OBA. Hemodynamic stability was variable, with dexmedetomidine-based OFA regimens sometimes associated with increased bradycardia and hypotension. PACU stay …

Exploring Di College Coaches’ Perceptions Of Holistic Coaching And The Factors Impacting Their Ability To Succeed In The Current College Sports Landscape, Deborah V. Hogan Phd

Journal of Issues in Intercollegiate Athletics

In the highly competitive Division I (DI) college sports system, coaches are expected to produce winning programs while developing their college athletes holistically. Recent changes in NCAA policies complicate the coach-athlete relationship, hindering coaches' ability to serve as effective holistic leaders. This study uses grounded theory to understand how DI coaches in high-profile sports perceive their roles as holistic leaders and manage external challenges to provide holistic college athlete experiences. Semi-structured interviews with 12 football and women’s basketball coaches revealed five main themes: 1) coaches are educators, 2) strategies for holistic coaching, 3) supporting Black college athletes, 4) college sports …

Ncaa Division I Senior Athletic Administrators' Perceptions Of And Experiences With Mental Performance Consultants And Their Services: A Qualitative Investigation, Morgan R. Eckenrod, Rebecca Zakrajsek, Johannes Raabe

Journal of Issues in Intercollegiate Athletics

At the National Collegiate Athletic Association (NCAA) Division I (DI) level, senior athletic administrators (SAAs) play a critical role in hiring Mental Performance Consultants (MPCs). Researchers found that NCAA DI administrators generally believe MPCs are beneficial in helping student-athletes manage competition pressures and improve performance, the number of full-time MPCs in NCAA DI athletic departments is still limited. In this study, eleven NCAA DI SAAs with at least one full-time MPC in their athletic department that solely delivered mental performance services were interviewed about their perceptions of and experiences with MPCs and their services. Using reflexive thematic analysis procedures, three …

Supporting The College Athlete Amidst The Onset Of Name, Image, And Likeness, Brennan K. Berg, Michael Hutchinson, Janelle E. Wells, David W. Walsh, Andre Simmond

Journal of Issues in Intercollegiate Athletics

Athletic administrators often assume a distinct stakeholder role that has the most immediate and frequent impact on college athletes’ well-being and retention. The implementation of name, image, and likeness (NIL) represents a historic transformation in college athletics. Utilizing a sport development framework, particularly the retention stage, to examine elite athlete development, how athletic administrators socially support college athletes in the new context of NIL and its impact on administrators’ work experiences were empirically assessed. Semi-structured interviews were conducted with 18 athletic administrators at nine universities. The themes of Implementation Challenges, Lack of Uniformity, Holistic Benefits to Athlete Well-Being, and Mostly …

Analysis Of Careers In And Through Intercollegiate Compliance, Michael A. Odio, Grace Wright, Thomas J. Aicher

Journal of Issues in Intercollegiate Athletics

This study examines job movements entering, exiting, and between NCAA compliance-related positions using a sample of 100 LinkedIn profiles. The analysis of the 441 job movements establishes job and organizational tenure figures and patterns in how people matriculate through certain positions. Theory related to career boundaries is used to interpret the job movements and draw conclusions about patterns related to educational backgrounds (e.g., master’s and law degrees), the role of internships and graduate assistantships, and more. The findings provide new insight on career dynamics in NCAA compliance and underscore the need to focus on studying subsectors in college sport to …

Exploring Sport Leaders’ Sensemaking And Enactment Of Inclusive Leadership, Elizabeth Taylor, Sean Dahlin, Janelle Wells, Erika Gray

Journal of Issues in Intercollegiate Athletics

While diversity, inclusion, and leadership shape individual behaviors and organizational culture, historically they have been researched as independent theoretical streams. Examining these lines has been fruitful to advance our understanding of diversity, inclusion, and leadership separately; however, we lack an understanding of how leaders understand and engage in inclusive leadership. Thus, this study explores how college sport leaders make sense of and enact inclusive leadership. Through 16 semi-structured interviews with senior-level athletic administrators we constructed four themes: fostering employees’ uniqueness, strengthening team belongingness, learning centered development, and actioning values-based care. This work both bolsters and extends Korkmaz and colleagues’ (2022) …

House Rules: Athlete, Coach, And Staff Perspectives On The Shifting Ncaa Landscape, Daniel Springer

