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Utilizing board certification to advance practice and promote specializationthrough formal assessment of pharmacists' knowledge and skills is one way the profession demonstrates its commitment to improving knowledge and competence as well as assuring optimal outcomes for patients. Credentialing and privileging in health care provides an opportunity for selfregulation, peer recognition, and evaluation of a professional's education, training, experience, and competence. Board of Pharmacy Specialties currently recognizes more than 51,500 active pharmacist board certifications in 14 specialties. While oriented primarily to pharmacy practice in the United States, at least one board-certified pharmacist is located in more than 50 countries, including Spain. The purpose of this paper is to highlight the intersections of board certification and international advanced pharmacy practice frameworks.El uso de las certificaciones para impulsar el perfeccionamiento y la especialización profesional mediante la evaluación formal de los onocimientos y habilidades de los profesionales de farmacia es una de las maneras en que la profesión farmacéutica demuestra su compromiso con la mejora del nivel de competencia profesional de los farmacéuticos y la obtención de los mejores resultados clínicos de los pacientes. La certificación y la acreditación en el ámbito sanitario brindan oportunidades de autorregulación, de reconocimiento entre colegas y de evaluación de la educación, formación, experiencia y competencias de los profesionales. El Board of Pharmacy Specialties actualmente reconoce a más de 51.500 armacéuticos con certificaciones activas en 14 especialidades farmacéuticas. Aunque las certificaciones están orientadas principalmente a profesionales que ejercen en los Estados Unidos, hay al menos un farmacéutico certificado en más de 50 países, incluido España. El objetivo de ste artículo es poner de manifiesto el papel de las certificaciones otorgadas por el Board of Pharmacy Specialties con los mecanismos de especialización profesional existentes a nivel internacional. sound, defensible process. The verriding concern of BPS is to ensure that the public receives the level of harmacy services that will improve a patient’s quality of life. A total of 14 specialties are currently recognized by BPS13,14, including: • Board Certified Nuclear Pharmacist (BCNP), since 1978. • Board Certified Nutrition Support Pharmacist (BCNSP), since 1988. • Board Certified Pharmacotherapy Specialist (BCPS), since 1988. • Board Certified Psychiatric Pharmacist (BCPP), since 1994. • Board Certified Oncology Pharmacist (BCOP), since 1996. • Board Certified Ambulatory Care Pharmacist (BCACP), since 2009. • Board Certified Critical Care Pharmacist (BCCCP), since 2013. • Board Certified Pediatric pharmacy Specialist (BCPPS), since 2013. • Board Certified Geriatric Pharmacist (BCGP), since 2017. • Board Certified Cardiology Pharmacist (BCCP), since 2017. • Board Certified Infectious Diseases Pharmacist (BCIDP), since 2017. • Board Certified Sterile Compounding Pharmacist (BCSCP), since 2018. • Board Certified Transplant Pharmacist (BCTXP), since 2018. • Board Certified Emergency Medicine Pharmacist (BCEMP), since 2020.

Interactions between the mammalian host and commensal microbiota are enforced through a range of immune responses that confer metabolic benefits and promote tissue health and homeostasis. Immunoglobulin A (IgA) responses directly determine the composition of commensal species that colonize the intestinal tract but require substantial metabolic resources to fuel antibody production by tissue-resident plasma cells. Here, we demonstrate that IgA responses are subject to diurnal regulation over the course of a circadian day. Specifically, the magnitude of IgA secretion, as well as the transcriptome of intestinal IgA+plasma cells, was found to exhibit rhythmicity. Oscillatory IgA responses were found to be entrained by time of feeding and were also found to be in part coordinated by the plasma cell–intrinsic circadian clock via deletion of the master clock geneArntl. Moreover, reciprocal interactions between the host and microbiota dictated oscillatory dynamics among the commensal microbial community and its associated transcriptional and metabolic activity in an IgA-dependent manner. Together, our findings suggest that circadian networks comprising intestinal IgA, diet, and the microbiota converge to align circadian biology in the intestinal tract and to ensure host-microbial mutualism.

