Inflammatory Mechanisms of Organ Crosstalk during Ischemic Acute Kidney Injury

Acute kidney injury (AKI) is a common complication during inpatient hospitalization, and clinical outcomes remain poor despite advancements in renal replacement therapy. AKI in the setting of multiple organ failure (MOF) remains a formidable challenge to clinicians and incurs an unacceptably high mortality rate. Kidney ischemia-reperfusion injury (IRI) incites a proinflammatory cascade and releases cellular and soluble mediators with systemic implications for remote organ injury. Evidence from preclinical models cites mechanisms of organ crosstalk during ischemic AKI including the expression of cellular adhesion molecules, lymphocyte trafficking, release of proinflammatory cytokines and chemokines, and modification of the host innate and adaptive immune response systems. In this paper, the influence of kidney IRI on systemic inflammation and distant organ injury will be examined. Recent experimental data and evolving concepts of organ crosstalk during ischemic AKI will also be discussed in detail

“Assessment of Student Readiness for Clinical Education in Mixed-mode Curriculum Delivery: A Case Study”

Purpose – The purpose of this case study is to describe a simulation-based assessment designed to assure student readiness for a first full-time clinical experience in an entry-level Doctor of Physical Therapy program that transitioned to mixed-mode instruction during the COVID-19 pandemic. Design/methodology/approach – A cohort of 40 second-year physical therapy students whose content delivery mode, assessment methods and curricular sequence deviated from the curricular plan participated in a new assessment using standardized patients. The assessment was developed to preferentially address the knowledge, skills, abilities and professional behaviors (KSAs) that were typically assessed with other methods before the pandemic. Findings – The assessment was useful in identifying students who required additional learning experiences to meet expected levels of competence before transition to a first full-time clinical experience. It also identified KSAs that needed to be strengthened within the entire cohort of students. Research limitations/implications – This case study provides an example of feasible implementation of an assessment of student readiness for clinical education that may guide future development of standardized assessments in health profession education (HPE) programs that have or plan to transition to mixed-mode content delivery. Originality/value – This case study highlights the need and process for developing and implementing additional assessments in HPE programs when planned changes or unexpected variations in curriculum delivery occur. This evidence-based assessment preferentially addresses the affective domain of learning and includes competency standards that have recently been developed for physical therapy education in the USA

Modelling the dynamics of intramammary E. coli infections in dairy cows: understanding mechanisms that distinguish transient from persistent infections

The majority of intramammary infections with Escherichia coli in dairy cows result in transient infections with duration of about 10 days or less, although more persistent infections (2 months or longer) have been identified. We apply a mathematical model to explore the role of an intracellular mammary epithelial cell reservoir in the dynamics of infection. We included biological knowledge of the bovine immune response and known characteristics of the bacterial population in both transient and persistent infections. The results indicate that varying the survival duration of the intracellular reservoir reproduces the data for both transient and persistent infections. Survival in an intracellular reservoir is the most likely mechanism that ensures persistence of E. coli infections in mammary glands. Knowledge of the pathogenesis of persistent infections is essential to develop preventive and treatment programmes for these important infections in dairy cows

Brain Trust: Students for Students: VCU to RPS Mentorship Program

As a public, urban research institution, Virginia Commonwealth University embraces the importance of developing university-community partnerships that generate innovative solutions to societal challenges and prepare engaged citizens of tomorrow. The Students for Students: VCU to RPS Mentorship Program provides a model that will connect current VCU students to current Richmond Public Schools (RPS) students through a formal, multi-year mentorship. The ultimate goal of this program is to support and positively influence RPS students, while providing current VCU students with an opportunity to give back to the community while developing their mentorship skills. The mentoring relationship will seek to motivate RPS sophomores, juniors and seniors to improve school performance, graduate on time, and craft a post-high school path

Preconception exposures and adverse pregnancy, birth and postpartum outcomes:Umbrella review of systematic reviews

Background Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period. Objectives To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes. Data sources MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions. Study selection, data extraction and synthesis Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach. Results We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as ‘high’ quality and two as ‘moderate’. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40 years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations. Conclusions Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations

Inflammatory mechanisms of organ crosstalk during ischemic acute kidney injury

Acute kidney injury (AKI) is a common complication during inpatient hospitalization, and clinical outcomes remain poor despite advancements in renal replacement therapy. AKI in the setting of multiple organ failure (MOF) remains a formidable challenge to clinicians and incurs an unacceptably high mortality rate. Kidney ischemia-reperfusion injury (IRI) incites a proinflammatory cascade and releases cellular and soluble mediators with systemic implications for remote organ injury. Evidence from preclinical models cites mechanisms of organ crosstalk during ischemic AKI including the expression of cellular adhesion molecules, lymphocyte trafficking, release of proinflammatory cytokines and chemokines, and modification of the host innate and adaptive immune response systems. In this paper, the influence of kidney IRI on systemic inflammation and distant organ injury will be examined. Recent experimental data and evolving concepts of organ crosstalk during ischemic AKI will also be discussed in detail

Infants’ emotional and social experiences during and after the transition to early childhood education and care

The socio-emotional experiences of infants during transitions to early childhood education and care (ECEC) and across their first year in these out-of-home contexts are not well known. In an international project across five countries (New Zealand, Finland, Australia, Scotland and the United States), observational data, video of key moments, plus re-probing interviews with parents and teachers concerning 10 infants (six females) aged 5–13 months were collected across the first year of ECEC. An embedded case study design was used to analyse infant experiences from both quantitative and qualitative perspectives. Findings indicated low positive affect on infants’ first day of ECEC that increased after the first week and throughout the first year of ECEC. Drop-off periods remained a time of negative emotionality for the first month of ECEC. Over time more positive emotional experiences were evident, with peer interactions fostering positive affect, activeness and involvement, while one-on-one interactions with teachers were an important context for interpersonal engagement and well-being. These findings shed light on the highly charged emotional experience for infants when they transition to institutional care, and how these might be ameliorated in practice.peerReviewe

Supporting well-being in retirement through meaningful social roles: Systematic review of intervention studies

Context The marked demographic change toward greater proportions of older people in developed nations poses significant challenges for health and social care. Several studies have demonstrated an association between social roles in later life and positive health and well-being outcomes. After retiring from work, people may lose roles that provide purpose and social contacts. The outcomes of interventions to promote social roles in retirement have not been systematically reviewed. Methods We examined three research questions: (1) What kinds of intervention have been developed to promote social roles in retirement? (2) How much have they improved perceived roles? (3) Have these roles improved health or well-being? We included those studies that evaluated the provision of social roles; used a control or comparison group; targeted healthy retirement-transition adults who were living in the community; provided an abstract written in English; took place in a highly developed nation; and reported social role, health, or well-being outcomes. We searched eight electronic databases and combined the results with hand searches. Findings Through our searches, we identified 9,062 unique publications and eleven evaluative studies of acceptable quality, which reported seven interventions that met our inclusion criteria. These interventions varied in year of inception and scope, but only two were based outside North America. The studies rarely reported the quality or meaning of roles. Only three studies used random allocation, thus limiting inferences of causality from these studies. Interventions providing explicit roles and using supportive group structures were somewhat effective in improving one or more of the following: life satisfaction, social support and activity, physical health and activity, functional health, and cognition. Conclusions Social role interventions may improve health and well-being for people in retirement transition. Future research should improve the quality of intervention and assessment and look at which interventions are most effective and acceptable in facilitating social roles for diverse older populations. © 2013 Milbank Memorial Fund

A Stellar Population Gradient in VII Zw 403 - Implications for the Formation of Blue Compact Dwarf Galaxies

We present evidence for the existence of an old stellar halo in the Blue Compact Dwarf galaxy VII Zw 403. VII Zw 403 is the first Blue Compact Dwarf galaxy for which a clear spatial segregation of the resolved stellar content into a "core-halo" structure is detected. Multicolor HST/WFPC2 observations indicate that active star formation occurs in the central region, but is strikingly absent at large radii. Instead, a globular-cluster-like red giant branch suggests the presence of an old (> 10 Gyr) and metal poor (=-1.92) stellar population in the halo. While the vast majority of Blue Compact Dwarf galaxies has been recognized to possess halos of red color in ground-based surface photometry, our observations of VII Zw 403 establish for the first time a direct correspondence between a red halo color and the presence of old, red giant stars. If the halos of Blue Compact Dwarf galaxies are all home to such ancient stellar populations, then the fossil record conflicts with delayed-formation scenarios for dwarfs.Comment: Accepted for publication in the Ap