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As I stand up to invite Olivia's mom into the room, Olivia smiles weakly. By the time Olivia and her mom leave, all three of us are clear about the supervision plan and the steps we'll take to keep Olivia safe till her next visit. As her mother tears up and reaches out to hold Olivia's hand, I emphasize we're going to work together to keep Olivia safe. When Olivia's mom joins us and sits down, I explain I'm proud of Olivia for sharing her sense of anguish and hopelessness with me. [Extracted from the article]

Stimulated Raman scattering (SRS) microscopy is a label-free quantitative optical technique for imaging molecular distributions in cells and tissues by probing their intrinsic vibrational frequencies. Despite its usefulness, existing SRS imaging techniques have limited spectral coverage due to either a wavelength tuning constraint or narrow spectral bandwidth. High-wavenumber SRS imaging is commonly used to map lipid and protein distribution in biological cells and visualize cell morphology. However, to detect small molecules or Raman tags, imaging in the fingerprint region or “silent” region, respectively, is often required. For many applications, it is desirable to collect SRS images in two Raman spectral regions simultaneously for visualizing the distribution of specific molecules in cellular compartments or providing accurate ratiometric analysis. In this work, we present an SRS microscopy system using three beams generated by a femtosecond oscillator to acquire hyperspectral SRS image stacks in two arbitrary vibrational frequency bands, between 650–3280 cm–1, simultaneously. We demonstrate potential biomedical applications of the system in investigating fatty acid metabolism, cellular drug uptake and accumulation, and lipid unsaturation level in tissues. We also show that the dual-band hyperspectral SRS imaging system can be adapted for the broadband fingerprint region hyperspectral imaging (1100–1800 cm–1) by simply adding a modulator.

Background:It is currently inconclusive whether different intracytoplasmic sperm injection (ICSI) timings post oocyte retrieval (POR) lead to altered chance of clinical pregnancy and live birth following in vitrofertilization (IVF) treatment. This study, therefore, aimed to synthesize literature-based evidence for better clinical guidance regarding ICSI practice.Methods:A systematic review and meta-analysis were performed according to PRISMA guidelines. Studies were searched for in PubMed, MEDLINE, EMBASE, and the Cochrane Library. Outcome endpoints included clinical pregnancy and live birth rates (LBRs).Results:A total of 605 records were retrieved in the initial search. After exclusion, 30 articles were included for further screening for eligibility. For meta-analysis, 1 prospective and 5 retrospective cohort studies were included for pooled analysis, from which clinical pregnancy rates (CPRs) were evaluated in 6 studies while LBRs were evaluated in 3 studies. CPRs were comparable when ICSI was performed at (a) <2hours POR (risk ratio or RR = 1.00, 95%confidence interval [CI] 0.94–1.08) vs 2+hours, (b) <3hours (RR = 1.01, 95%CI 0.88–1.16) vs 3+hours, (c) <4hours (RR = 0.99, 95%CI 0.93–1.05) vs 4+hours, (d) <5hours (RR = 0.98, 95%CI 0.93–1.02) vs 5+hours, and (e) <6hours (RR = 1.05, 95%CI 0.90–1.23) vs 6+hours. However, LBR was reduced when ICSI was performed <5hours POR vs 5+hours (RR = 0.94, 95%CI 0.89–0.99), but such reduction disappeared when comparing <6hours POR (RR = 1.09, 95%CI 0.85–1.38) vs 6+hours.Conclusions:CPRs remain comparable when ICSI is performed at a range of timings up to 6-hour POR. However, LBR may benefit slightly by scheduling ICSI between 5- and 6-hour POR.

