Perfluorooctanoic acid exposure assessment on common carp liver through image and ultrastructural investigation

Perfluorooctanoic acid (PFOA) poses particular concern as an emerging pollutant in both surface and ground waters. Fish, as a natural inhabitant of these waters and being highly representative of vertebrates, represents an ideal animal model to assess the toxic effects of PFOA. Hereby, liver microscopic texture was comparatively evaluated in individuals of common carp subchronically exposed to PFOA using grayscale differential box counting, a fractal analysis method. Furthermore, liver cytoplasmic glycogen areas and ultrastructure were also evaluated and compared to the image analysis findings. Redundancy Analysis was performed to assess, in summary, how much the variation of fractal dimension and lacunarity was explained by the concentration of PFOA in liver, the mass of liver and the number of proliferating cell nuclear antigen (PCNA)-immunoreactive nuclei. Treatment group ordination was better determined by fractal dimension than lacunarity. Interestingly, a significant complexity increase was associated with the modification of liver microscopic texture due to PFOA exposure. This complexity increase was related to “cloudy swelling”, possibly representing a primarily adaptive strategy against PFOA challenge, rather than a slight, reversible form of degeneration as traditionally proposed. The occurrence of endoplasmic reticulum stress, unfolded protein reaction and hormetic response was proposed and discussed

The international literature underpinning collaborative practice within practice based experiential learning for the initial education of student pharmacists : a scoping review

Abstract Introduction Interprofessional team working within healthcare [1] enables the use of complementary areas of expertise. Collaborative practice (CP) builds on this and enhances recognition and respect for such expertise which facilitates professional synergy. Development of CP needs to be built into initial education programmes and there is global progress. [2] Further, a WHO Framework highlighted the importance of courses developing CP in experiential learning (EL) environments. [1] There is need to develop both CP and EL within pharmacy courses to meet governmental and regulatory aspirations around the clinical and prescribing roles of pharmacists. Aim The aim of this part of a scoping review was to describe the different characteristics of the international literature around the development, implementation and evaluation of CP within practice based EL for initial education of student pharmacists. Methods The six-stage Arksey and O'Malley framework and the PRISMA extension for Scoping Reviews for reporting were followed. Eligibility criteria were defined (Table 1) and electronic searches of relevant databases (Medline, IPA, CINAHL and Google Scholar) conducted from inception to April 2020. MeSH terms and other relevant subject headings and text words were used. First stage involved screening titles / abstracts and second stage involved review of full text articles. A charting tool was developed and used to extract data on: country, study design, methods of evaluation, sector of practice, stage of students, professional groups involved, monitoring and assessment and scope for development. Findings were presented as a descriptive narrative summary. All steps involved independent checks by two of the review team. Results Twenty-eight papers were included with most from the USA (16 papers), with the remainder from Australia (5 papers), UK (5 Papers), Canada and the Netherlands (1 paper each). The majority of papers described quantitative methods using a wide variety of published (some validated) scales (20 scales including RIPLS, SPICE, CPAT) and a number of bespoke survey tools. The main focus was at 'Kirkpatrick model of educational evaluation' level 3 – with 13 papers focussing on changes to professional behaviours. Papers focussed on either hospital (12 papers) or primary care initiatives (12 papers) with the remaining four describing cross-sectoral settings. Only 6 papers stated that they focussed on specific healthcare specialities and the remainder were in general medical facilities. The nature of initiatives and activities varied with a predominance of focus to include later years of study. Only 3 papers included only pharmacy and medicine students.. Detailed information was lacking on methods of student assessment: some reported this involved reflection, with limited reporting of tools to assess competencies. A wide array of further research proposals was articulated. Conclusion This scoping review highlights the range of work already carried out. The diversity highlights the need for consideration of commonality in the nature of activity and tools to evaluate outcomes to ensure transferability to practice. There are many challenges influencing further development and implementation of CP. Facilitating matters by using the evidence base to add to existing placements without restructuring curricula across courses / institutions has been proposed by some authors

Interprofessional education during experiential learning placements for student pharmacists in Scotland. Exploring current support provision and stakeholder views.

Introduction Increasing global awareness that interprofessional team working is essential within modern healthcare systems has led to regulatory bodies mandating the inclusion of interprofessional education (IPE) within undergraduate curricula. The General Pharmaceutical Council specifies in the 2021 initial education and training standards the requirement for an interprofessional learning plan in which “IPE must mirror practice”.1 Pharmacy educators are intensifying their efforts to ensure student pharmacists are presented with opportunities to develop collaborative competencies. Curricular development and implementation initiatives must explore structures and processes to ensure that experiential learning (EL) environments are conducive to supporting student pharmacists’ interprofessional learning. Aim To explore structures and processes needed to support effective planned and unplanned IPE during EL placements for student pharmacists. Methods A mixed methods approach underpinned by the Biggs 3P theoretical framework was adopted.2 This included (1) A document analysis reviewing resources including student pharmacist/EL facilitator university handbooks and NHS Education for Scotland Preparation for Facilitating Experiential Learning (PFEL) training - a mandatory requirement for all EL facilitators hosting student pharmacists on placement in Scotland. (2) A pre-piloted online survey distributed to EL facilitators. Survey development, guided by the Interprofessional Facilitation Scale, aimed to encourage EL facilitators to self-evaluate their own IPE facilitation skills.3 The final survey tool included ten items with responses rated on a 4-point Likert scale (Poor, Fair, Good and Excellent) and a demographic section (3) Online semi-structured focus groups/dyadic interviews conducted with six EL facilitators, four practice educators and two academic staff were recorded and transcribed. Descriptive statistics were employed for quantitative data generated from the survey tool; for qualitative data content analysis was applied to develop emerging themes. Ethical approval was granted (S292) from the School of Pharmacy and Life Sciences Ethics Review Committee at Robert Gordon University. Results (1) The document analysis concluded that although the resources reviewed could not be specifically classed as training to support IPE, data collected provided context to EL placements and the training and pre-activities that student pharmacists and EL facilitators complete. Three main themes emerged: “Lack of specific IPE training focus”, “Varied terminology”, “Lack of IPE pre-learning activities”. (2) The survey was completed by ninety EL facilitators working in various practice settings: hospital 41.1% (n=37); primary care 25.6% (n=23); community 21.1% (n=19); academia 2.2% (n=2); other 8.9% (n=8). Survey responses indicated that 51.1% (n=46) and 42.2% (n=38) of respondents rated their ability to role model positive interactions with other healthcare professionals as good and excellent. However, responses to items relating more specifically to IPE facilitation skills indicated a lower confidence level. (3) Initial themes emerging from focus groups/dyadic interviews include “Profession-related perceptions of IPE”, “Factors influencing IPE delivery and student learning”, “Factors influencing future developments”. Discussion/Conclusion This exploratory study has provided valuable insight into multifactorial aspects affecting IPE during EL placements; this will be used to guide future development of IPE initiatives. One limitation is that student pharmacists were not included in this study; the next phase of this research programme will explore student pharmacists’ perceptions of IPE in EL

