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Internationally, a growing number of interprofessional education (IPE) offices are being established within academic institutions. However, few are applying educational improvement methodologies to evaluate and improve the interprofessional (IP) learning opportunities offered. The University of Manitoba IPE Initiative was established in 2008 to facilitate the development of IP learning opportunities for pre-licensure learners. The research question for this secondary analysis was: what, if any, changes in the number and attributes of IP learning opportunities occurred in the academic year 2008-2009 compared to 2011-2012? The Points for Interprofessional Scoring (PIPES) tool was used to quantify the attributes of each IP learning opportunity. Most notably in 2012, eight (73%) of 11 IP learning opportunities achieved the highest PIPES score (> 55), compared to only four (36%) in 2009. The concept of the PIPES score is introduced as an educational improvement strategy and a potential predictor of achieving the desired educational outcome: collaborative competence.

Interprofessional education (IPE) is a growing focus for educators in health professional academic programs. Recommendations to successfully implement IPE are emerging in the literature, but there remains a dearth of evidence informing the bigger challenges of sustainability and scalability. Transformation to interprofessional education for collaborative person-centred practice (IECPCP) is complex and requires "harmonization of motivations" within and between academia, governments, healthcare delivery sectors, and consumers. The main lesson learned at the University of Manitoba was the value of using a formal implementation framework to guide its work. This framework identifies key factors that must be addressed at the micro, meso, and macro levels and emphasizes that interventions occurring only at any single level will likely not lead to sustainable change. This paper describes lessons learned when using the framework and offers recommendations to support other institutions in their efforts to enable the roll out and integration of IECPCP.

The objective was to examine effects of treating commercial beef feedlot cattle with therapeutic doses of tulathromycin, a macrolide antimicrobial drug, on changes in the fecal resistome and microbiome using shotgun metagenomic sequencing. Two pens of cattle were used, with all cattle in one pen receiving metaphylaxis treatment (800 mg subcutaneous tulathromycin) at arrival to the feedlot, and all cattle in the other pen remaining unexposed to parenteral antibiotics throughout the study period. Fecal samples were collected from 15 selected cattle in each group just prior to treatment (Day 1), and again 11 days later (Day 11). Shotgun sequencing was performed on isolated metagenomic DNA, and reads were aligned to a resistance and a taxonomic database to identify alignments to antimicrobial resistance (AMR) gene accessions and microbiome content. Overall, we identified AMR genes accessions encompassing 9 classes of AMR drugs and encoding 24 unique AMR mechanisms. Statistical analysis was used to identify differences in the resistome and microbiome between the untreated and treated groups at both timepoints, as well as over time. Based on composition and ordination analyses, the resistome and microbiome were not significantly different between the two groups on Day 1 or on Day 11. However, both the resistome and microbiome changed significantly between these two sampling dates. These results indicate that the transition into the feedlot-and associated changes in diet, geography, conspecific exposure, and environment-may exert a greater influence over the fecal resistome and microbiome of feedlot cattle than common metaphylactic antimicrobial drug treatment.

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. Such guidelines should address all aspects of CUS within a hospital or health system. These include leadership, training, competency, credentialing, quality assurance and improvement, documentation, archiving, workflow, equipment, and infrastructure issues relating to communication and information technology. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. THe purpose of this paper was to create a model for SWCUS development and implementation.

IntroductionAcute gastroenteritis (AGE) is a common and burdensome condition that affects millions of children worldwide each year. Currently available strategies are limited to symptomatic management, treatment and prevention of dehydration and infection control; no disease-modifying interventions exist. Probiotics, defined as live microorganisms beneficial to the host, have shown promise in improving AGE outcomes, but existing studies have sufficient limitations such that the use of probiotics cannot currently be recommended with confidence. Here we present the methods of a large, rigorous, randomised, double-blind placebo-controlled study to assess the effectiveness and side effect profile of Lactobacillus rhamnosus GG (LGG) (ATCC 53103) in children with AGE.Methods and analysisThe study is being conducted in 10 US paediatric emergency departments (EDs) within the federally funded Pediatric Emergency Care Applied Research Network, in accordance with current SPIRIT and CONSORT statement recommendations. We will randomise 970 children presenting to participating EDs with AGE to either 5 days of treatment with LGG (1010colony-forming unit twice a day) or placebo between July 2014 to December 2017. The main outcome is the occurrence of moderate-to-severe disease over time, as defined by the Modified Vesikari Scale. We also record adverse events and side effects related to the intervention. We will conduct intention-to-treat analyses and use an enrichment design to restore the statistical power in case the presence of a subpopulation with a substantially low treatment effect is identified.Ethics and disseminationInstitutional review board approval has been obtained at all sites, and data and material use agreements have been established between the participating sites. The results of the trial will be published in peer-reviewed journals. A deidentified public data set will be made available after the completion of all study procedures.Trial registration numberNCT01773967.

