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Christine Pearce and Julie Marshman describe how a development framework offers specialist nurses a structured career pathway with clarified roles and standardised titles. [ABSTRACT FROM AUTHOR]

We sought to determine whether combined chemical, mechanical, and heat cleaning was superior to standard cleaning for the decontamination of 32 sink and shower drains harboring carbapenemase-producing organisms (CPOs). Of 16 intervention drains, 10 (63%) were decontaminated until day 7 versus 1 (5%) of 16 comparator drains (P = .002). Intensive cleaning may be useful if administered repeatedly in drain-associated CPO outbreaks.

Three-dimensional (3D) visualization of vitrified cells can uncover structures of subcellular complexes without chemical fixation or staining. Here, we present a pipeline integrating three imaging modalities to visualize the same specimen at cryogenic temperature at different scales: cryo-fluorescence confocal microscopy, volume cryo-focused ion beam scanning electron microscopy, and transmission cryo-electron tomography. Our proof-of-concept benchmark revealed the 3D distribution of organelles and subcellular structures in whole heat-shocked yeast cells, including the ultrastructure of protein inclusions that recruit fluorescently-labeled chaperone Hsp104. Since our workflow efficiently integrates imaging at three different scales and can be applied to other types of cells, it could be used for large-scale phenotypic studies of frozen-hydrated specimens in a variety of healthy and diseased conditions with and without treatments., Competing Interests: Declaration of Interests V.G. and J.M. are employed by Zeiss Research Microscopy Solutions. All other authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

New techniques for obtaining electron microscopy data through the cell volume are being increasingly utilized to answer cell biologic questions. Here, we present a three-dimensional atlas of Plasmodium falciparum ultrastructure throughout parasite cell division. Multiple wild type schizonts at different stages of segmentation, or budding, were imaged and rendered, and the 3D structure of their organelles and daughter cells are shown. Our high-resolution volume electron microscopy both confirms previously described features in 3D and adds new layers to our understanding of Plasmodium nuclear division. Interestingly, we demonstrate asynchrony of the final nuclear division, a process that had previously been reported as synchronous. Use of volume electron microscopy techniques for biological imaging is gaining prominence, and there is much we can learn from applying them to answer questions about Plasmodium cell biology. We provide this resource to encourage readers to consider adding these techniques to their cell biology toolbox., Competing Interests: The authors have declared that no competing interests exist.

Background: Junior doctors at the Royal Devon and Exeter Hospital spend hours every day creating and updating patient lists for all surgical specialties on Microsoft Excel spreadsheets. This not only consumes time that should be spent on clinical tasks, it allows for human errors, system errors and patient safety concerns. Our aim was to reduce time spent on the list and reduce the chance for error., Methods: We measured the time junior doctors spent creating and updating the surgical lists for one specialty, and on-call shifts. Our first Plan-Do-Study-Act (PDSA) cycle was to introduce clinical secretaries; this reduced the time spent by ward teams on the list but had no effect on the on-call team. We then worked with the hospital application developer to adapt software currently used to suit all surgical teams. Once completed, this software was rolled out alongside the existing spreadsheet method with a view to a switch after a transition period., Results: The introduction of clinical secretaries reduced the time spent on the colorectal surgery list from 99.22 min a day to 43.38 min. The on-call team however did not benefit from this intervention. Following the introduction of the new software, the day on-call team time spent on the list changed from 121 min a day to 4.66 min. The night on-call team time changed from 91 min to 7.38 min., Conclusion: Reducing the time juniors spend compiling surgical lists has clear benefits to patients with extra time for junior doctors to clerk patients. The use of an automated system removes the chance of error in transcription of blood results. Due to the success of this project, colorectal, upper gastrointestinal, urology, vascular and on-call teams have adopted the new list permanently., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An unresolved problem in tooth enamel studies has been to analyze simultaneously and with sufficient spatial resolution both mineral and organic phases in their three dimensional (3D) organization in a given specimen. This study aims to address this need using high-resolution imaging to analyze the 3D structural organization of the enamel matrix, especially amelogenin, in relation to forming enamel crystals. Chemically fixed hemi-mandibles from wild type mice were embedded in LR White acrylic resin, polished and briefly etched to expose the organic matrix in developing tooth enamel. Full-length amelogenin was labeled with specific antibodies and 10 nm immuno-gold. This allowed us to use and compare two different high-resolution imaging techniques for the analysis of uncoated samples. Helium ion microscopy (HIM) was applied to study the spatial organization of organic and mineral structures, while field emission scanning electron microscopy (FE-SEM) in various modes, including backscattered electron detection, allowed us to discern the gold-labeled proteins. Wild type enamel in late secretory to early maturation stage reveals adjacent to ameloblasts a lengthwise parallel alignment of the enamel matrix proteins, including full-length amelogenin proteins, which then transitions into a more heterogeneous appearance with increasing distance from the mineralization front. The matrix adjacent to crystal bundles forms a smooth and lacey sheath, whereas between enamel prisms it is organized into spherical components that are interspersed with rod-shaped protein. These findings highlight first, that the heterogeneous organization of the enamel matrix can be visualized in mineralized en bloc samples. Second, our results illustrate that the combination of these techniques is a powerful approach to elucidate the 3D structural organization of organic matrix molecules in mineralizing tissue in nanometer resolution.