The purpose of this article is to analyse Adam Smith’s view of death in The Theory of Moral Sentimentsfor commercial society to determine whether the current commodification of goods (e.g. pharmaceuticals) and services (e.g. cryogenics) to assist people to deal with the fear of death was what Smith envisioned for meaningful existence and to find out what he proposed as a means to manage the fear of death in existence. The investigation revealed that Smith’s book contains many references to death as a source of anxiety that negatively influences the lives of people, their happiness and meaning in life, and ignites fear and anxiety. The cultural measure of Smith’s time to manage the fear of death are magnanimity (e.g. war and suffering), the comfort of wealth, posthumous happiness (e.g. duty and sacrifice) and philosophy (e.g. Stoicism). The problem for Smith is that wealth and commodities, as is the case with the other means to deal with the fear of death, do not result in being-for-itself without the assistance of the impartial spectator which is a cognitive mechanism for self-awareness and socially located meaning-creation in the world with others.

Despite 49.1% of registered pharmacists in the UK being from a Black, Asian and Minority Ethnic (BAME) background, senior management roles within pharmacy are dominated by white males. People from BAME communities may experience minority stress which contributes to a professional attainment gap compared with non-BAME colleagues. Minority stress describes additional stressors, such as unconscious bias, micro-aggression and racial minority stress, experienced by minoritized people to adhere to the social norms of the majority. There is little evidence describing experiences of minority stress in pharmacy practice and education. The aim was to explore experiences of racial minority stress in pharmacy education and practice.

Aims and methodIn-patients on mental health wards are commonly prescribed hypnotics for the long-term management of disturbed sleep. Specific sleep disorders remain underdiagnosed and effective behavioural interventions are underused. We developed a suite of three educational interventions (a video, poster and handbook) about sleep, sleep disorders, the safe prescribing of hypnotics and use of psychological strategies (sleep hygiene and cognitive–behavioural therapy for insomnia, CBTi) using co-design and multiprofessional stakeholder involvement. This controlled before-and-after study evaluated the effectiveness of these interventions across seven in-patient psychiatric wards, examining their impact on hypnotic prescribing rates and staff confidence scores (data collected by retrospective drug chart analysis and survey respectively).ResultsA marked reduction was seen in the percentage of patients prescribed hypnotics on in-patient prescription charts (−24%), with a 41% reduction in the number of hypnotics administered per patient (mean reduction −1.142 administrations/patient).Clinical implicationsThese simple educational strategies about the causes and treatment of insomnia can reduce hypnotic prescribing rates and increase staff confidence in both the medical and psychological management of insomnia.

Purpose: Stress and burnout are continuous concerns in clinical settings. This has been exacerbated due to the recent COVID-19 pandemic which has impacted health-care professionals globally. Supervision can support staff in clinical setting and help prevent stress and burnout. The purpose of this review is to consider the efficacy of mobile apps for reducing stress and burnout in clinical settings and supervisions. Design/methodology/approach: A comprehensive literature search was carried out using online databases such as Scopus, PubMed, CINAHL, PsychINFO, PsychARTICLES, MEDLINE and SAGE. From the searches, nine studies were included in the review after meeting the inclusion criteria. Findings: Of the nine studies, eight related to stress and/or burnout and one related to work engagement. There were no specific studies which related directly to the use of mobile health (mHealth) for clinical supervision. Research limitations/implications: Through a focus on the efficacy of mHealth for stress and burnout in clinical settings and supervisions, the review highlights the efficacy of mHealth apps used in for stress and burnout in clinical settings and the importance of engagement of clinical staff. This will not only provide a higher quality of empirical evidence, but it will also lead to more positive outcomes for the mental health of clinical staff. Originality/value: This review focussed upon the efficacy of mHealth for stress and burnout in clinical settings and supervisions. In comparison to previous reviews, this review differs because it combines both stress and burnout and clinical supervisions as the focal areas for improvement via the use of mHealth.