Discovery of Rapid Hard X-ray Variability and New Jet Activity in the Symbiotic Binary R Aqr

Two Chandra observations of the R Aqr symbiotic binary system taken 3.3 years apart show dramatic changes in the X-ray morphology and spectral characteristics in the inner 500 AU of this system. The morphology of the soft X-ray emission has evolved from a nearly circular region centered on the binary system to an hourglass shape that indicates the formation of a new southwest jet. Synchrotron radiation from the new jet in contemporaneous VLA radio spectra implies the physical conditions in the early stages of jet development are different from those in the more extended outer thermal jets known to exist for decades in this system. The central binary source has two X-ray spectral components in each of the two epochs, a soft component and a highly absorbed hard component characterized by T ~ 10^8 K if fit with a thermal plasma model. The spectrum hardened considerably between 2000.7 and 2004.0, primarily due to increased flux above 5 keV, suggesting a change in the accretion activity of the white dwarf on a timescale of a few years or less. Point-source Fe K emission is detected at the position of the central binary system in both observations. While the earlier observation shows evidence of only a single emission peak near Fe K alpha at 6.4 keV, the later observation shows a more complex emission structure between 6 and 7 keV. Finally, we have discovered a modulation in the hard X-ray flux with a period of 1734 s at a 95% confidence level in the 2004 observation only. The modulation potentially arises from standing shocks in an accretion column and we have explored the possibility that the white dwarf in R Aqr is analogous to the magnetic white dwarfs in Intermediate Polar.Comment: 31 pages, 14 figures, 1 table To be published in ApJ, expected April 10 issue. AAS LaTex styl

Assessing the relationship between molecular rejection and parenchymal injury in heart transplant biopsies

[Abstract] Background: The INTERHEART study (ClinicalTrials.gov #NCT02670408) used genome-wide microarrays to detect rejection in endomyocardial biopsies; however, many heart transplants with no rejection have late dysfunction and impaired survival. We used the microarray measurements to develop a molecular classification of parenchymal injury. Methods: In 1320 endomyocardial biopsies from 645 patients previously studied for rejection-associated transcripts, we measured the expression of 10 injury-induced transcript sets: 5 induced by recent injury; 2 reflecting macrophage infiltration; 2 normal heart transcript sets; and immunoglobulin transcripts, which correlate with time. We used archetypal clustering to assign injury groups. Results: Injury transcript sets correlated with impaired function. Archetypal clustering based on the expression of injury transcript sets assigned each biopsy to 1 of 5 injury groups: 87 Severe-injury, 221 Late-injury, and 3 with lesser degrees of injury, 376 No-injury, 526 Mild-injury, and 110 Moderate-injury. Severe-injury had extensive loss of normal transcripts (dedifferentiation) and increase in macrophage and injury-induced transcripts. Late-injury was characterized by high immunoglobulin transcript expression. In Severe- and Late-injury, function was depressed, and short-term graft failure was increased, even in hearts with no rejection. T cell-mediated rejection almost always had parenchymal injury, and 85% had Severe- or Late-injury. In contrast, early antibody-mediated rejection (AMR) had little injury, but late AMR often had the Late-injury state. Conclusions: Characterizing heart transplants for their injury state provides new understanding of dysfunction and outcomes and demonstrates the differential impact of T cell-mediated rejection versus AMR on the parenchyma. Slow deterioration from AMR emerges as a major contributor to late dysfunction

Managing Radiation Degradation of CCDs on the Chandra X-Ray Observatory--III

The CCDs on the Chandra X-ray Observatory are vulnerable to radiation damage from low-energy protons scattered off the telescope's mirrors onto the focal plane. Following unexpected damage incurred early in the mission, the Chandra team developed, implemented, and maintains a radiation-protection program. This program--involving scheduled radiation safing during radiation-belt passes, intervention based upon real-time space-weather conditions and radiation-environment modeling, and on-board radiation monitoring with autonomous radiation safing--has successfully managed the radiation damage to the CCDs. Since implementing the program, the charge-transfer inefficiency (CTI) has increased at an average annual rate of only 3.2x 10(exp -6) (2.3 percent) for the front-illuminated CCDs and 1.0x10(exp -6) (6.7 percent) for the back-illuminated CCDs. This paper describes the current status of the Chandra radiation-management program, emphasizing enhancements implemented since the previous papers