Guidelines for resident training in veterinary clinical pathology. IV: Laboratory quality management-Teaching domains, competencies, and suggested learning outcomes

BACKGROUND

The 2019 ASVCP Education Committee Forum for Discussion, presented at the annual ASVCP/ACVP meeting, identified a need to develop recommendations for teaching laboratory quality management principles in veterinary clinical pathology residency training programs.

OBJECTIVES

To present a competency-based framework for teaching laboratory quality management principles in veterinary clinical pathology residency training programs, including entrustable professional activities (EPAs), domains of competence, individual competencies, and learning outcomes.

METHODS

A joint subcommittee of the ASVCP Quality Assurance and Laboratory Standards (QALS) and Education Committees executed this project. A draft guideline version was reviewed by the ASVCP membership and shared with selected ACVP committees in early 2022, and a final version was voted upon by the full QALS and Education Committees in late 2022.

RESULTS

Eleven domains of competence with relevant individual competencies were identified. In addition, suggested learning outcomes and resource lists were developed. Domains and individual competencies were mapped to six EPAs.

CONCLUSIONS

This guideline presents a framework for teaching principles of laboratory quality management in veterinary clinical pathology residency training programs and was designed to be comprehensive yet practical. Guidance on pedagogical terms and possible routes of implementation are included. Recommendations herein aim to improve and support resident training but may require gradual implementation, as programs phase in necessary expertise and resources. Future directions include the development of learning milestones and assessments and consideration of how recommendations intersect with the American College of Veterinary Pathologists training program accreditation and certifying examination.

Observation of the Doubly Charmed Baryon Ξ_{cc}^{++}

A highly significant structure is observed in the Λ_{c}^{+}K^{-}π^{+}π^{+} mass spectrum, where the Λ_{c}^{+} baryon is reconstructed in the decay mode pK^{-}π^{+}. The structure is consistent with originating from a weakly decaying particle, identified as the doubly charmed baryon Ξ_{cc}^{++}. The difference between the masses of the Ξ_{cc}^{++} and Λ_{c}^{+} states is measured to be 1334.94±0.72(stat.)±0.27(syst.)  MeV/c^{2}, and the Ξ_{cc}^{++} mass is then determined to be 3621.40±0.72(stat.)±0.27(syst.)±0.14(Λ_{c}^{+})  MeV/c^{2}, where the last uncertainty is due to the limited knowledge of the Λ_{c}^{+} mass. The state is observed in a sample of proton-proton collision data collected by the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 1.7  fb^{-1}, and confirmed in an additional sample of data collected at 8 TeV.

DPP4 inhibition attenuates filtration barrier injury and oxidant stress in the zucker obese rat

OBJECTIVE

Obesity-related glomerulopathy is characterized initially by glomerular hyperfiltration with hypertrophy and then development of proteinuria. Putative mechanisms include endothelial dysfunction and filtration barrier injury due to oxidant stress and immune activation. There has been recent interest in targeting dipeptidyl peptidase 4 (DPP4) enzyme due to increasing role in non-enzymatic cellular processes.

METHODS

The Zucker obese (ZO) rat (aged 8 weeks) fed a normal chow or diet containing the DPP4 inhibitor linagliptin for 8 weeks (83 mg/kg rat chow) was utilized.

RESULTS

Compared to lean controls, there were increases in plasma DPP4 activity along with proteinuria in ZO rats. ZO rats further displayed increases in glomerular size and podocyte foot process effacement. These findings occurred in parallel with decreased endothelial stromal-derived factor-1α (SDF-1α), increased oxidant markers, and tyrosine phosphorylation of nephrin and serine phosphorylation of the mammalian target of rapamycin (mTOR). DPP4 inhibition improved proteinuria along with filtration barrier remodeling, circulating and kidney tissue DPP4 activity, increased active glucagon like peptide-1 (GLP-1) as well as SDF-1α, and improved oxidant markers and the podocyte-specific protein nephrin.

CONCLUSIONS

These data support a role for DPP4 in glomerular filtration function and targeting DPP4 with inhibition improves oxidant stress-related glomerulopathy and associated proteinuria.

