Conflict or co-operation? Ontarian pharmacists battle for an increased scope of practice

Pharmacists across Ontario have recently had their scope of practice expanded. Among the new responsibilities are Medscheck programs, vaccine administering, ordering lab tests, and the renewal of prescriptions before authorization from physicians. Further expansions such as prescribing for minor ailments are currently being explored. Both scope of practice changes (those implemented and those being discussed) re-structure healthcare divisions of labour. In doing so, they lead to a situation where pharmacists’ scope of practice increasingly overlaps with part of medical doctors’ and nurses’ jurisdictions. Historically, there has been considerable interprofessional conflict between medicine and pharmacy that has limited pharmacists’ scope of practice. Do these recent changes mean that interprofessional conflict is less relevant within the system of professions? Do they suggest a new era of healthcare professional collaboration and co-operation? Or do they suggest the system of professions is changing in fundamental ways? This research will seek answers to these questions through a content analysis of documents such as the Health Professions Regulatory Advisory Council (HPRAC) 2008 Interim Report to identify the contexts and rationales shaping these scope of practice changes. Findings reveal that other professions are supportive but hesitant to expand the scope of practice of pharmacists.To conclude, current research is missing the investigation of the impact of an increased scope of practice of pharmacists on the profession itself. This research will be of interest both to sociologists and to pharmacists. It will help us begin to understand both the benefits and consequences of an increased scope of practice in the profession

What is Causing This Man\u27s Rectal Pain and Urinary Retention?

Case: A 23-year-old man presented to an urgent care office with a 2-week history of rectal pain and scant rectal bleeding. In the few days leading up to his presentation, he also had a fever of 101° F (38.3° C), inguinal lymphadenopathy, and urinary retention

In situ imaging of vortices in Bose-Einstein condensates

Laboratory observations of vortex dynamics in Bose-Einstein condensates (BECs) are essential for determination of many aspects of superfluid dynamics in these systems. We present a novel application of dark-field imaging that enables \texttt{\it in situ} detection of two-dimensional vortex distributions in single-component BECs, a step towards real-time measurements of complex two-dimensional vortex dynamics within a single BEC. By rotating a $^{87}$Rb BEC in a magnetic trap, we generate a triangular lattice of vortex cores in the BEC, with core diameters on the order of 400 nm and cores separated by approximately 9 $\mu$m. We have experimentally confirmed that the positions of the vortex cores can be determined without the need for ballistic expansion of the BEC.Comment: 5 pages, 4 figure

Translation inhibition by rocaglates activates a species-specific cell death program in the emerging fungal pathogen Candida auris

Fungal infections are a major contributor to infectious disease-related deaths worldwide. Recently, global emergence of the fungal pathogen Candida auris has caused considerable concern because most C. auris isolates are resistant to fluconazole, the most commonly administered antifungal, and some isolates are resistant to drugs from all three major antifungal classes. To identify novel agents with bioactivity against C. auris, we screened 2,454 compounds from a diversity-oriented synthesis collection. Of the five hits identified, most shared a common rocaglate core structure and displayed fungicidal activity against C. auris These rocaglate hits inhibited translation in C. auris but not in its pathogenic relative Candida albicans Species specificity was contingent on variation at a single amino acid residue in Tif1, a fungal member of the eukaryotic initiation factor 4A (eIF4A) family of translation initiation factors known to be targeted by rocaglates. Rocaglate-mediated inhibition of translation in C. auris activated a cell death program characterized by loss of mitochondrial membrane potential, increased caspase-like activity, and disrupted vacuolar homeostasis. In a rocaglate-sensitized C. albicans mutant engineered to express translation initiation factor 1 (Tif1) with the variant amino acid that we had identified in C. auris, translation was inhibited but no programmed cell death phenotypes were observed. This surprising finding suggests divergence between these related fungal pathogens in their pathways of cellular responses to translation inhibition. From a therapeutic perspective, the chemical biology that we have uncovered reveals species-specific vulnerability in C. auris and identifies a promising target for development of new, mechanistically distinct antifungals in the battle against this emerging pathogen. IMPORTANCE Emergence of the fungal pathogen Candida auris has ignited intrigue and alarm within the medical community and the public at large. This pathogen is unusually resistant to antifungals, threatening to overwhelm current management options. By screening a library of structurally diverse molecules, we found that C. auris is surprisingly sensitive to translation inhibition by a class of compounds known as rocaglates (also known as flavaglines). Despite the high level of conservation across fungi in their protein synthesis machinery, these compounds inhibited translation initiation and activated a cell death program in C. auris but not in its relative Candida albicans Our findings highlight a surprising divergence across the cell death programs operating in Candida species and underscore the need to understand the specific biology of a pathogen in attempting to develop more-effective treatments against it.Published versio