Coral populations from reef habitats that experience extreme daily abiotic fluctuations have been suggested as candidates to survive and proliferate under future climate change. Few studies, however, have exposed corals from dynamic environments to the synergistic effects of ocean warming and acidification to investigate whether tolerance of present‐day environmental variability is maintained under future climate stress. This study assessed the impact of RCP2.6 (+0.8°C and +25 ppm) and RCP4.5 (+1.3°C and +66 ppm) ocean warming and acidification on the survivorship, primary calcification (i.e., extension), secondary calcification (i.e., densification), and protein densities of Isopora paliferaoriginating from two distinct reef habitats (abiotically variable reef flat vs. stable reef slope) over 9 weeks. Temperature and pCO2were offset from a reef slope baseline temperature of 26.0°C ± 0.6°C and pCO2concentration of 559 ± 56 ppm, incorporating natural diurnal variability. A trade‐off was observed in I. paliferaoriginating from the reef flat, which significantly increased tissue protein densities but reduced densification relative to corals from the reef slope. Survivorship nor extension rates differed between corals originating from the variable or stable reef habitats. Mortality increased under RCP4.5 as extension rates increased, indicating that energetic investment in skeletal expansion becomes unsustainable under future climate stress. Increasing temperature and CO2reduced calcification rates irrespective of the corals originating reef habitat suggesting with future climate change, exposure to greater environmental variability may not benefit coral calcification. These results demonstrate that tolerance to present‐day abiotic variability does not necessarily infer resilience to moderate future ocean warming and acidification conditions.

This paper examines the place of theory in qualitative medical research. While theory’s place in research planning and data analysis has been well-established, the contribution of theory during qualitative data collection tends to be overlooked. Yet, data collection is not an asocial or apolitical process and requires reflection and analysis in and of itself. Therefore, drawing on an exemplar case study research project which focused on patients’ use of medicines, the paper argues that engaging with theory to think reflexively, throughout a project but particularly during the process of data collection can ensure the rigour and trustworthiness of qualitative data. In this case study, we draw on sociologist Erving Goffman’s theoretical framework of the dramaturgical metaphor to address the multiplicity of roles that healthcare practitioners undertaking qualitative research have to occupy and navigate. Rather than painting researchers out of their research through a naïve search for ‘objectivity’, reflexivity that is scaffolded by theory, offers a way through which researchers’ biases and subjectivities can be made explicit and their data analysis transparent. In making this argument, we encourage medical researchers to engage with, and be attuned to, theoretical perspectives outwith their own discipline.

Advances in the engineering of comprehensive skeletal muscle models in vitrowill improve drug screening platforms and can lead to better therapeutic approaches for the treatment of skeletal muscle injuries. To this end, a vascularized tissue-engineered skeletal muscle (TE-SkM) model that includes adipocytes was developed to better emulate the intramuscular adipose tissue that is observed in skeletal muscles of patients with diseases such as diabetes. Muscle precursor cells cultured with and without microvessels derived from adipose tissue (microvascular fragments) were used to generate TE-SkM constructs, with and without a microvasculature, respectively. TE-SkM constructs were treated with adipogenic induction media to induce varying levels of adipogenesis. With a delayed addition of induction media to allow for angiogenesis, a robust microvasculature in conjunction with an increased content of adipocytes was achieved. The augmentation of vascularized TE-SkM constructs with adipocytes caused a reduction in maturation (compaction), mechanical integrity (Young's modulus), and myotube and vessel alignment. An increase in basal glucose uptake was observed in both levels of adipogenic induction, and a diminished insulin-stimulated glucose uptake was associated with the higher level of adipogenic differentiation and the greater number of adipocytes.

ABSTRACTNeurons have highlighted the needs for decentralized gene expression and specific RNA function in somato-dendritic and axonal compartments, as well as in intercellular communication via extracellular vesicles (EVs). Despite advances in miRNA biology, the identity and regulatory capacity of other small non-coding RNAs (sncRNAs) in neuronal models and local subdomains has been largely unexplored.We identified a highly complex and differentially localized content of sncRNAs in axons and EVs during early neuronal development of cortical primary neurons and in adult axons invivo. This content goes far beyond miRNAs and includes most known sncRNAs and precisely processed fragments from tRNAs, sno/snRNAs, Y RNAs and vtRNAs. Although miRNAs are the major sncRNA biotype in whole-cell samples, their relative abundance is significantly decreased in axons and neuronal EVs, where specific tRNA fragments (tRFs and tRHs/tiRNAs) mainly derived from tRNAs Gly-GCC, Val-CAC and Val-AAC predominate. Notably, although 5ʹ-tRHs compose the great majority of tRNA-derived fragments observed invitro, a shift to 3ʹ-tRNAs is observed in mature axons invivo.The existence of these complex sncRNA populations that are specific to distinct neuronal subdomains and selectively incorporated into EVs, equip neurons with key molecular tools for spatiotemporal functional control and cell-to-cell communication.

