Barrier Formation in the Human Fetus is Patterned

We recently demonstrated patterned stratum corneum maturation and skin barrier formation during fetal development in rodents and rabbit. The presence of skin patterning in these mammals led us to predict patterned barrier formation during human infant development. Here we extend our mammalian study and demonstrate patterned stratum corneum development and skin barrier formation in the pre-term human infant. Surprisingly, we show initiation of human barrier regionally as early as 20–24 wk gestational age (22–26 wk menstrual age), bringing barrier formation close to the time of periderm disaggregation. We use the mouse model to show that patterns of periderm disaggregation mirrors barrier formation. Periderm disaggregation follows and recapitulates barrier pattern, suggesting a relationship between the processes. This work reveals regional patterning in skin maturation and barrier formation in the human infant and demonstrates that initiation of human skin barrier formation in utero coincides with the current lower limit of viability of the pre-term infant

It’s All About Trust and Respect: Cultural Competence and Cultural Humility in Mobile Health Clinic Services for Underserved Minority Populations

To explore participants\u27 perceptions of cultural competence and cultural humility in mobile health clinic (MHC) service delivery, using the Cultural Competence Model (CCM) as an organizing framework. Methods. We conducted five focus groups with an ethnically diverse group of English-and Spanish-speaking men and women, ages 20–67, residing in five underserved neighborhoods in a Southeastern U.S. city. Data analysis followed a thematic approach and iterative qualitative content analysis. Results. Participants expressed a desire for well-trained and caring staff who practice cultural humility. Conclusions. By applying the CCM\u27s five-pronged constellation of cultural abilities, health care personnel could ultimately be more responsive to ethnically diverse clients. There is a need to reinforce compliance with Culturally Linguistic and Appropriate Service (CLAS) standards and to develop programs to increase providers\u27 cultural awareness, knowledge, and skills that ultimately could reduce non-emergent emergency room visits and their associated costs

Perceptions of and Preferences for a Mobile Health Clinic for Underserved Populations

Background: Research has established that members of particular demographic groups are inordinately burdened by differential healthcare access. Mobile health clinics (MHCs) are emerging across health systems to improve access to care of marginalized populations. This study explored the perceptions and concerns of community residents living in underserved neighborhoods toward MHC services. Methods: This study used a qualitative descriptive design with 5 focus group meetings. Purposive sampling was used to recruit ethnically diverse, English- and Spanish-speaking men and women ages 20–67 residing in 5 underserved neighborhoods in Greenville County, SC. Results: Participants (N = 35) felt positive about obtaining personalized health care through an MHC unit. MHCs were viewed as convenient, situated in a central location in the community. Participants described positive qualities of MHCs, including cleanliness, attractiveness, convenience, comfort, consistency, compassion, and safety. Participants suggested the MHC should provide basic emergency “triage” care and transport to the hospital if necessary, and act as a conduit for offering health education and access to affordable prescriptions. Participants’ preferences for days of service varied; however, consistency of service and placement in a safe community area were more important. Conclusions: Findings demonstrated that it is important for health systems to ascertain the level of acceptance and readiness among residents in underserved communities for an MHC; this assessment should take place prior to launching the MHC. Delivering health care through an MHC involves more than providing tangible healthcare services to community residents. Consistent, respectful, and high-quality care should be the foundation of MHC development and ongoing implementation

Macrophage transactivation for chemokine production identified as a negative regulator of granulomatous inflammation using agent-based modeling

Cellular activation in trans by interferons, cytokines and chemokines is a commonly recognized mechanism to amplify immune effector function and limit pathogen spread. However, an optimal host response also requires that collateral damage associated with inflammation is limited. This may be particularly so in the case of granulomatous inflammation, where an excessive number and / or excessively florid granulomas can have significant pathological consequences. Here, we have combined transcriptomics, agent-based modeling and in vivo experimental approaches to study constraints on hepatic granuloma formation in a murine model of experimental leishmaniasis. We demonstrate that chemokine production by non-infected Kupffer cells in the Leishmania donovani-infected liver promotes competition with infected KCs for available iNKT cells, ultimately inhibiting the extent of granulomatous inflammation. We propose trans-activation for chemokine production as a novel broadly applicable mechanism that may operate early in infection to limit excessive focal inflammation

Features of discourse and lexical richness at different performance levels in the APTIS speaking test (AR-G/2017/2)