A multiple-baseline across participants design was used to investigate the effect of the Cover-Copy-Compare (CCC) intervention on multiplication-fact fluency for students with emotional and behavioral disorders (EBD). Although CCC is a well-researched intervention for mathematics, limited research has been conducted with students with EBD even though these students often struggle academically. Results indicate that a functional relation was established between CCC and an improved number of digits correct per minute for multiplication problems for only one of three elementary-age boys with EBD. Tau-U effect sizes ranged from no effect for one participant to a large effect for another participant. The length of the intervention and the initial level of a student's skills may be related to the effectiveness of CCC for students with EBD and should be explored in future studies.

This article revisits the vast historiography on everyday life in Vichy France to address the moral questions and historical claims implicit in the bystander category. It addresses how historians conceive the relationship between bystanders and Jews, arguing that they implicitly erase the structural violence between the two groups by reproducing the liberal ethics implicit in the slogan "never again" in their own method—and in spite of their commitment to a boundary between history and memory. Drawing on the insights of postcolonial and political theory, it suggests that the category, if rethought, might account for popular complicity in genocidal violence. [ABSTRACT FROM AUTHOR]

Harmful algal biotoxins in the marine environment are a threat to human food safety due to their bioaccumulation in bivalve shellfish. Whilst official control monitoring provides ongoing risk management for regulated toxins in live bivalve molluscs, no routine monitoring system is currently in operation in the UK for other non-regulated toxins. To assess the potential presence of such compounds, a systematic screen of bivalve shellfish was conducted throughout Great Britain. A rapid dispersive methanolic extraction was used with UHPLC-MS/MS analysis to test for fifteen cyclic imines and seven brevetoxins in 2671 shellfish samples taken from designated shellfish harvesting areas around Great Britain during 2018. Out of the 22 toxins incorporated into the method, only pinnatoxin G, 13-desmethyl spirolide C and 20-methyl spirolide G were detected, with maximum concentrations of 85.4 µg/kg, 13.4 µg/kg and 51.4 µg/kg, respectively. A follow up study of pinnatoxin G-positive samples examined its potential esterification to fatty acids and concluded that following hydrolysis, pinnatoxin G concentration increased by an average of 8.6%, with the tentative identification of these esters determined by LC-HRMS. This study highlights the requirement for ongoing monitoring of emerging threats and the requirement for toxicological and risk assessment studies. [ABSTRACT FROM AUTHOR]

Potassium ions (K+) are critical electrolytes that regulate multiple functions in immune cells. Recent studies have shown that the elevated concentration of extracellular potassium in the tumor interstitial fluid limits T cell effector function and suppresses the anti-tumor capacity of tumor-associated macrophages (TAMs). The effect of excess potassium on the biology of myeloid-derived suppressor cells (MDSCs), another important immune cell component of the tumor microenvironment (TME), is unknown. Here, we present data showing that increased concentrations of potassium chloride (KCl), as the source of K+ ions, facilitate autophagy by increasing the expression of the autophagosome marker LC3β. Simultaneously, excess potassium ions significantly decrease the expression of arginase I (Arg I) and inducible nitric oxide synthase (iNOS) without reducing the ability of MDSCs to suppress T cell proliferation. Further investigation reveals that excess K+ ions decrease the expression of the transcription factor C/EBP-β and alter the expression of phosphorylated kinases. While excess K+ ions downregulated the expression levels of phospho-AMPKα (pAMPKα), it increased the levels of pAKT and pERK. Additionally, potassium increased mitochondrial respiration as measured by the oxygen consumption rate (OCR). Interestingly, all these alterations induced by K+ ions were abolished by the autophagy inhibitor 3-methyladenine (3-MA). Our results suggest that hyperosmotic stress caused by excess K+ ions regulate the mitochondrial respiration and signaling pathways in MDSCs to trigger the process of autophagy to support MDSCs' immunosuppressive function by mechanisms independent of Arg I and iNOS. Overall, our in vitro and ex vivo findings offer valuable insights into the adaptations of MDSCs within the K+ ion-rich TME, which has important implications for MDSCs-targeted therapies. [ABSTRACT FROM AUTHOR]