Anxieties can be typical to pregnancy. At the beginning of the COVID-19 outbreak, pregnant women were classified as at risk and advised to shield. This may have caused increased generalised anxiety disorder and health anxiety across the demographic. This study aimed to explore current, actual and perceived levels of generalised anxiety disorder and health anxiety in pregnant women during the COVID-19 outbreak. A sample of 674 participants completed an online questionnaire consisting of demographic and pregnancy related questions, the GAD-7 and HAI. The COVID-19 outbreak has increased self-reported levels of general anxiety and health anxiety in pregnant women. Of the sample, 633 (94%) agreed that the outbreak had increased their general anxiety; 607 (90.1%) also reported increased health anxiety. Due to the negative effects that anxieties may cause during pregnancy, it is recommended that reintroducing normality to pre- and postnatal healthcare, where safe to do so, will be beneficial.

Laughter is relatively unexplored in Adam Smith’s economic philosophy. In this article, laughter in Smith’s two major works The theory of moral sentimentsand An inquiry into the nature and causes of the wealth of nationswill be surveyed to assess the role it possibly played in his work, and whether there is a link between laughter and economics. It will be argued that although it is not a major theme in Smith’s work, there is a link between laughter and economics. Laughter is understood from the perspective of the instincts of self-interest and sympathy with the corresponding socio-ethical assessment in which the impartial spectator plays a central role. Hence, Smith understood laughter as a social deliberated phenomenon, and not an individual response to an event. This social dimension is where the assessment of laughter takes place to gauge propriety. It will be highlighted that the assessment in many of the references that Smith makes to laughter are mostly embedded in a disjunction or binary connective that consists of self-interest and sympathy. This disjunction is cross-categorical and often of the weak type which results in a tension between self-interest and sympathy. It will be argued that disjunction resists reduction of self-interest that is seen in the excess and narcissism of contemporary capitalism.

Skeletal muscle is a tissue that is directly involved in the progression and persistence of type 2 diabetes (T2D), a disease that is becoming increasingly common. Gaining better insight into the mechanisms that are affecting skeletal muscle dysfunction in the context of T2D has the potential to lead to novel treatments for a large number of patients. Through its ability to emulate skeletal muscle architecture while also incorporating aspects of disease, tissue-engineered skeletal muscle (TE-SkM) has the potential to provide a means for rapid high-throughput discovery of therapies to treat skeletal muscle dysfunction, to include that which occurs with T2D. Muscle precursor cells isolated from lean or obese male Zucker diabetic fatty rats were used to generate TE-SkM constructs. Some constructs were treated with adipogenic induction media to accentuate the presence of adipocytes that is a characteristic feature of T2D skeletal muscle. The maturity (compaction and creatine kinase activity), mechanical integrity (Young's modulus), organization (myotube orientation), and metabolic capacity (insulin-stimulated glucose uptake) were all reduced by diabetes. Treating constructs with adipogenic induction media increased the quantity of lipid within the diabetic TE-SkM constructs, and caused changes in construct compaction, cell orientation, and insulin-stimulated glucose uptake in both lean and diabetic samples. Collectively, the findings herein suggest that the recapitulation of structural and metabolic aspects of T2D can be accomplished by engineering skeletal muscle in vitro.

To explore the impact of lived experiences of pharmacy students with atopic dermatitis (AD) on perceptions of learning in pharmacy curriculum.