Classification of drugs in absorption classes using the classification and regression trees (CART) methodology

Classification and regression trees (CART) were evaluated for their potential use in a quantitative structure-activity relationship (QSAR) context. Models were build using the published absorption values for 141 drug-like molecules as response variable and over 1400 molecular descriptors as potential explanatory variables. Both the role of two- and three-dimensional descriptors and their relative importance were evaluated. For the used dataset, CART models showed high descriptive and predictive abilities. The predictive abilities were evaluated based on both cross-validation and an external test set. Application of the variable ranking method to the models showed high importances for the n-octanol/water partition coefficient (logP) and polar surface area (PSA). This shows that CART is capable of selecting the most important descriptors, as known from the literature, for the absorption process in the intestinal tract.

Evaluation of a rural community-based disability service in Queensland, Australia

INTRODUCTION

The article outlines the evaluation framework devised for a semi-formal disability service project in central Queensland, Australia, which was implemented using a community-based, participatory model. Utilising a service framework known as Community-Based Rehabilitation and an implementation strategy adapted from Participatory Rural Appraisal, this model is presented as a potential alternative for rehabilitation and disability services in the light of concerns that such services are poorly tailored and inadequate in remote and rural areas of Australia.

METHOD

In recognition of the difficulty of evaluating such participatory and community-based initiatives, this evaluation was based on the analysis of large amounts of qualitative data from multiple sources, which were categorised against key themes drawn from the literature, using a SWOT analysis (strengths, weaknesses, opportunities and threats). It is suggested that this innovative and multifaceted evaluation methodology may have broader application.

RESULTS AND CONCLUSIONS

Findings of the service evaluation indicated positive informal, community and social outcomes. Formal structural and organisational outcomes were found to be limited with a possibility of compromising the long-term viability of the initiative. Suggestions are made regarding the process of implementing similar research initiatives. The model may have application in similar rural community-based initiatives internationally.

People, partnerships and human progress: building community capital

The Victorian-era journal The Sanitarian used on its masthead the slogan 'A nation's health is a nation's wealth'. Today, we are re-discovering that wisdom, recognizing that health is indeed a form of wealth. Moreover, we are beginning to understand that wealth is not merely our economic capital, but includes three other forms of capital--social, natural and human capital. Health is one key element of human capital. A healthy community is one that has high levels of social, ecological, human and economic 'capital', the combination of which may be thought of as 'community capital'. The challenge for communities in the 21st century will be to increase all four forms of capital simultaneously. This means working with suitable partners in the private sector, making human development the central purpose of governance, and more closely integrating social, environmental and economic policy. Community gardens, sustainable transportation systems and energy conservation programmes in community housing projects are some of the ways in which we can build community capital.

Developing a rural community-based disability service: (I) service framework and implementation strategy

In response to widely recognised dilemmas associated with rehabilitation and disability service provision in remote and rural areas of Australia, a community-based, participatory approach to service development was adapted for a disability service project in central Queensland. The service framework, known as Community Based Rehabilitation (CBR), fosters the involvement of community members in disability service provision. Although this framework has been described previously, few guidelines exist regarding appropriate implementation of such an approach. Consequently, the implementation strategy known as Participatory Rural Appraisal (PRA) was adopted. Participatory Rural Appraisal has been reported to foster the participation and decision-making of community members in community projects. The present article describes the application of this implementation strategy to disability service provision in a relatively under-resourced rural shire. The rationale, framework and process of the pilot are described. A subsequent publication will document the service component, detail evaluation findings and describe the long-term outcomes of this research.

Healthy communities must also be sustainable communities

The author contends that healthy communities must be both environmentally and socially sustainable, given that health depends on the quality of the built and natural environments, and that global change resulting from the industrial economy is affecting the web of life. He argues that suburban sprawl wastes scarce resources and disproportionately places those resources in the hands of suburban dwellers. Urban areas can be made more environmentally sustainable, especially with respect to energy consumption, which will help reduce air pollution and climate change and contribute in other ways to improved health.