This study investigated features of discourse competence and vocabulary use across levels and tasks in the Aptis Speaking Test. These features are considered to be strongly linked with general performance and are in both the Common European Framework of Reference for Languages (CEFR) language level descriptors and the Aptis rating scale. Discourse competence was operationalised in terms of the textual features of cohesion and coherence. Selected aspects of cohesion and lexical richness were examined through quantitative and qualitative methods, while coherence was analysed employing qualitative methods. The findings of the quantitative analyses show little variation in the use of cohesive devices across levels and tasks; however, some distinctive differences were observed in vocabulary use and features of coherence, including topic development. Qualitative analysis revealed that candidates’ performances varied according to the task prompts and their approaches to the tasks. These findings provide test developers with a more nuanced understanding of relevant aspects of the construct of L2 speaking that are elicited through the tasks used at different levels in the Aptis Speaking Test, and have the potential to inform future development/refinement of the speaking tasks and the rating scales currently used

Charge carriers in dynamic ferroelectric domain walls

Ferroelectric domain walls (DWs) are the subject of intense research at present in the search for high dielectric, gigahertz responsive materials with novel functionalities[1]. Crucial to the integration of DWs into nanoelectronics is a proper understanding of the local electronic landscape around the wall and the influence this has on the behaviour of the DW under variable electric fields. A high degree of mobility under small electric fields is especially desirable for low power applications which escape from the critical current thresholds required to move magnetic domain walls[2]. Perovskite oxides are prime candidates for tuning the thermodynamic variables affecting the energy landscape of DWs and thus controlling their orientation/charge state[3]. Here we present an investigation into the behaviour of ferroelectric DWs under dynamic fields and the specific charge carriers present at DWs

Pharmacists Are Not Mid-Level Providers

Pharmacists should not be classified as “mid-level” providers. This classification implies that there are different levels or a hierarchy of providers when in fact each health care provider brings unique and essential knowledge and contributions to the health care team and to the care of patients. Pharmacists are no exception. Timely issues germane to pharmacists, including dependent and independent practice, provider status, and professional identity, contribute to the rationale that pharmacists, just like all other health care providers, should be classified by their professional identity. While use of the term mid-level provider to identify various practitioners may not seem consequential, in today’s health care environment, words do matter when it comes to attributing value, and the contributions of all health care providers should be recognized as equally important to the patient care team

Development of the Human Fetal Kidney from Mid to Late Gestation in Male and Female Infants

BACKGROUND During normal human kidney development, nephrogenesis (the formation of nephrons) is complete by term birth, with the majority of nephrons formed late in gestation. The aim of this study was to morphologically examine nephrogenesis in fetal human kidneys from 20 to 41weeks of gestation. METHODS Kidney samples were obtained at autopsy from 71 infants that died acutely in utero or within 24h after birth. Using image analysis, nephrogenic zone width, the number of glomerular generations, renal corpuscle cross-sectional area and the cellular composition of glomeruli were examined. Kidneys from female and male infants were analysed separately. FINDINGS The number of glomerular generations formed within the fetal kidneys was directly proportional to gestational age, body weight and kidney weight, with variability between individuals in the ultimate number of generations (8 to 12) and in the timing of the cessation of nephrogenesis (still ongoing at 37weeks gestation in one infant). There was a slight but significant (r2=0.30, P=0.001) increase in renal corpuscle cross-sectional area from mid gestation to term in females, but this was not evident in males. The proportions of podocytes, endothelial and non-epithelial cells within mature glomeruli were stable throughout gestation. INTERPRETATION These findings highlight spatial and temporal variability in nephrogenesis in the developing human kidney, whereas the relative cellular composition of glomeruli does not appear to be influenced by gestational age.This study was supported by funding from the National Health and Medical Research Council (NHMRC) (1011136) of Australia and National Institutes of Health (NIH) USA grant 3U01DK094526-04S1 (PI A P McMahon). Author Danica Ryan was the recipient of the Biomedicine Discovery Scholarship from Monash University and author Megan R. Sutherland was supported by a NHMRC CJ Martin Fellowship

Report of the 2020-2021 Professional Affairs Standing Committee: Pharmacists Unique Role and Integration in Healthcare Settings

EXECUTIVE SUMMARY The 2020-21 Professional Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to the committee’s work this year; (2) Identify opportunities and models of integration of pharmacist care services in physician and other health provider practices beyond primary care; (3) Differentiate and make the case for the integration of pharmacist care services from that of other mid-level providers; and (4) From the work on the aforementioned charges, identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides information on the committee’s process to address the committee charges, describes the rationale for and the results from a call to colleges and schools of pharmacy to provide information on their integrating pharmacist care services in physician and other health provider practices beyond primary care practice, and discusses how pharmacist-provided patient care services differ from those provided by other healthcare providers. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to CTAP and AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges