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While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking. Publications regarding education from other allied health and medical fields have shown the value of student-centered learning. The use of reflective practice to move perfusion students from thinking about actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to a student-centered clinical model. Our institution’s teaching process has developed into a multi-point procedure to make our students into reflective practicing clinicians. Student preceptor evaluations were reversed to allow the students to evaluate themselves first, with feedback from the preceptor given subsequently. Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted. The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions. Students were also given three skill/experience levels with goals to reach and move through during the rotation. These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation. Overall, moving from a teacher-centered to a student-centered clinical rotation has helped make students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning. The incorporation of these processes will hopefully lead students to become lifelong reflective perfusionists.

Background: Multiple sclerosis (MS) is a clinically heterogeneous disease underpinned by inflammatory, demyelinating and neurodegenerative processes, the extent of which varies between individuals and over the course of the disease. Recognising the clinicopathological features that most strongly associate with disease outcomes will inform future efforts at patient phenotyping. Aims: We used a digital pathology workflow, involving high-resolution image acquisition of immunostained slides and opensource software for quantification, to investigate the relationship between clinical and neuropathological features in an autopsy cohort of progressive MS. Methods: Sequential sections of frontal, cingulate and occipital cortex, thalamus, brain stem (pons) and cerebellum including dentate nucleus (n = 35 progressive MS, females = 28, males = 7; age died = 53.5 years; range 38–98 years) were immunostained for myelin (anti-MOG), neurons (anti-HuC/D) and microglia/macrophages (anti-HLA). The extent of demyelination, neurodegeneration, the presence of active and/or chronic active lesions and quantification of brain and leptomeningeal inflammation was captured by digital pathology. Results: Digital analysis of tissue sections revealed the variable extent of pathology that characterises progressive MS. Microglia/macrophage activation, if found at a higher level in a single block, was typically elevated across all sampled blocks. Compartmentalised (perivascular/leptomeningeal) inflammation was associated with age-related measures of disease severity and an earlier death. Conclusion: Digital pathology identified prognostically important clinicopathological correlations in MS. This methodology can be used to prioritise the principal pathological processes that need to be captured by future MS biomarkers. [ABSTRACT FROM AUTHOR]

Objective: Older people with multiple sclerosis (MS) have a less active radiological and clinical presentation, but many still attain significant levels of disability; but what drives worsening disability in this group? Methods: We used data from the UK MS Register to characterize demographics and clinical features of late‐onset multiple sclerosis (LOMS; symptom onset at ≥50 years), compared with adult‐onset MS (AOMS; onset 18–49 years). We performed a pathology study of a separate MS cohort with a later onset (n = 18, mean age of onset 54 years) versus AOMS (n = 23, mean age of onset 29 years). Results: In the Register cohort, there were 1,608 (9.4%) with LOMS. When compared with AOMS, there was a lower proportion of women, a higher proportion of primary progressive MS, a higher level of disability at diagnosis (median MS impact scale 36.7 vs. 28.3, p < 0.001), and a higher proportion of gait‐related initial symptoms. People with LOMS were less likely to receive a high efficacy disease‐modifying treatment and attained substantial disability sooner. Controlling for age of death and sex, neuron density in the thalamus and pons decreased with onset‐age, whereas actively demyelinating lesions and compartmentalized inflammation was greatest in AOMS. Only neuron density, and not demyelination or the extent of compartmentalized inflammation, correlated with disability outcomes in older‐onset MS patients. Interpretation: The more progressive nature of older‐onset MS is associated with significant neurodegeneration, but infrequent inflammatory demyelination. These findings have implications for the assessment and treatment of MS in older people. ANN NEUROL 2024;95:471–486 [ABSTRACT FROM AUTHOR]

James Neal begins this essay with the introduction of the 1996 paper, "Choosing Our Futures," by calling it a provocation, and a call to arms for the academic library community to challenge complacency and move forward toward fundamental change. Neal writes here that in the context of extraordinary economic pressures, the early transformation of scholarly communication, new thinking about the role and nature of higher education, rampant technological innovation, rapidly shifting user behaviors and expectations, the authors confront the classic debate on the nature of transformation. Will it be incremental, evolutionary, or revolutionary? They also flirt with the prospect of extinction: that is, will it be terminal, the demise of the academic library, or will it be phyletic, the library surviving by progressing to a new species? They call for the systematic application of new knowledge to new resources to produce new goods and new services, responsive to the market. They advocate a process of lowering the costs and increasing the benefits of the work, adding value. They encourage new and deliberate thinking about existing challenges and unmet needs, a focus on solutions. Neal maintains that the "Choosing Our Futures" essay that was an important think piece when it was written in the 1990s remains so today because it translates thoughtful reflection about local practice into a series of observations and thoughts about the future of academic libraries. Neal concludes that this sort of writing still has a place in "College and Research Libraries " today because research libraries must continue to deliberate the past, document and analyze the present, and debate prospects and evolution to grow and remain strong, and relative.

Simple Summary: The role of complement in cancer has raised much attention over the last decade. Recent studies have pointed to the tumor-promoting effects of complement activation within the tumor microenvironment of various cancers. The aim of our study was to assess the expression of the complement anaphylatoxin C3a and its receptor C3aR in the context of primary and metastatic brain tumors. We observed a high expression of C3aR in Grade 4 diffuse gliomas, i.e., glioblastoma multiforme, IDH-wildtype (GBM) and astrocytoma, IDH-mutant, Grade 4, compared to less aggressive primary brain tumors and brain metastasis. In GBM, C3aR was detected in tumor-associated macrophages, which also expressed VEGF, suggesting pro-angiogenic and tumor growth-supporting activities. In addition, robust levels of C3a were detected in GBM. Lastly, our results pointed to the critical role of TGF-β in the regulation of C3a and C3aR expression. Besides providing novel insights into glioma pathogenesis, our findings open new therapeutic avenues (C3aR antagonists) for this lethal disease. The complement (C) innate immune system has been shown to be activated in the tumor microenvironment of various cancers. The C may support tumor growth by modulating the immune response and promoting angiogenesis through the actions of C anaphylatoxins (e.g., C5a, C3a). The C has important double-edged sword functions in the brain, but little is known about its role in brain tumors. Hence, we analyzed the distribution and the regulated expression of C3a and its receptor C3aR in various primary and secondary brain tumors. We found that C3aR was dramatically upregulated in Grade 4 diffuse gliomas, i.e., glioblastoma multiforme, IDH-wildtype (GBM) and astrocytoma, IDH-mutant, Grade 4, and was much less expressed in other brain tumors. C3aR was observed in tumor-associated macrophages (TAM) expressing CD68, CD18, CD163, and the proangiogenic VEGF. Robust levels of C3a were detected in the parenchyma of GBM as a possible result of Bb-dependent C activation of the alternative C pathway. Interestingly, in vitro models identified TGF-β1 as one of the most potent growth factors that upregulate VEGF, C3, and C3aR in TAM (PMA-differentiated THP1) cell lines. Further studies should help to delineate the functions of C3a/C3aR on TAMs that promote chemotaxis/angiogenesis in gliomas and to explore the therapeutic applications of C3aR antagonists for brain tumors. [ABSTRACT FROM AUTHOR]

Background: The extent of cortical pathology is an important determinant of multiple sclerosis (MS) severity. Cortical demyelination and neurodegeneration are related to inflammation of the overlying leptomeninges, a more inflammatory CSF milieu and with parenchymal microglia and astroglia activation. These are all components of the compartmentalised inflammatory response. Compartmentalised inflammation is a feature of progressive MS, which is not targeted by disease modifying therapies. Complement is differentially expressed in the MS CSF and complement, and complement receptors, are associated with demyelination and neurodegeneration. Methods: To better understand if complement activation in the leptomeninges is associated with underlying cortical demyelination, inflammation, and microglial activation, we performed a neuropathological study of progressive MS (n = 22, 14 females), neuroinflammatory (n = 8), and non-neurological disease controls (n = 10). We then quantified the relative extent of demyelination, connective tissue inflammation, complement, and complement receptor positive microglia/macrophages. Results: Complement was elevated at the leptomeninges, subpial, and within and around vessels of the cortical grey matter. The extent of complement C1q immunoreactivity correlated with connective tissue infiltrates, whilst activation products C4d, Bb, and C3b associated with grey matter demyelination, and C3a receptor 1+ and C5a receptor 1+ microglia/macrophages closely apposed C3b labelled cells. The density of C3a receptor 1+ and C5a receptor 1+ cells was increased at the expanding edge of subpial and leukocortical lesions. C5a receptor 1+ cells expressed TNFα, iNOS and contained puncta immunoreactive for proteolipid protein, neurofilament and synaptophysin, suggesting their involvement in grey matter lesion expansion. Interpretation: The presence of products of complement activation at the brain surfaces, their association with the extent of underlying pathology and increased complement anaphylatoxin receptor positive microglia/macrophages at expanding cortical grey matter lesions, could represent a target to modify compartmentalised inflammation and cortical demyelination. [ABSTRACT FROM AUTHOR]

The extent of grey matter demyelination and neurodegeneration in the progressive multiple sclerosis (PMS) brains at post‐mortem associates with more severe disease. Regional tissue atrophy, especially affecting the cortical and deep grey matter, including the thalamus, is prognostic for poor outcomes. Microglial and complement activation are important in the pathogenesis and contribute to damaging processes that underlie tissue atrophy in PMS. We investigated the extent of pathology and innate immune activation in the thalamus in comparison to cortical grey and white matter in blocks from 21 cases of PMS and 10 matched controls. Using a digital pathology workflow, we show that the thalamus is invariably affected by demyelination and had a far higher proportion of active inflammatory lesions than forebrain cortical tissue blocks from the same cases. Lesions were larger and more frequent in the medial nuclei near the ventricular margin, whilst neuronal loss was greatest in the lateral thalamic nuclei. The extent of thalamic neuron loss was not associated with thalamic demyelination but correlated with the burden of white matter pathology in other forebrain areas (Spearman r = 0.79, p < 0.0001). Only thalamic neuronal loss, and not that seen in other forebrain cortical areas, correlated with disease duration (Spearman r = −0.58, p = 0.009) and age of death (Spearman r = −0.47, p = 0.045). Immunoreactivity for the complement pattern recognition molecule C1q, and products of complement activation (C4d, Bb and C3b) were elevated in thalamic lesions with an active inflammatory pathology. Complement regulatory protein, C1 inhibitor, was unchanged in expression. We conclude that active inflammatory demyelination, neuronal loss and local complement synthesis and activation in the thalamus, are important to the pathological and clinical disease outcomes of PMS. [ABSTRACT FROM AUTHOR]

On July 1, 2006, The Research Libraries Group, Inc. (RLG) and the Online Computer Library System (OCLC) combined their organizations and resources. RLG's products and services were integrated with OCLC's, and RLG's program initiatives went forward within an expanded OCLC Research division. This was a historic moment for libraries and research institutions consonant with the incredible changes in the information environment that had been underway during the previous decade. The expansion of WorldCat that resulted and the renewed attention given to research libraries by OCLC in the merger has positively impacted libraries around the globe. KEYWORDS research libraries, cooperative programs, union catalogs, archives, museums, online services, specialized databases, research, community building DOI: 10.1080/01930820903238545

What shapes and extends user expectations? How well is the library positioned to meet and exceed those needs? How are library collections, services, technology, space, staffing, and organization influenced by these developments? What new roles and responsibilities are being embraced and advanced? This article outlines the growing desires and requirements of the academic research library user under the impact of digital and network technologies, with a focus on the student, the teacher, and the researcher. KEYWORDS library users, library 2.0, library space, library and faculty relations

Football, also known as soccer or association football, is popular but has a potential link with dementia developing in retired players. The FA and soccer regulators in the USA have imposed guidelines limiting players exposure to heading, despite controversy whether this dementia is caused by heading the ball, a form of mild repetitive head injury (RHI), over many years. Substantial data exist showing that many ex-North American Football players develop a specific neurodegenerative disease: chronic traumatic encephalopathy (CTE), the neuropathological disorder of boxers. In the United Kingdom evidence for the neuropathological basis of footballers’ dementia has been slow to emerge. A 2017 study revealed that in six ex-soccer players four had CTE with Alzheimer’s disease (AD) and two had AD. A 2019 study showed that ex-footballers were 3.5 times more likely to die from dementia or other neuro-degenerative diseases than matched controls. We argue that in childhood and adolescence the brain is vulnerable to heading, predicated on its disproportionate size and developmental immaturity. RHI in young individuals is associated with early neuroinflammation, a potential trigger for promoting neurodegeneration in later life. Evidence is available to support the guidelines limiting heading for players of all ages, while professional and non-players should be included in prospective studies to investigate the link between soccer and dementia. [ABSTRACT FROM AUTHOR]

Library collections preservation and security programs increasingly compete for resources with an expanding array of rigorous collection, service, and technology needs. In a recent survey of Association of Research Libraries members on preservation programs, lack of funding was overwhelmingly identified as the leading preservation challenge. Libraries are developing innovative strategies to build budget support and to attract new external funds through grants, statewide initiatives, fund-raising campaigns, and entrepreneurial activities. This paper focuses on the range of preservation and security strategies now available to libraries, the infrastructure and tools needed to advance a successful program, the various audiences requiring education and advocacy, and the core qualities of a preservation effort--and the way each of these elements intersects with resource development activities. KEYWORDS. Fund-raising, education, vendors, federal support, foundations, preservation

University presses and research libraries have a long tradition of collaboration. The rapidly expanding electronic scholarly communication environment offers important new opportunities for cooperation and for innovative new models of publishing. The economics of libraries and scholarly publishers have strained the working relationship and promoted debates on important information policy issues. This article explores the context for advancing the partnership, cites examples of joint efforts in electronic publishing, and presents an action plan for working together. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: [c] 2001 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Research libraries, university presses, electronic scholarly communication