Future directions in population health

The long-term health of the population will be influenced by a number of major forces in the next century. In this brief review, particular emphasis is placed on environmental and economic forces. Major global environmental changes include climate change and global warming, resource depletion, ecotoxicity and reduced biodiversity. We do not yet know the impact on longevity of lifetime exposure to a mix of persistent toxic chemicals in our environment, since it has only been widespread in the past 40-50 years. The health impacts of global warming are only just beginning to be understood and could be profound. But perhaps the most profound threat to population health is economic growth, to the extent that it undermines environmental and social sustainability. We need a new form of capitalism, one that simultaneously increases environmental, social, economic and human capital, if population health is to be maintained in the 21st century.

Indicators that count! Measuring population health at the community level

We begin with a discussion of some vitally important conceptual and methodological issues. These issues concern our understanding of community, of health, of population health and its determinants, of the concept of 'measurement' and the values that underlie it, and our reasons for wishing to measure these constructs. We then present a framework for indicator categories, propose some criteria for indicator selection and suggest an initial set of core indicators. This indicator set reflects not simply health status--no matter how broadly defined--but also the environmental, social and economic determinants of health and the "healthfulness" of the community itself. Our most important conclusion is that if the information that is contained in the data of the indicator set is to be transformed into knowledge that can empower and emancipate the community, it has to be developed in consultation with the local community and local users of the information.

Creating health and health promoting hospitals: a worthy challenge for the twenty-first century

States that it seems self-evident that a hospital should be a healing environment, a healthy place to work, should not harm the health of the environment and should contribute to and be a source of health in the community, but argues that hospitals have not paid a great deal of attention to many of these issues until recently. Suggests that in recent years, a new and broader understanding of health promotion has led to a re-examination of the ways in which hospitals can be both healthy and health-promoting. Begins by exploring the broader concepts of health promotion that lay the foundation for the creation of healthy and health-promoting hospitals and provides some examples of how these approaches are being applied.

A comparison of HIV/AIDS knowledge among high school freshmen and senior students

Statistical data show that heterosexual transmission of AIDS among teenagers is a significant problem. The purpose of this study was to assess and compare the level of knowledge concerning HIV/AIDS among high school freshmen- and senior-level students and to determine the association between certain demographic variables and the students' knowledge level. A convenience sample of 169 freshmen and 274 senior high school students were surveyed at a local area high school (N = 443). A 49-item knowledge questionnaire, used by the high school district HIV/Abstinence program, and a demographic questionnaire developed by the investigators were used to collect the data. The findings revealed that both the freshmen and senior students had several misconceptions about HIV/AIDS, including the modes of transmission, the sure way of preventing the sexual transmission, donating blood, and the usual causes of death for people with AIDS. A comparison of the mean knowledge scores among freshmen and senior students indicated there was no significant difference among the two groups. The mean knowledge score of the seniors was significantly affected by whether they had received HIV/AIDS education. However, this was not the case for the freshmen. African American students, especially the female students, had significantly lower knowledge scores than other ethnic groups.

Bacterial lipopolysaccharide copurifies with plasmid DNA: implications for animal models and human gene therapy

During the course of gene therapy experiments in rodents, using intramuscular injections of plasmid DNA derived from Escherichia coli, we noted dose-related toxicity. This observation prompted a search for possible contaminants of DNA samples. We used the highly specific and sensitive limulus amoebocyte lysate assay (LAL), to monitor endotoxin bioactivity in DNA samples, and found plasmid DNA derived from standard E. coli bacterial strains, using traditional DNA isolation protocols, to be heavily contaminated with endotoxin, or lipopolysaccharide (LPA). Standard DNA isolation procedures resulted in the copurification of up to 500 micrograms/ml of LPS. LPS is a potent inducer of cytokines and other inflammatory mediators, and may complicate the use of naked DNA in gene therapy. The copurification of endotoxin with plasmid DNA also has important implications for in vitro transfection studies and microinjection of DNA into embryos. A simple and efficient protocol to reduce LPS contamination of plasmid DNA was developed. The conversion of intact bacteria to spheroplasts prior to the isolation of plasmid DNA, incubation with lysozyme, treatment with the detergent n-octyl-beta-D-thioglucopyranoside (OSPG) and polymyxin-B (PMB) chromatography, allowed the isolation of plasmid DNA containing less than 50 ng/ml LPS. This represents a 10,000-fold reduction in LPS contamination, compared to conventional methods of plasmid DNA purification, avoids potentially toxic reagents such as ethidium bromide, and produces a higher yield of plasmid DNA.

A comparative study of prothrombinase and thrombin inhibitors in a novel rabbit model of non-occlusive deep vein thrombosis

A quantitative and non-occlusive deep vein thrombosis model was developed in rabbits. We used this model to test the antithrombotic activity of the prothrombinase complex inhibitors factor rXai and its chemical analog glutamyl-glycyl-arginyl chloromethyl ketone inactivated human factor Xa (EGR-Xai), along with the thrombin inhibitors D-phenylalanyl-prolyl-arginyl chloromethyl ketone (PPACK) and heparin. Dose dependent effects of the inhibitors during constant infusion were monitored. Measurements included thrombus weights, hemostatic parameters and both cuticle and ear bleeding times. In this model, factor rXai and EGR-Xai had comparable in-vivo efficacy, and showed 80%-93% inhibition at plasma levels of 6.5 nM (rXai) and 8 nM (EGR-Xai). Effects on ex-vivo clotting times varied among the inhibitors. At 80-100% thrombus inhibition, factor rXai and EGR-Xai had no statistically significant effect, while PPACK extended thrombin clotting time (TCT) times 2.3-fold, and heparin prolonged both activated partial thromboplastin time (APTT), prothrombin time (PT) and TCT ex-vivo clotting times 6.9-, 1.2-, and 7-fold respectively. At these dosages, cuticle and ear bleeding times were prolonged for all inhibitors and showed increases of 177%-389% (cuticle) and 45%-129% (ear). Our results demonstrate that direct inhibition of prothrombinase complex assembly is effective in arresting venous thrombosis.

Xylem development in relation to water uptake by roots of grapevine (Vitis vinifera L.)

Axial resistance (R_a ) was estimated from xylem diameter measurements obtained from periodic acid and toluidinc blue O (PAS-TBO) stained sections of Vitis vinifera L. ev. Shiraz. Multiple linear regression showed a strong negative relationship between axial resistance and either root diameter or distance from the root tip. Water stress treatments did not affect the relationships, but plant age significantly influenced the intercept of the regression. The use of both lignin and cytoplasm stain showed that some vessels retained degenerating protoplasm which would impede water flow. Inclusion of these vessels in calculations of axial resistance could account for the underestimation reported by some authors in comparison with experimental determinations. Calculations based on the assumption that all xylem vessels, large and small, are involved in axial water conduction showed that use of mean xylem diameter might result in overestimating values by a magnitude of between 1.7 and 4.4. The use of individual xylem vessel diameters gave more accurate estimation of axial resistance. Some adjacent secondary xylem and metaxylem vessels were observed to merge into single vessels as a result of breakdown of the wall between them. Implications of such a developmental phenomenon are discussed.

Enhancing health--a new agenda for Ontario

Recognizing that changes in demography, the social environment, economics, technology and political trends are underlying factors affecting health, Paradigm Health in Toronto examined these considerations to assess change to achieve a positive vision of health. Phase I of the study looked at opportunities and threats from the broad external environment affecting health, examined the internal strengths and weaknesses of the present Ontario health system, and analyzed the participants in the system. Phase II identified the important strategic issues gathered from the environmental study, and the strategies which could deal with these issues.

Lalonde and beyond: looking back at "A New Perspective on the Health of Canadians"

The Lalonde Report was published in 1974, and was the first significant government report to suggest that health care services were not the most important determinant of health. After reviewing the evidence, the report suggested that there were four "health fields"--lifestyle, environment, health care organization, human biology--and that major improvements in health would result primarily from improvements in lifestyle, environment and our knowledge of human biology. Lalonde also indicated a broad understanding of the determinants of health in subsequent speeches. While the report was greeted sympathetically at the time, it did not have all that significant an impact in Canada. It was criticised on a number of grounds, in particular that it paid too much attention to lifestyle and too little attention to environment. Furthermore, because health is a provincial responsibility in Canada, while the report was a federal report, there was no mechanism readily available to implement the recommendations of the report. The report was nonetheless widely hailed outside Canada, and similar (and often better) reports were published in Britain, the USA, Sweden and elsewhere. The report remains a highly regarded contribution to the transformation in thinking about health that has occurred in the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug abuse double-think

Images