Existing techniques for electron- and ion-beam lithography, routinely employed for nanoscale device fabrication and mask/mold prototyping, do not simultaneously achieve efficient (low fluence) exposure and high resolution. We report lithography using neon ions with fluence <1 ion/nm(2), ∼1000× more efficient than using 30 keV electrons, and resolution down to 7 nm half-pitch. This combination of resolution and exposure efficiency is expected to impact a wide array of fields that are dependent on beam-based lithography.

Meta-analytic studies have concluded that although training improves spatial cognition in both sexes, the male advantage generally persists. However, because some studies run counter to this pattern, a closer examination of the anomaly is warranted. The authors investigated the acquisition of a basic skill (spatial selective attention) using a matched-pair two-wave longitudinal design. Participants were screened with the use of an attentional visual field task, with the objective of selecting and matching 10 male-female pairs, over a wide range (30% to 57% correct). Subsequently, 20 participants 17-23 years of age (selected from 43 screened) were trained for 10 hr (distributed over several sessions) by playing a first-person shooter video game. This genre is known to be highly effective in enhancing spatial skills. All 20 participants improved, with matched members of the male-female pairs achieving very similar gains, independent of starting level. This is consistent with the hypothesis that the learning trajectory of women is not inferior to that of men when acquiring a basic spatial skill. Training methods that develop basic spatial skills may be essential to achieve gender parity in both basic and complex spatial tasks.

In the current climate of budgetary restraint in the health care system, cost effectiveness is a concept which surfaces with increasing frequency, especially in reference to health care services funded by government. Since significant elements of pharmacy services in Canada are thus funded (including in most provinces, hospital pharmacy services, and prescription drug plans for senior citizens), it is important that pharmacy "tune into" the concept, and recognize it as an essential criterion to be met in the maintenance of existing services and in the development of new services. Prerequisite to a consideration of cost effectiveness is, of course, consideration of effectiveness; and a statement about the effectiveness; and a statement about the effectiveness of a service implies a potential for measurement of effect or outcome. In the 1980s, as pharmacy focuses its efforts on patients rather than products, that effect must surely be defined in "people" terms. One of the important dimensions of today's patient-focussed pharmacy services is patient counselling, more broadly, patient education.

Phencyclidine (PCP) is a popular illicit drug often misrepresented as some other hallucinogenic substance and distributed in widely varying dosage forms and strengths. Users of hallucinogenic drugs may present with unintentional PCP overdoses. Toxicological laboratory analyses are essential to establish the diagnosis. In nine admitted overdose patients, the consciousness level ranged from alert to comatose on presentation, and all showed a prolonged recovery phase with agitation and toxic psychosis. Severe behavior disorder, paranoid ideation, and amnesia for the entire period of in-hospital stay are characteristic. In very high dose patients, shallow respiratory excursions and periods of apnoea and cyanosis coincided with generalized extensor spasm and spasm of neck muscles. Excessive bronchial secretions, gross ataxia, opisthotonic posturing, and grimacing occur. PCP toxic psychosis should be considered in drug-abusing patients presenting with schizophrenic-like symptoms, psychosis, or other bizarre behavior, whether or not they admit to taking PCP.

Available information on patterns of alcohol and drug abuse among health professionals, as well as information on abuse versus impairment, is reviewed. Past and present attitudes and approaches to helping the alcohol- or drug-impaired health professional in Ontario are examined.

There has been considerable recent interest in the study of Jamaican ganja users as a potentially valuable source of information on the effects of long-term cannabis consumption. However, reported data on the cannabinoid content of Jamaican material have been limited to those of Rubin and Comitas for a small number of samples of unknown representativeness. In the present study, the cannabinoid content was determined on 36 samples purchased from various ganja dealers at two different periods, derived from crops treated differently with respect to fertilization, and representing the range of types locally considered to differ in quality or potency. The analytical results agreed well with those of Rubin and Comitas, and indicated that samples with a delta9-THC content of 4.0% or more were apt to be comparatively rare. The median value was 2.3% by weight. Some of the variation in the THC content of the samples was clearly attributable to the different seasons in which they were purchased, and some may have been due to differences in the type of fertilizer used in cultivation. Local judgement as to the potency of samples proved generally sound, although by no means infallible.

Quantitative analysis of beverages prepared at home by staff of the Addiction Research Foundation revealed a lower and much more variable caffeine content of both tea and coffee than had been reported in earlier studies, most of which were based on analysis of laboratory-prepared beverages. Median caffeine concentration of 37 home-prepared samples of tea was 27 mg per cup (range, 8 to 91 mg); for 46 coffee samples the median concentration was 74 mg per cup (range, 29 to 176 mg). If tea and coffee as drunk contain less caffeine than generally supposed, the potency of caffeine may be greater than commonly realized, as may the relative caffeine content of certain commercial preparations, including chocolate and colas. The substantial variation in caffeine content emphasizes the need to establish actual caffeine intake in clinical, epidemiologic and experimental investigations of caffeine effects.