Background Individuals with familial adenomatous polyposis (FAP) harbor numerous polyps with inevitable early progression to colon cancer. Complex microbiotic-tumor microenvironment perturbations suggest a dysbiotic relationship between polyp and microbiome. In this study, we performed comprehensive analyses of stool and tissue microbiome of pediatric FAP subjects and compared with unaffected cohabiting relatives through 16S V4 region amplicon sequencing and machine learning platforms. Results Within our FAP and control patient population, Firmicutes and Bacteroidetes were the predominant phyla in the tissue and stool samples, while Proteobacteria dominated the polyp/non-polyp mucosa. A decline in Faecalibacterium in polyps contrasted with a decline in Bacteroides in the FAP stool. The alpha- and beta-diversity indices differed significantly within the polyp/non-polyp groups, with a concurrent shift towards lower diversity in polyps. In a limited 3-year longitudinal study, the relative abundance of Proteobacteria and Fusobacteria was higher in polyps compared to non-polyp and stool specimens over time. Through machine learning, we discovered that Archaeon_enrichment_culture_clone_A13, Micrococcus_luteus, and Eubacterium_hallii in stool and PL-11B10, S1-80, and Blastocatellaceae in tissues were significantly different between patients with and without polyps. Conclusions Detection of certain bacterial concentrations within stool or biopsied polyps could serve as adjuncts to current screening modalities to help identify higher-risk patients.

Parasitic worms are amongst the most common pathogens to infect humans and have a long-established history of inflicting disease in their hosts. There is a large body of evidence that states intestine-dwelling helminths ensure their survival by influencing the host immune response against them. In recent years, it has become apparent that the large and diverse microbial communities that exist in the gastrointestinal (GI) tract of the host and within the parasite itself have a pivotal role in worm survival and persistence. Using a variety of mouse models (including laboratory, germ-free and rewilded mice), there have been new insights into how bacteria and worms interact with each other; this includes the discovery that Trichuris is unable to hatch and/or infect their host in the absence of bacteria, and that these worms contain a Trichuris-specific gut microbiota. These interactions are determined in part by the capacity of the host, gut microbiota and worms to communicate via metabolites such as butyrate, which are microbially derived and have known immunoregulatory properties. By exploring the contribution of gut bacteria to worm infections and the intricate relationship that exists between them, an exciting and emerging field in whipworm parasitology is established.

Transition of care (TOC) in adolescents and young adults (AYAs) with chronic gastrointestinal disorders has received increased attention, especially in those with inflammatory bowel disease. AYAs with hereditary polyposis syndromes are a heterogeneous group of patients with overlapping and complex medical needs. These patients are particularly vulnerable because of the risk of loss of continuity of care and subsequent poor disease outcomes. The Pediatric Committee of the American College of Gastroenterology commissioned a report with recommendations on TOC in AYAs with hereditary polyposis syndromes. This report aims at achieving best practice by both pediatric and adult gastroenterologists despite the paucity of published evidence in this population reflected in the included PRISMA report. Therefore, the group extrapolated findings from the literature related to other chronic gastrointestinal disorders, and a high degree of expert consensus was scored for all recommendations. The report addresses TOC through identifying shared domains followed by specific recommendations in disease management, including models of care, providers and patient and socioeconomic factors relevant to TOC. Areas of strong emphasis include the need for early planning, flexibility in the transition process to maintain continuity during major surgical procedures, patient and family psychological readiness, liaison among team members addressing transition, and changing insurance coverage in this population.

Introduction: PCI interventions carry the risk of mortality. Minimizing by appropriate selection of patients, procedural technique, aftercare is critical. Despite advances, mortality risk has not significantly changed. Registries have been developed to assess and report outcomes/quality of care. Methods: Mortalities identified in the National Cardiovascular Disease Registry [NCDR] database from 2017-2020 @ Stony Brook University Hospital were identified and reviewed. The 2017 mortalities were compared with Vizient [Analytics providing cost/quality/value benchmarking & practice improvement feedback] predictors of mortality (case mix index [CMI]) and NYS PCI database which use different risk adjusters. Results: There were 79 mortalities over 4 years (average age 79, M:F ratio 2.07 [54/26], 76 died in-house). Cause of death [59 cardiac, 8 neurologic, 4 infection, 1 hemorrhage, 1 pulmonary, 3 unknown; 10 cases attributed to surgery]. Mortality rates remained constant over time. Vizient expected mortality rates show poor correlation with NCDR predictions, which may reflect in part patient selection and unadjusted comorbidity. NCDR correlation with the more restrictive risk adjusted NYS DOH mortality rates is better than for Vizient. NCDR mortality for 2017 was 1.4% [21/1503]; NYS DOH 30 day reported OMR1.76%, EMR 1.36%, RAMR of 1.46% for all [26/1,476] cases and RAMR of 0.95% for non-emergent [1,150] cases. Conclusions: The NCDR provides a useful tool to benchmark PCI mortality, but unadjusted comorbidity, as demonstrated by mismatches in predicted outcomes] adversely affects observed mortality. Increased attention to patient selection may provide improvements in outcomes, decrease mortality risks, and improve value. Value: Improving patient selection improves NCDR mortality and result in lower costs and better reported outcomes. Patients, Providers and Payers may benefit from the provision of appropriate services and improved outcomes..

Introduction: Despite advances in angioplasty equipment and technique, reducing the incidence of CVA has remained an elusive target. Strokes increase mortality, cost and length of stay, residual disability. Hypothesis: 1. Monitor and benchmark CVAs, 2. Drill down for predictors, lapses in care, 3. Form a multidisciplinary group to identify failure modes, process controls. Methods: CVAs complicating coronary PCI from 2017 to present were reviewed. Results: There were 32 CVAs [5 hemorrhagic; 27 thrombotic] occurring in 6410 PCI by 18 operators [0.5%] & 9 deaths [0.28] CVA pts were high acuity: 2 [0.06] post Cardiac arrest, 11 [.34] STEMIs, 8 [.25] Non-STEMIs, 12 [.38] ACS. Age > 65 years in 22 [0.69]. Comorbidity: CVA/TIA/Carotid disease 8 [0.25], PAD 6 [0.19], CKD 4/5 in 3 [0.09], Atrial fib 4 [0.13], LVEF < 35% 12 [0.38]. Ventricular support for cardiogenic shock in 5 [0.16]. Access changed from femoral to radial with 7 CVA [0.22] associated with radial, 22 [0.69] with femoral, and 3 [0.09] with both. Anticoagulation: heparin alone 5 [0.16] and bivalirudin ± heparin in 27 [0.84]. Most interventions utilized bivalirudin. PCI with Heparin & Aspiration thrombectomy, in 5 [0.16] had a higher thrombotic CVA risk. Multidisciplinary review concerns included: 1. pt factors [bleeding/clotting history, current meds and side effects, risk factors for CVA/TIA {e.g. STEMI/non-STEMI, cardiogenic shock, atrial fibrillation, age, carotid disease}, 2. Equipment {e.g. access sheath size and length, catheter preshaped/shaped/multiple, wire [e.g. straight, curved tip, shapeable, hydrophilic, exchange], thrombectomy, angioplasty [balloon, rotoblator, stent], 3. Personnel [experience, volume, trainees], 4. Process [Anticoagulation {timing, heparin,/bivalirudin, dose, monitoring}, Cleaning hands/wires/bowl, Catheter exchanges, Case Duration. Patient monitoring, Brain attack protocol activation and response. Conclusions: The multidisciplinary group formulated a7 C’s Chain of prevention to lessen the risk of CVA: Continuous monitoring , Contributing factor identification, Consensus development of best practices, Cleanliness , Compulsive attention to detail / technique, Communication , Controversies in Care [notably DOACs].

Nitrite-oxidizing bacteria belonging to the genus Nitrospira mediate a key step in nitrification and play important roles in the biogeochemical nitrogen cycle and wastewater treatment. While these organisms have recently been shown to exhibit metabolic flexibility beyond their chemolithoautotrophic lifestyle, including the use of simple organic compounds to fuel their energy metabolism, the metabolic networks controlling their autotrophic and mixotrophic growth remain poorly understood. Here, we reconstructed a genome-scale metabolic model for Nitrospira moscoviensis (iNmo686) and used constraint-based analysis to evaluate the metabolic networks controlling autotrophic and formatotrophic growth on nitrite and formate, respectively. Subsequently, proteomic analysis and 13C-tracer experiments with bicarbonate and formate coupled to metabolomic analysis were performed to experimentally validate model predictions. Our findings support that N. moscoviensis uses the reductive tricarboxylic acid cycle for CO2 fixation. We also show that N. moscoviensis can indirectly use formate as a carbon source by oxidizing it first to CO2 followed by reassimilation, rather than direct incorporation via the reductive glycine pathway. Our study offers the first measurements of Nitrospira’s in vivo central carbon metabolism and provides a quantitative tool that can be used for understanding and predicting their metabolic processes.ImportanceNitrospira are globally abundant nitrifying bacteria in soil and aquatic ecosystems and wastewater treatment plants, where they control the oxidation of nitrite to nitrate. Despite their critical contribution to nitrogen cycling across diverse environments, detailed understanding of their metabolic network and prediction of their function under different environmental conditions remains a major challenge. Here, we provide the first constraint-based metabolic model of N. moscoviensis representing the ubiquitous Nitrospira lineage II and subsequently validate this model using proteomics and 13C-tracers combined with intracellular metabolomic analysis. The resulting genome-scale model will serve as a knowledge base of Nitrospira metabolism and lays the foundation for quantitative systems biology studies of these globally important nitrite- oxidizing bacteria.