There is a need to overcome the donor-site morbidity and loss of volume over time that accompanies the current clinical approaches to treat soft tissue defects caused by disease and trauma. The development of bioactive constructs that can regenerate adipose tissue have made great progress toward addressing the limitations of current therapies, but their lack of vascularization and ability to meet the significant dimension requirements of tissue defects limit their clinical translatability. Microvascular fragments (MVFs) can form extensive vascular networks and contain resident cells that have the ability to differentiate into adipocytes. Therefore, the objective of this study was to determine if vascularized adipose tissue could be engineered using a fibrin-based hydrogel containing MVFs as the sole source of microvessels and adipocyte-forming cells. The potential for MVFs from different fat depots (epididymal, inguinal, and subcutaneous) to form microvascular networks and generate adipocytes when exposed to growth media (GM), adipogenic differentiation media (ADM), or when treated with GM before adipogenic induction (i.e., they were allowed to presprout before adipogenic induction) was evaluated. MVFs treated with adipogenic induction media, both with and without presprouting, contained lipid droplets, had an increase in expression levels of genes associated with adipogenesis (adiponectin and fatty acid synthase [FAS]), and had an increased rate of lipolysis. MVFs allowed to presprout before ADM treatment maintained their ability to form vascular networks while maintaining an elevated lipid content, adipogenic gene expression, and lipolysis rate. Collectively, these results support the contention that MVFs can serve as the sole source of biologic material for creating a vascularized adipose tissue scaffold.Impact statementMicrovascular fragments have both the ability to form extensive vascular networks and function as a source of adipocytes. These phenomena were exploited as vascularized adipose tissue was generated by first allowing for a period of angiogenesis before the adipogenic induction. This strategy has the ability to provide a means of both improving soft tissue reconstruction while also serving as a model to better understand adipose tissue expansion.

Introduction SARS-CoV-2 has been identified as the pathogen causing the outbreak of Coronavirus Disease 2019 (COVID-19) that started in Wuhan, China, in December 2019. SARS-CoV-2 has human-to-human transmission ability and universally contagious to all populations. The main transmission patterns are respiratory droplets transmission and contact transmission. The purpose of this study is to propose a protocol that may be used as a guide to reduce the incidence of COVID-19 infections among otolaryngology care teams.Methods A prospective cohort study was conducted to show the efficacy of our protocol to prevent transmission to health-care providers from March 11, 2020 through April 14, 2020. The protocol consisted of a series of protective measures that we applied to all health-care providers, then testing of our providers for COVID-19 using reverse transcription polymerase chain reaction along with immunoglobulin M (IgM) and immunoglobulin G (IgG) testing at the end of the study period to ensure effectiveness.Results Our protocol resulted in zero transmissions to our health-care providers during the duration of the initial study. We were involved in greater than 150 sinonasal, skull base, open airway, and endoscopy procedures during this study. At the conclusion of the initial 5 weeks, we had no health-care providers test positive for SARS-CoV-2.Conclusion According to our proposed protocol, we were able to provide care for all patients in clinic, hospital, emergent, intensive, and surgical settings with no transmission of SARS-CoV-2 by symptomatology and post evaluation testing.

ABSTRACTIntroduction: Thymoquinone (TQ), 2-isopropyl-5-methylbenzo-1, 4-quinone, the main active constituent of Nigella sativa (NS) plant, has been proven to be of great therapeutic aid in various in vitro and in vivo conditions. Despite the promising therapeutic activities of TQ, this molecule is not yet in the clinical trials, restricted by its poor biopharmaceutical properties including photo-instability.Area covered: This review compiles the different types of polymeric and lipidic nanocarriers (NCs), encapsulating TQ for their improved oral bioavailability, and augmented in vitro and in vivo efficacy, evidenced on various pathologies. Furthermore, we provide a comprehensive overview of TQ in relation to its encapsulation approaches advancing the delivery and improving the efficacy of TQ.Expert opinion: TQ was first identified in the essential oil of Nigella sativaL. black seed. TQ has not been used in formulations because it is a highly hydrophobic drug having poor aqueous solubility. To deal with the poor physicochemical problems associated with TQ, various NCs encapsulating TQ have been tried in the past. Nevertheless, these NCs could be impending in bringing forth this potential molecule to clinical reality. This will also be beneficial for a large research community including pharmaceutical & biological sciences and translational researchers.