This quantitative study explored the relationship between counselor burnout (Counselor Burnout Inventory, CBI), life balance (Life Balance Inventory, LBI), and self‐compassion (Self‐Compassion Scale, SCS) among 331 fully licensed and provisionally licensed counselors throughout the United States with at least 2 years of experience in various clinical settings and providing direct clinical services. Results of two canonical correlation analyses (CCAs) explored the relationship between (a) the subscales of the LBI and the CBI and (b) the subscales of the SCS and the CBI. Both CCAs indicated a statistically significant relationship demonstrating that: (a) increased life balance was associated with lower burnout and (b) increased self‐compassion was associated with lower burnout. Counselors experiencing burnout may turn to increasing their life balance or increasing self‐compassion practices to increase their quality of life. [ABSTRACT FROM AUTHOR]

Objective: The Striped Bass Morone saxatilis is one of the most sought‐after recreational fish species along the US Atlantic coast. Regulations and a strong conservation ethic among anglers make Striped Bass among the most frequently released coastal marine fishes. A recent rule requires anglers to use circle hooks when targeting Striped Bass with natural baits, yet the conservation benefit of this action remains unclear. Methods: We used acoustic telemetry to monitor the fate of Striped Bass that were recreationally caught with baited hooks (n = 349) and to estimate the influence of various biological (fish size), fishery (fight time, handling time, hook location, bait type, and hook type), and environmental (water temperature and air temperature) variables on postrelease survival. Result: A semi‐quantitative score of fish release condition was the single best predictor of mortality. A broader dataset that included untagged fish (n = 716) was used to identify the best predictors of fish release condition, which included hook location and handling time. Conclusion: Contrary to expectations, the circle hooks used in this study did not result in lower release mortality than conventional J‐hooks. Impact statementStriped Bass are a popular recreational sport fish in the United States, with most fish being caught and released. To increase the survival of released fish, anglers are now required to use circle hooks when fishing with bait. This study found that using circle hooks does not increase the survival of released Striped Bass. [ABSTRACT FROM AUTHOR]

Nature‐based tourism has a unique opportunity, and arguably responsibility, to promote widespread action on climate change. However, research suggests an aversion to providing information that might appear divisive or 'ruin' peoples day, particularly in places that are vulnerable to degradation.We explore how exposure to climate change information in vulnerable nature settings influences indicators of (i) the visitor experience and (ii) climate change engagement. Using a quasi‐experimental approach, we provided climate information on tourist boats operating on the Great Barrier Reef, Australia and compared visitor experiences with a control condition where climate information was not provided. Visitor surveys (n = 656) assessed perceptions and experiences.Overall, visitors on trips where climate information was provided were more likely to report that the reef experience exceeded their expectations and did not report any reduction in subjective trip satisfaction.However, we detected minimal effects of climate information on indicators of climate engagement (threat awareness, action awareness, or information seeking), suggesting room for improvement in interpretation approach and design. Indeed, visitors reported high levels of acceptability for incorporating more information about climate change, particularly about actions.Synthesis and applications: These results suggest that providing climate information does not undermine visitor experiences and while further research is required to determine the most effective approach for influencing climate change engagement, an appetite for more information exists. It is possible that what tourism operators are fearful of, may be an opportunity to improve outcomes aligned with both industry and environmental objectives. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Atmospheric composition is governed by the interplay of emissions, chemistry, deposition, and transport. Substantial questions surround each of these processes, especially in forested environments with strong biogenic emissions. Utilizing aircraft observations acquired over a forest in the southeast U.S., we calculate eddy covariance fluxes for a suite of reactive gases and apply the synergistic information derived from this analysis to quantify emission and deposition fluxes, oxidant concentrations, aerosol uptake coefficients, and other key parameters. Evaluation of results against state-of-the-science models and parameterizations provides insight into our current understanding of this system and frames future observational priorities. As a near-direct measurement of fundamental process rates, airborne fluxes offer a new tool to improve biogenic and anthropogenic emissions inventories, photochemical mechanisms, and deposition parameterizations. Key Points Airborne flux observations for a suite of reactive gases Direct constraints on production, loss, and surface-atmosphere exchange Comprehensive evaluation of chemical budgets over a temperate forest