The wastewater treatment sector embraces mixed-culture biotechnologies for sanitation, environmental protection, and resource recovery. Bioprocess design, monitoring and control thrive on microbial processes selected in complex microbial communities. Microbial ecology and systems microbiology help access microbiomes and characterize microorganisms, metabolisms and interactions at increased resolution and throughput. Big datasets are generated from the sequencing of informational molecules extracted from biomasses sampled across process schemes. However, they mostly remain on science benches and computing clusters, without reaching the industry in a clear engineering objective function. A bilateral bridge should actionize this information. As systems microbiologists, we miss that engineering designs and operations rely on stoichiometry and kinetics. The added-value provided by microbial ecology and systems microbiology to improve capital (CAPEX) and operating expenditures (OPEX) needs to be addressed. As engineers, we miss that microbiology can be provide powerful microbial information on top of physical-chemical measurements for quantitative process design (e.g., nutrient removal systems) with detailed scientific description of phenomena inside microbiomes. In this perspective article, we allied academia and industry to address the state of shared knowledge, successes and failures, and to establish joint investigation platforms. Our roadmap involves three milestones to (i) elaborate an essential list of microbiological information needed to implement methods at the process line; (ii) characterize microbiomes from microorganisms to metabolisms, and shape conceptual ecosystem models as primer for process ecology understanding; (iii) bridge engineering and mathematical models with an analytical toolbox for fast- vs. high-throughput analyses to discover new microbial processes and engineer assemblies. We praise for a harmonized "language of love"(incorporating common vocabulary, units, protocols) across the water and environmental biotechnology sector to team up mindsets for a sewer- and plant-wide integration of systems microbiology and engineering.

This paper describes a semi-powered ankle prosthesis and corresponding unified controller that provides biomimetic behavior for level and sloped walking without requiring identification of ground slope or modulation of control parameters. The controller is based on the observation that healthy individuals maintain an invariant external quasi-stiffness (spring like behavior between the shank and ground) when walking on level and sloped terrain. Emulating an invariant external quasi-stiffness requires an ankle that can vary the set-point (i.e., equilibrium angle) of the ankle stiffness. A semi-powered ankle prosthesis that incorporates a novel constant-volume power-asymmetric actuator was developed to provide this behavior, and the unified controller was implemented on it. The device and unified controller were assessed on three subjects with transtibial amputations while walking on inclines, level ground, and declines. Experimental results suggest that the prosthesis and accompanying controller can provide a consistent external quasi-stiffness similar to healthy subjects across all tested ground slopes.

Many recent publications on doctoral education issues are available, and it can be challenging to keep up with the literature that can inform our commitment to implementing best practices. In an ef...

The number of doctoral programs being offered by Christian universities is expanding, bringing new opportunities, needs, and challenges to these postsecondary institutions. Currently, 46 of the 113...

We describe the synthesis of Xyzidepsin, a depsipeptidic analogue of HDAC inhibitor Romidepsin (FK228), using a solid-phase strategy. Our latent thioester solid-phase linker was synthesized in 92% yield (three steps). Chemoselective conditions unmasked the thioester functionality and cyclized the depsipeptidic macrocycle. An IC50 value of 0.50 μM ± 0.05 was obtained for U937 cells. This synthetic route, well-suited to SAR, represents a generalizable route toward all manner of analogues, including structures with acidic and basic amino acids.

Glacial retreat in response to warming climates in the arid Xinjiang region of northwestern China directly impacts downstream water resources available for local communities. We used high-resolution satellite imagery from 1969 to 2014 to delineate spatial changes in 54 active glaciers in the upper Kaidu River Basin in the Tian Shan as well as their past expanses during the Little Ice Age (LIA). We manually delineated their boundaries based on the interpretation of glacial, geomorphic and topographic features. From the total glacier surface area, we estimated glacier volume and mass. From 1969 to 2014, glacier area decreased by 10.1 ± 1.0 km2 (relative loss of 34.2 ± 3.5%) and mass by 1.025 ± 0.108 Gt (relative loss of 43 ± 4.6%). From the LIA maximum (est. 1586 CE) to 1969, relative losses were less (25.7 ± 4.3% area loss and 33.1 ± 5.7% mass loss). Our results indicate that glacier recession is accelerating over time and that the glaciers are currently losing over 1.5 times more relative area than elsewhere in the Tian Shan. Using linear and non-linear projections, we estimate that these glaciers may disappear between 2050 and 2150 CE if climatic warming continues at the same pace.

This article critically assesses celebrities’ labour on the red carpet, with particular attention to the ways in which they engage with a variety of social and political issues. Through a discursiv...