Purpose: Previous research has provided limited evidence on whether and how demographic factors associate with sensory processing patterns (SPP) in adults. This paper aims to examine relationships between SPPs and sociodemographic factors of age, sex, education and ethnicity in healthy adults. Design/methodology/approach: A cross-sectional study design was used. A total of 71 adult participants was recruited from the community, using convenience sampling. Each participant completed the Adolescent/Adult Sensory Profile (AASP) and the Depression Anxiety Stress Scales – short version (DASS-21). Demographic information on age, sex, education and ethnicity was collected. Results were analysed using descriptive statistics and multivariate analyses of covariance (MANCOVA). Findings: SPPs, as measured by the AASP, were significantly correlated to demographic factors of age and education after controlling for emotional distress using the DASS-21. A statistically significant multivariate effect was found across the four dependent variables (low registration, seeking, sensitivity and avoiding) for the age category, F = 6.922, p= 0.009, ηp2= 0.145, in the presence of a covariate DASS. The education category showed significance only in the seeking domain (p= 0.008, ηp2= 0.10) after controlling for DASS. There was no significant correlation between SPPs and gender or ethnicity. Results also indicated that mean scores of participants in this study were “similar to most people” as standardised in the AASP. Research limitations/implications: This was a cross-sectional study with limitations including that the study used a relatively small sample and was based on self-reported healthy participants. Practical implications: SPPs may correlate with healthy adults’ age and to a lesser extent education. This suggests that it might be helpful to consider such demographic factors when interpreting SPPs in clinical populations, although further research in larger samples is needed to reach firmer conclusions about possible implications of demographic variables. Originality/value: The findings in this paper add to the growing evidence that suggest that SPPs vary with sociodemographic factors.

ObjectivesThis project explored the deployment of pharmacy assistants to inpatient wards in a new role as ‘medicines assistants’ (MA).MethodsWard-based MAs were introduced to six wards across two UK hospitals to support medicines administration. Each 30-bed ward delivered acute inpatient services with MAs supporting typical nursing medication administration rounds to 15 patients. Data were collected using activity diaries, observations, clinical audit and semistructured interviews with pharmacy assistants, pharmacy technicians, clinical pharmacists, nurses, ward managers and pharmacy managers. Thematic analysis, descriptive statistics and the Mann-Whitney U test were used to analyse qualitative and quantitative data, respectively.ResultsMAs were able to act as a point of contact between the ward and the pharmacy department and were perceived to save nursing time. A statistically significant reduction in the length of time to complete morning medication administration to 15 patients was observed (mean 74.5 vs 60.8 min per round, p<0.05). On average, 17.4 hours of medicines-related activity per ward per week was carried out by MAs rather than by nursing staff. Participants identified broader training and clarity was needed in relation to the accountability and governance of patient-facing roles.ConclusionPharmacy assistants deployed as MAs can contribute to saving nursing time and bridge the gap between nursing and pharmacy professionals.

The impact of memory loss on the self in Alzheimer's disease (AD) is poorly understood. Previous research is mixed on whether episodic or semantic memories are most important for supporting identity. The present study examined autobiographical memories cued by self-images (e.g., I am a father) and non-self-related cues in 16 AD patients and 29 healthy older adults. The AD group generated fewer self-images and memories compared to controls, but demonstrated similar temporal organization of self-cued memories. In both groups, self-images were supported by semantic memories that were temporally clustered around times of identity-formation. These self-supporting memories are proposed to form a scaffold to support the self and may persist the longest in AD, as opposed to memories from early adulthood per se. In both AD and control groups, self-images cued more semantic memories than non-self-relevant cues, further suggesting that semantic autobiographical memories play a fundamental role in supporting the self. These findings demonstrate that the self remains largely intact in AD, in spite of severe episodic memory deficits and global cognitive decline. In later stages of the disease, these self-supporting memories could provide effective tools for reminiscence therapy.