Journal of Issues in Intercollegiate Athletics

The House settlement is an inflection point in NCAA Division I athletics, ushering in a new model of institutional revenue sharing, roster regulation, and athlete compensation. While legal and financial analyses dominate public discourse, less is known about how these shifts are understood by those working and competing within athletic departments. This study draws on narrative analysis of interviews with 11 athletes, coaches, and staff across five anonymized Power 4 institutions to examine how the House settlement is being interpreted as it takes effect. Three narrative foci emerged: 1) financial prioritization and resource allocation, 2) shifting culture, relationships, and meaning, …

The Impact Of Geographic And Community Diversity On The Transitionary Experiences Of International College Athletes, Marek Taškár, Chris Corr, Nicole Sellars, Sarah Stokowski, Karina Jolly, Trevor Bopp

Journal of Issues in Intercollegiate Athletics

International college athletes migrating to the United States for athletic competition encounter unique challenges such as language barriers, cultural adjustment, and familial detachment. These obstacles can hinder international college athletes’ transition compared to those of domestic athletes. While supportive programming and personnel have been illustrated to ease the transition and foster acculturation among international college athletes, the impact of the geographic location of an institution may impact the acculturation process for international college athletes. Given the importance of acculturation to athletic and academic success, this study examined how cultural diversity within communities hosting NCAA member institutions affects international college athletes’ …

Mobile Health (Mhealth) Access In A Dc Population With Fall Diagnosis: Background Research To Inform Equitable Access To Mhealth Platforms As Part Of An Emergency Medicine Department-Initiated Digital Fall Prevention Program, Leah Steckler, Krystl Haerian, Nasima Mannan, Addison Gwinner, Colton Hood, Michael Williams

Emergency Medicine Faculty Posters and Presentations

Background: Falls are the leading cause of injury-related death in adults over age 65 (CDC, 2024). Traditional exercise-based interventions may have an impact on fall prevention (US Preventive Services Task Force et al., 2024). Providing these programs is resource-intensive, however mHealth applications may expand comprehensive fall prevention. We seek to know if there are differences in the interactions with mHealth in adults ages 65-89 in the Medical Faculty Associates (MFA) population and if these differences are related to social determinants of health (SDOH).

Methods: IRB waiver was obtained for human subjects research. We accessed data from years 2019-2024 in Epic …

The Security Trilemma: A Critical Research Agenda, Adem Yavuz Elveren, David M. Fields

Working Papers

No abstract provided.

Wake Up Running! : A Call To Ethical Leaders In Quest Of Democratic Space, Walter Earl Fluker

Intersections

No abstract provided.

Full Issue

Intersections

No abstract provided.

Week Of November 2, 2025, Student Life

College, School and Department Newsletters, Magazines, and Journals

Your weekly hub for events, resources and updates.

State Of California Cannabis Reporting, University Of Mississippi – National Center For Cannabis Research And Education

California

No abstract provided.

Moderators Of Peer Influence Effects For Adolescents’ Smoking And Vaping Norms And Outcomes In High And Middle-Income Settings, Jennifer M. Murray, Sharon C. Sánchez-Franco, Olga L. Sarmiento, Erik O. Kimbrough, Christopher Tate, Shannon C. Montgomery, Rajnish Kumar, Laura Dunne, Abhijit Ramalingam, Erin L. Krupka, Felipe Montes, Huiyu Zhou, Laurence Moore, Linda Bauld, Blanca Llorente, Frank Kee, Ruth F. Hunter

Economics Faculty Articles and Research

Background: Peer influence is central to adolescent smoking initiation, yet its impact varies depending on individual and contextual factors. Understanding which moderators (personality, contextual, cultural, and environmental traits) shape these processes can inform more effective prevention strategies. We investigated hypothesized moderators of peer influence for adolescent smoking/vaping norms and other smoking-related outcomes in high and low-middle-income countries (LMICs): Northern Ireland and Bogotá.

Methods: Across 12 schools (n = 1,344, age 12–13 years), participants completed novel behavioral economics experiments measuring social norms, and self-report surveys, before and after school-based prevention interventions (ASSIST and Dead Cool). We examined how peer influence …

Ready Or Not? Merits Of An End-Of-Fourth-Year Summative Osce, Shruti Chandra, Md, Mehp, Deborah Ziring, Md, Katherine Berg, Md, Mph, Stefani Russo, Md

JeffMD Academic Affairs

Purpose

To develop a summative OSCE for fourth-year medical students to assess core clinical skills for internship readiness and remediate low performers.

Program directors report gaps between expectations and interns’ skills.

End of clerkship OSCEs, End of third-year summative OSCE

• Different competencies assessed
• Not reflective of graduation skills

An end-of-fourth-year summative OSCE was developed to

• Assess advanced reasoning and communication
• Assure residency readiness
• Identify and remediate clinical skills deficiencies