Change in Knowledge of and Adherence to the Low-Sodium Diet in Patients with Heart Failure after Nutrition Education by a Registered Dietitian Nutritionist

Nutrition intervention by a registered dietitian nutritionist (RDN) is effective in improving patients’ knowledge or adherence to low-sodium diet (LSD, <2,000 mg/d); however, changes in knowledge and adherence in heart failure (HF) patients.   have not been simultaneously assessed in the same study Therefore, the objective of the present study was to identify both HF patient sodium knowledge and adherence to the LSD before and after an education session with an RDN. A quasi-experimental study with a one-group, pre-test post-test design was conducted. An RDN conducted a 15-minute individualized nutrition education regarding the LSD at the initial visit. Sodium knowledge was measured by the Parkland Sodium Knowledge Test, and sodium intake was measured by a 29-item sodium-specific food frequency questionnaire created by NutritionQuest© at both the initial and follow-up visits. A total of 71 patients were educated on the LSD and assessed for changes in sodium knowledge and intake at their next visit. Most patients were middle aged, obese, male, and non-Hispanic Black with an education level of greater than 12 years. At the initial visit, the majority of patients were considered knowledgeable but not accordant to the LSD. Following RDN education, sodium knowledge significantly improved and sodium intake significantly decreased. RDNs should be included as members of the HF multidisciplinary team to increase sodium knowledge and reduce sodium intake through individualized nutrition education

Developing a scale for measuring perceptions of ethical misconduct

The purpose of the study is to develop a scale to measure individual’s ethical misconduct perceptions in the workplace. The Ethics Resource Center (2014) identified the most frequent types of ethical misconduct within the United States. These behaviors served as the 28 initial items for the implicit perceptions of ethical misconduct scale. A previous study identified four dimensions of unethical misconduct: Deceit, Use of Drugs and Alcohol, Sexual Misconduct, and Theft. The perceptions of ethical misconduct survey items were reduced to reflect the four dimensions. Therefore, we propose a confirmatory factor analysis on a separate data set will confirm these dimensions. We also believe that perceptions of ethical misconduct will be positively correlated with counterproductive work behaviors (CWBs). Additionally, individuals with dark personality traits, such as psychopathy, narcissism, and Machiavellianism, were more likely to perceive unethical misconduct as ethical

Self-bound droplets of light with orbital angular momentum

Systems with competing attractive and repulsive interactions have a tendency to condense into droplets. This is the case for water in a sink, liquid helium and dipolar atomic gases. Here, we consider a photon fluid which is formed in the transverse plane of a monochromatic laser beam propagating in an attractive (focusing) nonlocal nonlinear medium. In this setting we demonstrate the formation of the optical analogue of matter wave droplets, and study their properties. The system we consider admits droplets that carry orbital angular momentum. We find bound states possessing liquid-like properties, such as bulk pressure and compressibility. Interestingly, these droplets of light, as opposed to optical vortices, form due to the competition between long-range s-wave (monopole) and d-wave (quadrupole) interactions as well as diffraction.Comment: 11 pages, 6 figures. General improvements and restructuring, supplementary material now part of main tex

A qualitative study of single-trauma and dual-trauma military couples

Trauma survivors and their partners may experience unique dynamics due to the ongoing effects of previous trauma exposure and current trauma symptoms. The current qualitative study attempted to compare and contrast single-trauma couples (one partner reports a trauma history or high traumatic load) with dual-trauma couples (both partners report a trauma history or high traumatic load) to further understand the systemic effects on couple functioning in a sample of military couples. Overall, both positive and negative effects from previous trauma on the couple relationship were reported by participants, including increased awareness, communication, support, coping strategies, and trauma-related triggers, with dual-trauma couples reporting more trauma-related triggers and communication problems. Clinical and research implications for further study are described

Generation of high-winding-number superfluid circulation in Bose-Einstein condensates

We experimentally and numerically demonstrate a method to generate multiply quantized superfluid circulation about an obstacle in highly oblate Bose-Einstein condensates (BECs). We experimentally achieve pinned superflow with winding numbers as high as 11, which persists for at least 4 s. Our method conceptually involves spiraling a blue-detuned laser beam, around and towards the center of the BEC, and is experimentally implemented by moving the BEC in a spiral trajectory around a stationary laser beam. This optical potential serves first as a repulsive stirrer to initiate superflow, and then as a pinning potential to transport the superfluid circulation within the BEC. The spiral technique can be used either to generate a high-winding-number persistent current, or for controlled placement of a cluster of singly quantized vortices of the same circulation. Thus, the technique may serve as a building block in experimental architectures to create on-demand vortex distributions in BECs